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.
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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.