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Monday, December 28, 2015

A Hotel Doctor's Christmas


A travel insurer reported a sick child at the Anaheim Holiday Inn, near Disneyland forty miles away. Freeway traffic was tolerable, but when I arrived and knocked no one answered. 

I walked around the lobby. With my suit, beard, and black bag, I look like a doctor in an old Hollywood movie, but no one responded. A waitress in the hotel restaurant asked at everyone’s table, but no one admitted calling a doctor. I drove away in a good mood. When hotel guests call and then disappear, I’m out of luck, but travel insurers pay for no-show visits.

I was a mile from home when the insurer called. The mother was on the line, claiming she had been waiting in the lobby. I was stiff from two hours of driving, tired, and hungry, but if I were sick, I’d consider that a poor excuse for a doctor to refuse to see me. So I drove back to Anaheim. To my everlasting credit, I was entirely pleasant to the mother, waving off her excuses. The child had a cold.

Thursday, December 24, 2015

Christmas Season


In the Pasadena Sheraton last Sunday, my phone rang for a visit in Irvine. Pasadena is twenty miles from home, Irvine fifty miles. I would miss supper by several hours, but the month before Christmas is slow, so I was pleased at another visit.

I often drive to Irvine but not from Pasadena, so I consulted Siri from my I-Phone. She directed me toward the nearest freeway but told me to turn off as I reached it. That didn’t seem right, but disobeying Siri is usually a bad idea. A drive through city streets to the Long Beach Freeway saved several miles but probably not much time.

I settled down for the trip before realizing with a shock that she was directing me toward the Santa Ana freeway. No one takes the Santa Ana freeway. It’s always jammed. Sure enough, as soon as I drove on, traffic slowed to a crawl.

I arrived after 1½ hours to face another irritation. The address, 2120 Waterbury, wasn’t a street address but suite 2120 at the Waterbury Apartments. Siri found the complex but getting to 2120 among the buildings was my job.

It was night. The guest was a traveler and unfamiliar with the area. There was no parking except in locked underground garages, so I couldn’t wander far from my car. Also (and I’m not making this up) it was raining. In the end, she came out and searched the streets until we encountered each other. The visit, as usual, was the easy part.

Leaving, I drove to the San Diego freeway, the sensible, if not the shortest, route from my house to Irvine. To my dismay, traffic was crawling. Weekends are usually OK, but I should have remembered that this was the Sunday before Christmas.

Sunday, December 20, 2015

Another Easy Visit


I drove to Glendale to care for an elderly Argentine lady who had been vomiting. That can be a tricky problem in an old person, but she was recovering, so I felt comfortable leaving her with advice and medication.

During the visit, I had the experience of listening to someone with a thick Spanish accent denounce Mexicans. She had eaten in a Mexican restaurant and was certain the spicy food made her ill. Argentina is a country with extensive cattle ranches and a largely steak and potatoes diet. 

Wednesday, December 16, 2015

Another Failure of Communication



“My son with pain in ear. Maybe he need a doctor.”

“I can come to the hotel.”

“Not today. I give medicine. Maybe if he has pain tomorrow.”

“So you’ll call me tomorrow?”

“Yes. Can you come in the morning?”

“Yes.”

“When.”

“I can be there between 9 and 12.”  Strictly speaking, I can come at any time, but I like to avoid driving during the rush hour.

“Three hours is too long. We want to visit the city.”

“You said you’d call tomorrow. When you call, I’ll tell you exactly when I’ll be there.”

“OK.”

Most guests who promise to call never call, so I put the matter out of my mind. After noon the following day, the phone rang. It was the concierge at that hotel. “I’m afraid we’ve had a complaint, Doctor Oppenheim,” she said. “Mr. Desai in 403 says he and his family have been waiting over three hours. Are you going to come?....”

Saturday, December 12, 2015

No American Would Have Such Good Insurance


Hearing a Hispanic accent, I assumed the caller was a travel insurer, and I was right. Standby M.D is one of the good agencies. It phones; I make the visit; I fax an invoice; it sends a check. Latin Americans make up most of my travel insurance patients.

A guest at the Sheraton had been awake all night with an earache. The call arrived at 4:30 a.m., but that’s almost my waking time. Freeway traffic was light. I arrived at his room in half an hour.

One thing seemed strange. His name sounded American, but this is not rare in many Latin American countries. But he also looked American and spoke American English. He told me his pain began soon after he boarded a plane in Managua.

“So you live in Nicaragua?” I asked.

“No. Vancouver,” he said.

The light dawned.

“Of course,” I added. “You’re Canadian. No American would have such good insurance.”   

Tuesday, December 8, 2015

More Evidence of America's Greatness


Opening an envelope from an international travel insurer, I expected a check but found a form letter containing a dozen boxes, each listing a reason why payment was denied. An “X” through one box revealed that I had not submitted my invoice on an HICF 1500 claims form.

That’s the form American doctors send to American health insurers. It’s hopelessly complex, full of codes, questions, boxes, and charges – far longer than my simple invoice. Despite this, it’s badly organized. One must enter today’s date three times.

I found a HICF form and filled it out, leaving many cryptic questions blank, guessing answers where I wasn’t certain, and inventing a long, fictional breakdown of my services because I charge a flat fee. An American insurance clerk would post it on the office bulletin board for general amusement.

Two weeks later, a check arrived. Foreign insurers are not up to speed, but they’re trying.

Friday, December 4, 2015

How to Get the Best of Both Worlds


A lady with a cold phoned for a doctor at 4 p.m. on a Tuesday.

From my home to hers in the Hollywood Hills required a thirteen mile drive through city streets (twice that on the freeway). I go during the rush hour but only for patients a good deal sicker. In her case, I would schedule a visit for 9 or 10 p.m.

Sadly, the lady hadn’t called me but Get Heal, a new service that promises a housecall within an hour and charges a flat $99.

It pays doctors $75 an hour, lower than the going rate, but provides a medical assistant who drives, a delightful perk. Unfortunately, the dispatcher explained, the medical assistant lived near my destination. Would I make the drive myself? Heal would pay extra. If not, Heal would send a cab.

I chose a cab. Fifteen minutes later an Uber car pulled up. We crept through traffic. The medical assistant was there when we arrived. I cared for the patient. We crept back.

Heal earned $99 for my two hours’ work, but I earned $150. The Uber driver earned half that. The driver, dispatcher, and a dozen other employees collected their salaries. Get Heal has an office in Santa Monica and an impressive web site.

Everyone agrees that $99 for a housecall is a money-loser. Perhaps this patient was an outlier, but none of the eight Heal housecalls I’ve made has taken less than an hour door-to-door.

If you need a housecall in Los Angeles, phone Get Heal and ask for Doctor Oppenheim. You’ll get the best of both worlds until one of us goes out of business.

Monday, November 30, 2015

Discovering a Normal Part of your Body


A young woman at the Georgian Hotel felt a cold coming on, so she inspected her throat and discovered a dozen bumps on the far end of her tongue. I reassured her, but she wanted a doctor to see them.

I love housecalls where I know the diagnosis as soon as I hang up the phone. This qualified because the guest had discovered a normal part of her body. When you examine your tongue in the mirror, it seems smooth. People rarely stick it out far enough to reveal a clump of wart-like taste buds deep inside.

I also love telling a fearful patient that he or she has nothing to worry about, so this was a satisfying encounter for both of us.

It may save you some anxiety to memorize the following normal parts of your body.

- Put a finger inside your mouth and feel the gums behind your lower teeth. Moving just to the left and right reveals two hard lumps which may not be the same size. These are part of your mandible, the jawbone.

- With thumb and forefinger, pinch your neck just below the jaw to feel two lumps that mark either end of the hyoid bone that circles the front of your windpipe. You can wiggle them from side to side.

- Run your finger down the middle of your breastbone to an inch beyond the lower end, then push. You’ll feel a hard mass. That’s another bone, the xyphoid process. One guest was certain had a stomach tumor.

- Feel your major lymph node areas (neck, armpit, groin), and remember what you find. Part of the immune system, lymph nodes swell in response to an infection then shrink after it passes - except sometimes a node or two won’t shrink but remains forever as a pea-sized, moveable granule beneath the skin.

Thursday, November 26, 2015

Ultimatums are Risky


Could I see a gentleman at the Omni with an upset stomach?

The dispatcher for International Assistance was delighted to learn that I could. In most cities, dispatchers work hard to find a doctor willing to make a housecall but not in Los Angeles.

I copied the guest’s name, age, room, and insurance I.D. I quoted a fee. That was acceptable. I said I would arrive within an hour. He was pleased to hear that. Then I dropped the bomb. I needed a credit card number.

I could hear the air go out of his balloon.

“We always send a guarantee of payment.”

“And I always receive one. But you don’t pay.”

Some travel insurers pay promptly. Others require repeated phone calls. Pestering the billing department relentlessly usually works, but sometimes I run out of patience, and many visits for International Assistance remained unpaid after six month.

“I’m not sure we have a credit card.”

“Yes, you do. Ask your supervisor.”

All travel insurers have company credit cards but they vary greatly in their willingness to give them out. Some do it routinely. Others require an ultimatum. I hated dealing with Universal Assistance until they coughed up a credit card number. Now I love it when they phone.

But ultimatums are risky. The dispatcher agreed to consult his supervisor and call me back, but I never heard from him.

Sunday, November 22, 2015

A Rash During the Rush Hour


A guest in Long Beach had red spots.

This looked like a terrific visit; skin problems are usually easy. A sudden rash is frightening but almost never indicates something serious. I have no objection to making a diagnosis over the phone, but guests are terrible at describing a rash’s appearance. In any case, they want the doctor to look at it.

My only problem was that the call arrived at 5 p.m. on a Friday, and Long Beach is thirty miles away. I avoid long freeway drives during the rush hour, so I told him I could come around 9.

That wouldn’t work, he replied. He had a business engagement that evening. But he’d be happy to see me the following morning.

Saturday morning drives are easy, but a rash that arrives quickly may depart quickly. I wanted this visit, so I told him I would leave immediately and be there in an hour. Or two. 

Wednesday, November 18, 2015

Hitting the Jackpot


A call arrived during breakfast. Half an hour later the phone rang again. I was pleased because it was an ideal time for multiple housecalls.

I exercise regularly, always before noon because later the gym becomes crowded. Two morning housecalls makes arriving before noon impossible. This doesn’t happen often, so I reward myself by skipping the gym without feeling the usual guilt. Keeping fit is healthy, but an hour of exercise is as exciting as an hour brushing your teeth, and I’m suspicious of anyone who claims to enjoy it.

Where was the second patient? I routinely drive twenty miles between visits so I awaited the location with anticipation. He was at the same hotel, a rare treat!

A downside was that both seemed to be suffering my least favorite illness: a viral respiratory infection. You’ve heard plenty about my reluctance to give antibiotics when they won’t help.

My good luck held. The first guest had a cough and high fever, probably pneumonia because listening to her lungs revealed abnormal noises. In an otherwise healthy person, pneumonia is the only common chest infection that medical science can cure. So I cured her.

On another floor, I examined a middle-aged man who explained that he had bronchiectasis. This is an uncommon condition in which a small area of the lung becomes obstructed and suffers frequent infections. This was another, so I gave him antibiotics in good conscience.

These were satisfying encounters, but there was a downside. Because both patients were at the same hotel, I finished before 11 o’clock, too early to skip my workout without guilt.

Saturday, November 14, 2015

Broken Glasses


An elderly lady smiled and gestured me to come in. As I followed, she remained silent, a sign that she spoke no English. If someone doesn’t know “hello” comprehension is generally poor. 

“Portuguese.” she said.  “Speak Spanish?”

When I shook my head, she took up her cell phone. The first number didn’t answer. The second, after a short conversation in Portuguese, proved unfruitful. She continued dialing. She was Brazilian, and most South American travelers have travel insurance. If I phone the insurance agency’s 800 number, someone will interpret. Unfortunately, my call hadn’t come from a travel insurer but a national housecall service, Expressdoc. When Expressdoc needs a housecall in Los Angeles, it calls me.

I could phone Expressdoc and ask for the agency’s number, but that makes them uncomfortable. I sympathize; housecalls is a viciously competitive business.

The lady finally found a multilingual friend, and we proceeded with the consultation, passing the phone back and forth. As usual, delivering medical care was the easiest part of the housecall. She had broken her glasses. She complained of a headache, but I suspected she wanted a doctor’s note so insurance would pay for a replacement.

Tuesday, November 10, 2015

A Prominent Scam


A guest at the Luxe explained that he was in town for six weeks and needed a disabled parking pass. He had the Department of Motor Vehicles form. All he needed was a signature.

I offered to come to the hotel, but – even at half my usual fee – he didn’t want to pay. I could have politely withdrawn, but he might then ask the hotel to recommend another doctor, never a good idea. As I do when it’s an easy service, I told him I would sign the form gratis if he came to my house.

After hanging up, I felt uneasy. Eleven percent of Los Angeles drivers have a disabled parking pass; it’s clearly a scam, and I didn’t want to add to it. What if I had to refuse him? When guests complain after I refuse narcotics, hotel management takes this with a grain of salt, but a parking pass….

You can imagine my relief when I answered his knock and saw that he had only one leg.  

Friday, November 6, 2015

What Antibiotics Do To Your Body


When I started out in the 1980s, pharmaceutical companies sold pills labeled “placebo.” They don’t do that today, so a doctor who wants to prescribe one uses a real drug.

Today’s most popular placebos have names like amoxicillin and Z-pak (azithromycin). These help many conditions but not the respiratory infections for which most are prescribed.

Swallowing any antibiotic kills trillions of germs inside your body. If it’s a placebo, those germs are not causing your problem. Other germs immediately move in. Of course, those are germs that can grow in the presence of that antibiotic. If, in the future, they decide to make trouble, another course of that antibiotic might not discourage them. Do you want that?

Experts have been denouncing placebo antibiotics for decades, but their arguments are feeble. They warn about side-effects and allergies, but these are rare. Most antibiotics, useful or not, are safe over the short term.  
  
The long-term consequences are catastrophic. Soaking the environment with unnecessary antibiotics is giving rise to extraordinarily resistant bacteria. Even today about 40,000 Americans die of infections no antibiotic can treat, and this increases every year.

But who cares? It’s a fact that people with a short-term problem don’t take the long view. That might include your doctor.

Monday, November 2, 2015

Another Free Service


Her child’s nose was bleeding, explained the mother. Could I come?

I was tempted. Once in the hotel room, I would ask questions. I would take out my otoscope and peer up the child’s nose. In the end I would reassure the mother and tell her to pinch the nose and wait. The bleeding would probably stop. Persistent nosebleeds are rare and require expert attention. Then I would collect my fee and leave. 

Over the phone, the mother revealed that the child was in good health and suffering a cold.  Respiratory infections occasionally produce a nosebleed. I reassured the mother and told her to pinch the nose and wait. When I phoned later, the bleeding had stopped. 

Thursday, October 29, 2015

The Year of Viagra


FDAs in Europe and Japan approve new drugs after deciding that the benefits outweigh the risks. Aware that any bad side-effect produces an avalanche of lawsuits, America’s FDA takes far more care. No matter how many lives a new drug will save, it wants the risk to be zero. This is hard and usually impossible, so our FDA takes a long time to make up its mind.

As a result, other nations often have access to new treatments years before America. We complain all the time, but no one expects the FDA to change.

There was a delightful exception:  Viagra, discovered in Britain but first released in the US. It’s my impression that no foreign businessman in 1998 considered his US trip a success unless he returned home with a bottle. My records show forty hotel guests who summoned me with this in mind.

I loved visiting guests who aren’t sick. While I have no objection to filling certain prescriptions over the phone, Viagra is a powerful drug with serious side-effects. Experts advise us to examine and educate everyone who wants it.

No one objected to paying for a visit, so I came and asked about the guest’s medical history, performed an exam, and delivered my Viagra guidance. It doesn’t enlarge the penis; it’s not an aphrodisiac, it won’t prolong intercourse or delay ejaculation. It only encourages an erection.

No one failed my exam. One gentleman from Indonesia asked for 5,000 tablets. Suspecting these were for resale, I worried about the legality, but this was no problem insisted the happy pharmacist who called me to confirm.  

Sunday, October 25, 2015

The End is in Sight


I keep an eye on Craigslist and the internet for new competitors on the housecall scene, and they turn up regularly. Other hotel doctors gnash their teeth, but I send off my C.V.

Being experienced and available 24 hours a day is an appealing quality, so they often respond. Working for competitors is sometimes painful if they send me to one of my hotels. There’s little I can do because I can’t match their marketing techniques (my lawyer warns me not to be more specific).

Mostly I take for granted that this younger, aggressive, social-media savvy, ethically challenged generation will drive us older hotel doctors out of business. Luckily, I’m already collecting from my retirement savings and social security, so I work because I enjoy it.

Wednesday, October 21, 2015

Tricky Problems


It upsets me to collect a fee and then send a patient to a clinic or emergency room for care I can’t provide in a housecall. I try to anticipate these.

Many guests phone after a painful accident, hoping I can tell them it’s not a fracture. Sadly, unless it’s visible to the naked eye, I can’t. It turns out that medical science does little for broken toes, ribs, or noses, and most common fractures (arms, wrist, hand, finger, foot, ankle) are not emergencies. If a guest is willing to wait till office hours, I can make them an appointment with an orthopedist.

Upset stomachs make up the second most common ailment I hear about. These usually don’t last long, and I carry medicines that help. Stoics often prefer to wait. This is not unreasonable, but the longer symptoms – usually vomiting – last, the less likely that medicine will help. After about a day of vomiting this becomes so unlikely that I send the guest to where they can receive IV fluids.

Abdominal pain is usually benign in a young person but less so as the years pass. It’s tricky. Entire books have been written on it. I recommend Early Diagnosis of the Acute Abdomen by Zachary Cope, a British surgeon. He wrote it in 1921, revised it every few years till he died in 1971, and it’s still being revised. You can download it free; I suggest trying for the oldest edition. He’s a droll and witty writer, easy for laymen to understand.

Saturday, October 17, 2015

When the Doctor Needs Your Help


Everyone agrees that doctors have no magical powers…. except… maybe… if you really need them…..

What if you’re scheduled to deliver an important speech or attend a wedding or visit Disneyland, and you absolutely can’t be sick? In that urgent situation, wouldn't smart doctor think deeply and come up with a cure?

Doctors love to help you, but they also want you to feel helped. If we do our best, but you’re unhappy, that hurts more than you know.

So if you want the doctor to prescribe a placebo make it absolutely clear that you will be disappointed unless you get “something.”

This happens so often that many doctors assume every patient yearns for magic. That’s why, for example, giving useless antibiotics for respiratory infections is not a sign of incompetence. Even good doctors do it.

Really, I don’t hold anything back for especially deserving patients. It sounds odd, but if you don’t want a placebo, let the doctor know. Say something like “I just want to know what’s going on. If an antibiotic won’t help, that’s fine with me.”

That sounds like you’re telling the doctor how to do his job, but many need your help.

Tuesday, October 13, 2015

Not Again!!


I was minding my own business on a plane returning to Los Angeles last week when I heard the elderly man in the adjacent middle-seat say:  “Victoria... Victoria?.... Victoria?...    VICTORIA!!...” Turning, I saw that he was shaking his wife who had passed out.

I informed the flight attendants who produced the traditional oxygen bottle plus a stethescope and blood pressure cuff and made the usual request for any doctor on the plane. The wife began responding, if groggily. Her blood pressure was undetectable, but engine noise made listening difficult.

By this time, another doctor arrived. She was about forty years younger than I and anxious to be involved. The wife had never fainted, and she was recovering too slowly to blame a heart irregularity. The leading possibility was a stroke – either a transient ischemic attack (TIA) which resolves completely or a full-fledged stroke. We wouldn’t know which for hours, so my suggestion was to land the plane.

This is not a decision airlines make lightly, and my physician colleague did not express an opinion. Headphones and a long cord appeared, and, after some delay, she spoke to a doctor on the ground who advised taking the wife to the rear of the plane, laying her on the floor, starting an intravenous line, and observing. With the other doctor leading the way, everyone trundled up the aisle.

The couple returned to their seats when the plane began its approach two hours later. The wife seemed all right although she had no memory of what had happened. Paramedics came on board at the gate and led the couple away.

I waved off the flight attendants' thanks, but they insisted on giving me five thousand frequent flier miles.      

Friday, October 9, 2015

Getting Help, Part 2


My relations with other Los Angeles housecall doctors are civilized but not close. As a result, when I leave town there’s only one colleague I trust to cover. Mostly this works out. I schedule my trips so they don’t conflict with his.

When I’m in town I’m always available. That includes after bedtime, in the movies and restaurants, and during social events. It includes concerts and live theater, but I sit on the aisle, so I can hurry to the lobby when my phone buzzes. None of this bothers me greatly (my wife is another matter).  

One event causes problems: baseball games. One of my brothers has Dodger season tickets, and we attend a dozen times during the season. We go to a restaurant and then the game: almost the only time we get together; I love it and don’t want to be interrupted. I’m out of commission only about six hours, and occasionally my colleague can’t cover.

I could continue to answer the phone, but crowd noise in the stadium makes conversation difficult. It also reveals that I’m having fun, and patients hate disturbing a doctor during his leisure time. My solution is to change my phone message to announce that I’m unavailable until (whatever time the game ends) and then turn off the phone. Genuine emergencies are very rare in a hotel doctor’s practice, and so far it’s turned out all right. But I’m always looking for help.

Monday, October 5, 2015

What Makes a Hotel Guest Sick?


American water.

Travelers worry that our fierce advocacy of the free market includes opposition to government meddling in the water supply. I regularly assure them that all American tap water is drinkable.

American food.

No one believes that Taco Bell or McDonald’s sell healthy food, but foreigners worry that these exotic, colorful substances are toxic. We Americans are warned about eating in nations with poor sanitation; about one in three American tourists get sick. If we’re careful, our sickness rate drops to… Actually, it doesn’t drop. No one knows how to prevent traveler’s diarrhea. The Swiss get sick when they come to the US.

Air conditioning

Americans accept air conditioning with even more enthusiasm than personal firearms, but most of the world has never caught on. They tolerate it as an odd American custom but believe that air from a machine is unhealthy whether it’s automobile exhaust or a box in a window. When someone gets sick, they turn it off.

Sitting in the Plane

Travelers blame the airline for any illness that occurs within a week of flying. This is not so for aches and pains and unlikely for an upset stomach but true for respiratory infections.

Stress

Vacations are stressful, particularly if children are involved. They miss their friends; they hate the food; they prefer watching TV to sight-seeing; they refuse to adjust their sleeping hours.  It turns out that stress makes everything worse, but it doesn’t cause anything, so there’s no reason for the parents to get sick. When they do, it’s a respiratory infection and the children’s fault.

Thursday, October 1, 2015

Keeping a Child Safe


On days I don’t go to the gym, I take a brisk one-hour walk through my neighborhood.
One of my favorite routes passes an elementary school a mile away.

Except for dog-walkers, the streets are deserted at this early hour, but a few blocks from the school the sidewalks gradually fill with children in their colorful outfits and backpacks accompanied by a parent. Past the school I overtake the adults, often in chatty groups, as they head home.

Parents taking their children to school…. When did that start?...

I entered first grade in Cleveland, Ohio, in 1946. The school was three blocks away. My mother dressed me and showed me the door and, even in the dead of winter, I walked alone. I met friends along the way. I never saw an adult.

No big deal. But halfway through the year I took a test. Afterward my parents agreed that I could attend a special school for gifted children.

It required a six block walk and then a long streetcar ride. I made the trip alone every day. The school had a cafeteria, but, for reasons lost in history, I left the campus at noon and ate lunch, usually a hamburger, at a nearby diner. It cost a dime. Remember, I was six years old. I never regarded this as odd, and no adult I encountered gave me trouble.

It was not all smooth sailing. Once, years later in Los Angeles, I encountered a bully my own age who cuffed me around painfully.

Sunday, September 27, 2015

Another Spiked Drink


It was one a.m. as I drove Santa Monica Boulevard, but crowds packed the sidewalks in West Hollywood, lining up to hear the latest band. A few blocks beyond, I parked at the Ramada.

A guest led me to the bathroom where her companion lay in the empty tub, clutching a towel and moaning. This was not the first time I cared for a patient in a bathtub or even the tenth.

“We’ve been out drinking,” explained the guest. “But not more than usual, and she didn’t have more than me. Do you think they put something in her drink?”

This was not the first time I heard that – or the tenth. Guests often suspect foul play when someone becomes violently ill after drinking.

I examined the patient as best I could without moving her because she insisted she could not move. Afterward I explained that alcohol is a toxin that messes up the brain, usually in pleasant ways but occasionally not.

After delivering an injection for vomiting, I told her to suck on ice chips and phone if she wasn’t feeling better in a few hours. So far everyone has recovered.     

Wednesday, September 23, 2015

An Exotic Travel Destination


Tourists come to America expecting a strange foreign land. They usually leave satisfied, but encountering an American doctor is an unexpected bonus, so everyone on the tour gathers round, and I often go about my business in front of a large attentive audience.
 
My largest consisted of the entire company of the Chinese Peking Opera lined up along the wall of a ballroom in the Hollywood Roosevelt. One of its members had begun behaving bizarrely. I concluded he was suffering an anxiety attack which a tranquilizer might help. 

This took place well before Chairman Mao’s influence became passé, so it was likely the Opera’s resident physician had no Western training. Etiquette demanded I treat him as a colleague, so I presented my advice as a suggestion.

After consulting other senior figures, he gave his approval. No one except the interpreter spoke English, so many subtleties were lost, but everyone seemed satisfied, and the entire troupe lined up to shake my hand.

Saturday, September 19, 2015

Doctors Are Always Late


At 6 p.m. on the Friday before Labor Day, I learned that a flight attendant in Costa Mesa had a cold. I prefer not to drive 46 miles during the rush hour, so I promised to be there between 9 and 10. That was acceptable. Airline crew are not demanding.

Five minutes later a guest at the downtown Doubletree asked for a visit. This was a bad juxtaposition. Scheduling it for after Costa Mesa meant an arrival time near midnight.

Reluctantly I told her to expect me at around eight. Since it was the evening before a holiday, I gave myself over an hour for a 25 minute drive. To my surprise, the freeway flowed freely, so I was early. I worried the guest might not be in the room. When I say I’ll arrive “around eight” guests often hear “eight.” They leave, planning to return at eight or a little after. But the guest answered the door.

The freeway to Costa Mesa was also fast, and this time no one answered my knock at 8:30. The front desk was unhelpful.  

This was a situation I hate. Airlines have strict rules about sick crew, so this guest required a visit. If I waited until 9 and then left, I might get a call on the way home. If she was out partying, I might get it several hours later. I did not acquire my peerless reputation by refusing calls, so I’d make the return trip.

As I fumed and paced, the guest returned. I expressed relief, but she did not apologize. She was present at the appointed time, and no one expects a doctor to be early.

Tuesday, September 15, 2015

Medicine is Easy; Parking is Hard


A 23 year-old foreign student at the University of California had bronchitis. I live three miles from UCLA but this was the University of California at Irvine, 52 miles away. I quoted a fee that took this into account and was not overjoyed when it was accepted.

Navigating inside a huge campus is tricky, but Siri calmly directed me to the correct address. It was, as I suspected, the residence hall main office. No one lived there. I phoned the student to ask where to park because the streets were forbidden. He said he would come out and direct me.

When I phoned again in ten minutes, he assured me he was on his way. He arrived and guided me through winding streets to a parking lot with signs threatening serious consequences to anyone without a permit. He swore that it was OK. It was August; the campus was deserted, so I took the chance.

He wore shorts and t-shirt, appropriate for a hot summer day. Sweating in my suit, I trudged at his heels for several blocks, passing building after building until we reached his. It was a student dormitory, so there was no air conditioning. The visit went fine.    

Friday, September 11, 2015

Girls Are the Best


 “...allo!!” shouted a little girl from her bed as I walked in, but that was her only English. Her French parents had called because she was running a 101 fever.

She seemed delighted to see me and jumped to sit on the edge for her exam. Smiling happily she waited as I quizzed the parents, opened her mouth widely when asked and made no complaint when I poked my otoscope into her ears.

I found everything normal. She had a virus that might last a few days and required only Tylenol. Staying in bed was not necessary. Everyone seemed pleased, the child most of all; she waved goodbye as I left.

I loved that visit. Readers are familiar with my admirable qualities, but I admit that I am not the sort of jovial physician who enchants young children. Mostly I do fine, but I’ve endured plenty of encounters with apologetic parents and a screaming, struggling toddler.

These are almost all boys. Adult male pugnaciousness has not made the world a comfortable place, and it works equally badly in children. They get the exam regardless, but it’s drawn out and painful. The parents are embarrassed, the doctor relieved when it’s over.

Little girls rarely make a scene. If frightened, they keep quiet. If not, they realize, almost from birth, that charm works wonders. Everyone relaxes and takes care of business. Women should run the world.   

Monday, September 7, 2015

A Dog-Eat-Dog Business, Part 10


My last post reported a housecall service that charged an unbelievable fee. By an odd coincidence within a week I came across another new service with an even more unbelievable fee: $99.

A high-tech startup similar to Airbnb, Uber, and Lyft, Heal is clearly the wave of the future. You download its app. If illness strikes, you click on it, enter information, and (according to the web site) a doctor arrives within an hour. Business was brisk, its medical director assured me.

With a “medical assistant,” driving, Heal’s doctors care for acute illnesses, performing complex procedures that I don’t do such as suturing, injecting joints, and even complete physical exams.

Paying the doctor, driver, staff, and investors at $99 per housecall seems impossible, especially since the web site emphasizes that there are no extra charges. On the other hand, taxi companies complain bitterly about Uber, and hotels denounce Airbnb, yet both are prospering. Financial acumen is not my strong point, so it’s possible that Heal will drive me and my more expensive colleagues out of business.

If so, I might to work for them. Pay is low for a doctor but acceptable to me. Having a driver would relieve a major stress, and I might enjoy not being on-call 24 hours a day. This blog would vanish, but you could read Heal’s. It lacks my whimsy, being mostly earnest medical advice and public relatoins, but $99 will not include entertaining literary diversions.

Let me know if it works for you.

Thursday, September 3, 2015

A Dog-Eat-Dog Business, Part 9


I keep an eye on the competition, searching the internet for various combinations of “hotel doctor,” “house call doctor,” “housecall,” etc. My blog turns up but never a web site or one from other veteran hotel doctors. We don’t advertise, a sure sign that our days are numbered.

Last week, I came upon International Medical Services which promised to send a highly qualified doctor to a home, office, or hotel at a moment’s notice. When I phoned, its medical director knew my name, having dealt with me at previous jobs.

Like all new arrivals, he insisted that business was thriving. In fact, as we spoke, a hotel guest needed a visit, and I was welcome to go. I asked about the fee.

“We charge between $1600 and $2000. The doctor gets half.”

“Guests won’t pay that!”

“We don’t have trouble. These people have travel insurance.”

He suggested I quote $1200 and then add a few hundred dollars for medicines and supplies. That was their doctors’ routine.

I visited a young woman at the Hampton Inn with a simple urine infection. She handed over her credit card without complaint.

That felt creepy. I mailed $600 with a note asking him not to call again.

The Hampton Inn is not an upscale hotel. How did he persuade its staff to refer guests? My legal advisor warns me not to speculate.

Sunday, August 30, 2015

Another Incident in a Hotel Doctor's Glamorous Life


Younger, cooler, more expensive doctors own the franchise on Los Angeles film shoots, but I go now and then.

A European director staying at the Langham in Pasadena consulted the concierge, so I answered the call.

After driving miles through suburbs I encountered the usual cluster of trailers, street barriers, and police. It was a warm summer day in Los Angeles, but Pasadena is always ten degrees hotter, so I squeezed my car next to a trailer to take advantage of the shade.

Workers hurried about, but I was the only one wearing a suit, so I stood only a few minutes baking in the sun before an assistant approached. Like every aide I’ve met on film sets, she was young and beautiful. I hate to imagine the hiring policies of production companies. 

She led me into a trailer, thankfully air-conditioned, where I waited fifteen minutes until the director made time. He had a rash and worried about bed bugs.

Many foreigners believe Americans fall below civilized standards of cleanliness. We think of personal hygiene in terms of body odor, but they notice that we allow dogs free run of our houses, and we don’t take off our shoes when we come inside. That the Langham is very expensive does not rule out bedbugs, but I diagnosed hives, an allergic reaction.

I’m not sure my reassurance convinced him, but he was a workaholic like so many of my patients. Workaholics neglect their health which is not a good thing but when he hurried back to the set I considered it likely that he would put it out of his mind.

Wednesday, August 26, 2015

Lost in Translation, Part 2


5:30 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher I would be at the hotel in an hour.

The freeway was clear. Parking, even downtown, would be easy. My phone rang as I drove. It was the guest’s travel insurer warning that there was no answer when he phoned to tell her when I’d arrive. When guests call directly and then vanish, I don’t get paid, but this is not the case with travel insurers, so I drove on. It was unlikely she had left the hotel.

At this hour, I check at the desk to make sure I don’t knock at the wrong door. The clerk confirmed the room, called, and reported that someone had answered and then hung up.

It was good news that she was present, not so good that she had immediately hung up. That’s a sign that a guest’s English is not good. 

A young Japanese woman greeted me at the door, ushered me inside, consulted her Ipad, then announced in triumph: “......stomach!!....”

One advantage of travel insurance is that dispatchers will interpret. Despite my admonition, they prefer to edit, abridge, and summarize rather than simply translate; their English is often rudimentary, and passing the phone back and forth makes for a long, tedious visit.

On the plus side, hotel guests usually have uncomplicated problems. It worked out fine. 
  




Saturday, August 22, 2015

A Black Spot


“You’ve got a black spot,” said my wife when I asked her to scratch my back.

“Black as the tar in the road?” I asked. She confirmed this, but as I quizzed her she realized that black was bad and began retreating. Maybe it was dark brown.

She took a picture with her cell phone. It was an inch in diameter, dark, and lumpy but not obviously malignant looking. Wives always discover things on their husbands which the husbands, being men, ignore. Later they die.

I decided I needed to see an expert. It was Friday, and I didn’t want to spend an anxious weekend, so it had to be today.

The best dermatologist in Los Angeles is Pamela Rand. She does not accept insurance, Medicare included, so I use others for routine skin problems. I wanted her, but she was on vacation.

I like the doctor I see at the UCLA dermatology clinic in Santa Monica, but the clerk reported no openings until Tuesday. When I pressed, she transferred me to a nurse who, after consulting for several minutes, reported she could move me up to Monday. I would have pulled rank as a physician had I been frightened, but I was only uneasy.

A few dermatologists phoned at random were not helpful. I phoned the main UCLA clinic in Westwood and learned that there were no openings except in distant suburban facilities. Thousand Oaks and Westlake were about forty miles; Porter Ranch seemed closer.

The drive was long, but parking was free. The dermatologist took a quick look and told me it was benign. I sat patiently as she educated me on seborrheic keratoses (age spots) and accepted her handout. Doctors don’t learn that I’m a physician unless they ask. It doesn’t get me better medical care, and some doctors feel uncomfortable having one as a patient.