Sunday, March 29, 2015

Trying to Reach the Doctor

A two-month old at the Sunset Marquis was vomiting. I care for infants, but vomiting in someone so young is tricky. It would be a cop-out to send the parents to an urgent care clinic because its doctor would be a G.P. like me – and, by the law of averages, less competent. Emergency room doctors have more skill, but inflicting an ER experience on this guest was overkill. Fortunately, I have a pediatrician colleague.

I phoned his office. A message urged me to call 911 if I had an emergency but otherwise to leave a message. I dialed his cell phone but reached voicemail. It was 10 a.m. on a weekday, so he was in the office. I phoned the office again and hit “zero” to connect me with the answering service who agreed to page him.

After ten minutes, he phoned and agreed to speak to the guest. I contacted the guest half an hour later. No one had called.

I phoned the office and encountered the same rigmarole. Eventually, the pediatrician explained that the guest had been on the phone, so he had left a message. He agreed to call again.

Everything worked out, and the guest was happy.

Twenty thousand Los Angeles hotel guests can dial my cell phone at any time, and I always answer in person. Sometimes this is inconvenient, but, like most doctors, I have a great job and earn a generous income, so this is a small price to pay. I don’t understand why I have so much trouble getting doctors to answer the phone.  

Wednesday, March 25, 2015

A Hotel Doctor's Contract

People ask about my contract with hotels. There is none. Concierges, operators, and bellmen call because they know me. They have my cell number, and I encourage them to give it to guests.

Guests sometimes praise me, but their praise goes to concierges et al. If they decide to complain, usually because I won't give them something they want, they go to the general manager, often galvanizing him into one of several upsetting actions.

If he consults the hotel lawyer, he always hears that he must never, never help sick guests because guests who sue the doctor will also sue the hotel that recommended him. At any given time, about ten percent of hotels are in this my-lips-are-sealed mode, but it’s a changing ten percent because it never lasts. Guests persist; most employees want to help, and most competing hotels have doctors, so it’s bad public relations. 

Referring the complainer to a competitor is a major upset. Anxious to make a good impression on his first call from Doctor Oppenheim’s hotel, he may relax his standards.  

Some managers make up a list, instructing staff to hand it to guests but to never recommend an individual. They believe (incorrectly) this will eliminate their liability. The employee who makes up the list confines her research to the internet and adds doctors she knows in no particular order. As a result, it includes doctors who don’t make housecalls and walk-in clinics with limited hours. Fortunately once the list is made the hotel forgets about it. As years pass, even the doctors who make housecalls drift away, but I remain. I’m patient.

Saturday, March 21, 2015

Be Careful What You Ask For

“Could you come and give me some penicillin?”

Uh oh.  

The guest had a sore throat. He was fifty years-old. The only throat infection that antibiotics cure is strep, largely a disease of children and adolescents. Strep in a fifty year-old is so rare that I’ve never seen a case.

I prescribe antibiotics when they’ll help. Many doctors are more liberal, and it’s possible that his family doctor gave antibiotics whenever he suffered a sore throat. Everyone (including doctors who prescribe them) agrees that unnecessary antibiotic prescribing is a worldwide scandal; it’s unhealthy for the patient and a catastrophe for the environment.

Doctors who prescribe unnecessary antibiotics claim that patients “demand” them. In fact, after I’ve seen these patients, ninety percent are perfectly happy. About ten percent seem puzzled but remember their manners. Only a tiny minority give me a hard time.

But a tiny minority of a minority does not equal zero. Over thirty years, plenty of patients have lost their temper or (in the case of women) burst into tears. While not as mortifying as being sued for malpractice, it’s in the ballpark.

Unlike doctors in an office, I have the advantage of a phone conversation before seeing the patient. If a guest hints that he requires an antibiotic, I discuss his symptoms, suggest that antibiotics might or might not work, and try to gauge the likelihood that he won’t take no for an answer.

In this case, the guest seemed particularly assertive. I didn’t want to take the risk, so I referred him to a local walk-in clinic where he’ll probably get his penicillin.

Tuesday, March 17, 2015

Converting Two Visits into No Visits

A man at the Bonaventure was suffering an earache. The pain was not severe and had been present several days, but he wanted it checked. This seemed like an easy visit.

But it was 5:00 on Friday. My traffic app showed a solid red line for the ten mile freeway drive downtown, converting a half-hour trip into… I hated to contemplate it. I explained that I could be at his room between 8 and 9. That was fine with him.

I had barely hung up when the phone rang again. A guest at the Warner Center Hilton had diarrhea. The Hilton is fifteen miles in the opposite direction from the Bonaventure with an equally red freeway. I could have scheduled it for later, but if a third call arrived….

The guest was not terribly ill, so I pointed out that most diarrhea is self-limited. I gave dietary advice and recommended an over-the-counter remedy that was a good as the one I hand out (actually the same), and suggested we talk again in a day. Happy to get free medical advice, he agreed.

At 6:30 the Bonaventure operator called to inform me that the guest wanted to cancel the visit. When I phoned both guests the next day, they were doing fine.

Friday, March 13, 2015

You'd Better Ask How Much!

Before hanging up the phone, I tell guests my fee, but this is not universal among hotel doctors. Guests may learn when the doctor hands over the invoice at the end of the visit.

It’s often a bombshell. A few weeks ago, a guest showed me a bill for $840, and I’ve seen higher. It takes huge balls for a doctor to do this, but it works. Most people will quarrel with an unreasonable charge if it arrives in the mail but not face-to-face with a doctor in a room far from home.  

Long, long ago I made visits for a national concierge agency that boasted it would fulfill a hotel guest’s every need. It was a luxury service, but not everyone in an upscale hotel is filthy rich. After collecting an immense fee from several resentful guests, I stopped accepting the agency’s calls.

Monday, March 9, 2015

Calling Paramedics

If you want reach a hospital as fast as possible, get in your car and drive.

Paramedics are slower. They’re essential if a problem might be life-threatening or require special handling such as a fracture. They sometimes transport even if their expertise isn’t required, but it’s not guaranteed. If you have a bellyache or high fever, they might tell you to take a cab.

Phoned in the middle of the night, some hotel doctors determine that everyone requires paramedics. With no office job I don't mind wee hour calls, but it's often difficult convincing a hotel that it has an urgent problem.

“You have an elderly man, Mr. Elwood, in 435. He’s confused and can’t get out of bed. He needs paramedics.”

“I’ll send a bellman up right away.”

“No, you have to call the paramedics.”

“I’ll call Security. They’ll send someone to the room.”

“You have to call the paramedics.”

“Maybe you should talk to the manager on duty.”

At any hour, the noisy arrival of the ambulance followed by a train of fire engines disturbs everyone, so persuading a hotel to make the call often takes an effort.

Thursday, March 5, 2015

Sometimes This Job is a Snap

I saw a man at the Hollywood Roosevelt with a numb arm. That’s an odd complaint but unlikely to represent something serious in a 26 year-old.

He’d fallen asleep on the plane, resting his head on his palm with an elbow on the arm rest. On awakening he felt numbness down his forearm. This was easy.

The ulnar nerve that supplies the hand passes under your medial epicondyle, the knob you can feel inside your elbow. It’s a poor design because the nerve runs near the surface. Injuring it produces tingling down your arm to the little finger. It’s the “funny bone.”

Cab drivers who spend the day with one arm resting on the door often complain of numbness. Once they stop doing this, the discomfort disappears.

Sunday, March 1, 2015

Drugs are Cheap

Getting a syringe from my supply closet, I noticed that only a dozen remain. I’d better order more. A hundred syringes costs $12.

I buy from an internet medical supply company. For orders under $200 it charges a fat “handling fee,” so I try to order enough to exceed it. Most of my purchases are drugs, but that presents a problem because they’re so cheap.

I notice other hotel doctors charging $50 to $150 for an injection. I carry seven injectables. The content of a single shot of all seven rarely cost more than a dollar.   

What do I need?..... I stock B12 not because it’s necessary but because guests ask for it. This doesn’t happen often, so my bottle is almost out of date. The price has gone up, but it’s still $31 for a 30cc vial. That’s thirty injections.

I’m down to a few dozen Ondansetron tablets, the best nausea remedy. Ten bottles of thirty will set me back $37.

It never hurts to stock up on loperamide (Imodium is the brand), my favorite diarrhea treatment, but I was surprised to discover the price has jumped to ten times what I paid a few years ago: $104 for five hundred. Many old but important drugs such as penicillin that once cost pennies a pill have skyrocketed to dazzling levels. The weird thing about loperamide: it’s sold over-the-counter. Walmart charges $5.00 for a bottle of 72. That works out to $35 per five hundred. I’ll buy loperamide from Walmart.

I’m not short of many drugs, and buying too many is dangerous. At over ten dollars a bottle, my most expensive is antibiotic drops for swimmer’s ear. Swimmer’s ear has been unexpectedly rare, and I recently discarded five bottles that expired in January. My remaining three expire in May. Should I buy more? Doctors have to make tough decisions…