Friday, November 29, 2013

Rashes Are Easy

Some hotels visits are hard; some are easy. I love the easy ones.

A lady at a Sunset Strip hotel had seen a doctor for an allergic rash, and now she wasn’t feeling right. Rashes are easy, and her symptoms were probably medication side-effects, so I expected no problem. That seemed to be the case. Her rash was improving, and she agreed to stop the medicine.

She handed me her Visa card. I took out my cell phone, dialed the credit card company’s computer, and entered a series of numbers at its request. It denied approval. This often means a typing error, so I entered the numbers again. Another denial.

In the distant past, guests would apologize profusely and promise to send a check once they returned home. Some kept the promise, but I quickly decided this was not the way to go.

This guest seemed genuinely puzzled. She wondered if the hotel was responsible. At check-in, a hotel often places a hold on a large sum from the guest’s credit card to ensure it gets paid. She wondered if this exceeded her limit. She phoned the front desk and confirmed this. There followed a long series of calls, referrals, consultations, and arguments before the hotel agreed to remove the hold. It worked. The computer reversed itself and approved.

Saturday, November 23, 2013

Searching for a Doctor on the Internet

If you get sick in a local hotel, you might google “Los Angeles hotel doctor.” My name turns up but only with links to this blog. I don’t have a web site. Nor do my long-established competitors.

You haven't searched in vain because several young doctors turn up. All promise to arrive promptly and deliver superior care. Don’t take their word for it. Testimonials from rating services such as Yelp are unanimously enthusiastic. Five out of five stars.

In fact, sick guests are more likely to appeal to the hotel than the internet, but these doctors have been working their charms on bellmen, concierges, and desk clerks.

All this takes money and work, but it’s not going to waste. Old hotel doctors possess an exquisite ability to detect an interloper, and these doctors are definitely setting foot in my territory. Listening to my colleagues grumbling, I know they are not immune.

As I complain regularly, only a minority of general managers have the good sense to designate an individual, usually me, as the house doctor. I have never solicited hotel employees. It wasn’t necessary when I began because there was no competition. I’m too shy or perhaps too lazy to begin. The result is that I am losing business. In a way.  

Friday, November 15, 2013

Searching for a Doctor on Craigslist

A caller from the Airport Hilton asked how much I charged.

Guests often ask this question. If I answer immediately, the guest is likely to thank me and hang up. So I always respond that phone calls are free and might be all he or she needs. What’s the problem?....

He wasn’t a guest, the caller replied. Hilton management was checking on what hotel doctors charge. There had been an incident…. 

With over 1,000 rooms, the Hilton is one of the largest hotels in Los Angeles. It should generate 100 requests for a doctor per year, but my average has hovered around twenty since it called for the first time in 1991. Like most non-luxury chains, the Hilton has no policy for dealing with guests who want a doctor, and plenty of new competitors are offering their services. Many charge spectacular fees. As I regularly grumble in this blog, hotels pay no attention unless a guest complains which rarely happens.

But here was a complaint, and I was happy to answer. Learning my fee, the caller agreed that it was a big improvement. He would pass along the information.

When I asked about the other doctor, he gave me an 800 number. I called and learned that I was speaking to USA Housecalls, a nationwide service. When I asked for the medical director, the person who answered said he was the owner.

When the owner answers the phone, that doesn’t suggest calls are pouring in, but I introduced myself as a veteran Los Angeles hotel doctor. He immediately went into PR mode and told me he had been in business 23 years. Hearing that I’d only learned of his existence today, he admitted that he was just getting started in Los Angeles and was using two young doctors who had caused some difficulties. He urged me to send my CV.

Googling, I later learned that he had advertised for doctors on Craigslist. 


Sunday, November 10, 2013

I Have Syphilis

Those were the first words from a young flight attendant as soon as we had exchanged greetings.

Earlier, he had told his supervisor of a groin rash. I had popped a tube of antifungal cream into my bag and driven off, expecting an uncomplicated visit.

I asked how he knew this, confident that he had searched the internet and received the usual terrifying and wrong information.

“My boy friend has the same sore. He went to a clinic. They did a test and said he had syphilis and gave him a shot of penicillin.”

I couldn’t argue with that. He would need the same test and injection. Since he was flying back the next day, he could take care of it then.

“I can’t!” he pleaded. “I don’t go to Australia for two weeks.”

His destination was Cairo because he worked for an Egyptian airline. On sexual matters Arabs are less easy-going than Australians, and he was frightened of the consequences if his employer found out.

I encounter this now and then. Even in the US where discrimination is illegal, employees worry. I rarely encounter syphilis, so I don’t carry injectable penicillin, but I handed over an approved alternative treatment, and he promised to follow up with his doctor in Australia. Later, writing my medical report, I worked hard to write an accurate if ambiguous description of an acute bacterial penile infection.  

Tuesday, November 5, 2013

Doctors Earn a Lot

The average family doctor earns $189,000 a year. My 2012 physician income did not reach two thirds of that, but I’m not complaining. When friends express wonder at its size, I happily agree. When they suggest that doctors earn a great deal, I acknowledge that America pays doctors generously. 

Editorials occasionally express disapproval. Like my colleagues, I note the errors (assuming, for example, that most of the health care dollar goes into the doctor’s pocket) then move on.  It never occurs to me to respond. Among problems of our health system that infuriate Americans, the size of our incomes is well down the list. 

Others protest, and I wish they wouldn’t. I can’t remember the last defense that didn’t sound whiny. Every doctor beats two dead horses.

The first is what I call the Ophra Winfrey defense.

“Ophra Winfrey (or Alfred Pujols or the chairman of Disney) makes. . .  How many lives do they save?”

Similar excuses include:

“A plumber charges. . .”

And the traditional:

“Lawyers make three hundred dollars an hour, so. . .”

The media pour out a daily stream of outrage at the latest baseball contract, lawsuit settlement, or CEO salary. Doctors aren’t the only ones comparing themselves to lawyers, plumbers, and celebrities. Everyone does.

Worse, almost everyone who uses this argument earns less than I do. People who feel underpaid for their own honest labor are unlikely to agree that doctors are in the same boat.

Number two, equally feeble, is the trash compactor defense.
 “The average American pays more for alcoholic beverages than. . .” 
“My last malpractice premium was. . .”

“The consumer price index proves that doctors incomes haven’t. . .”
“Ten years ago, Medicare paid ... for a cataract operation.  This year it paid a mere. . .”

The trash compactor is a machine that converts a hundred pounds of trash into a hundred pounds of trash. A physician using this defense doesn’t grow less prosperous.

The best justification of our income lies in what we do:  we comfort the afflicted, relieve suffering, and save lives. I look on medicine as a noble, humanitarian calling, perhaps the noblest. Patients acknowledge this. So what’s the problem?

It’s this: humanitarians shouldn’t make a lot of money. Few laymen believe clergymen, nurses, social workers, paramedics, teachers, policemen, or firemen are overpaid. They are less certain about doctors, but it doesn’t upset them if they have good insurance and enough money.

What are we doing about those who can’t afford us? Some doctors volunteer an afternoon or two. A few genuine humanitarians work full-time with the poor at a salary unacceptable to most of us. The majority does little.

That statement produces an avalanche of disagreement. Poverty is no barrier in their practice, a chorus of doctors insists. They make allowances for anyone in financial difficulty. This is a frivolous argument. Few among us refuse a patient who pleads for charity, but it doesn’t happen often.

Why don’t the needy call? They don’t hesitate to consult clergymen, social workers et al. I believe it’s because we are so powerful and prosperous and (ironically) because no influential group objects to this. In the debate over caring for the uninsured, no one wants doctors to shoulder the burden. Repeated cuts in Medicare and Medicaid have produced enormous psychic but little material suffering. Nor has the increasing skimpiness of private health insurance. Whatever changes occur in the years ahead, Obamacare included, there’s no chance a physician’s income will come to equal that of, say, a police officer.

Doctors enjoy the best of both worlds. We care for the afflicted. For this we are widely admired and well paid. Sacrifices are expected - but only of our time and mental health. It’s hard to feel guilty because almost no one wants us to feel guilty. 

Friday, November 1, 2013

The Five Actions of a Hotel Doctor

After the door opens and I exchange greetings, my first action is to look down at the floor. If I see a pile of shoes, I remove mine. You may think this is a quaint foreign custom, but some Americans have adopted it. When you consider what people and animals deposit outside, it seems terribly unsanitary track it onto your rugs.

My second action, on entering the room, is to identify the patient. A doctor making a housecall is an exotic event even for Americans, so I often encounter a large, attentive audience.

My third is to brush off apologies as guests rush to clear a space for my bag and clipboard. Apparently no one reads or writes while traveling, so desk and chairs are piled with belongings.

My fourth action is to suggest that someone turn off the television. Time and again, a patient begins talking – and I can’t hear. Guests often seem startled at this request – and occasionally miffed. What’s the problem?.....

It’s surprising how many people around the world turn the TV on before breakfast and leave it on. It’s the background to their daily life.

My fifth action, after listening to the patient, is to announce that I will wash my hands. This produces more apologies as guests rush to tidy up the bathroom.

I hope this held your attention. You should realize that any competent blogger must write at least once a week, or his audience drifts off. Being a hotel doctor may be world’s best job, but it’s not always full of excitement. Writing is often harder than practicing medicine.