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Sunday, December 30, 2012

A Difficult Christmas


A woman began vomiting the morning after Christmas dinner.

People blame upset stomachs on their last meal, but mostly these are viral infections. Although miserable, they rarely last long. Doctors enjoy short-lived illnesses because we get the credit when they go away.

She hadn’t vomited for several hours and was already feeling better. As I was congratulating myself on an easy visit, I heard the unmistakable sound of retching from the bathroom. This was her husband, the woman explained, adding that her mother and two year-old were also ill.

When the husband appeared, I took care of him. Unlike his wife, he welcomed an injection in addition to antivomiting pills which I also gave the mother as well as medication for her cramps and diarrhea. The child had diarrhea and little interest in eating but did not look ill. I limited myself to dietary advice and left my phone number.

When I phoned the following day, the husband informed me that the family was fine although everyone had been vomiting all night.

Tuesday, December 25, 2012

How to Summon a Hotel Doctor

Getting sick far from home is miserable enough; you shouldn’t have to scramble for help. Here’s the best strategy.

1. Ask a hotel employee.

This often succeeds, but you may see him scratch his head. ‘... St. Mary’s is the nearest emergency room. Take Seventh Avenue about a mile, then...’ 

Don’t give up. Relations with the ‘house doctor’ are informal. He or she is never a hotel employee, and many on the staff are unaware of such a person. ‘You’re our doctor?  I didn’t know we had a doctor...’ is a comment I hear at hotels I’ve visited for years.

2. Ask the manager.

All know hotel doctors although you’ll occasionally hear: ‘I’m sorry but we can’t recommend anyone. Here’s a list of local hospitals...’ You are encountering one consequence of today’s malpractice crisis. The hotel’s lawyer has assumed (correctly) that a guest who sues the doctor will also sue the hotel that recommended him, so the lawyer has forbidden the staff to name anyone. When a manager clams up, you have four choices.

A. Demand a doctor.

Occasionally I visit an assertive guest who refuses to take no for an answer. I introduce myself to the manager afterwards, but he or she invariably insists that this was an exception, and the hotel can never, never mention my name.

B. Phone another hotel and ask for its doctor.

All luxury hotels (Four Seasons, Ritz-Carlton, Peninsula) have doctors; popular chains (Hilton, Holiday Inn, Hyatt, Ramada) are unpredictable, but the larger the hotel, the more likely you’ll succeed.

C. Phone a national house call service.

All claim to operate nationwide, but  you're out of luck if no moonlighter happens to be available. Some names to Google are Expressdoc, Housecall USA, AM-PM House calls, Hoteldocs. Their fee not only pays the doctor but the organization, so it can take your breath away. Ask how much and then ask for the extras because the meter may start running as soon as he walks through the door. I’m pretty sure I’m the only hotel doctor who charges a flat fee.

D. Call your family doctor for advice.

The law requires that a doctor be available to patients. You should reach him or someone covering. If not, complain to your state medical board.

What about insurance? Specific travel insurance pays for almost everything, and it’s cheaper than you think. Traditional health insurance may pay a fraction or apply it to your deductible. HMO’s are variable. All claim to cover emergencies, but they look skeptically on house calls…. I hate giving the following advice and never obey it myself: read your policy.


Wednesday, December 19, 2012

Nonsense that Everyone Believes

Here are myths that most laymen take for granted. A more serious problem is that many doctors also believe them. 

1.  If it hurts, it needs an x-ray.
Excellent for detecting fractures, X-rays are surprisingly unhelpful in other painful conditions.  Almost everyone suffering an excruciating headache, backache, bellyache, or hacking cough wants to know what’s going on inside, and they assume that, like Superman’s X-ray vision, a film reveals this, but it doesn’t.

2.  If your sputum turns green you need an antibiotic.
Your respiratory tract produces a quart of mucus every day.  When irritated, it produces more and the sputum may turn yellow, green, or brown. In an otherwise healthy person, this has no significance.

3. If one medicine isn’t working, you need a better medicine.
Understandable in a layperson but doctors should know better. In medical school, students are drilled in the rule:  if a drug isn’t working, switching is almost never the solution. Find out why the patient isn’t improving. It’s more likely that the diagnosis is wrong.

4.  Spicy food irritates your stomach.  Fats are hard to digest.  Tasteless and colorless (i.e. bland) food is soothing.
All proven false by good studies. 

5. High blood pressure causes headaches or dizziness.
Ordinary high blood pressure causes no symptoms.

6. Bronchitis requires an antibiotic.
“Bronchitis” is almost always a viral infection; antibiotics don’t work.

7. Injections work faster than pills.
Sometimes, sometimes, not.  Doctors can charge for an injection. If they write a prescription, the pharmacist gets the money.

***Another warning. It looks like this blog will vanish on January 15 when my Medscape E-mail service goes out of business. Appeals to Google Help have proved fruitless. I plan to start another, and it will probably have the same name The Hotel Doctor. Keep your eyes peeled. ***

Thursday, December 13, 2012

Disappointment

“We have a guest who needs a doctor. Are you available?”

“I am. If you connect me to his room, I’ll try to help.”

My tone was businesslike, but joy filled my heart. The caller was the Renaissance which never called. Acquiring a competitor’s hotel is a rare and delightful event.

A male voice answered after two rings. “There’s something in my eye.”

“Tell me what happened.”

“It’s no big deal. If you give me tweezers, I’ll take it out myself.”

“You mean it’s visible?”

“There’s a sliver stuck in my eyeball… Don’t tell me to go to a hospital. I’ll sign anything. Come to the room. Or get me tweezers.”

He interrupted my response.

“No hospital! No emergency room! Bring legal documentation to protect your liability. I’ll sign. You have to look at my hand. It’s been broken for two weeks. Come alone. Don’t bring any FBI or CIA.”

I called the concierge to report that this was a matter for the police or paramedics. She admitted that the guest was causing a considerable disturbance.

Sadly, I realized that the Renaissance was not changing doctors. Hotels hate dealing with crazy, drunk, or disruptive guests. When the regular doctor refused to come, the staff, in desperation, began calling other doctors in hopes that one would make the problem go away. This happens once or twice a year.

Friday, December 7, 2012

Cash Flow Problems

“Pick up card! Pick up card!” intoned the computer.

Unlike other messages, this never means a typing mistake, but I re-entered the numbers and heard the same announcement.

Wearily, I phoned International Assistance to explain that their credit card had been rejected. The dispatcher put me on hold for several minutes before returning with another card number. In the past, I’ve gone through several before hearing the computer’s approval, but this one worked, and I left for the hotel.

International Assistance insures travelers from Latin America. It’s sent me on nearly 900 housecalls since the 1980s, but over the past decade it began requiring months of pestering before sending a check. Finally I lost patience and demanded a credit card. Credit card companies charge about six percent of my fee, but they’re a big convenience. I punch in data; two days later money appears in my bank account.

Slow payments usually means an organization is struggling. They’re maxing out their credit cards and getting them cancelled but keeping others in reserve. A few have gone out of business, owing money, but International Assistance has been irritating doctors for years; many colleagues refuse its requests. It’s the oldest of half a dozen travel insurers that call me, so this may be a tactic for minimizing cash flow.

Sunday, December 2, 2012

A Dog-Eat-Dog Business, Part 3

November is my slowest month. Calls remain scanty until Christmas, but the last week of December is always the busiest of the year. Don’t ask me why.

Thirty years of records confirm this, so I should keep calm when the phone remains silent, but it’s not easy. Hotel doctoring is viciously competitive.

Waiting at the local carwash, my eye ran over a sheet of ads along one wall. Among notices for personal injury lawyers, pest control, acupuncturists, and pizzas was a photo of a smiling young man in a white coat carrying a doctor’s bag. According to the text, a phone call would bring him to your door at a fee less than an emergency room’s. All ads for housecalls deliver this cheerful boast, never mentioning that the average ER visit, as of 2009, cost $1318.    

My first instinct was to chuckle at the waste of money. Few customers at a carwash will pay the going rate for a housecall. My second instinct was to worry. This fellow was ambitious. His web site features the same photograph plus testimonials from rating sites such as Yelp describing him as a healer of Christ-like compassion.

My third instinct was to recall a visit to Le Petite Hermitage, a small boutique hotel off the Sunset Strip. The guest had spoken to this doctor the day before, decided against a visit, and expressed pleasure at finding me and my lower fee. Since Le Petite Hermitage was a regular, I assumed he’d gotten the name from the internet. Now I’m not so sure because this occurred early in the year, and hotel hasn’t called since.

In large hotels employees know me by sight and take for granted, even without an official announcement, that I’m the house doctor. Since it has only 80 rooms, I may not visit Le Petite Hermitage for months at a time, so I’m not a familiar face. As a result, when an entrepreneurial physician makes an appearance to extol the benefits of his service including, perhaps, an amenity for the employee who refers a guest, he makes an impression.