Saturday, May 30, 2015

A Costly Mistake

Since 1984, twelve hotel guests cleaned their ears with a Q-tip, extracted it, noticed that the cotton had vanished, and called me.

These are mildly stressful visits because I worry that the cotton may be too distant to reach, and I don’t like poking with needle-nosed tweezers. So far I’ve been lucky, but my last visit didn’t work out as planned.

“I don’t see anything,” I said after looking in the ear.

The guest insisted that I must be in error. I looked again. Nothing that didn’t belong.

While he thought this over, I looked in the bathroom. On the floor near the sink lay a tiny ball of cotton.

He tried to laugh this off, but I could see his pain. I’d made the visit at the request of a housecall service that had already collected on his credit card, so there was no way I could give him a discount. It was an expensive mistake.

Tuesday, May 26, 2015

Another Arab Prince

It seemed a routine visit for an upset stomach until I knocked at what turned out to be the penthouse suite of a Beverly Hills hotel. The man who answered identified himself as “the prince’s personal assistant.” I followed him into another large room where the prince, an elderly Saudi, lay in bed. It was five in the morning.

The assistant indicated the patient – not the prince but a young woman sitting nearby, looking wan. I took her into another room to deliver my care. She was an American in her twenties, and I wondered why she was in the prince’s room at this hour. Perhaps she was a prostitute, but she seemed nice. 

When I returned to the bedroom, the prince thanked me for coming, adding that he had a personal problem. He suffered crippling back pain and had run out of medication. Could I help? As we talked, I noticed the assistant waggling his finger in a gesture indicating that I should not pursue the matter. I took the hint.

Accompanying me to the elevator, the assistant explained that everyone preferred that the prince’s doctor handle the prince’s drugs. Then he paid me with a sheaf of hundred dollar bills. Later I counted ten.

Most Arabs that I see are ordinary people, but over thirty years the occasional prince turns up. They tip heavily and provide material for this blog, but so far every experience has been uncomfortable.

Friday, May 22, 2015

Losing Two Out of Three

A guest at the Hollywood Heights with an upset stomach requested my services. I had barely hung up when an Englishman at the Shangri-La wanted a doctor for a respiratory infection. These hotels were not convenient – the Hollywood Heights is ten miles east, the Shangri-La in Santa Monica five miles west. But two visits make for an excellent day, so I drove off in a good mood.

As I approached Hollywood, the phone rang. My heart sank when I learned the caller was the Sheraton in Pasadena, twenty miles away – thirty from Santa Monica.   
Having visits pile up, especially those with long drives, oppresses me, so this was one I’d prefer to skip.

This guest’s husband, who was driving to the hotel from the airport, was suffering a cough and sore throat and wanted a doctor when he arrived. Launching my no-visit effort, I explained that viral infections cause the overwhelming majority of these illnesses, so a doctor can do little except relieve symptoms. I suggested discussing this with her husband when he arrived, and I left my phone number. She agreed. With that weight off my shoulders, I continued on to the Hollywood Heights.

After finishing, I reversed my course and headed for Santa Monica. As I neared the hotel my phone rang. “A friend of mine found a bottle of amoxicillin,” said the Shangri-La guest. “I think I’ll give it a try and save you the trip.”

Having lost that visit, I immediately called the Pasadena Sheraton. The husband had arrived, and they had decided to wait.

Monday, May 18, 2015

The Kiss of Death

Malpractice insurers look with suspicion on doctors who operate pain clinics or diet clinics or who perform botox injections or liposuction. My brother saved $12,000 on his premium when he gave up obstetrics – and that was twenty years ago. Doctors pay a fat surcharge if they engage in controversial practices, perform legitimate if risky procedures, or have personal difficulties such as an alcohol problem or numerous malpractice suits.

None of this applies to me. From a malpractice carrier's viewpoint, I’m easy money. I see perhaps one fifth as many patients as an office doctor. Being travelers, they’re younger and healthier than average. Even better, most are foreigners who don’t sue.

Except for writing large checks, I ignored this area until a letter arrived in 2003 from my malpractice carrier. It was a routine survey with questions about the nature of my practice: hours of operation, employees, office locations, number of patients, hospital affiliations, procedures.

I made certain they understood that I was a full-time housecall doctor who cared for a small number of healthy, unlitiginous patients.

A few weeks later the company cancelled my insurance. It was a big shock. When I applied to other carriers, all turned me down. I contacted an insurance agent who was very helpful and obtained a policy from a company in Illinois that specializes in difficult cases. It cost five times what I had been paying.

My record remains squeaky-clean, but each year when she applies to the regular carriers, they decline. They won’t insure a housecall doctor, she explains.

How does this affect my competitors? It doesn’t. They visit hotels as a sideline, usually from an office practice. If asked, none would deny that they make housecalls, but no carrier forbids them, and they’re so uncommon that applications for malpractice insurance don’t ask about them. .

Boasting that I am America’s only fulltime housecall doctor produces flattering feedback, but it was the kiss of death to tell my malpractice carrier. Perhaps they remember celebrities from Michael Jackson to Elvis Presley whose lurid deaths seem to include a doctor who made home visits.

Thursday, May 14, 2015

The Conundrum of Ear Pain

I hate forbidding guests from flying because of the ticket-change fee. The era when a doctor’s note impressed the airline is long gone. It still works for travel insurers, a good reason to buy a policy.

My problem arises most often with ear pain.

Cabin pressure at cruising altitude drops only about 25 percent from sea level, but that’s significant. If you bring a bag of potato chips you’ll notice that it swells like a balloon. Air in any closed space does the same. If you have gas, you’ll have more gas. If air in your middle ear can’t escape, the ear will feel stuffy and then painful. If pressure increases still more, it may blow a hole in the eardrum. This relieves the pain, and most small perforations heal in a few weeks, but we don’t like to encourage them.

The best preventative is a chemical nasal spray (Afrin, Dristan). As you sit in the plane before takeoff, spray generously, wait five minutes for it to work, and spray again. This should send the spray far up to reach the eustachian tube opening, the only connection between your middle ear and the outside world. Do the same before the plane begins its descent, an hour before landing.

Flying doesn’t cause ear infections, so if you felt fine before boarding, it’s OK to wait if your ear hurts after landing. Pain should improve after a few days. If you see a doctor, he’ll forbid you to fly.

Sunday, May 10, 2015

Tooting My Horn

Would I see a lady at the Airport Hilton with an eye problem?

I asked the dispatcher from Amerilink, a travel insurance agency, for details, but she couldn’t provide them.

It turned out that the lady had no complaints. Apologizing, she explained that she had neglected to pack her glaucoma drops. Would I write a prescription? I was happy to comply. Amerilink would pay my usual fee.

These delightful visits are not rare. Travelers with insurance who forget a medicine often lie because they suspect, correctly, that the carrier will not pay for the truth.

When a hotel calls directly, I always speak to the guest. If he or she has forgotten a legitimate medication, I phone a pharmacy to replace it, gratis. I don’t have the gall to collect a fee for delivering a prescription.

Readers of this blog know what a humble physician I am, but this is one time I will boast. Many competing hotel doctors charge for any service they perform over the phone, including simple advice. If a guest calls the 800 number of one of the half-dozen national housecall services that advertise widely, he or she will have choice of (1) a paying visit, (2) going to an emergency room, or (3) nothing.

Wednesday, May 6, 2015

Dodging a Bullet

The army does not hand out generous transportation allowances, so it housed this family in a single room of a Days Inn. Arriving, I squeezed past stacks of luggage and between three rollaway beds where the children slept.

I suspected the officer’s wife had pneumonia. She looked sicker than usual: feverish and short of breath. While not alarming, it required some thought.

Doctors make most decisions based on evidence or gut feeling, but sometimes a third factor intervenes: inconvenience. For example, as a patient it’s risky to be the final appointment before lunch or at the end of the day. There’s a small chance the desire to get out of the office will influence the doctor. Rarely, this leads to a decision that comes back to haunt him. I’ve been around long enough to follow a rule: if I’m about to chose an option that saves aggravation, I do the opposite.

Leaving after giving an appropriate antibiotic for pneumonia was a reasonable option, but the rule applied. Reluctantly, I announced that she needed to go to an emergency room.

A major hassle followed. The father did not normally care for the children, so I sat patiently for half an hour as he woke them, struggled with their clothes, made several phone calls to reschedule his flight, then shifted a dozen boxes between his wife’s bed and the door. After this was well under way, I left to fetch my car, parked two blocks away. Fitting six people into a tiny Honda took additional effort.

It was a relief to usher them into the waiting room, explain matters to the clerk, and say my goodbyes. It was a greater relief to learn, when I called the hospital later, that the wife lay in the intensive care unit, intubated, and on a respirator, fighting a catastrophic pulmonary infection.

Saturday, May 2, 2015

The Most Deeply Compassionate Physician

I’m an early riser, so the 5:30 a.m. phone call last week found me at my computer writing this blog. The caller was Le Montage, a luxury hotel in Beverly Hills.

It was a perfect time. Wilshire Boulevard was deserted. The hotel was three miles away. I could park on the street. Guests during the small hours are particularly grateful. I was home in time for breakfast.

My last visit to Le Montage occurred several months ago. The call arrived at 3 a.m.

That I am Los Angeles’ leading hotel doctor is beyond doubt, but I have never dominated the elite establishments (Bel Air, Four Seasons, Beverly Wilshire, L’Hermitage, Peninsula, Beverly Hills Hotel). These already had doctors when I began in 1983.

After a few decades, some took notice, and I often covered for their doctors, but nowadays when these hotels call, it’s generally during the wee hours.

I suspect this is because a new generation came on the scene a few years ago including several young aggressive doctors building a concierge practice. Concierge doctors offer an exclusive personal service, but they accept only cash. They have no interest in Hiltons, Ramadas, Holiday Inns et al whose middle-class guests might object to the fees, but luxury hotels are a different matter. They solicited with considerable success.

“Do you think they're paying off the concierges and bellman?” asked a veteran colleague when the subject came up.

"They wouldn't stoop to that," I responded. It's illegal. I’ve met several of these doctors, and they seem personable. Check their web sites (google “Los Angeles house call doctor”). All describe themselves as skilled and deeply compassionate. Read their testimonials or the Yelp comments. Unanimous praise.

When these physicians introduce themselves to bellmen and concierges, they undoubtedly emphasize their skill and deep compassion. Who would not be impressed?

As midnight approaches, bellmen and concierges go home. The skeleton night staff has never encountered these exceptional physicians, so when a guest falls ill, they call Doctor Oppenheim.