Monday, July 28, 2014

The No-Housecall Mode

Half a dozen times per year, a hotel guest suffers a bloody nose. I don’t make housecalls for nosebleeds because there’s nothing I can do. Treatment is to pinch the nose, releasing pressure every five minutes to check if bleeding has stopped. I tell guests to repeat until they get bored. If bleeding persists, the next step is cautery or nasal packing, both of which require expertise.

I regularly hear “I can move it, so I know it’s not broken…” but this is as true as most popular medical theories.  Examining a wrist, finger, ankle, foot, or ribs I can suspect a fracture, but I’m never certain. Most common fractures aren’t urgent, so I often tell guests it’s OK to wait to see if there’s quick improvement. If not, they need an X-ray.

All insect bites look the same, bee stings included. Redness and itching spread, peaking at two days before slowly fading. I explain this over the phone, but guests often want me to take a look.

When a guest suggests he has bronchitis, I immediately go into no-housecall mode because this is a fake diagnosis doctors use when they prescribe an antibiotic as a placebo (other fake diagnoses are “sinus infection” and “strep”). You may be surprised to read that bronchitis is not a disease but a fancy medical term for coughing. 

Not every guest who mentions bronchitis is demanding an antibiotic, but all are seeing me for the first time. They’ve seen their family doctor many times, and if he or she routinely prescribes antibiotics (so common even good doctors do it), my failure to do so requires an explanation. Most guests accept it, but a minority do not conceal their disappointment, and a tiny minority are upset.

I hate it when I do the right thing and patients are unhappy, so I refer these guests to a walk-in clinic where the doctor will probably prescribe an antibiotic for their bronchitis. 

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