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Friday, August 30, 2013

Resisting Temptation

A businessman at the Hilton-Garden asked a pharmacist to recommend a cream for his insect bites. To his alarm, he learned that what looked like insect bites might be Lyme disease and that he should consult a physician.

This provided another delicious temptation in the life of a hotel doctor. I could make a housecall, assure the man he did not have Lyme disease, and collect my fee. He would feel vastly relieved and grateful. Everyone would be happy.

The businessman described half a dozen itchy pimples around his ankles. Even over the phone, it was obvious that they were insect bites. I reassured him, and he was relieved and grateful, but no money changed hands.

Monday, August 26, 2013

We Yearn to Help

If a prescription gave you diarrhea or made you vomit, you might complain. But until well into the twentieth century, the average American looked on a good “purge” as a way to expel disease. Physicians took pride in their cathartics, and when patients discussed a doctor’s skill, they gave high marks for the violence of his purges.

A person who visits a doctor expects certain behavior. Nowadays Americans frown upon exorcism, bleeding, or purging, but we expect medicine. It should be one only a doctor can prescribe; over-the-counter drugs don’t count. Pills are good, but an injection is better. Of course, modern drugs often work, but this is a minor matter compared to the deep human desire that a doctor do something.

I apologize if this sounds mildly insulting; I suspect most of you will deny expecting a drug. You want whatever will help. If nothing will help, you want to know.

Such sensible patients do appear, but no day passes when I don’t see disappointment in a patient’s eyes when he or she realizes I don’t plan to “give them something.” 

Doctors genuinely want to help you, and we feel bad when we can’t. We also feel bad when we do our best, and it’s obvious a patient doesn’t feel “helped.” So many of us add a prescription to convince you that we’re doing what a proper doctor should do.

Friday, August 23, 2013

I Prefer Vomiting and Diarrhea

Two women at the Holiday Inn were ill. The mother suffered several hours of severe low abdominal pain with vomiting and diarrhea. It seemed like the usual stomach flu. I assured her it wouldn’t last long and gave medication to relieve her symptoms.

Her adult daughter also complained of severe low abdominal pain but without other symptoms. Viral gastroenteritis can occur without vomiting or diarrhea, but I feel reassured when they’re present. It’s a good rule that when two members of a family are ill at the same time, it’s the same illness, but no rule is absolute.

The problem is that isolated low abdominal pain in a young woman can indicate an urgent problem such as ectopic pregnancy or twisted ovary. This seemed unlikely, but I couldn’t rule it out. If she weren’t better in a few hours, I explained, she must go to the local emergency room. She did not object.

When I phoned a few hours later, the mother’s symptoms had vanished, and the daughter told me she felt a little better. Patients tend to tell doctors what they believe we want to hear, so “…a little better,” does not reassure me. Pressed, she admitted that she wasn’t feeling better. When urged to go to the emergency room, she worried about her lack of insurance and the late hour but promised to give it serious consideration.

I passed a restless night. When I phoned the next morning, she had recovered.

Tuesday, August 20, 2013

The World's Worst Travel Insurer

International Medical Assistance has a terrible reputation despite being my leading source of business. So far in 2013, it’s called 118 times. Every doctor who knows IMS, including the colleague who covers when I’m away, refuses its calls because it’s so hard to get paid.

Most travel insurers pay within a month or two. If they don’t, a call to the claims department corrects matters.

In the past, IMS never paid within two months. When I called, the claims department assured me that a check would be mailed in the near future or that my invoice had never arrived. When I called a week later, I heard the same explanation.

IMS was in business when I took up hotel doctoring thirty years ago and, for obvious reasons, happy to send patients. It didn’t take long for me to grow annoyed. Payment took six month or a year and required persistent phone calls. In 1993, with my practice prospering, I began refusing its calls.

In 1998, IMS changed ownership. A representative called to apologize for my difficulties and promise that it would now pay promptly. I was convinced.

But nothing changed!! Checks didn’t arrive. I resumed pestering the billing department. By 1998 several competing hotel doctors had appeared. IMS was infuriating to deal with, but it provided plenty of business and – eventually – paid.

My frustration tolerance has diminished with age. In 2012 I was considering dropping IMS when a representative called to announce that it was again under new management. Payment would now be made every month directly into my checking account.

Sure enough, in January 2013, December’s payments appeared – minus several visits. Wearily, I picked up the phone. The problem remained when the February payment appeared, also for too little. The March payment was too much but it didn’t even out. April’s payment was also excessive; now I owed them. The May payment again missed several visits.

That’s when I realized that IMS is cheap but not dishonest. It’s simply incompetent. Its claims department will never get my invoices right. Sometimes it pays too little, sometimes too much, never exactly what I bill. I’ve stopped phoning. As long as payments are in the ballpark of what they owe, it’s good enough for me. 

Saturday, August 17, 2013

The Meaning of Life

I believe that things happen because they happen. We weren’t put on Earth for a purpose. You’re born, you do your best, you die.

This is not a popular point of view. Every writer and TV personality you’ve heard of disagrees, including several with a medical degree. Yet I’m convinced that searching for an explanation is the best way to understand natural phenomena but useless as a personal philosophy.  

“I’ve got cancer!!!...  Why me?” This is the first question almost everyone asks. If you believe the universe (God for those less cool) cares about you, everything happens for a reason, so this question has an answer.

But now the cancer victim has an extra job. Besides confronting the disease, he must look deep inside and learn how this is part of the plan. If he’s successful, he’ll feel better. Or she.

You’ve read essays by people who have (1) gotten cancer, (2) reexamined their lives, and (3) achieved inner peace. I’m sure this happens, but in my experience most of us do not find misfortune an opportunity for spiritual growth.

Exhorting patients to find themselves only adds to their burden. I especially dislike media doctors who urge victims to fight their disease, asserting that optimism aids healing. Be happy or die.

Most cancer patients pull themselves together and deal with immediate problems. That’s the best they can do, and it’s not bad. 
  

Wednesday, August 14, 2013

You Think I have a Soft Job

The phone rang at 1:10 a.m. A national housecall agency needed a visit in Anaheim, fifty miles away. I agreed to go but quoted a larger fee because of the hour and distance. The dispatcher said she would request approval get back to me.

After ten minutes I called to ask about the delay.

“I’m sorry," she said. "We’re waiting for the E-mail.”

“E-mail!! Can’t you phone?”

Apparently not. Approval had to come from Madrid or Buenos Aires. I waited another fifteen minutes before calling again. Learning that the E-mail still hadn’t arrived, I told the dispatcher I had changed my mind, and I went back to bed.

Sunday, August 11, 2013

More Humor

"Can you go to Pasadena?” asked a dispatcher from Expressdoc, a housecall service. I could.

“Bloating and nausea,” was the reply when I asked for the patient’s symptoms. Once I arrived at the Pasadena Hilton, I learned that, besides bloating and nausea, the guest was suffering hot and cold flashes, difficulty breathing, dizziness, and blurred vision.

My diagnosis was an anxiety attack. She agreed that this was reasonable. She remembered similar episodes.

“I don’t have more stress than most people, but obviously I’m not handling it well. Why is this happening?”

“Because no one is perfect.”

She laughed, but I believe this. I explained that an anxiety attack is a tiresome body malfunction like a backache or allergy. You suffer, deal with it, and feel better, but it’s likely to recur. Almost everyone believes that stress causes anxiety. When it becomes chronic, victims undergo psychotherapy which sometimes works. I treat it as a simple malfunction; this also works pretty well.

Friday, August 9, 2013

Humor in Medicine

This concerns the same hotel guest I wrote about three days ago. I had cared for her son who was feverish and had vomited twice. It was the usual stomach virus that might last a day. I reassured her and gave anti-nausea pills.

“I’m concerned about his fever. How often should I measure it?”

“Whenever you want.”

“I’m not comfortable with that. How often?”

“Are you worried about his fever?” I asked.

“Of course.”

“In that case don’t take his temperature.”

This is my usual witty response to patients frightened by fevers. It startles them, but my explanation reassures them. This lady was not startled. She was offended.

“I work in the medical profession, doctor, and that is dangerous advice.”

“Actually not.” I explained that when otherwise healthy people get sick, they look sick. If they don’t look sick, they’re probably not sick, and having a fever doesn’t change matters. Infants and the elderly are exceptions; otherwise this is a good rule. People worry too much about fevers.

“I’ve heard different. Fever can kill.”

“You see life-threatening fevers in diseases like meningitis and rabies, but these patients look sick. I haven’t seen a life-threatening fever in thirty years. Sick people look sick. Make your decision on calling a doctor on that basis. Never mind the fever.”

“We’re done here.” She held out her credit card.   

Tuesday, August 6, 2013

Worry


At the end of the visit, a guest handed over her credit card. I wrote its number at the bottom of my medical record form. Seeing this, the guest frowned.

“Do you shred that after you use it?” she asked.

I shook my head no. “It goes into my files.” 

Her jaw clenched at this answer. I phoned the credit card company and began entering answers to its computer’s questions. She hovered, staring anxiously at my form.

“So you don’t shred my number... I thought everyone shredded credit card numbers…”

The computer announced its approval. After hanging up, I tore off the bottom of my form and gave it to her. She seemed vastly relieved.

Friday, August 2, 2013

Why Doctor Oppenheim Isn't Rich or Famous

The better we conventional doctors handle a problem, the less you’ll read about “alternative” treatments. Your local health food store doesn’t sell an herbal remedy for appendicitis. Don’t laugh. Until a century ago victims died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. This is one of many genuine medical miracles we take for granted. Some of us remember the herpes panic of the late seventies. The AIDS panic that followed overshadowed it, but Time and Newsweek published cover stories on herpes, and the New York Times described it as the twentieth century bubonic plague. Alternative remedies were everywhere, not a few sold by entrepreneurial doctors. Then a good drug appeared, and the market for herpes cures dried up.

On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. If you want a treatment that works but that conventional doctors ignore, check the internet, a bookstore, or your favorite magazine. You’ll find plenty.

Many alternative healers are M.D.’s like me. They have names like Deepak Chopra and Andrew Weil. They agree that scientific medicine has much to offer but insist that it is merely one of many routes to healing. 

They assert that it’s equally important to tap our spiritual energy, maintain a healthy optimism, promote natural healing with balanced and pure nutrients available through their web sites, and keep an open mind to cures wrought by eastern religion, nonwestern medicine, and pioneering researchers ignored by the establishment.

It is my belief that this is nonsense, but as someone convinced that science is the road to truth, I’m obligated to present evidence.  So….

I write an obscure blog. Weil and Chopra write bestsellers. My books never sold much (I’ve written five, none self-published). I cannot figure out how to sell ads for this blog. Weil and Chopra do not have this problem. They sell wonderful stuff on their web sites. They appear on TV all the time. I’m shy; I would refuse if asked, but no one asks.

It doesn’t look good, does it? Maybe I’m wrong.