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Thursday, December 29, 2016

When a Doctor Sees a Doctor, Part 2


Doctors enjoy chatting about diseases but not their own. We’re as frightened as you, and we want a doctor who sympathizes and makes it go away.

Some doctors don’t understand this. They assume that, being in the business, we don’t require any touchy-feely stuff and that it’s OK to talk shop.

Twenty years ago my dermatologist biopsied a bump near my ear. When he revealed it showed a basal cell carcinoma, he had me look through the office microscope at the biopsy slide, and I saw my cancer cells. Ik!....

Five years ago, my internist heard a heart murmur and sent me to a cardiologist. After determining that I had a damaged mitral valve, he led me into an adjacent room to show the ultrasound. Since I was a doctor, he took for granted that I wanted to know the technical details, but I absolutely did not want to see a film of my poor, diseased heart in action. As he happily pointed out the leaky valve I tried not to look.

We returned to his office where he extolled the skills of a cardiac surgeon at the nearby university hospital who had great success repairing heart valves. While it wasn’t urgent, he was certain I’d enjoy talking to him.

I found another cardiologist whom I like much better. I might need surgery in the future, he explained. He’ll let me know. I see him for an ultrasound every six months. Otherwise I try not to think about it.

Sunday, December 25, 2016

A Hotel Doctor at the Movies


My phone buzzed. 

I sit on the aisle in theaters, so I can hurry out before speaking.

“Can you see a guest at the Sheraton?”

“Which Sheraton?”

The insurance dispatcher gave an address that I didn’t recognize. It turned out to be in San Francisco, so I was back in the theater in less than a minute. This doesn’t happen often. Mostly, when a call arrives, I leave.

When hotel guests phone directly, the conversation always takes a few minutes. Even if a housecall isn’t necessary, I’ve missed too much of the movie.

When insurance agencies phone, a housecall is almost always necessary, and it takes a few minutes to copy the information. 

What to do then…. Most patients are willing to wait a few hours until the movie ends, but I never ask them. While I don’t deny that I’m a deeply caring person, I’m also a Type-A personality. If there’s work to be done, I can’t relax until it’s done, so I always leave. This does not sit well with my wife, so we usually go to the movies in two cars.

Cashiers give me a refund if I explain that I’m a doctor on-call, but once the movie is under way, I don’t ask. My fee for a visit is much higher than a movie admission. Most of the time I’m happy to get away. I doubt if I return to a quarter of the movies after I’m called away.

Wednesday, December 21, 2016

When a Doctor Sees a Doctor, Part 1


You might believe that doctors deliver better care to other doctors, but I’m not sure that’s true. It might be worse.

As a hotel doctor, I’d rather not care for a guest who happens to be a physician. For one thing, he’s likely to hint that I shouldn’t charge him.

He’s also less likely to give up his authority. Non-physicians often tell me their diagnosis and the proper treatment. Sometimes they’re right, but they rarely object if I disagree. They assume I know more than they do. When physician hotel guests tell me their opinion on the initial phone call, I’m tempted to let them have their way and avoid a housecall. Once in the room, I’d rather not be treated as a colleague. 

When I go to new doctors, I never reveal my profession (under “work” I write “self-employed”). They’re supposed to ask, but it’s not a priority.

My current dermatologist doesn’t know I’m a doctor, so I listen patiently to many explanations that aren’t necessary, but that’s fine with me. I want her to treat me like everyone else. After five years, my family doctor casually asked what I did for a living, and I could detect his surprise when I answered. But I’m satisfied with the medical care he delivers. On the rare occasion he makes a suggestion that I disagree with, I behave like any other patient. I keep my mouth shut and ignore it.

Saturday, December 17, 2016

Some Lawyers are not so Smart


I hate doctor TV series except out-and-out comedies such as Scrubs. All TV doctors say things doctors never say and do things doctors never do. 

I’m certain everyone with expertise, whether in the law, plumbing, or stamp-collecting, rolls their eyes when TV writers portray them.

Having said this, I confess that my wife and I love The Good Wife which is about lawyers. It’s brilliantly written, but I have no quarrel with legions of lawyers who fill the “comment” section of web sites with furious denunciations of its inaccuracies. I acknowledge that those in The Good Wife do things lawyers never do (such as sleuthing), and they are dazzling in courtroom cross-examinations.

I sympathize because, in the years before I became a hotel doctor, I was cross-examined twice. I was not the defendant but one of the doctors who cared for the patients whose misfortune produced the suits.

Having watched TV lawyers tear witnesses to shreds, I was nervous. Asked certain questions, I would have had to think hard to defend my actions, but those questions never came.

The lawyers seemed not terribly sharp. It was clear that they hadn’t boned up on their client’s medical problems. I had no trouble.

One lawyer enlarged a xerox of a page in the patient’s chart and displayed it before the court. Unlike the other illegible scrawls, my entry was neatly typed. Clearly that was suspicious, he proclaimed. How did I explain that?

This did not show great acumen. How much IQ would it have taken to learn that I typed all my chart notes?   

Tuesday, December 13, 2016

Don't Harm My Child


Examining a sick child during a routine hotel visit, I asked about previous illnesses, allergies, and hospitalizations. I asked if his immunizations were up to date.

“They’re not,” said the mother. “We don’t do vaccinations in this family.”

Evidence that immunization saves lives is overwhelming. Evidence is also overwhelming that people with deeply held beliefs are immune to evidence, so using it to change their minds is fruitless. I’ve never succeeded.

Sticking to straightforward common sense, I explain what these parents must do.

“Your family doctor is a menace. It doesn’t matter that you like him or that he agrees not to immunize your children.”

“He believes that immunization is good. Your research convinces you that he’s wrong, and you’re certain you’re preventing him from harming your child. But if this doctor believes one horribly wrong thing, there must be others. We use thousands of injectables, drugs, and procedures. There’s no way you can check them all out.”
“The only logical solution is to take your child to someone who will never do anything that might harm him. M.D.’s and osteopaths are hopeless. Even alternative schools – herbalists, naturopathy, acupuncture, chiropractic – do stuff. You should consider a psychic healer.”
In truth, I’ve never said this. I take care of the immediate problem and keep my mouth shut.

Friday, December 9, 2016

You Don't Want to Know


A doctor should wash his hands before examining you. If he doesn’t, do you remind him? I’m sure you don’t although popular health writers urge you.

A doctor in the office has seen someone who may be sicker than you before he arrives. You may not want to know this, but studies confirm that handwashing is rare.

I wouldn’t be writing this if I weren’t an exception. Ironically, before most visits I’m at home where no one is sick. My hands are less likely to transmit an infection, but I wash anyway.

In a hotel room, I have no high-tech office and subservient staff to proclaim my charisma. It’s all on me, so I wear a dark suit and tie, carry a traditional doctor’s bag, and maintain a quiet dignity. After interviewing the guest, I excuse myself to wash my hands.

I also wash before leaving. In this case, I’m looking out for myself. Perhaps half of sick hotel guests suffer upper respiratory or GI infections, and I don’t want to catch them. For the same reason, I ask the guest to open the door for me.

Monday, December 5, 2016

A Bright High School Student


The Kentucky legislature recently required doctors to pass a course in abusive pediatric head injuries. I’m licensed in Kentucky as well as California.

With an afternoon to spare, I found an approved course on the internet, paid $30, and spent an hour reading a mass of information on the causes, symptoms, treatment, prevention, and my legal obligations when I encounter babies with brain injuries from abuse. I can’t remember any, but doctors regularly miss them.

I couldn’t possibly recall more than a fraction of that material, but there would be mass confusion if too many doctors failed, so the test at the end was easy. I printed a certificate of completion and filed it in case the Medical Board checked. They do that but not very often.

California requires every physician to pass a course on domestic violence and another on care of the elderly. After finishing Kentucky's mandatory AIDS course, I discovered that the Board had cancelled the requirement.

Doctors grumble about activists who persuade states to add their favorite subject to the education hours that we must all fulfill. But no one has solved the problem of keeping us up-to-date. Ninety percent of problems a G.P. sees are easy. A bright high school student could handle them. The remaining ten percent require thought, but even if we mess up, most patients do OK over the short term. That’s why fakes with no medical training but a professional manner can practice for years before a disaster unmasks them.

Thursday, December 1, 2016

Drilling a Hole


A guest stubbed her toe.

Her big toenail turned black. This was a subungual hematoma: bleeding under the nail. If blood can’t escape, pressure builds, and it hurts.

The solution is to make a hole. Medical books have long told us to heat the end of a paper clip until it is red-hot and then burn through the nail.  

I don’t know about you, but I wouldn’t allow anyone near my flesh with a red-hot instrument. One can also dig with something sharp such as a scalpel. That takes work.

The solution is an electrical drill. One can buy one with a tiny bit, but I don’t see many subungual hematomas, so I borrow my wife’s. The smallest bit is 1/16th inch which is larger than necessary.

It’s a hefty instrument that makes a loud noise. Guests look uneasy when I approach, but the operation is painless, and when the breakthrough produces a spurt of blood, pain vanishes.

Sunday, November 27, 2016

How To Tell a Bad War Movie


It’s easy. Look for the gasoline bombs.

I reminded myself of this last week watching Hacksaw Ridge which received ecstatic reviews and tells a genuinely inspiring story but seems aimed at young adults. I found it too full of stereotypes but, far worse, historically inaccurate.

Everyone remembers the first twenty minutes of Saving Private Ryan because Steven Spielberg made an immense effort to get it right. Mel Gibson’s crew had other priorities in Hacksaw Ridge, most likely staying within budget.

World War II battles featured lots of explosives – shells, grenades, mortars, bombs. When explosives explode, debris and dirt fly into the air. Fire may appear later when flammable stuff burns, but explosives don’t produce flames. Special effects people can duplicate an explosion with explosives, but it’s tricky and expensive and probably dangerous.

Much easier is a gasoline bomb. Pour a little gasoline in a can. Allow the fumes to collect and ignite them with a spark. Poof!! A ball of flame. It doesn’t make much noise, but you can add that later.

A cheap battle scene features a crowd of soldiers running across a field of gasoline bombs. Flames shoot up everywhere. Some soldiers fall down. It looks spectacular. Teenage boys like that. 


Sorry.... Sometimes I get distracted from hotel doctoring.... 




Wednesday, November 23, 2016

Trying to Reach the Doctor


A flight attendant in Costa Mesa was suffering flu symptoms. The news arrived at 7:30 a.m. After writing down the information, I delivered my mantra to the dispatcher.

Costa Mesa is 45 miles away in Orange County. I can go but not during the freeway rush house. Was it OK with the patient if I arrived between 10 and 11? Usually it’s OK. If not, I suggest calling one of the Orange country doctors.  

The airline agency knows doctors in Orange County, but when its dispatcher calls one, she reaches voicemail or a receptionist or an answering service. She leaves a message and waits…and waits… You know how it is when you want to talk to your doctor.

I’m probably the only doctor in the world who answers his own phone. Harassed dispatchers from all my clients soon learn this, so they ask me to make housecalls throughout California.

Some destinations are too far. When they’re not, some agencies don’t want to pay extra. I don’t solicit distant hotels for the same reason. But the airline agency pays generously, so I go regularly to Orange County.

Saturday, November 19, 2016

Noise is Everywhere


“Could you please turn down the television?”

“Huh…?”

I repeated the question – not because the guest didn’t hear but because the request seemed to strike him as peculiar. He turned down the volume but not a great deal.

This happens routinely. Families from around the world check into a single hotel room, turn on the TV, and go about their business. Some watch, others ignore it. All would consider it rude to talk while I interview a patient but most make no move to the yammering television unless I mention it.

Tuesday, November 15, 2016

Going Blind


Late one evening, a guest called to say his son had gone blind. That was beyond my expertise, I explained, but the guest insisted on a housecall.

Sure enough, the son, age 18, seemed blind although my exam was otherwise normal. He seemed only mildly upset. A stroke affecting a tiny area of the optic nerve can cause blindness with no other symptoms, but this would be extremely odd. It could be psychosomatic, but it’s risky to jump to this conclusion, and the family insisted that nothing stressful was happening.

I sent them to an emergency room. The doctor found nothing abnormal and summoned an ophthalmologist who concluded that the blindness was psychosomatic. You’re probably wondering if he was right, but this is a real story. They checked out, and I never learned what happened. 

Friday, November 11, 2016

Temptation


“Could you check out my ankle? I don’t want to go to an emergency room.”

These are tempting calls. I could make the housecall, solemnly examine the painful, swollen ankle, express sympathy, wrap it in an Ace bandage (universally agreed to be not much use), and tell the guest to see a doctor if he’s not dramatically better in a day or two. Happy to avoid rushing to an emergency room, the guest would consider his money was well spent.

Of course, I could have told him this over the phone. If walking on an injured ankle is painful, it requires medical attention. But unless pain is unbearable or the skin is mangled, it’s not an emergency.  

Furthermore, the medical attention should be delivered by a doctor who knows ankles such as an orthopedist. Going to an emergency room is a bad idea. You’ll get an x-ray, a bill for around a thousand dollars, and advice to see a doctor if you’re not better in a day or two.

Monday, November 7, 2016

A Better Medicine


“My doctor gives me Bactrim to take whenever I get another infection, and I need more.”

Antibiotic requests are good news to some hotel doctors who know that, provided they go along, the guest will happily hand over the fee. An easy visit.

When I see these patients and do my best and don’t prescribe an antibiotic if they don’t need one (usually the case), most are grateful, but a minority aren’t. It’s not a small minority, and I hate driving off to what might be an unpleasant encounter.

Hearing this request I go into “no-housecall” mode, perhaps mentioning that the illness is self-limited and doesn’t require medical attention or directing the guest to an urgent-care clinic. I don’t want to see them.

But I gave this lady her Bactrim.

There is a single exception to the rule that healthy patients are wrong when they decide that they need an antibiotic: the common, uncomplicated urinary tract infection. In fact, it’s OK to prescribe over the phone. Scientific studies show that this works as well as an office visit.

Thursday, November 3, 2016

Better to Be Right Than Wrong


A guest told me she had a stomach virus, so I drove off in a relaxed mood. This is the second most common complaint that a hotel doctor sees and easy to deal with.

But it wasn’t easy. The guest was huddled on the bed, looking very ill. I could barely touch her abdomen. I wondered if she had acute pancreatitis or a gallstone.

The paramedics arrived and took her off.

When I called that evening, the husband answered. I learned that by the time the emergency room doctor saw her, she wasn’t feeling so bad. After several hours and many tests, he sent her out with a prescription and the diagnosis of a stomach virus. She was now better.

Naturally, I expressed pleasure at her recovery. He thanked me for my concern, but I admit to a touch of chagrin. A doctor must send a patient to an emergency long before he’s 100 percent certain there’s an emergency. Otherwise, he’d decide not to send some who needed to go: a much worse scenario. Still, it feels better to be right than wrong.  

Sunday, October 30, 2016

Fear


Leafing through mail revealed a letter from a law office. I broke into a sweat and then calmed myself. Malpractice suit announcements rarely arrive in ordinary US mail. Sure enough it was simple request for records. Someone was having trouble with an insurance company. I get these once or twice a year, and they never fail to upset me.

Whether they win or lose, sued doctors rarely pay a penny, but it’s a horrible experience which they all dread. Doctors worry if something is not going right – say a patient who should get well is not getting well or seems dissatisfied. We all want to do better, but never absent from a doctor’s thoughts is that he doesn’t want to be sued.

You may wonder about the odds that this will happen. The answer: a hundred percent. Five percent of American family doctors are sued each year. The highest risk specialties are neurosurgery and cardiac surgery: 19 per cent sued each year.

To make sure your doctor has never been sued, find one who has just entered practice. If you want to investigate, most states make it easy. You can look me up at the California Medical Board site by entering my name. Feel free to do so. I’m clean.

But state boards are not terribly efficient, and many have time limits – say ten years – after which they drop the information.

Every bad thing that’s happened to a doctor is in the National Practitioners Data Bank in Washington. Hospitals and clinics query it when they’re checking out a doctor. When they don’t, you often read the results on the front page. 

The NPDB is off limits to the general public. Activists yearn to change this, but every professional organization would fall upon any legislator who agreed.

Wednesday, October 26, 2016

Lost in Translation, Part 5


“My husband…  not good…”

“Tell me what’s happening.”

“….chest…. Not good.”

The desk clerk helped by repeating my words in a loud voice.

“She doesn’t speak much English,” he pointed out.

She wasn’t Hispanic, so there was no hotel employee to interpret. If she had travel insurance, someone at the agency office would help, but it was hopeless to ask about it.

“Would you like me to come to the hotel?”

“WOULD YOU LIKE THE DOCTOR TO COME TO THE HOTEL!!” 

She would. I then listened as the clerk informed everyone within shouting distance of my fee.

The scene in the room resembled absurdist theater. One guest made funny noises (?coughing). Another tapped various parts of the patient’s body. A third read from an English phrase-book (…“can you prescribe an appropriate medication…?”)

Everyone listened intently when I asked a question and then exchanged glances to see if anyone understood. Finally, all nodded agreement.

I’m exaggerating. Guests have simple problems, and there’s usually enough comprehension to get along. So far everything has worked out.

Saturday, October 22, 2016

A Critical Feature


The Airport Hilton has a long entrance drive that accommodates perhaps twenty parked cars without blocking traffic. Le Mondrian has a tiny drive that fits three or four.  

These are critical features in hotels without parking lots. Desk clerks always validate my parking lot ticket, but valet tickets are a crapshoot.

My tactic where I’m not known is to park as far from the entrance as possible, walk briskly up to a valet, hand him my key, announce “I’m the hotel doctor; they let me park,” and hurry into the hotel while he’s digesting the news. 

I look like a Hollywood B-movie doctor (elderly, grey beard, suit, black bag), but this does not impress valets who may run after me. If they try to hand me a parking slip I wave it off, sometimes successfully.

If I accept it, the valet is likely to drive my car off into the basement where it will take fifteen minutes to retrieve while I argue about paying. It’s a hard life.

Tuesday, October 18, 2016

Things Guests Ask For That I Can't Provide


“A shot to put her out.”

More than once I’m called when a guest suffers a tragic loss such as the death of a child or spouse. Distressed to witness the misery, family members want me to put her to sleep. This works in the movies, but in real life tranquilizers can’t do more than make someone drowsy. Only a general anesthesia produces sleep. No one except celebrity doctors uses it on a housecall, and you’ve read the headlines describing what sometimes happens.

“A note to change my flight.”

Now and then guests call after recovering from an illness and realizing that it’s expensive to replace a cancelled ticket. They offer to pay my fee if I’ll come and write a note, but I don’t like claim that a patient is sick if he isn’t. My tactic is to fax a note that tells the truth:  “Mr. Jones states that he was ill and unable to travel.” No one has complained, so it might work. 

“A placebo!”

No guest asks for a placebo. What they say is “You absolutely have to give something to make me better!”

In most areas of life, it’s important to tell people what you want, but it’s risky in a medical situation. Doctors want to do the right thing, but they also want you be happy with the encounter. Don’t tempt them.

Friday, October 14, 2016

The Sight of Blood


With one obvious exception, blood normally remains out of sight. Its appearance may not be ominous but always requires an explanation from someone with more experience than you. Here are some pearls.

Bleeding gums.  Asked for the cause, doctors think of leukemia and other sources of clotting deficiency. It’s true that if your blood clots poorly, this is often the first sign. However, the most common cause of bleeding gums is poor dental hygiene.

Coughing up blood. Anyone who reads the classics knows that this means you have tuberculosis. That’s rare these days. I’ve never seen it. Mostly it’s the result of an ordinary respiratory infection. Coughing up a few flecks of blood is usually not worth pursuing, but don’t make the decision on your own.

Blood in the stool. Accompanied by pain this usually means an anal fissure, a crack in the skin. Blood in the stool is one of the seven warning signs on cancer, but I encounter bowel cancer as often as tuberculosis. The blood I see is from a fissure, hemorrhoids, or colitis.

Vomiting blood is a serious matter and also urgent. I send guests to an emergency room although a few flecks may be the result of stomach irritation. When that happens, I may make a housecall, and sometimes what I see in the toilet is not blood. Again, don’t make the decision on your own.

What types of bleeding are always ominous?... That’s a question too depressing for this blog. Google it.   

Monday, October 10, 2016

Another Stoic


“She thinks her drink was spiked,” explained the caller whose friend was bent over the toilet.

I explained that alcohol is a toxic drug no less than aspirin or penicillin and occasionally provokes an oddball reaction. Common stomach viruses cause most vomiting. Did her friend want me to come?

“I’ll ask.”

I waited for a long time.

“She wants to know if we can buy a medicine.”

I said that there are no good over-the-counter antivomiting drugs, but most vomiting episodes don’t last long.

“I’ll tell her.”

I waited for a long time.

“Will you give her a shot to stop the vomiting?”

I explained that I carry antivomiting shots and antivomiting pills and that they work pretty well. It’s a bad idea for a doctor to make promises.

“Hold the line.”

I waited a long time.

“She wants to know what she can eat.”

“Nothing,” I said. She should suck on a piece of ice until she hasn’t vomited for a few hours.

By now I suspected that the guest was not inclined to spend money. This is common, especially in Americans. 

“Does she want me to come?” I asked.

After the usual wait, I learned that she planned to take my advice and call back if she needed assistance.   

Thursday, October 6, 2016

Waiting for the Other Shoe


I buy drugs and give them out gratis. Ten years ago generic Lomotil, the leading diarrhea remedy, jumped from about $20 per thousand to over $200. I switched to Imodium which is probably as good. It’s sold over the counter at Walmart. I buy a lot of drugs at Walmart.

In 2014, I wrote that I tried to reorder doxycycline, an old antibiotic that remains the best treatment for several common infections. My supplier’s web site quoted $1,600 for 500. I knew that was a typo because I’d paid $30 the year before. But it wasn’t. Fortunately, there’s another antibiotic that works well at only four times the old cost. 

Some of you are aware of the furor over the skyrocketing price of Epipen, a device that makes it easy to inject adrenalin during a severe allergy attack. Google it if you’re not. Read the justification from the company’s chief executive. Doesn’t it sound smarmy and dishonest? Don’t you hate her? Epipen is sold throughout the world at the old price, and the company does not complain that it’s losing money.

Congressional Republicans have joined Democrats in denouncing the increase. The furor will fade; the price will remain. Unique among western nations, American government agencies are forbidden from influencing drug prices, and no one to the right of Bernie Sanders is suggesting a change.

Several times a year a similar kerfuffle hits the headlines and runs its course, but I deal with it regularly. A year ago a bottle of my antibiotic ear drops went from about $8.00 to $300. So far antibiotic eye drops haven’t done the same, and experts say one can substitute them, but I’m waiting for the other shoe to drop.

Sunday, October 2, 2016

A Special Service


“Someone needs to check my nephew. He’s shaking and really upset. How quick can you be here?”

This was a bad call in many ways. I managed to learn that the child was in good health before a fire alarm roused everyone from bed at 11 p.m. He seemed to be frightened, perhaps more than usual. I had no doubt that he would recover, but that was hard to communicate.

I try not to make housecalls for anxiety attacks because many guests begin recovering while I’m on the freeway and cancel. Keeping the guest on the phone works better. After a half hour of to-and-fro and reassurance they admit they’re not feeling so bad.

This was one time that being reliable got me into trouble. The lady had called the front desk pleading for a doctor. Within seconds she was talking to a doctor. Weird!

She undoubtedly assumed that I was a special service provided by the hotel. Perhaps I was sitting by a phone in the lobby.

In any case, my efforts to keep her talking didn’t work. People are very protective of children. She insisted that a doctor must come. Reluctantly, I agreed. Then I had to mention something I never mention until it’s necessary. When I make a housecall, there’s a fee….. 

She was shocked. “I’m not going to pay that!” she said. “We’ll take him to the hospital!” She slammed down the phone.

This has happened before. I had to speak to her, not only to negotiate the fee but to assuage my fear that she would denounce me to the hotel. But the fire alarm was still in progress. She was not in her room, and it took fifteen minutes before the hotel could track her down. By that time she admitted that the child was feeling better.

Wednesday, September 28, 2016

Little Red Bumps


 “They’re little bumps all over… Sort of red.”

“Could you be more specific?”

“Little red bumps over my body… spots. Some are raised. They sort of itch…”

Americans, even with a college degree, are painfully inarticulate. Can you describe the face of someone familiar? Novelists do it all the time, but I bet you’d have trouble. Words like nodule, pustule, blister, wheal, plaque, ulcer, scale, and fissure are not obscure medical terms. Educated people know what they mean but can’t seem to use them.

If a caller said “I have dozens of one to three millimeter pustules surrounded by a red base, mostly on my back and chest, not so many on my arms and legs,” my diagnosis is “chicken pox.” But “red bumps” is the best many can do.

I’m happy to make diagnoses over the phone, and guests are eager not to pay for a visit. I have little trouble with respiratory infections and upset stomachs, but skin problems frustrate me.

“I worry about bedbugs. Do you think it’s bedbugs?”

“What do they look like?”

“Little red bumps….. Do you think it might be an allergy?”

“Could you be more specific?”

“Bumps…They’re raised, some of them, and they're red….”

Saturday, September 24, 2016

The Upside of Cheap Motels


Cheap motels have many advantages from a hotel doctor’s point of view.

Valets are absent, so I can park inside and safely ignore the threatening signs. Security is absent, so elevators respond to whatever floor I push, and I don’t have to explain myself to the front desk. Americans are absent because they can’t afford the fee. I love America but I also love foreign patients. They’re deferential, and they don’t sue.

On the downside, customer service declines with the price of the room. I often need to call in a prescription or consult with the insurance. When I pick up the hotel phone and punch “9” for an outside line, I may hear a busy signal because many hotels require a deposit before opening the phone. If I identify myself as a doctor, larger hotels open the line, but clerks in cheap hotels refuse unless the guest comes down and pays.

Insurers send me to hotels that don’t call, so I take the opportunity to introduce myself. In mainline hotels, staff remember their manners. They smile, listen intently as I make my pitch, agree that my service sounds wonderful, and thank me effusively for my business card. Then they probably forget about me. It’s rare to pick up business, but I always leave feeling good.  

In cheap motels, clerks don’t disguise their lack of interest. “Nobody gets sick,” they say.   

Tuesday, September 20, 2016

Lost in Translation Again


“Spik Spanish?”

Not a phrase I like to hear. Ninety percent of Latin American guests speak enough English to get along, and Hispanic hotel staff are usually available. Unfortunately, this visit occurred at a small Super 8, and the single employee on duty was American. Under these circumstances, I shake my head apologetically and proceed in English.

“Tell me what’s going on,” I asked.

As usual when something exotic like an American doctor appears, there was a substantial audience. Usually someone volunteers to interpret. Sure enough, a man stepped forward. He tapped patient’s abdomen and then whirled his finger around his mouth.

“Is she vomiting?” I asked.

Blank looks from everyone, a bad sign. I waited, hoping someone else would contribute, but the man merely repeated his gestures.

I phoned the insurance agency’s 800 number. Its employees are Hispanic and willing to interpret.

“Would you ask what’s bothering her and tell me what she says?” I said after explaining the situation.

I handed over the phone and the lady began a long monologue. When she finally handed back the phone, I listened to the insurance clerk. “She is sick from eating. She give medicine from Argentina, but it does not help. She wants a medicine to help.”

That was too little information. I tried to be specific. “Would you ask what are her symptoms?”

Another long conversation followed by a short, unsatisfactory translation. Eventually I learned enough to thank the clerk, adding that I would examine the patient and then call back for more interpreting.

At the end I gave instructions and medication, and everyone seemed happy. I always leave with the uneasy feeling that the interpreter has left out a great deal. Fortunately the ailments I encounter are usually easy, and the occasional exception is obvious.  

Friday, September 16, 2016

Almost Stiffed


“This is one time the hotel will not be able to charge the bill,” reported the manager one evening when he called about a Middle-Eastern family.

Since I usually collect from the guest, I assured him that that was not a problem.

He connected me to the room where I spoke to someone whose English was not good. The speaker or perhaps someone else had an allergy or maybe a rash that needed a cream. Did I know the proper cream?.... After much to and fro they decided I should come at 11 a.m. the following day.

The guest who answered the door showed me a rash on her neck. It was a simple contact dermatitis. I explained and handed her a tube of cortisone cream. That, of course, was the easy part.

The room was a luxurious suite. The patient was Philippine, so I knew she was a servant. It was disturbing to notice that she was alone. I suspected she did not expect to pay; sure enough, she looked puzzled when I presented my invoice and more puzzled when I explained that the hotel would not pay.

I passed an uncomfortable ten minutes as she noodled with her cell phone, trying to reach her employers. Had they deliberately absented themselves to avoid paying? It might not have been deliberate; sometimes extremely rich people never concern themselves with paying for stuff because it’s always taken care of.

She asked if she could call the hotel. I shrugged, resigned to being stiffed. But it turned out the current manager had no objection to charging the bill.

Monday, September 12, 2016

Worry


A worried mother phoned, asking me to see her two year-old who had a fever of 101.

I’d seen the child two days earlier. He had a 101 fever but was not particularly sick, and my exam was normal. I diagnosed a virus, handed over a bottle of Tylenol, and told the mother he might feel under the weather for two or three or four days.

Patients often call after a few days to tell me the illness hasn’t gone away. Sometimes they report a new symptom that gives me pause, but mostly nothing has changed. That was the case this time, so I reassured the mother. Another housecall wasn’t necessary.

People rarely argue with a doctor, so the mother did not disagree with my reassurance. But worry is contagious. No one is perfect, and there was a tiny chance that something terrible was brewing up.

I could have relieved my mind by sending them to a clinic. The doctor would find nothing and reassure the mother. If something terrible happened later, he was the last doctor she had seen, and I would be off the hook. But I didn’t do that, so I worried.

Thursday, September 8, 2016

Unsafe


A young man stood blocking the door.

“I want to see your license,” he said.

I showed him. He examined it suspiciously and didn’t move.

“Get out of the way!” said a voice inside. 

Reluctantly, he let me pass. I approached the patient, apparently the man’s girl friend, who had phoned me because of an earache. As she described her problem, he glowered from the doorway.

“I don’t think you’re a doctor,” he said, interrupting. “Where’s your white coat?”

“Shut up, asshole!” she shouted before turning back to me. “He’s being a jerk. He’s probably a little high. Don’t worry.”  

“You should leave,” he said a few minutes later. Approaching, he delivered a gentle shove to my shoulder. The girl friend cursed and pushed him violently.

“Sorry, but I’m not feeling safe here,” I said. I walked out and went down to the lobby. The woman appeared a minute later, full of apologies, and we finished the consultation.