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Monday, October 28, 2013

Being Awakened Twice

“How quick can be in Costa Mesa?” asked the dispatcher for Expressdoc, a housecall agency. The call got me out of bed at 11 p.m.

“In about an hour.” 

“Can’t you make it earlier?”

“Costa Mesa is forty miles away. How sick is he?”

“He has back pain. He wants to go to an emergency room, but we said we could send a doctor. Let me see if he’ll wait.”

After fifteen minutes passed, I phoned the agency.

“I’ve been trying to reach him, but it looks like he’s gone to the hospital. If he comes back, is it OK to call you?”

“No. If he comes back, tell him I’ll be happy to see him in the morning.”

I have no objection to being awakened to make a housecall, but I don’t want to be awakened twice. After breakfast, I phoned the guest. He hadn’t gone to the emergency room, but he was feeling better.

Thursday, October 24, 2013

Nearing the End of the Road

I have never denied being America’s most successful hotel doctor. No one makes as many visits (passing 16,000 in 2012) or works at it exclusively. All others do it as a sideline.

Yet time is passing. I’m not the only Los Angeles hotel doctor collecting social security. A new generation is muscling in, displaying the energy of youth, fierce marketing skills, and a useful absence of ethics. All are concierge doctors, building cash-only practices that serve patients willing to pay to have a physician at their beck and call.

Even in Los Angeles, these are a limited resource, so concierge doctors have cast an eye on hotels, a major source of cash-payers.

“I guess no one’s been sick,” is the lie I hear when an employee explains why her hotel isn’t calling. I’ve been hearing it lately. Despite this, 2013 looks to be a record year with calls running twenty percent over 2012.

Partly it’s because my field is consolidating. National housecall services are expanding, and almost all use me. This is no news to my competitors, but marketing to these firms presents difficulties for a concierge doctor.

One obstacle is their spectacular fees: double or triple mine. This may strike you as terrible business practice, but it’s no problem with hotels. Hotels don’t care what a doctor charges unless guests complain. They rarely do.

In addition, when concierge doctors introduce themselves to a hotel employee, extol their virtues, and perhaps offer an amenity for every referral, they have a receptive audience. This doesn’t work so well at a corporate office.

Finally, concierge doctors are young and busy. Immediate 24-hour service is a concierge doctor mantra, but providing it is impossible for anyone with a practice and active social life. My leisure activities are reading and writing.

The result is that concierge doctors ask my help regularly. They send me to their patients but increasingly to my hotels and those of my colleagues. When I retire, it won’t be because business is declining.       

Saturday, October 19, 2013

A Plug for a Book

Try to find The Hotel, A Week in the Life of the Plaza by Sonny Kleinfeld. Published in 1989, it’s long out of print, but you’ll love it. Kleinfeld is a journalist who spent a week in the famous New York hotel and wrote about twenty chapters describing every position from the doorman, desk clerk and laundry worker to the kitchen staff, concierge, security, bellhops, housekeeping, and management.

I was impressed at the difficulty of keeping such an institution running smoothly and satisfying demanding guests (not you or me but some). If you want to know the hardest job in a hotel, there’s no contest. It’s the housekeeper’s.  

The book includes a chapter on the hotel doctor that kept me scratching my head. Mostly, he complains.

It infuriates him that guests call at 1 a.m. with a bad cold. Any call from an exclusive Los Angeles hotel like the Four Seasons would thrill me. Why was he upset? Did he volunteer for the job? Is he working for free? I have no problem seeing guests who aren’t very sick no matter what the hour.

I take for granted that doctors go into medicine because they want to help people, and unlike other helping professions (clergymen, firemen, social workers) we’re paid very well. Almost no one calls me during wee hours unless they’re feeling bad. That may represent poor judgment, but who thinks clearly when they’re miserable?   

Tuesday, October 15, 2013

A Weird Letter From My Doctor

I take good care of myself, but I’m 73, and the best life-style only postpones the inevitable.

I’ve been seeing a cardiologist at the Pacific Heart Institute, a four-man group in Santa Monica. He is excellent. I would be seeing him still but for a strange letter that arrived last month.

Insurance companies and Medicare have been reducing payments, it began, and more cuts are threatened. In response other cardiology groups were merging, lowering the quality of their care. Pacific Heart Institute vowed to maintain its standards. But how to do that while continuing to accept insurance?

The solution was to offer an “Enhanced Access Program.” An accompanying sign-up sheet listed three levels of benefits.

For $500 a year I could choose the “SELECT” level. Among its features are priority in appointments, prompt notification of test results, waiver of miscellaneous office fees, a special internet portal, and a customized wallet card with my EKG tracing.

$1800 per year would bump me to “PREMIER” status: same day appointments, direct e-mail and phone access to my cardiologist, and a free vascular risk assessment.

At $7,500 a year (that’s not a typo), the deluxe “CONCIERGE” level gives 24 hour access to my “personal” cardiologist, same day visits, same day tests, and a call from my personal cardiologist to discuss results.

I could check a fourth box. Lacking a title, it merely stated “I choose not to participate… No fee.” The doctor would continue to see me if I decided not to pay up.

Paying extra to get the doctor’s attention is routine where doctor incomes are low. It was the norm in the old Soviet Union and remains so in Russia, China, and Eastern Europe.

American doctors are the world’s richest, but they didn’t get that way by ignoring sources of income. If you follow the news, you know that cash-only or “concierge” practices are a growing niche. They’re so popular that professional organizations such as the AMA have set up ethical guidelines. As I wrote on June 27, this seems like setting up guidelines for operating a Mexican cancer clinic, but mine is a minority view.

I’m angry, but mostly I’m frightened about my heart which will require major surgery in the near future. I need to believe my doctor is focused on caring for me, and I thought I had found one. Then he suggested I pay him extra.     

Friday, October 11, 2013

Seriously Burned

I awoke at my usual time, wrote for a few hours, ate breakfast, and went back to bed. I had answered a wee-hour request from a distant hotel, and I was sleepy.

When business is slow, I take actions that encourage calls such as going to a movie or trying to take a nap. Unfortunately, this works when I don’t want it to, so the phone rang as I drifted off. It was a lady at the Custom hotel whom I’d seen the day before for vomiting and diarrhea. She was better and desperate to return home, but her insurance insisted on another exam before allowing her to travel. Visiting guests who aren’t sick is a perk of hotel doctoring, and I was happy to comply.

Returning home I headed straight for bed, but the phone rang as my head touched the pillow. A lady at Le Parc explained that had undergone eyebrow waxing, and a clumsy cosmetologist had inflicted serious burns. I suggested that serious burns around the eye require more care than I could deliver on a housecall, but she demanded a visit.

I consoled myself with the knowledge that guests often exaggerate their problems. This proved to be the case when she showed me several pink spots over her eyelids and forehead. These were mild, first-degree burns, I explained, similar to sunburn. I handed over a tube of soothing cream and assured her that they would heal completely in a week.

I was wrong, she said bluntly. Because of her extremely delicate skin, she would be scarred for life.

Monday, October 7, 2013

An Odd Foreign Custom

When I finish caring for American guests, I accept their thanks and money, and I leave. With  guests from another country, I often find myself discouraging them from accompanying me to the elevator or down to the lobby or (if it’s a private house) to my car.

I mentioned this excessive politeness to a colleague from South America.

“They probably thought you were in a hurry to get away,” he said.

When I protested, he explained.

“When I first came to the US and visited an acquaintance, I was disturbed when he shut the door behind me after I left. Did I offend him, I wondered. Is he happy to get rid of me….? In my country, you always accompany an honored guest when he leaves and make sure he is safely on his way. To stay behind is not courteous. But this is what Americans do.    

Friday, October 4, 2013

Another Freebie

A guest at the Georgian hotel in Santa Monica wanted a housecall, said the desk clerk. She had a urine infection.

That was good news. The Georgian was not far, and urine infections are usually easy.

“The guest has gone to dinner,” the clerk added. “She’d like you to come at 9 o’clock.”

I hate it when hotels make an appointment without consulting me. I want to talk to guests before a visit. It’s surprising how often their self-diagnosis is wrong. They need to know how much I charge and that they’ll have to pay directly. Learning this, some guests reconsider. A few guests assume the doctor is in the hotel, so it’s no big deal if they’re late or decide to skip the consultation entirely. Finally, it’s stressful to kill time at home, hoping another call doesn’t arrive to complicate matters.

Sure enough, at 8:30, as I was about to leave, the phone rang. A guest at the Airport Hilton was vomiting. Vomiters don’t like to wait. There was no way to contact the Georgian guest to suggest a delay, but I decided I could make the visit and reach the Hilton in an hour. I hurried off.

Freeway traffic stopped cold at my exit. Santa Monica was holding an arts festival. The streets were jammed; the police were out in force directing traffic and manning barriers. After half an hour, I had advanced two blocks when I realized the beachfront, including the Georgian, was sealed off. Normally, I would park six blocks away and walk to the hotel, but this would make me outrageously late for the poor vomiter at the Hilton.

Guests usually agree to wait when I explain the problem.

“I just flew in from London. There’s no way I can stay awake,” said the Georgian guest, hearing that I’d like to return when traffic eased.

In the end, I phoned a prescription into a nearby pharmacy and made my way to the airport.