Sunday, August 30, 2015
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
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
“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.
Tuesday, August 18, 2015
A yoga instructor was attending a convention of like-minded devotees when one vendor gave him a sample of a natural energy pill. Within half an hour, he knew that his blood pressure was out of control.
Patients who know when their blood pressure is high are wrong because high blood pressure causes no symptoms. But he was certainly jittery.
In fact, his pressure was higher than I’d like in a 43 year-old man, but he admitted that his family doctor had also found this. He had been trying to control it through yoga.
I read the label on the bottle. Each pill contained a mixture of herbals and vitamins and a large dose of caffeine. I never drank coffee, and my first experience with caffeine – in a wake-up pill in college – was dramatic. I loved feeling super-alert, but I understand why a more mellow personality might not.
The effect was already wearing off, and he had no objection to my explanation. When I suggested that it was time to treat his hypertension, he promised to ramp up his yoga.
Friday, August 14, 2015
Stepping out of the shower, a Doubletree guest stumbled and nicked his leg. He had paid little attention, but now, two days later, the wound had grown painful.
That sounded like a good visit until he delivered the bad news: the hotel would pay my fee.
I label these “medicolegal” visits and I don’t collect. When a hotel offers to pay, it’s usually because the guest is making a fuss, and management has already agreed to other expenses such as comping the bill.
I don’t want to be part of the problem, and it’s a chance to remind upper management of my value. During the usual visit I never see a general manager. Most are only vaguely aware of my existence, and a few are surprised to learn that the hotel can call a doctor.
The guest’s shallow, one-inch, laceration was healing normally. I doubt he would have called if he had had to pay.
I shook hands with the general manager and assured him that there was no significant problem. I added that, as the hotel’s doctor, I was always available, and he should feel free to consult me under these circumstances. I waved off his offer to pay. He expressed gratitude.
Don’t assume that this guarantees a hotel’s loyalty. It’s been years since Loews in Hollywood and the Adventure hotel called. My last visits to both were medicolegal freebies.
Monday, August 10, 2015
A 2 year-old was ill with vomiting, diarrhea, fever, and a rash. That sounded bad.
I know a pediatrician who makes housecalls, and I considered sending him. But the news came from the guest’s travel insurer, and their announcements tend to be dramatic. I decided to go but to call him if matters seemed complicated.
The guest greeted me at the door with a cheerful toddler at his side. That, to my relief, was the patient. He still had diarrhea, and a spotty rash was present but fading.
Suffering a respiratory infection, the child had seen the family doctor and received the traditional antibiotic. For some reason, instead of amoxicillin (the world’s most popular antibiotic for people who don’t need an antibiotic), he had prescribed Augmentin, excellent when necessary but a legendary stomach upsetter.
The parents took for granted that the solution was a better medicine and something for his rash and diarrhea. But this was a situation where stopping everything works best.
Thursday, August 6, 2015
“We have a situation with a guest…” explained the manager of the Georgian.
I love doing favors for hotel management, but this announcement did not seem promising. Medical science cannot quiet drunk, stoned, or disruptive guests, but hope springs eternal among staff.
This turned out to be not so bad. A guest was taking an injectable medicine for rheumatoid arthritis. It required refrigeration, and the hotel had agreed to store it. Unfortunately, for unclear reasons, someone had left it on top of the refrigerator all night. What should he tell the guest? Could I call a pharmacy to replace it?
The medicine was Humulin, a high-tech, genetically engineered monoclonal antibody. The pharmaceutical company that I patronize would sell me two doses for $5,000.
I did a Google search to find the manufacturer’s medication guide. While Humulin should be kept in cold storage, leaving it at room temperature for a few days is OK. You can bet the manager was grateful for this news.
Sunday, August 2, 2015
A Brazilian traveler had left her medication at home. Could I drive to Hermosa Beach and write some prescriptions? The caller was the guest’s travel insurer.
When hotel guests call directly, I tell them to go to a pharmacy and explain what they need. I would approve over the phone. It’s free; everyone is happy.
Before I could offer to do the same, the dispatcher informed me that, as a new policy, insurance would pay for visits to replace prescriptions. I could not turn down easy money.
It turned out not to be so easy. The traveler’s family doctor had faxed the prescriptions, but the writing was illegible and in Portuguese. There followed half an hour of debate, phone calls, and Google searches before I found the American equivalent of three of the four. The fourth never turned up, but it was probably an herbal remedy.