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Wednesday, June 4, 2014

Should I Make a Housecall?


Only half my callers require one.

As I often mention, I’m happy to phone a pharmacy when guests forget legitimate medication: blood pressure pills, heart pills, contraceptives, etc. I don’t do this for guests who tell me “I had the same thing last year, and my doctor prescribed……” 

Exceptions exist. If a caller has had gout I believe him. It’s acceptable to treat a young woman with a typical bladder infection over the phone. If you’re wondering about symptoms of a “typical” bladder infection, I’m not telling. You have to tell me. Most “my doctor prescribes...” calls concern upper respiratory infections where the guest has received the traditional useless antibiotic and believes he needs another.

Guests with stuffy ears don’t object to a housecall, but ordinary congestion causes bilateral ear discomfort without pain. Over the phone, I explain the aggressive use of nasal spray before takeoff and before the plane descends.

Injuries can be tricky. A doctor’s exam rarely diagnoses a fracture, but most common injuries are not urgent, even when a fracture is present. If guests are willing to wait until business hours, I can send them to an orthopedist’s office, more civilized than an emergency room. For back pain, a housecall is better. If you go where there’s an x-ray, you’ll get one, and experts agree that back x-rays are almost never helpful.

Much of my decision on making a housecall depends on the law of averages. Chest pain in a fifty year-old is usually not serious, but it’s unwise to assume this. It’s less unwise in a twenty year-old. A sore throat in a ten year-old might be strep which medical science can cure, but strep is mostly a disease of children and adolescents. After fifty it’s almost unheard of. The law of averages is a big help in bronchitis for which doctors often prescribe antibiotics. You’ll want to know what percent of bronchitis requires an antibiotic. It’s zero.

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