Tuesday, December 31, 2013

How a Hotel Doctor Is Like A Prostitute

2013 was my busiest year. Calls were up twelve percent. It's also the year when calls directly from hotels dropped below fifty percent.

I now make most visits at the request of national housecall agencies, international travel insurers, airlines, and a sprinkling of miscellaneous sources including other hotel doctors. That's fine with me.

About fifteen Los Angeles hotels call me exclusively. That leaves over a hundred, all of whom have my number but who call another doctor or no doctor and sometimes me. Competition for these hotels has become so cutthroat that I'm happy to leave it to others.

If you follow this blog you've learned about my excellent skills and low fees. Why would a hotel bother with anyone else? The answer is that service and price are useless marketing tools in medicine where the law of supply and demand doesn't work.

Providing a doctor produces no revenue for the hotel, and guests don't demand one, so most general managers pay no attention. Asked for help by a guest, employees are on their own.

They may simply give out a number, but many prefer the traditional arrangement once used to summon a prostitute. A bellman made a phone call. As the lady left, she stopped at the bell desk to drop off a portion of her fee.

It's illegal for a doctor to pay for a referral, but what are the options for someone yearning to break in to the glamorous world of hotel doctoring? Claiming to deliver superior medical care sounds weird. Advertising a low fee is vulgar.

Thursday, December 26, 2013

A Hotel Doctor's Christmas

I’m the only hotel doctor who loves to work on Christmas. Freeway traffic is light, always a bonus but more so on Christmas because my competitors, including those in Orange County, prefer their holidays undisturbed, so I make some distant visits.

Guests who fall ill are especially grateful to find a doctor. Employees, apologetic when they phone, are impressed when I make an appearance. Visiting a hotel that doesn’t call provides an irresistible opportunity to point out the superior service I deliver.

The only person not delighted by all this is my wife. Long ago, receiving a second call while engaged in the first, I missed the family Christmas dinner. I won’t do that again, but that’s only a matter of juggling a few hours.

Sunday, December 22, 2013

Good Doctors Do It

“I’m coughing my head off. My head is plugged. I have a fever. I’m on vacation, and I need something.”

I’ve seen over 4,000 guests with respiratory infections. To the average hotel doctor, this is an easy visit. He arrives, performs the traditional exam, prescribes the traditional antibiotic, and accepts his fee and the guest’s thanks. What’s not to like?

That the antibiotic is unnecessary doesn’t bother him. It would bother me, so I prescribe only when it will help. Despite my colleagues’ insistence that patients demand antibiotics, most of mine accept this. A minority appear disappointed, and a few make it painfully clear that I’ve missed the boat.

For decades, solemn editorials in medical journals have urged us to stop prescribing useless antibiotics, warning that they’re poisoning the environment, producing nasty, drug-resistant germs that are already killing thousands. 

Despite this, giving antibiotics for viral respiratory infections remains almost universal. Every doctor whose prescribing habits I know – admittedly a limited sample of about ten – does it. None believe they help. All tell me that patients expect them.

“I don’t want an antibiotic if I don’t need it,” intelligent patients tell me. “But how do I know?”

“You don’t, but bacterial respiratory infections are rare in healthy people.”

“What if it’s bronchitis? I get that a lot.”

“Antibiotics don’t help bronchitis.”

“That’s what my doctor gives me. Are implying he’s incompetent?”

“No.  Prescribing unnecessary antibiotics is so common that one could call it the standard of practice – meaning good doctors do it.”

If you’re coughing and in reasonably good health, the only common disease that antibiotics cure is pneumonia (229 diagnoses on my database). Everything else is a virus.

Wednesday, December 18, 2013

Easy Visits, Mostly

Every day a thousand airline flight crew spend the night in a Los Angeles hotel. Sometimes they get sick and call their supervisor. If they’re American, he tells them to take their American medical insurance and find a clinic. If they’re foreign, he tells them to stay put and wait for the doctor.

That will probably be me. I average half a dozen of these visits per month. I enjoy them because airline crew are young and healthy. Three-quarters suffer respiratory infections and upset stomachs. Since a doctor must certify if they’re fit to fly, I see plenty of ordinary colds.

A minor drawback is two pages of forms to fill out in addition to my medical record. A more serious problem is vomiting: the symptom in nearly half my airline calls. I hate driving during the rush hour, but vomiters don’t like to wait, so I often find myself creeping on the freeway.

Sunday, December 15, 2013

Recovering From Cocaine

He had turned bright red an hour earlier, a frightened guest informed me. Searching the internet revealed that this indicated dangerously high blood pressure. Could I come…?

This was as accurate as most internet medical advice, so I was not alarmed. In response to my questions, he admitted using cocaine earlier but emphasized that this had never happened before. His heart was pounding, his skin tingling, and his head pulsating but he denied having a headache or chest pain. Could I come?

What to do…. Allergic reactions turn patients red, but this is accompanied by itching which he didn’t have. Otherwise, his symptoms were typical of cocaine. They didn’t sound life-threatening, but it’s a bad idea to dismiss the possibility.

I do not like to make housecalls to frightened hotel guests. Waiting often becomes intolerable, so they dash off to an emergency room or call the paramedics before I arrive. When I suggested these possibilities, he refused, urging me to come quickly. I asked him to count his pulse. It was 100:  not terribly fast. I kept him talking, and he grew more calm.

A hotel doctor’s nightmare is a guest dying after he leaves the room, but dying before he arrives may be worse. It was a stressful drive.

When he opened the door, he wasn’t bright red, perhaps very faintly pink. When I took him to a mirror, he agreed that he had improved. His blood pressure was high, but not too high. His heart sounded normal. He was recovering from the cocaine.

Wednesday, December 11, 2013

A Sad Story

The caller was Chinese, and he wanted a medicine. That could mean anything. He gave the name which, through his thick accent, sounded like “desitin,” an over-the-counter treatment for diaper rash.

That didn’t seem right, so I coaxed him through the spelling (“S as in Shanghai….? “T as in Taiwan…?). The result was “dasatinib.” This turns out to be treatment for a common leukemia, FDA approved a few years ago, and superior to other treatments. A friend in China had asked the guest to obtain some.

I fulfill these requests if they sound legitimate, and this qualified. I made sure he understood that he must find a pharmacy and explain exactly what his friend needed including the dose, number of pills, and instructions. This sometimes involves phoning back to the home country. The pharmacist would then call me, and I would approve. A trip to the hotel wasn’t necessary.

The guest had phoned in the evening and mentioned that he was returning to China the following morning. When the day passed with no call, I had the sinking feeling that, by delaying till his departure day, the guest had waited too long. The average CVS or Walgreens might not stock these high-tech, chemotherapeutic drugs, so the pharmacist might refer him to a large medical center such as UCLA. This would take hours. With a plane to catch, the guest probably realized that there wasn’t time.  

Sunday, December 8, 2013

Sticking With the Errant Doctor

A guest had a flight in a few hours, explained the front desk manager of the Marina Marriott. His wife was ill and needed a doctor’s note to reschedule. How fast could I get there?

“Very fast,” I said. It was Saturday evening, and I was at the computer.

The Marriott had called regularly throughout the 1980s and 1990s before falling silent. Hotels occasionally do that, and this call gave me hope.

My competitors enjoy an active social life. It was the weekend, and hotels often turn to me when the regular doctor is hard to reach.

After caring for the guest, I returned to the lobby where the manager shook my hand.

“Thank you so much for coming,” he said. “We have your card, and we’ll be calling in the future.”

I drove off in a happy mood. These urgent requests arrive several times a year, and my prompt response has won me new clients.

But not often. Few hotels give a high priority to providing medical services. Ninety percent of the time the staff continues to call the errant doctor.

Still, I have fond memories. Twenty years ago, Loews phoned when its regular doctor hadn’t appeared after several hours. I hurried, but when I knocked on the guest’s door, it was the regular doctor who answered. The embarassed manager promised to make it up to me, and he kept his word.

Wednesday, December 4, 2013

You Must See "The Dallas Buyer's Club"

Everyone agrees it’s one 2013’s outstanding films. On Rotten Tomato’s site, a spectacular 42 of 42 reviewers approve. Matthew McConaughey delivers an Oscar-winning performance as a homophobic Texas good-old-boy who learns that he has AIDS in 1985.

Defying his doctor, who announces that he has thirty days to live and that no treatment exists, he pulls himself together, searches for treatments in places beyond the influence of the medical establishment (Mexico, for instance), smuggles them into the USA, and distributes them to AIDS victims despite government persecution.

Although I recommend The Dallas Buyer’s Club, I left halfway through. I couldn’t bear it because it contains every dumb Hollywood cliché about physicians and science.

Every doctor is a jerk except (a) the beautiful young woman doctor who finds Matthew McConaughey cool and (b) the seedy, unshaven doctor whom McConaughey stumbles upon running a Mexican clinic. After announcing that he has lost his US license (undoubtedly for being too compassionate), this doctor explains that his regimen of vitamins and immune boosters will help.

I am not one of those tiresome people who insist that movies stick to facts. History is boring and complicated. American movies must tell a coherent story with an upbeat ending and an admirable hero (Matthew McConaughey has flaws, but they are cute flaws: he is oversexed, a spendthrift, rude, and he lies – but only to bad people).

At that time, a hundred Mexican clinics sold AIDS treatments. None worked. Everyone who took them died. No American audience would accept Matthew McConaughey passing out fake drugs, so the screenwriters tweak the historical facts. In the movie, the drugs work.

I’m puzzled why conservatives denounce Hollywood for turning out liberal propaganda. The Dallas Buyer’s Club is a Tea Party dream. The government is a heartless oppressor. That includes the FDA which the writers confuse with the FBI because they create a menacing agent who threatens to arrest Matthew McConaughey. This FBI… I mean FDA agent never says “Your drugs don’t work!” He says “Your drugs are not FDA approved!” which, since he’s a villain, means they do work.  

Let me know how it turns out.

Monday, December 2, 2013

Rashes are Easy, Part 2

His client had developed redness over her eyelids. Could I come?

As I repeat, rashes are easy, and eyelid rashes mostly turn out to be one of two or three diagnoses. I asked for the room number.

The guest was in a meeting, the caller responded. When I arrived, I should ask the concierge to fetch her.

So I did. The concierge returned to say the meeting would end shortly. I waited fifteen minutes.

As expected, the eyelid rash was no problem. After accepting a tube of cream, she mentioned that her knee had hurt since her run the previous day. I examined the knee and reassured her. She added that her ankle had been bothering her for some time. I examined the ankle and gave my opinion. Then we talked about her husband who had a sore shoulder but refused to see a doctor.