Saturday, July 30, 2016

An Easy Visit

A young woman suffered an episode of dizziness earlier that day. By the time I arrived, she had recovered. The examination was normal, and I reassured her. 

Any sudden episode in a young, healthy person (dizziness, chest pain, shortness of breath, even fainting) is probably benign and not worth intensive investigation unless it keeps happening. We take these more seriously in the elderly.

Some guests are sicker than others, but I have a soft spot for guests who are not sick at all. 

Tuesday, July 26, 2016

Bedbug Calls

“All insect bites look the same,” I explained.

Bedbug calls are tricky. Victims are often unwilling to pay. When, confronted by an angry guest, hotels ask my help and offer to pay the fee, I come but refuse to take their money. The hotel will probably comp the guest’s room, and I don’t want to add to their expense and hassle. Also, since a bedbug call involves management, it’s excellent P.R.

Naturally, I hope that a grateful hotel will remember. This doesn’t always work, but I drove off in a good mood. I love nearby hotels, and the Westwood Comstock, which rarely calls, is three miles away. It’s also very exclusive, and my left-wing politics does not diminish the pleasure of caring for hotel guests with plenty of money.

The patient turned out to be more distressed than angry. Sometime guests show me a rash that is obviously not insect bites. Sometimes I see bites confined to the legs, meaning the guest acquired them while erect, perhaps at the beach. There were many bites on her upper body, so I couldn’t deny the possibility of bedbugs.

I delivered my opinion and handed over a free tube of cortisone cream and my business card. Everyone seemed pleased including the general manager who thanked me for my quick response. Now I must wait.

Friday, July 22, 2016

Departing From Your Routine

Twenty years ago I drove thirty-five miles to Pasadena to see a patient. When I opened the trunk to get my bag, it wasn’t there. I had left it at home. I drove back to retrieve it.

I mention this because last week I made a visit to the Hyatt Regency in Long Beach, thirty-five miles away. I had my bag, but when I consulted my invoice while waiting for the elevator, there was no room number. 

I recalled how it happened. I had never been to that Hyatt Regency, so I had stopped filling out the invoice at home to look up its address on the internet. I found it, copied it down, and forgot to add the room number from my telephone notepad. Departing from your routine is always perilous.

Worse, the patient was a woman. In our sexist society, when a couple checks in, it’s the man whose name goes in the register – and couples sometimes don’t share a last name. That was the case this time as I listened with a sinking heart as the desk clerk assured me that the guest list contained no such person.

Monday, July 18, 2016

The Wrong Way To Do It

“My son has a boil on his leg. Our doctor says he needs an antibiotic.  Could you come to the hotel and give the prescription?”

A boil is collection dead tissue, full of pus and germs. It has no blood supply, so an antibiotic can’t reach it. Antibiotics alone don’t cure boils.

Left alone, boils eventually go away, so victims who use one of the innumerable silly home remedies from the internet will give it credit. Allowing nature to heal is commendable but may require few weeks of misery.

Unnatural healing works instantly. The doctor cuts into the boil, squeezes out the pus, washes the cavity with saline, and then stuffs a strip of sterile cloth into the hole. A few days later, he or she pulls out the strip.

I don’t drain boils in a hotel room, so I had to decide where to send the guest. At an emergency room, the doctor would certainly do the surgery, but an emergency room is a tiresome experience.

A local walk-in clinic would be more civilized. The downside is that the doctor in a walk-in clinic would have a background similar to mine but probably without my vast experience and wisdom.

I sent the boy to a walk-in clinic where the doctor punctured the boil and sent them away with an antibiotic. The puncture might seal and the boil recur (that’s the purpose of packing it with the cloth). Or it might ooze for weeks before resolving. I wish the doctor had done it the right way, but the boil would eventually heal.

Thursday, July 14, 2016

Failures in Communication, Part 3

After a forty minute drive, I arrived at 4020 Los Feliz Blvd. No one answered my knock. Thinking the patient might have stepped out, I took a walk around the neighborhood and knocked again and also phoned to no avail. I returned home in a good mood. It was an insurance call, so I’d be paid.

Another call arrived at 5 p.m. I dislike driving during the rush hour, but the patient lived near Beverly Hills only five miles distant. The address was 821 Coldwater Canyon Drive, but I discovered that Coldwater Canyon addresses begin with 900. I continued north, assuming the numbers would drop when Beverly Hills became Los Angeles, but they kept getting higher.

Coldwater Canyon is a not-so-secret alternative to the freeway into the San Fernando Valley, so it’s bumper-to-bumper during the rush hour. Finally, I gave up, pulled into a side street, and phoned the patient. It’s not 821, he said, but 1821. The dispatcher had told me wrong or perhaps I had heard wrong.

That evening an insurer called to ask me to return to the Los Feliz patient. Insurers usually refuse to authorize a second visit to a no-show, but I was happy to go. The dispatcher repeated the address: 1420. Whoops. Whose mistake was that?....

Sunday, July 10, 2016

The Easiest Part of Medical Care

The phone rang at midnight for a housecall in Long Beach, 35 miles away. So far, so good. Freeways were clear, and the caller was a reliable travel insurer who agreed to my fee. Good.

The patient was young and suffering a fever. That sounded easy. The patient was a student at California State University, Long Beach. Uh oh.

Navigating a college campus is a nightmare. The address of a university is the administration building where no one lives. College buildings have names or numbers, but they follow their own logic.

The patients are foreign, unfamiliar with the geography, and unhelpful. Finally, campus police may be slow responding to rape and burglary, but they pounce fiercely on an illegally parked car. You don’t want to park inside a college campus without a permit.

Taking no chances, I parked on Bellflower Boulevard outside the entrance and walked far across the campus to the dormitories and International House where I assumed he was staying. As I approached, I saw that the barrier to the lot next to the building was raised, and I could have parked. C’est la vie. As usual, delivering medical care was the easiest part.

Wednesday, July 6, 2016

Do You Accept My Insurance, Part 2

“I can’t afford that,” wailed the guest, an Australian newlywed at the Biltmore when she learned my fee. She had travel insurance, and I had told her it would undoubtedly pay when she submitted my invoice. But unsophisticated travelers who have never used insurance or asked for a housecall often panic.

I lowered the fee to $250. She consulted her husband who countered with $150.  

Since it was 11 p.m. the drive downtown was easy. When the husband ushered me in, I discovered they were staying in a large, two-room suite. The Biltmore charges well over $300 per night for suites.

But they were young, and I didn’t know their story. I did my duty and pocketed his $150. I was not disturbed and had material for a blog post.

Saturday, July 2, 2016

Do You Accept My Insurance?

That’s the most stressful sentence a hotel doctor hears – more than “I’m having chest pain” or “my mother stopped breathing.”

American insurers look with deep suspicion on housecalls, and no hotel doctor wants to bill them. But almost no American has experience handing money directly to a doctor – and a housecall costs a good deal more than an office visit. Many of these guests agree to pay, but I often sense their discomfort. Other doctors are not so picky, but if they sound too reluctant I inform them of local walk-in clinics.

Foreign insurers are different. Many call me directly. Resigned to our rapacious medical system, they expect immense bills. I charge everyone the same, but I’ve been contacted by doctor-entrepreneurs who offer triple my usual fee to make their hotel calls in Los Angeles. They can afford this, they assure me, because they charge several thousand dollars for a housecall. This sounds creepy, but it apparently works because I’ve heard from these doctors more than once.