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Wednesday, December 31, 2014

Doing My Duty


“I can’t handle that in a hotel room,” I explained. “She probably needs an ultrasound.”

After consulting his superior, the dispatcher came back on the line to explain that they would like me to evaluate the guest, a flight attendant with vaginal bleeding, and deliver a recommendation.

If she had called directly, I would have sent her to an emergency room, but this request came from an agency that serves airline crew. It was paying the bill, and I had done my duty by warning that a housecall wasn’t appropriate. I was happy to make the visit. Once I confirmed her bleeding, I would simply call and report.

A young man opened the door. I entered, expecting to see a girl friend or wife, but he was alone, and he identified himself as the patient.

I checked the date of birth on my invoice. It was identical. He spoke excellent English, so there was no chance of a misunderstanding.

After dealing with his problem, I phoned the agency. Was there another flight attendant with vaginal bleeding waiting for me? After a long consultation, he assured me that no one knew. It was probably a mistake.

Sunday, December 28, 2014

You Don't Need a Better Medicine


“My doctor gave me amoxicillin a week ago, and my sinuses are still blocked. I need a stronger antibiotic.”

For perhaps the thousandth time, I responded: “You have a virus. Viruses can last a week, and antibiotics have no effect.” 

If a medicine isn’t working the next step is never to try another medicine but to discover why it isn’t working.

Sometimes the patient needs a better exam. Pain on urination usually means a bladder infection, and I’ve seen several women whose bladder infection didn’t go away after a course of treatment. They didn’t have a bladder infection but herpes. It was obvious when you looked, but the doctor hadn’t looked.

Sometimes the patient needs to wait. After rubbing cream on an insect bite, patients worry when it grows to an itchy patch several inches around. I explain that insect bites may worsen for two days and then resolve over the following days.

Sometimes the next step is to stop taking medicine. Treating pinkeye with drops usually helps, but patients occasionally return to complain that they’re worse. That’s because the drop has begun to irritate the eye. A few days after stopping, they feel better.

My malpractice lawyer warns me to warn you to read this purely for your own amusement. Only in mathematics are statements always true, my lawyer added. Even the best medical advice has exceptions.

So if a medicine isn’t working, don’t stay away from the doctor on the grounds that I said it was OK.

Tuesday, December 23, 2014

Japanese Never Travel Alone


The room contained four young men and extra beds, on one of which lay my patient looking miserable with a wet washrag on his forehead.

At my first question, several pulled out Japanese-American phrase books, a bad sign. It’s a fact that all Japanese study English in school, but all Americans study American history, and how much do they learn?...

Answers to my questions were on the order of “please perform a diagnostic evaluation” or “the reading of the thermometer seems excessive.” I had reluctantly decided to call their travel insurer’s 800 number (phone interpreting is tedious) when the tour leader entered. His English was rudimentary, and, loyal to his culture, he was too polite to tell me I was incomprehensible, but I managed to confirm my suspicion that the young man had influenza. Most likely it was Swine flu which, despite scary headlines, is no worse than regular flu but a terrible illness for young people who take for granted they’ll never be ill.

Friday, December 19, 2014

A Dog-eat-dog Business, Part 7


A travel insurer sent me to a large airport hotel that hasn’t called this year, so I decided to reintroduce myself.

“We don’t have a doctor,” said the lady in the security office.

“I’ve made hundreds of visits. Your office called me all the time.”

“I never did,” she insisted. She summoned a nearby officer who agreed that no one knew about a hotel doctor. She accepted my card and put it in a drawer.

My next stop was the concierge desk, but it was vacant. When times are tough, concierges are the first employees to go. The front desk clerks agreed that having a hotel doctor was a wonderful idea and thanked me for my cards.

“I guess no one’s been sick,” said the bellman cheerfully when I queried him. I had no doubt that whatever doctor he called tipped him $20 or $30 or $50 for the referral. This is illegal but a common practice. My veteran colleagues express outrage, and I have no reason to disbelieve them, but we all agree that several aggressive young doctors are paying generously. It’s the quickest way to break in. The bellman thanked me for my card and put it in a drawer.

If you assume that general managers hate choosing a doctor on the basis of his kickback, you’d be right. Sometimes. When I informed the GM of the Westin, he took action. When I informed the GM of a famous Beverly Hills Hotel he merely passed my letter on to the chief concierge who phoned to announce that I need expect no further calls from that hotel.

Sick guests often call the operator, so I dialed the hotel.

“Hi, Doctor Oppenheim. It’s been a long time.”

That was a pleasant surprise. The operator explained that she had worked there for twenty years and spoken to me many times. She added that her directory contained no doctor's name. She would be happy to take down my number and pass it around.  

I left feeling pleased with myself because I hardly ever market myself to employees. But that was in August, and the hotel still isn’t calling.

Monday, December 15, 2014

A Glamorous Job


A five-year-old was coughing and congested.

His parents were guests at Loews in Hollywood, nine miles away through city streets. Nineteen miles on the freeway would take less time provided traffic moved smoothly, but this was unlikely at 4 p.m. on a Friday. I told the mother that it sounded like a routine virus, but she insisted the child needed attention.

Sometimes being hotel doctor to the stars is not so glamorous. Then I recalled a pediatrician colleague who had expressed interest in helping out. I phoned his office. He was finishing his last patient and, to my delight, agreed to make the housecall. I was so relieved that I forgot to tell him a few things.

That evening he phoned to let me know the visit had gone well.  

“But it took almost two hours to reach the hotel, and they charged me fifteen dollars to park.”

Thursday, December 11, 2014

Helping a Lady


A guest at Checkers, an upscale downtown hotel, had the flu with a 103 fever. I washed my hands before examining her; afterwards I washed again and included my stethoscope. I’ve had the flu shot, but I still worry about catching it. This happened in 1977 and I remember it as the worst illness of my life until I became old.

I finished just before midnight. Returning to my car, I passed two young women arguing bitterly on the sidewalk. One insisted on walking to their hotel, the other objected because she was wearing high heels.

At my age, no one considers me threatening. As I started the engine, one of the women tapped on my window and asked for a lift. I drove her to the Bonaventure, six blocks away. She had been drinking but was coherent and grateful for the favor.

Sunday, December 7, 2014

Why I Like Foreigners


“Do you take insurance?” asked a Biltmore guest after learning my fee. She was 26 years old and an American.

Hearing that she would have to pay up front and submit my invoice, she decided to wait. She was suffering an upset stomach which would probably clear up in a day. I gave advice and told her to feel free to call.

“Could I have your name and room number?” I asked before hanging up.

“Is that so you can charge me?” she asked.

“Phone calls are free,” I said. “I just need to keep a record.”  

An hour later she called to say she had changed her mind. Could I come?

Her vomiting had stopped but not her nausea and headache. After an exam, I gave her two packets of pills: one for nausea, one for the headache.

“How much are these?” she asked.

“Nothing.” I assured her that she was over the worst of her stomach virus.  

“So it’s a minor problem that will go away. You came, but you didn’t do much for me.”

I agreed that I hadn’t cured her but perhaps I had helped in other ways. I could have mentioned the convenience of a housecall and the medicines I handed over, my long drive to the hotel, and the fact that my fee is less than the going rate. None of this would have worked. I simply expressed satisfaction that she was improving and told her to phone if problems developed.

“And then you’ll come back and charge me again?” she asked.

I explained that I rarely make a second visit for the same problem, but I would try to help.

Wednesday, December 3, 2014

Tempting the God of Housecalls


I was mildly entertained during 45 minutes of the new movie, Interstellar. The physics was wrong, and the politics of its dystopian future defied logic, but the production held my interest.

Then my phone buzzed for a housecall. Theaters will refund my money, but I don’t ask unless the movie has just begun. Admission is cheap compared to my housecall fee, and I can always return. Half the time, I’m happy to leave. When I attend a play or live performance, I ask a colleague to cover but never for a movie, although I sit on the aisle so I can hurry out and answer without disturbing the audience.

Doctors agree that patients call at the most inconvenient time, but I look forward to calls, so I try to persuade the fickle God of Housecalls that I don’t want to be interrupted. Going to a movie or restaurant or the dentist seems to accomplish this. If I have no plans for the afternoon, I may lay down for a nap even if I’m not tired. It’s my hope, often achieved, that the phone will ring as soon as I fall asleep.

I saw the final two hours of Interstellar a week later and remained mildly entertained. I won’t give anything away, but when a Hollywood movie features a conflict between science and love, only one outcome is possible.

Saturday, November 29, 2014

A Hotel Doctor's Thanksgiving


I had finished breakfast at 7 a.m. on Thursday when the phone rang. A Quantas pilot at the Hilton in Anaheim was suffering a respiratory infection. This was a great call in many ways.

That Hilton is forty miles away, but I don’t mind long drives provided traffic moves smoothly. Holiday mornings are a good time, and I could take the Santa Ana freeway which is two miles shorter than my usual route. I avoid the Santa Ana because it’s often jammed and in poor repair except for a tiresome five-mile stretch of construction. But it was fine at 7 a.m. on Thanksgiving.

Leaving the freeway, I drove past Disneyland where sidewalks overflowed with crowds streaming toward the entrance.

Unlike most patients with a respiratory infection, airline crew give priority to getting home, not to getting medicine. They hate being stuck in a hotel room, so I try to accommodate them.   

The drive home was easy. Unlike other clients, the airline agency requires a special form which I must fill out and fax to get paid. Happily, I checked boxes for “distance,” “after hours,” and “sat/sun/holiday,” all of which get me extra money. I have no objection to any of the three and actually prefer the last two because traffic is light. I’m perfect for this job.

Tuesday, November 25, 2014

I Was America's Leading Writer of Health Articles


I still hold the record for Woman’s Day – about 35 articles. I stopped as I reached middle-age in the 1990s in favor of my yearning to write literature. Don’t expect a plug for my fiction. It’s been published, but you have to look hard to find it.

Mass-market health articles deliver positive information that readers can use. Editors have no interest in controversy, muckraking, entertaining anecdotes, or the writer’s personal experience – the sort of material you find in this blog.

I knew this, but I sometimes broke the rules.

Here’s an example. Media doctors love to warn us of hidden dangers, ominous symptoms, and important information that would make us healthier if we only knew about it.   

I wanted to do the opposite – tell readers of things they don’t need to worry about and things that are supposed to make them healthier but don’t.

Patients worry that a headache means their blood pressure is high, fatigue that their blood pressure is low, and that their fifth cold of the year is a sign of low immunity. This is not true.

Green mucus, yellow diarrhea, smelly urine, sharp chest pains, and white spots on tonsils rarely require urgent action and usually no action at all.

Healthy readers learn that they can become super-healthy. If they are doing everything right, they can do still better – eat certain nutrients, cultivate a positive attitude – and “boost” their immune system, slow the aging process built into our DNA, and prevent disease. It's equally true that a terrific life-style will reduce a nine month pregnancy to seven months.

Media doctors insist that will-power and a positive attitude cures disease. To heal, you must fervently want to heal. I call that the “be happy or die” approach.

Editors hated this.

“Readers look up to us. Why should we tell them that our other doctors are wrong?” they asked. 

“We never tell a reader not to worry,” they added. “If she follows your advice, and something bad happens, she will blame you. And us. And she will sue.” 

This article remains unpublished. It never came close.

Saturday, November 22, 2014

We Love to Help You


A patient once kissed my feet after I removed a speck of dirt from his eye. Removing splinters and earwax also produces excellent feedback.

At the other extreme, if I deliver the best medical care for a respiratory infection or sore throat, I’m likely to feel discouraged when the patient delivers a tepid thanks as I leave. After all, he isn’t feeling better, and I haven’t done anything to cure him. Doctors addicted to gratitude give useless treatments (in this case, an antibiotic) to make sure the patient leaves feeling “helped.”

Doctor love helping patients. That’s why most of us went to medical school. If we’re doing our job, you leave feeling that the visit has been worthwhile. Cures produce intense gratitude, but doctors cure only a minority of the ailments they see, and doctors who pretend otherwise harm their patients.

Monday, November 17, 2014

My Favorite Infections


Urine infections are number one. Handing over a packet of antibiotics, I can assure a woman who has been running to the bathroom every half hour that she’ll feel better by the next morning. In men, urine infections are usually prostate infections; these resolve more slowly, but they resolve.

Eye infections (“pinkeye,” conjunctivitis) respond quickly to antibiotic drops; those that antibiotics won’t help (viral conjunctivitis which may be more common) also go away quickly. Since doctors prescribe drops for almost every red, irritated eye, we find these satisfying to treat.

Bacterial intestinal infections respond to antibiotics but most occur in poor parts of the world. They’re rare in the US where vomiting and diarrhea usually mean a “stomach virus.” Fortunately for everyone, these are generally short-lived, and I carry medicines that help.   

Amazingly, experts debate whether antibiotics help a middle ear infection. Doctors in many nations don’t prescribe them, but Americans do, so patients give us credit when they get better. We like that.

Even more amazing, experts don’t debate whether antibiotics help respiratory infections. All agree that they don’t, mostly. If you’re otherwise healthy and suffer a cough (a cold that hangs on, mucus that turns green, bronchitis), we can cure you – if it’s pneumonia. Otherwise, it’s a virus that lasts a few days to a week or two no matter what we do…. Yes, antibiotics don’t help “bronchitis.” Google it you don’t believe me.

Thursday, November 13, 2014

41 No-Shows


When there was no response after my third knock, I experienced a familiar sinking feeling. Under the category “no show,” my database reveals 41 entries. 

I phoned the room, but there was no answer. At the front desk, the clerks assured me that I had the correct number, and that they had no idea where the guest might be. A security officer opened the room and confirmed that no one was inside.

For mysterious reasons, guests occasionally wait downstairs. I wandered through the lobby and restaurants. With my beard, suit, and black bag, I look exactly like a doctor, and now and then my quarry jumps up and identifies themselves. Not this time.

“When do you plan to arrive?” asked a desk clerk who phoned an hour later, adding that my guest had been waiting in the lobby. When I spoke to the guest, he insisted that he’d “told the hotel” where he could be found. Guests respond badly to a suggestion that they pay for two visits, so I simply went back.

Sunday, November 9, 2014

This Has to Go Into My Blog!


A dispatcher from the agency that handles airline crew mentioned a sore throat, but the guest admitted to an “unprotected sexual contact” two nights earlier. The sore throat appeared soon after, and he was worried. Very worried.

No problem. Unprotected sex with a stranger is a bad idea, but the odds of disaster are low. I settled back to learn what happened, planning to deliver advice which would be mostly reassuring.

He seemed distracted. Asked for details of the contact, he didn’t remember. The phone rang. During the conversation, he pointed out that the caller (apparently his supervisor) had told him to go to a clinic, but someone had arrived who claimed to be a doctor. Could he explain?

That sounded odd. When he hung up, I suggested he call the agency to confirm my identity. He did so and then handed me the phone. The dispatcher apologized and admitted that the guest had been calling since the previous day and seemed disturbed. He hoped I could help.

Confirming my identity did not improve matters. When someone knocked at the door, he told them to go away. Ignoring me, he dialed the hotel phone. Reaching voicemail he explained that he had a clinic appointment but someone had sent a doctor. He needed an explanation. Hanging up, he dialed his cell phone, reaching a friend for a short chat during which he mentioned that there was a stranger in the room.

I suggested that if he wanted to go to a clinic, I could arrange it. Waving this off, he dialed another number. It wasn’t clear who or why he was phoning, but he continued for fifteen minutes. Someone knocked, and he told them to go away. When I expressed a wish to leave, he was standing at the door. For the first time I felt nervous. I repeated my request several times in a soothing voice. He opened the door a crack. I squeezed out, and he slammed it behind me.

In the lobby, I phoned the agency to explain that the guest needed a psychiatric evaluation. Minutes later, as I sat filling out forms, a noisy flotilla of fire trucks, police cars, and paramedic van pulled up.

I followed half a dozen men up to the room. Several crewmates were on the scene, trying to persuade the guest to open the door. They would have succeeded if given time, but the officers wanted to wrap things up.

If I were paranoid, I would not want to hear strange men pounding on my door demanding that I open so they could help me.

They broke in and hauled him off. Acute psychotic breaks rarely last long, and he was back in the room the next day, much better according to the dispatcher. He needed another visit to clear him to fly.    

Wednesday, November 5, 2014

Does Everyone Live Like This?!


The Beverly Garland is a sixteen mile freeway drive. The guest had phoned at 8 a.m. on Wednesday. I avoid distant housecalls during the rush hour; guests rarely object to waiting.

But I had finished breakfast. I had no plans for several hours, and a second housecall would make for a harassing morning. Why not get the visit out of the way?

I checked my traffic app. North on the 405 was not too bad; East on the 101 was solid red. Maybe it would ease by the time I reached it.

Driving north on the 405, and I shared my fellow drivers’ relief that we were not on the immobile southbound side. Half a mile before the connector to the 101, the right lane stopped cold. 

It took another 45 minutes to reach the hotel. I hate being late, but I had warned the guest, giving myself plenty of time. I was bored. I played the radio. I paid close attention to driving, moving at a steady few miles per hour instead of braking and accelerating constantly. Doing that requires allowing the car in front to move ahead some distance. Cars from the adjacent lane occasionally pulled into that space, infuriating the driver behind me. I hoped he wasn’t armed.

Getting stuck in the rush hour was my decision, but millions of people have no choice. They do it ten times a week. How can they live like that?.....

Saturday, November 1, 2014

It's Not an Ear Infection!


When I peered into the guest’s ear, the drum looked normal, so there was no middle-ear infection. When I pulled his earlobe, it hurt but not a great deal. In an external infection (swimmer’s ear), pulling is very painful.

Many adults with ear pain don’t have an infection (children are a different matter). I pressed a finger to his temple in front of the ear and asked him to open his mouth. That hurt badly. He had pain in the temperomandibular (jaw) joint.

The jaw joint is no different from the knee, ankle, or shoulder joint. You can injure it, or it can hurt for no obvious reason. This is common, but I can’t remember the last time someone complained of jaw pain. They tell me it’s an earache.

Flying with a middle-ear infection is a bad idea but no problem with jaw pain, so the diagnosis is good news, but guests are skeptical. Ear pain means an ear infection, and pain medicine lacks the cache of an antibiotic. Guests often make it clear that they’re not getting their money’s worth.

Tuesday, October 28, 2014

Extremely Easy Housecalls

A guest at Howard Johnson’s wanted my services at 3 o’clock on a Sunday afternoon. I had no plans till dinner. Freeway traffic would be no problem. It was a perfect time for a housecall. What a great job….

The desk clerk added that the guest was not in the hotel. He would return at midnight. Could I come then? So I set the alarm that evening and dozed until it went off.
                                                                                    *          *          *          *  
I regularly complain of how far I drive, but sometimes I hit the jackpot. Last week I saw a patient in my own neighborhood, a mile away. He suffered the most common illness I see, a respiratory infection, so I was there and back in half an hour. As I congratulated myself on my good fortune, the phone rang.

“Did the patient pay the deductible?” asked the dispatcher for the insurance service.

“You didn’t mention a deductible.”

“I forgot. There’s a $75 deductible.”

That was annoying. Cheap travel insurance requires a deductible, and guests never remember to pay. When dispatchers forget to tell me to collect it, I insist the carrier pay the full amount. They always agree but never tell the billing department, so it requires several pestering calls after the check arrives. Since this patient wasn’t far, it was easier to get in my car and make a second trip.



Friday, October 24, 2014

"I Need Oxygen!!"


Hearing this, I he know that (a) the guest is short of breath and (b) the guest doesn’t need oxygen – unless everyone in the room is having trouble breathing in which case this is not a medical problem.

If you suffer an illness that produces shortness of breath (asthma, heart failure, obstructive lung disease) breathing oxygen will not help much. Other treatments work better. These problems often require immediate attention and lengthy observation, so making a housecall is a bad idea.

It turns out that anxiety is the leading cause of shortness of breath in a hotel guest. This is never fatal, and I have good success treating it, but making a housecall is risky. Between the time I hang up and arrive at the room, some guests recover and either cancel or leave the room and hide out in the hotel until certain that I have come and gone.

My malpractice lawyer is whispering that I mustn’t suggest that no one needs oxygen. For example, victims of end-stage lung disease (mostly emphysema) often breathe from a bottle which they carry around. If the oxygen runs short, they need more. I tell them so if they phone. Any guest short of breath can phone me.    

Monday, October 20, 2014

Running Out of Medication


A Doubletree guest had run out of insulin. I could have made a housecall, written a prescription, and a pharmacist would have filled it. Instead I explained that insulin doesn’t require a prescription. She should go to the pharmacy and ask for it. The same is true for the morning-after pill, another request that arrives now and then.

An Italian guest at the Four Seasons brought a migraine prescription from her doctor. Pharmacies wouldn’t accept it. Could I come and write an American prescription? I told her to have the pharmacist phone, and I would approve it.

When housecall services (Expressdoc, Medicast, AMPM Doctors) send me to see guests who need a prescription, I write it, collect money, and leave. Those are easy visits, but guests are never grateful. Americans look sullen; foreigners understand that American doctors require immense fees for any service. When guests call directly, I take care of it over the phone, gratis. It’s no great sacrifice and good public relations.

It may even be good business. Long ago, when I returned from a day off, the doctor who covered told me a guest at the Casa Del Mar had phoned. That was exciting news; this was an upscale Santa Monica beach hotel which had never called. The guest obviously had a bladder infection, so the doctor phoned a prescription to a pharmacy. I nodded. Treating an infection over the phone is not a good idea, but simple bladder infections are considered an exception. He added that he had charged the guest $30 for the service. I mention this only because it happened during the 1990s, and I haven’t heard from the Casa del Mar since.

Thursday, October 16, 2014

When Everything Works Out Brilliantly


A call arrived as I was eating dinner at the home of friends. A gentleman at the Biltmore felt that his blood pressure was high. The meal was ending, so I took my leave.

Driving the twelve miles downtown, I parked and opened the trunk to retrieve my black bag. It wasn’t there. Dismayed, I realized I had left it at home.

I keep the bag in my car. My driveway is outside, and during hot weather I take it into the house to keep the heat from melting my pills. Getting a housecall jogs my memory, but I had driven to friends without giving it a thought.

I phoned the guest to explain that I’d have to return home. Before I could apologize, the guest apologized, explaining that he was running out of blood pressure pills and only needed a refill. He knew his travel insurance would not pay for this, so he claimed to feel ill. He wasn’t ill. I wrote him a prescription and went home.

This blog is full of incidents whose entertainment value is based on things going wrong. But sometimes everything works out.

Sunday, October 12, 2014

"Un Momento..."


I was out late one night and prepared for bed after eleven. As I was brushing my teeth, the phone rang for a housecall in Torrance, twenty miles distant.

Traffic was no problem, and Google maps deposited me at the correct address which turned out to be a massive apartment complex behind high walls. Now and then I drove past a gate with no guard and no evidence that it was the correct entrance. I phoned.

The patient’s husband answered. He was Italian and spoke rudimentary English, and his efforts to direct me were incomprehensible.

“Un momento…” There followed several minutes of silence. Just before I decided he had hung up, he came on the line and resumed his unintelligible instructions. Then my headlights illuminated a distant figure in the middle of the deserted street waving a flashlight.

He guided me to a gate, punched the code to open it, and directed me to visitor’s parking. I followed him through a maze of sidewalks to the correct building. After I cared for his wife, he guided me back to my car.

Wednesday, October 8, 2014

Housecalls Are Not Cheap


A lady fell, catching herself on outstretched palms. That often breaks the tip of the radius where it meets the wrist, and she felt pain in that precise area. She needed an X-ray and an office visit.

A man accidentally bent his forefinger far backwards lifting a heavy box. He suffered excruciating pain over the knuckle. I suspected a fracture or torn tendon. He needed the same follow-up.

Both patients lived in Santa Ana, a fifty mile drive. The director of the housecall service who phoned admitted that these were not typical clients, but someone wanted the visits and was paying generously.

The next day, the director informed me that a mobile X-ray van had gone to both apartments. The patients’ employer wanted to know my plans. That’s when I realized that I shouldn’t have made those visits. These patients had been injured at work, and the employer had decided a housecall was the cheapest way to handle them. That was his first mistake. The major advantage of a housecall is convenience; it’s cheap only for trivial problems.

Far worse was his failure to know that job-related injuries must be handled through Workers Compensation, a system most doctors, me included, take care to avoid. It is a bureaucratic nightmare, wildly expensive and corrupt. Your state legislators, Republican and Democrat, know this but keep quiet. Workers Compensation is the state government equivalent of Israel: no elected official in Washington dares criticize Israel.

I told the housecall service that I was out of the picture and that the employer should read the law, and find a doctor who deals with Workers Compensation.    



Saturday, October 4, 2014

Customers Come and Customers Go


American doctors complain about paperwork, but it’s no problem with me. I give guests a copy of the record I write in the room. I fax the same to housecall agencies and foreign travel insurers. American insurers look with deep suspicion on housecalls, so I don’t deal with them, and when foreign carriers feel the urge to adopt American techniques (complex codes, lengthy invoices, deductibles, fee schedules), I stop working for them.

This is less of a sacrifice than you’d think because they switch to a national housecall service, most of whom call me. I earn my usual fee, and the service bills the insurer more, often much more. The logic of this is unclear to me.  

Assistcard, an international insurer that has called for twenty years, stopped recently. When I phoned, a representative explained that Assistcard had made arrangements with other Los Angeles doctors who accepted less than I charged. I expressed congratulations, but this seemed unlikely. I charge less than the going rate, other hotel doctors do not work with travel insurers because they pay slowly, and doctors who agree to make housecalls on the side are not likely to drop everything and go. A week after that exchange, Assistcard resumed calling.

Calls from the Biltmore, once a regular, vanished in 2010. Last May the general manager phoned to announce that I was now the hotel’s doctor. I can’t remember the last time a manager did that. Sure enough, the hotel resumed calling. I’m sure an incident in the hotel convinced her that having me as the house doctor would be a good idea. Sadly, I forgot to ask for details.

Tuesday, September 30, 2014

Bringing the Housecall into the Twenty-First Century, Part 2


My July 2 post concerned Medicast, a service that arrived in Los Angeles with the goal of bringing the housecall into the internet age. Anyone can download the Medicast app. Clicking connects you to a dispatcher who records your credit card information and sends a text message to the doctor on-call who arrives at your “home, office, or hotel” within two hours. You can Google Medicast.

Its fees are less than those of traditional hotel doctors (who don’t advertise) and much less than the entrepreneurial concierge doctors who do.

Always alert to competition, I contacted Medicast whose directors expressed delight at my experience and welcomed me aboard. I attended an orientation where doctors learned to deal with their software. We left carrying an iPad.

Over thirty years, a dozen national housecall services have come to Los Angeles and, mostly, gone. Size is their great obstacle. When I collect a fee, I keep it all. After paying the doctor, a service has other people to pay. Success requires either a high patient volume or high fees.

My maximum volume has been about 2,000 calls per year, and I have never grossed more than $130,000 – a great deal to most of you but peanuts for a doctor. It’s unlikely any organization can match my volume.

One national housecall service has operated since the 1990s. Its site emphasizes the quality of its doctors, and this was certainly true when I was one. It called 26 times between 2000 and 2002 when I stopped working for them. I collected my usual fee. The service charged three times more, but dispatchers often failed to tell guests how much. As a result, when I handed over my invoice they expressed shock. Worse, they blamed me for the fee and did not hesitate to express their displeasure to the hotel. This cause me some difficulty. I'm sorry not to mention its name, but I'm as paranoid about being sued as the average doctor.

Getting back to the present, over the next two months, I received 16 calls from Medicast, the last in mid-July. Last week a director phoned to explain that calls were increasing but not to the extent they expected, so they were adopting a different business plan. Two days later, a courier arrived to reclaim the iPad.

Friday, September 26, 2014

Hotel Visits I Don't Make


I don’t make housecalls for certain symptoms: shortness of breath, chest pain, loss of consciousness, and severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, but possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you’ll sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when he guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind.  

Medical science has no cure for drunkenness, but hope springs eternal, so hotel staff continue to call.

Monday, September 22, 2014

Listomania


I once made sixty to eighty visits per year to the Crowne Plaza at the airport. Now I make about five.

During my last visit I noticed a printed handout on the bedside table containing a long list of clinics and doctors. Given a list, guests tend to call the first number first and then work down. My name was sixth.

When consulted, hotel lawyers always forbid staff from recommending a doctor. Should a guest ask for help, an employee should silently hand over a list, the longer the better. In this way, when the guest sues the doctor, he or she won’t sue the hotel. Lawyers admit that this doesn’t work, but they can’t help themselves. 

Told to make the list, a clerk takes the easy route by consulting the phone book and the internet where she finds clinics, local practices, and entrepreneurial physicians who charge spectacular fees. She won’t find established hotel doctors including me, but I'm well-enough known to be included.

Having produced the list, management forgets about it. As time passes, employees become careless about handing it out, especially since it produces bad feedback. Some numbers no longer work; for others, guests who want to speak to a doctor end up speaking to an answering service or receptionist. Clinics and local doctors don't make housecalls or answer questions. Better to give out a specific number, preferably mine.

It might take years for calls to return to normal, but I am patient. 

Thursday, September 18, 2014

How Can I Break Into Hotel Doctoring?


My first response is always: read my blog. Begun in 2009, it contains everything you need to know about hotel doctoring including how I started.

While it’s entertaining, it might not help. I began in 1983 when there was little competition. I do no marketing except an occasional letter to general managers. I have no web site; this blog, as I chronically complain, has never attracted a customer. I don’t pay hotel employees when they refer a guest (illegal but a long tradition). Yet I do fine. My database, so old it’s a DOS program, contains nearly 18,000 visits. No one will ever match that.

The quickest way to break in is to buy another doctor’s practice. Buying an office practice is bad business because patients drift away, but a doctor selling a hotel practice simply transfers the phone number. As long as the buyer responds to calls, he’ll keep every client because hotels rarely pay close attention to their house doctor.

This is no idle theory because a veteran colleague will soon retire. Another physician has purchased his clientele, a dozen of Los Angeles' and Beverly Hills’ most luxurious hotels. I have heard only good things about the buyer, but he is not an established hotel physician or a friend, so I plan to benefit.

Despite collecting Social Security for ten years, I have no plans to retire, but it’s hard to imagine me working beyond a few more years. I might entertain an offer.

Monday, September 15, 2014

Good News, Usually


A flight attendant with diarrhea is usually good news. Airline crew are young, so they suffer uncomplicated medical problems, and diarrhea qualifies. Her hotel in Costa Mesa was 46 miles away, but it was Saturday morning, so traffic would be light, and I’m paid extra for the distance.

To my annoyance, this was one of those inexplicable weekends when the freeway was jammed although it wasn’t a holiday, and I never saw an accident.

After caring for the guest, always the easiest part, I got back on the freeway and its creeping traffic. Ten minutes later my phone rang. This was bad news because freeway driving is more tiring than practicing medicine, and I had had enough. The caller was a national housecall service, and, to my surprise, the patient was in Costa Mesa, a half mile from where I’d been.

The service agreed to my usual fee for a long drive, so I retraced my route, cared for the guest, and returned to the crowded freeway. I was weary when I finally arrived home, hours past lunch time, but it had been a lucrative day in the fascinating life of a Los Angeles hotel doctor.  

Saturday, September 6, 2014

The Old Man's Friend


A guest was coughing and feverish, and I heard crackling noises, a sign of fluid, when I listened to his lungs. I suspected pneumonia.

I prefer diagnosing pneumonia to an upper respiratory infection because I can prescribe an antibiotic and skip the stressful explanation of why I’m not prescribing an antibiotic.

Unfortunately, this guest was 85. Most victims of pneumonia don’t need to be hospitalized. Even without treatment, most recover. This is not the case with the elderly where, long ago, pneumonia was known as “the old man’s friend.” Dying of pneumonia when you’re already feeble is apparently not a bad way to go.

The son did not like hearing that his father must go to an emergency room, but they went. When I phoned the following morning, I learned that the diagnosis was pneumonia. The doctor had prescribed an antibiotic and sent them out.

I was shocked. Hospitals always admitted elderly patients with pneumonia. What incompetent was on duty?...  Answering my concerns, the son assured me that his father was resting comfortably and promised to return to the hospital if symptoms worsened. When I called that evening and the following day, he repeated his assurances that his father was resting comfortably. That afternoon they had checked out.

If something bad happens, he will sue the hospital, but he will also sue me. It takes a long time for a malpractice lawyer to organize a suit, so his letter wouldn’t arrive for about a year.

Tuesday, September 2, 2014

Preparing to Leave Town


I’ll take a vacation soon. When I leave, I call-forward my phone to a colleague. He’s covered for twenty years and does a fine job, but I have to prepare the ground.

I warn Virginia Mastey. When Frenchmen, tourists or residents, want a housecall in Los Angeles they call her, and she calls me. I have no idea how she built this business; it’s only a sideline, and she charges less than the going rate. The visits are easy, but no other hotel doctor will work for so little.

I warn Inn-House Doctor, a national housecall service that also cares for foreign airline crew laying over in Southern California. You might assume that airlines flying into Los Angeles board crew overnight at nearby hotels, but they often bus them twenty to fifty miles away to Long Beach or Orange County. I live eight miles in the opposite direction from the airport, but Inn-House pays generously for long drives, so I go. Sadly, my colleague lives fifteen miles even further, so Inn-House must make other arrangements.

I remind my colleague that if two international travel services (I won’t name them), call, he should not refuse them. I will mail him a check on my return and handle billing myself. These services take months to pay and require repeated, pestering phone calls. Other hotel doctors won’t work for them.

Friday, August 29, 2014

Another Glamorous Film Shoot


“We’re at 501 West Olympic,” explained my caller. “Come up to the seventeenth floor.”

That’s downtown, my least favorite neighborhood for street parking. I might find a spot within three or four blocks, but it was hot, and I wear a suit. No problem, said the caller, directing me to crew parking a mile away.

I pulled into a lot jammed with mobile dressing rooms, equipment, cars, and a line of vans. An attractive young woman led me to the leading van which chauffeured me through downtown traffic and pulled into another line of vans to let me off. After phoning a contact number, I waited for another young attractive woman (all assistants at film shoots are attractive young women) to conduct me to an elevator which let me out into a crowded corridor.

It takes a small army to shoot a film. Dozens of people under thirty rushed about. They were probably crew. Lounging about and getting in the way, another dozen, mostly over thirty, were probably actors. A person in charge saw that I looked like a doctor and summoned the patient.

It was fortunate he wasn’t suffering hemorrhoids or jock itch because there was no privacy. We huddled in a corner and discussed his eye irritation. Afterward, the person in charge asked if I’d see someone who’d injured his neck in a fight scene. Leaving the building, I boarded the first of the line of vans and returned to the parking lot.  

Monday, August 25, 2014

Whether You Want Me or Not


If you want a housecall in Los Angeles, you’re likely to get me even if you don’t ask for me. 


I don’t have a web site, but searching the internet turns up several agencies and a few individuals that promise to send you a doctor at a moment’s notice. Many rely on me.


They also solicit hotels. Last week, the answering service for a national housecall agency informed me that a guest at the Marina International wanted a doctor. The Marina International is one of my regulars.


After I spoke to the guest, he asked me to come. I made a mental calculation before quoting the fee. The housecall agency keeps forty percent, so it was larger than usual. 


Since guests who call directly pay less, you might wonder why hotels don’t make sure they get the best price. The answer, of course, is that hotel management doesn’t know what doctors charge, nor do they care. Guests occasionally ask, but hotels never do.