Monday, March 24, 2014

The Most Difficult Calls

I stopped chopping an onion yesterday when the phone rang. A young man at the Airport Hilton had been vomiting all day.This was a difficult call.

For a hotel doctor, a difficult call refers not to an illness but to traffic conditions. It was four o’clock, so I would drive eight miles both ways during the freeway rush hour, returning hungry and with no dinner prepared. I delay some visits but not for acutely miserable symptoms, vomiting most often.

Before I left, the phone rang again. I yearned to hear that it was another airport hotel, but the guest was downtown, fifteen miles in the opposite direction. Worse, she had a migraine, so I couldn’t delay.

Delivering medical care is sometimes challenging. Always challenging and the mark of a seasoned hotel doctor is the ability to remain serene in gridlock.

Certain rules apply. Unless lanes are blocked, leaving the freeway for city streets is a bad idea.

Another rule is that blocking a lane at any hour stops traffic cold. Steady movement, however slow, is simply a sign of congestion.

“I wonder if there’s an accident,” I thought a dozen times after several minutes of immobility, but I never saw one. So much for rules.

Two housecalls which normally take two hours took four and a half, but I maintained my serenity, sucking on the hard candy I keep handy to dull my hunger and listening to a novel on my CD.

Returning home, I made a meal of dried fruit and nuts which I also keep handy for evenings with no supper.

Thursday, March 20, 2014

"Wow!... Hotel Doctors Charge That Much?!"

Guests don’t say that. Mostly I hear: “Do you mind if I call you back…..?”

Unlike the competition, I don’t confine myself to upscale hotels. Plenty of Holiday Inns, Ramadas, and motels call, and I quote fees less than the going rate. Colleagues point this out but admit that it’s not a competitive advantage because hotels don’t care what the doctor charges. Still, counting driving time, a hotel visit takes at least an hour, so it’s not cheap.

Helpless in a strange country and forewarned that medical care in America requires vast sums, foreign guests are easier to deal with.

American medical insurance takes a dim view of housecalls. No hotel doctor accepts it, so Americans, already disoriented at finding a doctor willing to make a housecall, learn that they must pay out of their pocket. It’s a shock.

I like to present myself as a humanitarian in this blog, and I often reduce my fee if the guest feels too miserable to leave the room, but mostly, when Americans object, I send them to an urgent care clinic.

Walking through the clinic door costs around $100. While this is much less than a housecall, clinics charge extra for tests, procedures, shots, and supplies, and the patient must find a pharmacy to fill a prescription. Telling all this to guests sounds too much like a sales pitch, so I prefer to send them to a clinic. Insurance might pay part of the bill.

Sunday, March 16, 2014

Another Disappointment

A Loews guest was suffering flu symptoms, but mostly he worried about feeling feverish. I explained that fever is not an ominous symptom. If he wanted to check, he could buy a thermometer. Or I could come to his room. He opted for the visit. I told him how much it would cost.

“Oh… I thought it was free,” he said.

I’ve heard this before. Your doctor doesn’t answer when you dial, but I do. Na├»ve guests think I’m a hotel service, sitting downstairs awaiting their call.

He was from Chile. Did he buy travel health insurance before coming to the US, I asked. He did. I explained that travel insurance pays for housecalls, and most insurance agencies call me. However, he must phone the insurance first to obtain approval. He promised to do so.  

Half an hour later my phone rang. It wasn’t Loews but the Doubletree. An elderly man had undergone electrical cardioversion for atrial fibrillation – an irregular heartbeat – a month earlier, and he was worried. His heart didn’t feel right, and its beats seemed fast; he counted 80 per minute. Atrial fibrillation often recurs after cardioversion, but his beat was regular, so that hadn’t happened. 80 beats per minute is not particularly fast. I assured him that he wasn’t describing anything dangerous. He repeated that he was worried and wanted me to check him.

These are the best visits. A guest is worried, and I’m already convinced that there’s nothing to worry about. Sure enough, the exam was normal. He was delighted at the news, and I was delighted to deliver it. Everyone was happy.

I was even more delighted to drive to the Doubletree because it’s only a few blocks from Loews. At any minute, I expected a call from the Loews guest’s insurance agency for another easy visit. But it never came.

Wednesday, March 12, 2014

Siri Would Catch That

Could I visit a Quantas crew member at the Marriott in Costa Mesa, asked the answering service at one a.m. Costa Mesa is fifty miles away, but the local doctor had just been there and didn’t want to go back.

I don’t work for nothing or keep office hours, so I have no objection to long drives during the wee hours. Unfortunately, the San Diego freeway, the major route to Orange County, closes at 11 p.m. for major construction at the San Gabriel interchange. You might think that this requires a modest detour, but closing the San Diego freeway, even at 2 a.m., produces an immense backup as it contracts to one lane leading to the exit. That’s followed by a long, slow drive through city streets.

Several aggravating experiences have persuaded me to take an alternate route through downtown and the Santa Ana freeway, a bumpy truck route and ten miles longer. After driving fifteen miles, I was dismayed to discover that the Santa Ana Freeway was also temporarily closed, a fact not revealed on my computer's Google Maps.

I followed the orange cones onto Washington Boulevard, a major street that intercepts the freeway further on. It was a deserted industrial area with little traffic, but I grew increasingly uneasy as the miles flew by with no freeway in sight. Pulling over, I consulted my ancient Thomas guide which revealed that I had turned the wrong way on Washington Boulevard and driven five miles back toward downtown.

“Siri would have caught that,” my wife pointed out later. Siri, of course, is Apple’s computer voice that recites your route on the I-phone GPS. She has proved valuable on vacations despite the occasional glitch. If you wander off course, Siri immediately recalculates it and tells you how to get back.

Thirty years of making housecalls has convinced me that I know everything about driving Los Angeles streets, a confidence not shaken by the rare occasion when I get lost. There’s an I-phone in my future.

Saturday, March 8, 2014

My Career as a Diet Doctor

Long before taking up hotel doctoring, I answered an ad from a practice that offered “weight control.” Dedicated diet doctors make so much money they don’t need to advertise for help. My employer was a regular G.P. experimenting with weight control as a sideline.

Every era has a weight loss miracle. During the 1970s it was human chorionic gonadotropin, HCG, a respectable hormone involved in reproduction. During that decade it acquired a reputation as a fat-burner. There were the usual flurry of bestsellers and HCG clinics, and then it went the way of disco.

My doctor merely made it known that he offered HCG. I doubt diet patients made up ten percent of the practice, but they provided an impressive cash flow. The women (only a rare male) came in weekly for a shot, a diet sheet, and a pep talk from the nurse. The doctor saw them monthly, but they paid the regular fee for every visit. He never claimed (to me) that HCG worked, only that patients believed in it, so it inspired them to stick to the diet.

But it didn’t inspire them. Any motivated patient who starts a diet, legitimate or silly, will lose ten or twenty pounds before the gnawing of hunger becomes tiresome. Losing more is much harder. This was no news to the HCG patients, but they were not paying good money to hear it. Their stubbornness amazed me. They signed up with the usual enthusiasm, came in for their shots, followed the diet, and lost their ten or twenty pounds. Then they stopped losing, but most continued to come in, month after month, taking the weekly shot and paying the fee.

Despite the universal opinion among thin people that dieters fail because they cheat, most of these women were trying hard. Alas, they were butting up against the ten-twenty pound limit. Losing more requires a tighter diet, self-denial, and regular exercise, a nearly impossible feat. The statistics doctors know (but you may not because popular magazines print only cheerful news about dieting) reveal how many fat people become thin and stay thin: a few percent.

Dropping that initial weight turns out to be a major advantage. Ninety percent of dieting’s health benefits (reduced risk of diabetes, lower cholesterol, less heart disease) are achieved by a ten percent weight loss. Alas, few patients thrilled to that knowledge because better health was not their goal. Many asked if the shot worked. At first, loyal to my employer, I admitted that opinion was divided. Eventually my answers grew blunt. This never offended the patients who were already suspicious. Many did not even drop out, but the news got back to my boss.

Tuesday, March 4, 2014

A Disorder I've Never Seen

“I’ve been trying to pick up stuff, and I can’t,” said a Ramada guest. “It started a half hour ago.”

“You mean your arm is weak?” I asked.

“No. Once I grab it, it’s OK.”

“Is it numb?”

“It feels fine. But when I reach out for something, I miss it. It’s weird.”

The guest was elderly but in good health. I suspected I knew the problem.

“Take your forefinger and touch your nose,” I suggested. “Can you do it?”

“No,” he said. “I keep hitting my face.”

This was something I’d never encountered but luckily I remembered my medical school neurology. This lady had suffered a cutoff of blood to her cerebellum, a structure at the base of the brain that controls coordination.

When you reach out, the brain instructs muscles to move your arm in the general direction of your goal. That’s the best it can do. The last few inches don’t require strength or mobility but fine, precise movements. That’s where the cerebellum takes over.

With the cerebellum out of action, you’d have normal consciousness, strength, and sensation but no coordination. You could walk but only slowly with a clumsy, wide-based gait. If you reached for something, your hand would wobble wildly as it approached. The classic test is to ask a patient to put a finger on her nose. Without a cerebellum, it’s almost impossible.

It could have been a temporary loss of blood supply, a “transient ischemic attack” (TIA) or a permanent loss, a stroke. Waiting to see which would be unwise, so I urged her to go to a hospital where she was admitted.

Saturday, March 1, 2014

A Dog-Eat-Dog Business, Part 5

I was attending a guest at L’Orleans when there was a knock. The guest was not dressed, so I opened the door to find myself eye-to-eye with another doctor. I recognized him as one of several young, entrepreneurial physicians eager to serve hotels, including mine.

Hotels occasionally summon a second doctor when the first is slow arriving. I arrive promptly so the sight of this doctor meant that L’Orleans had called him first, unsettling news.

“Looks like a communications slip-up,” he said cheerfully. “It’s nobody’s fault,” he added. “But it’s only fair, since we both made the trip, that we split the fee.”

I closed the door in his face and went back to work. When I returned to the lobby, the concierge apologized for the mix up, blaming the impatient guest.

She handed me an envelope. A few luxury hotels prefer paying me and adding it to the guest’s bill. When I counted the money later, I saw it was too little. She had given half to the other doctor. If she hadn’t, I realized, she wouldn’t have received her referral fee.