Sunday, February 24, 2013

The Same Thing

"My wife had strep last week. Now I have the same thing.”

I receive one “same thing” phone call per week. Naturally, guests hope I’ll agree.

This is not the traditional warning against self-diagnosis, because the guests are usually right. If necessary, I’m happy to phone a pharmacy with the appropriate prescription.

Everyone with an upset stomach suspects food poisoning. If your dinner companions are also sick, it’s a possibility, but if you’re the only one, you probably suffer the common stomach virus which makes you miserable for a day or two. Most guests with vomiting or diarrhea don’t want to travel to a pharmacy. For those willing, I sometimes provide symptomatic remedies. Sadly, in the US no common intestinal infection is curable with antibiotics.

Other acute illnesses are tricky, but a young woman who’s had several bladder infections knows when she has another. This is perhaps the only infection where it’s acceptable to prescribe an antibiotic over the phone.

Inevitably, respiratory infections produce the most “same thing” calls. Since one catches these from another person, the guests are on the right track. From my viewpoint, these are stressful calls because many guests proceed to tell me what they need, and they’re wrong.

As I repeat with boring regularity, many doctors, perhaps a majority, prescribe useless antibiotics for viral respiratory infections. That includes yours. That doesn’t mean you have a bad doctor; prescribing useless antibiotics is so common that competent doctors do it.

When, after hearing the symptoms, I explain that this doesn’t describe anything that antibiotics cure, guests assume there will be no antibiotic without a visit and a fat fee. In fact, I do everything possible to avoid a housecall because not giving an antibiotic guarantees an unhappy patient. If I yield to his entreaties, I hate myself.

Thursday, February 14, 2013

A Doctor's Routine

“Under your tongue… under your tongue… close your mouth… don’t bite!”

Seeing a thermometer, the guest had unbuttoned his shirt and lifted his arm. Over much of the world, doctors take a temperature in the armpit. It’s often a struggle to make a patient understand.

Once the thermometer is in place, I announce that I will wash my hands. This produces minor panic, and someone rushes to the bathroom to tidy up. After returning and announcing the temperature, I sometimes take the blood pressure. It’s not useful for most ailments I see, but patients, especially the elderly, often expect it.

After the examination, I announce the diagnosis and hand over an appropriate medicine. Then I give advice. You probably think it differs from patient to patient, but this is only partly true. I give several bits of advice regularly. These include:

“Rest doesn’t make this go away any quicker.”

Despite the universal belief, this is true for almost every illness, and it’s miserable to be confined to a hotel room during a vacation. I encourage sick guests to get out and have fun.

“You’ll feel bad for a few days, and then you’ll feel better.”

Once a doctor performs his magic, patients often expect immediate results. I receive plenty of calls the next day from guests wondering why they’re still sick.

“If you call, I answer in person.”

I demonstrate by holding up my cell phone. Of course, your doctor also encourages you to call, but have you tried? You reach voicemail or, if you’re lucky, a receptionist, and then you leave a message and wait. Being particularly compassionate, I want to spare patients this hassle. But I also don’t want them to call the hotel with the news that they’re not feeling better.

Sunday, February 10, 2013

Jumping to Conclusions

Midafternoon is a slow time, so I take a history class at UCLA, and I’m rarely disturbed. But my phone buzzed.

“This is International Assistance about the patient you saw today. She has begun to vomit and wants another visit. We have authorized it.”

Two hours earlier I had given ibuprofen to a woman with back pain. If the medicine upset her stomach, this would pass. I planned to deliver reassurance, but her husband came on the line and begged for a visit, so I agreed.

Not only did I have to leave class, but the patient was in Hollywood, a tedious eight mile drive through city streets with the rush hour beginning. After twenty minute of stop-and-go, a sense of unease grew. Ibuprofen shouldn’t cause such a violent reaction. Then I realized that the Hollywood patient was not from International Assistance but World Assistance.

International Assistance had called the previous night at 1 a.m. and sent me to the Airport Hilton for a guest suffering a migraine. I’d given an injection and left strong pain pills for later. I checked caller ID on my cell phone and, sure enough, I’d jumped to the wrong conclusion.

The Hilton was in the opposite direction. It took another twenty minutes to reach the freeway and join the rush hour creep. 

Tuesday, February 5, 2013

I'm Less Fond of Coughing

“I’ve been hacking up stuff for a couple days, and it’s turning green.”

“It sounds like the virus that’s going around,” I said. “It’ll last three or four or five or six more days and go away. Medical science doesn’t do anything dramatic.”

“At home I’d tough it out. But I have meetings all week, and I need something to knock it out. When can you get here?”

If you read this blog you know my heart sinks when I hear “I need something to knock it out….”  Either the guest will feel resentful if he doesn’t get an antibiotic, or I’ll go along (if it seems like he’ll lose his temper, and sometimes I’m too slow), and feel bad myself.

Believe it or not, in an otherwise healthy person (infants and the elderly excepted) the only common disease with a cough that antibiotics cure is pneumonia. Everything else is a virus.

Monday, February 4, 2013

I like vomiting

A businessman at the Standard had been throwing up since the wee hours. Expressing sympathy, I assured him I’d arrive within the hour. It was nine a.m., so the usual half-hour drive downtown might last longer.

Before leaving, I took an antivomiting suppository from the refrigerator and dropped it into my pocket. From my medication closet I extracted a syringe and packet of antinausea pills. This enables me to avoid restocking my bag after returning home; sometimes I forget.

The drive was tolerable. The guest was miserable, but he hadn’t vomited in two hours, so I suspected he was over the worst. I left feeling good. I like vomiting.

People chuckle to hear this. What I mean is that, from a hotel doctor’s standpoint, caring for a vomiting guest is usually satisfying.

In an otherwise healthy person, most episodes of vomiting don’t last long. I can help. When they recover, often within a few hours, they give me credit. Sure enough, he felt better by evening.