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.


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.