Friday, January 29, 2016

Be Careful What You Ask For

He had been coughing for several days, a guest explained, adding that he probably needed a Z-pak. When a patient suggests he needs an antibiotic, a doctor feels one of two emotions.

(1) Pleasure because this guarantees an easy visit. Give the antibiotic, and the patient will make it clear that the doctor has done what a good doctor does. I doubt most of you realize the importance of your gratitude. No matter how you try to conceal it, if you’re disappointed, we feel depressed.

(2) Depression. In an otherwise healthy person, the only common illness with a cough that antibiotics cure is bacterial pneumonia which is not common. All others are viral infections. These affect fifteen percent of everyone who consults a doctor, so they are no trivial matter.

Over the phone, I quizzed him about his symptoms and then explained that he was suffering a self-limited illness requiring only over-the-counter remedies. When he insisted that he needed a doctor, I directed him to a nearby urgent care clinic where he would get his antibiotic.

Monday, January 25, 2016

How Doctor Oppenheim Met His Wife

In 1975 I and a friend were fresh out of internship. He had a job at a Los Angeles clinic that remained open during the weekend. Few patients came, so I often visited, and we sat talking. The only other employee, a nurse – really a young woman who wore a white coat and acted as receptionist -- joined us. After a few visits I got up the nerve to ask her on a date.

She was committed, she explained. But she worked at the Woman’s Building, a flourishing feminist arts center. She offered to give me some phone numbers.

I declined. I was too shy to call women I didn’t know.

“Then what’s the solution?” she asked.

“Maybe they could call me.” I meant this as a joke and forgot about it until a week later when a woman phoned. I did my duty by asking her to dinner, and it proved an excellent decision.

There is more to it. It turns out that she and the nurse were candidates for a college art teaching position in Oakland. Both flew up for an interview. My future wife later learned that the nurse had already sewn up the job, so there was no point in the interview. During the plane ride, she had given me an enthusiastic recommendation, perhaps as a consolation prize. 

When we discussed how our lives and the nurse’s had progressed over the years, we agreed that my wife had gotten the better deal. 

Thursday, January 21, 2016

A Dog-Eat-Dog Business, Part 11

“This is Doctor Oppenheim,” I repeated several times before hanging up. Caller ID identified the Doubletree in Santa Monica, so I phoned to ask if someone had requested a doctor. Someone had.

“You answered, but you couldn’t hear me,” said the guest. “So I called the front desk again, and they gave me a different number. Another doctor is coming.”

That was upsetting because the Doubletree is one of my regulars. When asked, the guest gave me the 800 number of Hotel Doctors International, a service based in Miami.

“How much are they charging?” I asked.

“I don’t know. They just asked if I had insurance.”

That was a red flag. Many hotel doctors charge spectacular fees – and then assure guests that travel insurance will reimburse them. This rarely works with Americans, but foreigners make up half of our business including mine. Helpless and ill, forewarned of our rapacious medical system, they rarely make a fuss.

I told the guest that my fee was $250 and that he should call the agency and ask what it charged. It turned out to be $650 (far from the largest I’ve heard), so I made the housecall.

Afterward, standing on tiptoes to peer over the front desk, I saw the colorful business card of Hotel Doctors International stuck on the counter. The clerk, who had insisted that mine was the only number she knew, expressed surprise when I pointed it out.  

Sunday, January 17, 2016

All In a Day's Work

“She speaks Spanish. I’m not sure what’s going on, but she wants a doctor.”

The caller was the night manager at the Torrance Marriott. The hotel rarely calls, but I go regularly for crew of LAN, Chilean Airlines. An LAN crewperson who falls ill is supposed to call her supervisor who calls the central office who calls Federal Assist, a travel insurer, who calls Inn House Doctor, a national housecall agency who calls its answering service who then calls me. The guest hadn’t followed the procedure. If I made a housecall at her request, getting paid would be a major hassle.

I phoned the answering service which had no idea what do. I phoned Federal Assist who insisted it wasn’t responsible for arranging visits, but a dispatcher finally agreed to call the guest. I phoned the director of Inn House Doctor to alert him to the problem. Then I waited.

It was 6 a.m. It’s dangerous to make these housecalls before official approval because it may never arrive. But the rush hour was about to begin, and I couldn’t resist. I jumped in my car and drove twenty miles to the Marriott. The freeway moved smoothly, but two blocks before the hotel, barriers and police cars blocked traffic. A dead body had been found on the street. That I was a doctor making a housecall did not persuade the guard. No cars could pass.        

I parked and walked toward the hotel. A policeman hurried over as I passed the barrier, but he accepted my explanation and escorted me past the tent concealing the body.

The visit was easy, and official approval arrived while I was in the room. When I finished at 7:30, my sigalert revealed a solid red line of jammed freeway for my return. But I was in luck. I had been awake since 2 a.m. making the visit described in my last post on January 13.  So I returned to my car, tilted the seat back, and went to sleep.

Wednesday, January 13, 2016

Good News. Or Maybe Not.

2 a.m. calls rarely thrill me, but this was from the Beverly West, a boutique hotel that never calls. Happily, I threw on my suit and drove off. Traffic was light. Parking was easy.

Afterward I introduced myself to the desk clerk.

“I remember you from the Beverly Garland,” he said. “I’ve only been here two months.”

It’s flattering that employees continue to call when they change hotels, but it also meant that the Beverly West was probably not switching doctors.

“So you got my number from the Beverly Garland?”

He shook his head. “You’re on the computer. I picked you because the name was familiar.”

That was good news. Sort of. I’m probably on every hotel’s computer.

As the wee-hour desk clerk, he had little contact with veteran employees, but they would soon clue him in. After caring for a guest, the Beverly West’s regular doctor gives a “referral fee” to the employee that called. This is illegal but a hotel doctor tradition as well as a superb marketing tool.  

Saturday, January 9, 2016

Not Again!!!

“I have the European plague. I need a doctor.”

“Excuse me?...”

“I have the European plague. I need a doctor for the American plague.”

“I’m not sure what you mean. What’s the American plague?”

“My child is in the bathroom with the European plague. Can you bring the doctor for the American?”

What was he talking about?.... The exchange continued for some time until the light dawned. This was the fourth occasion this has happened in over thirty years and 30,000 phone calls. The guest had phoned the front desk because his electrical devices used European outlets which are different from ours. He needed an “adaptor.” The clerk, not listening carefully, had heard “a doctor” and forwarded his call to me.

But I was also not listening carefully. It’s human nature to hear what you expect to hear, so I assumed that the caller had a medical problem.

I had heard “European plague” when he had said “European plug.” He had not said “my child is in the bathroom” but “my shaver is in the bathroom….”

Tuesday, January 5, 2016

Another Christmas Rush

At 5:20 a.m., a national housecall service connected me with a guest at the Montage in Beverly Hills. She was suffering the flu; I told her I’d arrive in half an hour.

As soon as I hung up, I realized, to my dismay, that I had quoted my usual fee, forgetting that the call originated with the housecall service which takes a 40 percent cut. The Montage is a super-luxury hotel, and the guest was probably rich, but I couldn’t change the fee.

I was in luck. Not one but three guests in the room had the flu, so it worked out.

That day I had an appointment to service my car. At 9 o’clock, as I and my wife were about to leave, a hotel phoned. Before I could talk to the guest, call-waiting signaled another. I told the second guest I’d call back and then spoke to the first guest who had thrown out his back. That’s an easy visit, but I was feeling harassed, so I persuaded him to try pain medicines and wait for a day. I phoned the second guest but got voicemail. After several calls, I learned that the guest was taking care of business and would get in touch later.

Waiting at the dealership, I answered his call. My wife then drove me to Le Parc hotel in West Hollywood. My wife does not enjoy chauffeuring me on housecalls, so afterward I suggested lunch at her favorite Japanese restaurant. Japanese cuisine is not one of my favorites, so we don’t do this often. We planned to see a movie at a theater a few door away. Sadly, my phone rang as we were eating. Afterward, she ferried me nine miles through city streets to a downtown hotel.

During the long drive back, I phoned the dealership several times, but my car was not ready until half an hour after we reached home.

After retrieving it, we stopped off for groceries and then made dinner during which a call arrived from the Shangri-la in Santa Monica five miles away. I avoid driving during the rush hour, but Santa Monica is near enough to be an exception. The freeway was “could-be-worse” but street traffic was slow, made slower by construction for the new rail line.

It’s been months since I saw six hotel guests in one day. Once work was done, I felt pleased with myself and hoped this was a trend. That was December 29; on December 30 no calls arrived.   

Friday, January 1, 2016

Vomiters Hate To Wait

As I was driving, a guest phoned to ask when I’d arrive.

“In about fifteen minutes.”

On her initial call, I had told her I would arrive in forty-five minutes, and I was on schedule, so the call meant that she was still vomiting. Vomiters are impatient.

My database shows 2,328 entries for “gastroenteritis” (the common stomach flu). It’s my second leading diagnosis and far more satisfying than “upper respiratory infection” (4,584). Both are almost always incurable, but gastroenteritis rarely lasts more than a day; patients give me credit when it goes away and rarely quarrel with my treatment.

For common illnesses, every doctor has a routine. He asks the same questions, delivers the same advice, often word for word, and prescribes the same treatment. Provided he stays alert for hints that something different is happening, everyone is satisfied.

The guest greeted me at the door, a good sign. A guest in bed is OK, sprawled on the bathroom floor is not good.

I asked the usual questions and did not interrupt as she delivered a precise, item by item, account of dinner. Everyone blames an upset stomach on their last meal, a belief as correct as most popular health beliefs. I gave the usual advice which included telling her to stop what she was doing (putting fluid into her stomach as fast as it came out) and to suck on ice and wait.

I gave the usual antivomiting injection and two packets of pills which I had pocketed before leaving so I wouldn’t have to remember to restock my bag.

When I phoned later, she had recovered and expressed gratitude that I had cured her.