Tuesday, September 19, 2017

My Norwegians

Oil gives Norway the world’s highest standard of living because, unlike oil-rich countries in Africa and the middle-east, Norway has an honest government. Besides putting away money for the future, it invests heavily in infrastructure and services such as universal free medical care and college education. Many Americans consider such government programs soul-destroying, but Norwegians tolerate them pretty well.

A  Norwegian tour arrived in the city last year, and I cared for four members. Thanks to a good education, all spoke English.

They were guests at the Hollywood Heights hotel in my least favorite part of Los Angeles. Despite our legendary freeways, none reach from my neighborhood to Hollywood, so I drove nine miles through the city. Planned in the 1960s, the Beverly Hills freeway would have solved my problem, but it vanished from maps when the city insisted it be built underground, an excellent idea.

The first Norwegian suffered a urine infection, common and easy to treat. The second had a hacking cough, present several days, which tormented three roommates almost as much as the patient. I handed over cough medicine. The third had been vomiting. Everyone with an upset stomach blames their last meal, so I listened to a recital of everything he’d eaten. I gave medicine and told him he’d be better in a few hours.

The last had been to Universal Studios and thought she had sunstroke. Sunstroke is life-threatening, but there are lesser sun-related conditions, none of which she had. She did not even have the painful sunburn that northern Europeans acquire almost as soon as they get off the plane. Universal City is in an area hotter than Los Angeles proper, but weather hadn’t been abnormally hot.

Hearing my reassurance, she admitted that her nausea and anxiety may have represented a mild panic attack. She suffered them regularly. This one seemed to be receding…. The story continues in my next post.

Friday, September 15, 2017

Oppenheim's Rule

Less in high school, more in college, and even more in medical school, students agonized before a test, suffering during, and grumbled afterward about how badly they did.

At some point in life, I had an epiphany. It occurred to me that I was smarter than most people. If a test seemed hard to me, it was certainly harder for everyone else. So I would do fine. When I decided to think this way, a great weight lifted from my shoulders, and I stopped worrying about exams.

As a certified family practitioner, I must take a test every six years to keep my certification. With no office practice, I can’t take the shorter test given to colleagues. It takes three hours; later someone visits the office to evaluate their charts. I must take the same day-long written exam given residents fresh out of training.  It includes subjects I’ve long forgotten such as obstetrics and surgery, so I spend a lot of time guessing. But I did fine in exams I took at the age of 39, 45, 51, and 57. By the time I was 63, the questions seemed harder, and I was guessing more often. For weeks afterward I broke my rule and worried. Failure would be humiliating. Also, I’d have to pay $800 to take the test again. But the rule held. I passed.

Monday, September 11, 2017

Wee Hour Gridlock

The phone woke me at 11:30. A lady at a downtown hotel was suffering an allergic reaction. This was not bad news; downtown is not too far, I charge extra for calls that get me out of bed, freeway traffic is light, and I can sleep late. I wrote down the information and dressed.

Traffic was minimal, but as I approached the freeway interchange leading to downtown, a line of traffic cones forced me to the outside lane. The ramp heading north was closed. The highway department schedules inconvenient maintenance for the wee hours, and I occasionally encounter these obstructions. No problem, I thought. I continued on to the next exit and re-entered the freeway to retrace my route. Cones appeared, so the other north ramp was also blocked. By the time I learned this, I was forced onto the freeway heading south. Again I left at the first exit only to discover no on-ramp in the opposite direction.

Fortunately, there was Figueroa, the main street through downtown, so I decided to follow it. That turned out to be everyone’s idea, so I joined a gridlock that crept north.

I apologized for arriving an hour late, and the patient was too polite to express skepticism that heavy traffic at 1 a.m. was responsible.

Thursday, September 7, 2017

The Pleasures of the Beverly Hills Hotel

My September 3 post brings back memories of the Beverly Hills Hotel.

I love it. The hotel sits in a residential area of a city with benign parking laws, so I can leave my car on adjacent Crescent Drive. Because management ignores the tiresome obsession with security, even during the wee hours, I walk to the nearest door and never find it locked. I’ve made 135 visits.

I’m not the only doctor who loves the Beverly Hills Hotel. Although the oldest (built in 1912), later arrivals – Bel Air, Peninsula, Sofitel, and L’Hermitage share its reputation for opulence and expensiveness. However, something about it attracts the fawning attention of doctors, including those who don’t serve hotels.

I’ve never met the general manager. He has the authority to designate a hotel doctor, but GMs tend to leave that decision to guest service personnel. That works out fine for me – over the long term. Over the short term, aggressive doctors exert their charms. I’ve acquired and lost the Beverly Hills Hotel four times.

For an exciting year during the eighties, it called, and I visited Leonard Bernstein twice (I can mention his name because he’s dead). Then calls ceased. They resumed several years later before stopping again; this was probably the work of the unhappy celebrity whose visit I may have mentioned earlier. The hotel closed for renovations in 1994, reopening a year later with concierges who knew me from previous jobs -- always a good sign. Sure enough, calls began arriving. By this time, Doctor Lusman was on the scene (google “Jules Lusman”; you won’t regret it). He took over until he lost his license in 2002.

All luxury hotels call now and then, and a few call regularly, but I lack the key to winning their ongoing loyalty. This might involve something as straightforward as charming the general manager or as devious as money changing hands. I don’t know.

Sunday, September 3, 2017

An Encounter at the Beverly Hills Hotel

In 1995, a man wearing only pajama bottoms dashed into the lobby of the Beverly Hills Hotel as I stood at the concierge’s desk.

“Don’t pay him!” he screamed.

Without lowering his voice, he denounced my competence and asserted that, once he informed the general manager, I would never again enter the Beverly Hills Hotel.

He had consulted me for a painful anal condition. I didn’t find anything wrong but gave some suppositories from my bag. He showed no interest in suggestions for sitz-baths and stool softeners, finally interrupting to declare that he needed substantial pain relief, preferably by injection. He heard my explanation for declining in sullen silence.

I left the room without the usual pleasantries and made a beeline for the concierge but not to get paid. I never ask for money after a visit turns out badly. If the guest isn’t planning to complain, the sight of my charge on the bill might change his mind. In these situations I try to neutralize damage by warning that I’d seen a guest who might cause difficulties. I had barely begun when the man’s entrance made this superfluous.

I kept quiet, and he eventually ran out of gas and stalked off. To my relief, several amused employees urged me not to worry. This guest was well known to them. 

Wednesday, August 30, 2017

Flying and Blood Clots

I hear from travelers who notice puffy legs after a long flight. Some worry about a blood clot, but this almost never causes both legs to swell.

Your heart has no trouble pushing blood to the far end of your body but plays no role afterwards. Blood returns to the heart slowly, squeezed along by surrounding muscles. If you don’t move, it returns even more slowly. In the absence of movement, gravity induces blood to settle in the legs where plasma leaks through the distended veins into surrounding tissue. You can make the diagnosis if pressing a finger makes a visible dent. Veins grow leakier with age, but I see plenty of guests in the prime of life. The swelling should diminish after you begin moving or eliminate the effect of gravity. A night in bed usually helps.

Textbooks list dozens of serious causes “peripheral edema.” I can’t recall a hotel guest who had one, but it’s possible that a traveler with swollen legs may learn that he has heart, kidney, or liver disease and remember that I downplayed its seriousness.

So, my legal advisor insists I warn you not to feel reassured by what I’ve written. It’s just my opinion; you might be dangerously ill. Consult your family physician. Go to an urgent care clinic. Call the hotel doctor.

Saturday, August 26, 2017

The Celebrity B12 Franchise

Many singers and celebrities insist on a vitamin injection before a performance. That vitamin is almost always B12 because of (don’t jump to conclusions…) its color. Most drugs resemble water, but B12 is vivid red. Since everyone knows that injections trump pills, the same reasoning suggests that a brightly colored injection works even better.

My B12 experience impresses me with how closely celebrities resemble royalty. Arriving, I approach in stages – passing through rooms containing bodyguards, groupies, publicists, media, dressers. When I finally reach the room containing the celebrity and his intimates, he turns and drops his pants (women hold out an arm). I give the injection and depart. No one makes a move to pay, but I can expect a lesser person to come forward as I retrace my steps.

These requests don’t arrive often, so I wonder who owns the franchise on celebrity B12 shots in Los Angeles. It’s a gold mine. I also carry a vial of B complex – half a dozen B vitamins not including B12. It’s colorless, and I can’t remember anyone requesting it.

Tuesday, August 22, 2017

The Proper Role of Women Doctors

I was a medical student at NYU shortly after New York became the first state to legalize abortions in 1970. The big change, from a student’s point of view, was that deliveries at Bellevue plummeted. To ensure that we received training in obstetrics, NYU began sending us to Booth Memorial Hospital in Queens which served a middle-class population who wanted children. It was much nicer than Bellevue and the staff obstetricians were congenial.

During NYU’s obstetric rotation, students divided up into teams; mine consisted of me and two women.

One evening after midnight at Booth Memorial we were waiting for a delivery when the legendary Doctor Epstein arrived, an elderly obstetrician with an immense practice who had graduated medical school in 1928. With time on his hands, he gave my companions career advice.

They shouldn’t go into surgery, he warned. Surgeons must stand for hours. Being prone to varicose veins, women cannot tolerate that. He suggested anesthesiology because it’s so boring. Women are better at boring stuff. Since women have a natural love of children they couldn’t go wrong with pediatrics or child psychiatry.

This being a prefeminist era, the women were more amused than offended. But both went into pediatrics.       

Friday, August 18, 2017

A Few Celebrities

A famous actor at the Four Seasons showed me a pimple on his eyelid. This was a sty, I explained, a blocked gland. It wasn’t serious. There was no treatment except hot compresses. It would go away in a week or so.

He needed it to go quickly, he said. He had a television interview the following day. A previous doctor had stuck a needle into an earlier sty, and he’d be grateful if I did the same. He endured it stoically.

“You wouldn’t have any Oxycontin?” asked a guest. He was consulting me for a rash.

“I’m the doctor you call when you feel sick,” I said. “For Oxycontin you need a different sort of doctor.”

We parted on good terms. My refusal did not offend him; from his point of view there was no harm in making the request.

It’s wrong to divide celebrities into upstanding citizens and the drug-addled exceptions. They are a cross-section. Many work hard at their careers but enjoy the occasional drug if it’s available, and they move in circles where scoring requires only a modest effort. Wrecking your life with drugs, as with alcohol, takes persistence.  

Monday, August 14, 2017

Flying and Your Ears

Flying doesn’t cause ear infections, but getting on a plane if you’re stuffy can end painfully. My records show only a few dozen visits for ear pain because I handle most over the phone. If a guest felt fine before boarding, pain that begins afterward generally disappears after a few days, but it’s an unpleasant experience.

Before beginning this entry, I googled “ear pain on flying.” Internet medical advice is unreliable, and even reputable sites such as the Mayo Clinic and WebMD solemnly recommend feeble preventatives such as antihistamines and drinking fluids plus dangerous ones such pinching your nose and blowing (they warn you to do it “gently”). All deliver traditional advice: chew gum, suck on hard candy, yawn frequently, take oral decongestants. Traditional advice sometimes works but never dramatically.

The best preventative is a straightforward, chemical nasal spray (Afrin, Dristan, Sinex). When you’re sitting the plane before takeoff, spray, wait five minutes for it to work, and spray again. That sends the spray far up your nose to, hopefully, reach the eustachian tube opening, the only connection between your middle ear and the outside world. If the flight lasts more than a few hours, do the same before the plane begins its descent, an hour before landing. I give the same advice when guests call afterward. It’s not as effective then, but waiting works.

Thursday, August 10, 2017

Doctor Oppenheim's Screenplay

During the 1990s, I was called to the Bel Air hotel to care for a screenwriter working for Francis Ford Coppola. Chatting before I left, I revealed that I was a full-time hotel doctor.

“I bet you have great stories,” he said.

“Well…. As a matter of fact…”

At his urging, I mailed him a screenplay.

Does this surprise you? I work in Los Angeles. Why shouldn’t I write screenplays? Everyone else does.

I was reminded of this incident because my mail recently included a short story I’d submitted to the New Yorker. Across the inevitable rejection slip was a handwritten scrawl “great read but not quite...” That produced a surge of pleasure, but there is less there than meets the eye. Although the preprinted rejection is signed “the editors,” no New Yorker editor reads stories as they pour in, thousands per month. All are screened by low paid young English majors, happy to be on the first rung of the journalism ladder. They pass a minuscule handful on to editors who choose one or two for each issue.

I’m proud to have caught the eye of an overworked reader at America’s premier market for short stories, but there is no telling who will read my next submission. Even if it were the same person, she would not remember me, having read hundreds in the interval. Nevertheless, that rejection marks the highlight of my literary career since 2010. The highlight that year was an actual publication, but it was in the Wisconsin Literary Review. You won’t find it on the newsstand.

Everyone who learns I’m a hotel doctor urges me to write my memoirs, so I wrote them. I wrote a novel about a hotel doctor. I even wrote a proposal for a TV pilot featuring a Los Angeles hotel doctor. All those are, as we say in the business, making the rounds. The TV hotel doctor is not entirely based on me because, among his amusing quirks, he cannot resist extolling his screenplays to sick celebrities. I never do that. The writer mentioned above took the lead.

You may be curious for the upshot. He never replied.  

Sunday, August 6, 2017

The Law

A Finnish man with a fever was staying in a Hollywood Hotel. Treating flu symptoms is rarely satisfying, but I was pleased to learn that he was taking nothing for the fever. I handed over some Tylenol, and when I called back that evening he felt better. 

The following day was July 4. Hotel doctors look forward to holidays because freeway traffic is lighter. Sadly, no calls arrived. None arrived the day following or the day after that.

Deep down, no one believes in the law of averages. If you flip a coin heads ten times in a row, that’s not a fluke but as likely as any other combination. And the odds that the next flip will be heads remains fifty/fifty. It’s guaranteed that someone will win the lottery, but the winner always credits God. After several days with a silent phone, I conjure up images of a rival sweeping up my hotels with irresistible charm or fifty-dollar bills. But calls resumed

Wednesday, August 2, 2017

Against Medical Advice

A friend has had his gall bladder removed. He’s recovered, and you’ve agreed to drive him home. He is dressed and ready when you arrive. Hospital rules require the surgeon to examine him and approve the discharge, but after two hours the surgeon has not appeared. When asked, the nurse says he has been delayed. Asked an hour later, the nurse admits that no one knows where he is. They must wait.

An hour later, the exasperated friend announces that he will leave. You can’t do that says the nurse. If you do, you must sign this. She produces an impressive document that relieves the hospital of responsibility and lists terrible things that might happen when the signer leaves Against Medical Advice.

“Another thing,” adds the nurse. “If the doctor doesn’t sign the discharge, your insurance won’t pay.” Naturally, your friend decides to stay.

This happens all the time, but it’s nonsense.

First, you don’t have to sign an Against Medical Advice form. You can just leave.

Second, according to surveys, almost all doctors and nurses believe that medical insurance doesn’t pay if a patient leaves AMA, but it’s not true. Insurance pays.

Surveys also show that patients who leave AMA have a much higher rate of complication and readmission. Generally, it’s not a good idea. But, except for certain psychiatric cases, hospitals have no legal right to keep you.

Tuesday, July 25, 2017

A Risky Housecall

A lady at the Holiday Inn in North Hollywood reported that her husband was suffering diarrhea. She added that he had fainted during the last several episodes. I had never heard that before. Doubting that I could solve the problem, I told her we needed to call the paramedics. Sure enough, they took him to the hospital for a day of rehydration.

Friday, July 21, 2017

Warning! Make Sure You're Admitted!

This is strictly for American readers, but others will get a taste of the grotesqueries of our medical system.

Let’s say you’ve been vomiting for a few days and drag yourself to an emergency room. The doctor says you need IV fluids, so an aide wheels you to a room where you spend the night and most of the next day and then return home, feeling better.

Or you have chest pain. The ER doctor doubts that it’s a heart attack, but he wants to keep you for observation. After two days connected to a heart monitor and getting blood tests, you’re discharged, feeling better.

In both cases you’ll get a bill for at least $5,000, and YOUR HOSPITAL INSURANCE WON’T PAY!! 

Hospital insurance only pays if you’re admitted to the hospital, but remaining in a holding area for a few days or being kept “for observation” is not admission. You’re still an outpatient, so you’d better have good outpatient insurance.

If you’re over 65 and have Medicare Part A (which is free) but have decided to skip Part B (which costs $109 a month) you have no outpatient coverage. Part A only pays for the hospital. If you’re under 65 and have the usual Blue Cross or Blue Shield, you’re largely covered for hospital charges. Depending on the policy you’re willing to pay for, outpatient coverage varies. A lot. 

The solution, when the ER doctor announces that you need to stay for a while, is to ask: “am I admitted or not?”

Of course, you’re probably miserably sick or frightened (if not, maybe you shouldn’t be in an emergency room), so asking about insurance is not a priority. Woe unto you if you don’t.

Monday, July 17, 2017

The End of Narcotics

I once carried narcotics but gave it up. It’s too much hassle.

For garden-variety pain, codeine, Vicodin et al are sometimes but not always superior to over-the-counter pain medicines. I liked them because hotel guests have usually tried ibuprofen, Advil, Motrin, naproxen, etc. During the visit, I can hand over a few days of narcotics, and the guest knows he’s getting something different.

Nowadays, when I determine during the phone call that the guest only needs a pain medicine, I have nothing to offer, so I end up not making the visit. Many guests don’t want to pay the housecall fee in exchange for a prescription.

In an effort to fight the raging opioid epidemic, states have passed laws to keep track of narcotics. Pharmacists now send a report to the state for every narcotic prescription they fill. That’s easy because pharmacists already record everything on their computer, so they merely hit an extra button to send the report. 

If I hand out a few narcotics, I must sit down at my computer when I return home, find the reporting form, and fill it out. Some of the questions seemed cryptic, so I worried that I wasn’t doing it correctly. It seemed safer to stop handing them out.

Thursday, July 13, 2017

An Odd Anecdote

Long ago when I was a medical student, a woman came to our gynecology clinic to have an IUD removed.

Five years earlier, when abortions were still illegal, she had had an abortion. For some reason, the woman believed that IUDs were also illegal. The abortionist said that he would insert an IUD for an extra $180, and she agreed.

When the resident looked inside, he didn’t see a string hanging out of her cervix. All IUDs have this string, so they can be easily removed. He ordered an X-ray. It showed a bobby pin.

The resident removed it in the operating room, rusty but intact. It had served her well for five years.

Sunday, July 9, 2017

Gratitude is All I Get

The Adventure is a large motel near the airport that caters to foreign tourists on a budget. It’s full of colorful, young Europeans and Asians. The owner-manager phoned to inform me that his girl friend was sick. Could I see her? He would pay.

That was the third time he had asked me to see the girl friend who had a tendency to get sick. I like calls from general managers because it gives me a chance to do public relations.

After my first visit, I waved off his money but suggested that I’d like to be the Adventure’s doctor. He expressed gratitude and promised to tell his employees that I was the man.

Six months later, after the second visit, I refused his money and reminded him of his promise. He expressed gratitude and swore he would give my name to everyone.

Doing favors for general managers has won me new hotels, but it’s remarkable how often it hasn’t. Most of the time, gratitude is all I get. On my third call from the Adventure’s manager, I accepted his money.

Wednesday, July 5, 2017


I drove to care for a woman with a respiratory infection at the Georgian, a boutique beach hotel in Santa Monica. My phone rang as I pulled up at the entrance. The caller was JI, a Japanese travel insurance agency with a patient in a downtown hotel. Ten o’clock is perfect for driving downtown. Freeway traffic dips until noon when it begins a steady climb toward the evening rush.

“I can be there within the hour,” I said only to hear that the patient wanted someone between 4 and 6. I explained that people don’t realize how quickly I arrive. I could be there in 45 minutes. She checked but informed me that the guest wanted to go on a tour. Disappointed, I agreed to arrive at 4, a very inconvenient hour.

The phone rang soon after I returned home, a lady at the airport Westin whose husband was coughing. Did I accept Blue Cross? I didn’t. American insurance pays skimpily for a housecall, and billing requires skill and patience; foreign insurers do better. I gave directions to a walk-in clinic a mile away. Many Americans decide that paying for a housecall is preferable; she assured me she’d call back if she wanted a visit.

Saturday, July 1, 2017

Night of the Concierge Doctors

Hotel doctoring has always been a dog-eat-dog business, but after 2010 another tiresome phenomenon appeared: concierge doctors.

These provide a personal service for a large fee in cash, no insurance -- American insurance -- accepted. Google “concierge practice” for the creepy details. When asked, these doctors insist that they’re not in it for the money which means that they’re in it for the money.

Building an office concierge practice from scratch takes a long time, but hotels are low-hanging fruit. Ambitious concierge doctors visit the general manager, something I never do. Even more effective is telling the staff that every call is worth $50. It’s illegal for a doctor to pay for a referral, and all deny doing this, but bellmen and concierges have begun hinting that, maybe, I’d forgotten something when I walked by on my way out.

I charge $300 to $350 for a housecall. Concierge doctors charge between $600 and $3000…. $3000?! Who pays $3000? The answer is: foreign travel insurers. Everyone in the world knows about America’s rapacious medical system so when an insurance clerk in Spain or Japan gets a bill for $3000, he probably assumes that that’s the going rate. This is no small market; insured foreigners make up a third of a hotel doctor's business.

At the lower end, American hotel guests will usually pay $600 to $1000, although they grumble. There is no free market in hotel doctoring as in all other areas of medicine. If guests want a housecall at a hotel served by a concierge doctor, that’s what they pay.

Tuesday, June 27, 2017

More Free Services

A guest from the Avalon phoned; her husband had been vomiting. Learning the fee, she decided to transmit my advice (stop drinking fluids; suck on ice) and wait a few hours. When I checked back later, he was feeling better.

An elderly man from the Beverly Hills Plaza lost his luggage and needed a supply of half a dozen medications. Rather than endure the lengthy process of learning the name, dose, and instructions of everything, I told him to sort things out with a pharmacist who would phone, and I would approve it.

A man at Le Petite Hermitage wanted a chiropractor. I could have told him to find one on the internet, but it’s better P.R. if I do it. I found one.

I was pleased at these contacts because the Avalon and Beverly Hills Plaza and Le Petite Hermitage never phone. They belong to my competitors who are not so easy to reach and unwilling to provide free services over the phone.

Doing stuff over the phone is easy, so I don’t object, and hotels that call now and then sometimes decide to call regularly.

Friday, June 23, 2017

The Get-Out-of-Jail-Free Card

“Our flight leaves at nine. My son was vomiting all afternoon but stopped a few hours ago. Is it OK to go?”

If I came to the hotel and found nothing wrong, I couldn’t promise that the child wouldn’t resume vomiting. I’d be more confident after a day, but the family didn’t want to hear that.

“There’s six of us going to Australia. We can’t miss the flight.”

Long ago you went to the local airline office and exchanged your ticket. Today airline offices are a distant memory, and ticket exchange with its expensive penalties strikes fear into the heart of any traveler.

Some get on the plane and hope for the best. Others ask the airline for advice. No carrier wants a sick person on board, and every customer service agent knows what to say. 

“They want a doctor’s note,” explained the same caller later. “Can you come?”

Most “doctor’s note” visits are a snap because the guest has already recovered, so I’m simply handing over a piece of paper. This is never true while the illness hasn’t run its course. Guests yearn for me to clear them, but I almost never do. Failing that, they hope my note will persuade the airline to reschedule everyone gratis. This sometimes works, but the era when my note served as a get-out-of-jail-free card is long past.

In this case, they were lucky. The airline insisted that four proceed on to Australia, reticketed the mother and child for the next flight in four days with no penalty but also no reimbursement for the extra days in the hotel.

Monday, June 19, 2017

When Guests Drop Hints -Part 2

        Guest:  “I try not to.”
        This means “Yes” in answer to questions like:  “Do you cheat on your diet, stick Q-tips in your ears, consume too much food, alcohol, tranquilizers, salt,  or laxatives?.”

        Guest:  “I try.”
        This means “No” when I ask if someone has obeyed instructions that are almost impossible to obey (take a pill every four hours, stick to an exercise program, ignore a crying baby)...

        Guest:  “Everyone tells me what a great doctor you are….”
        My heart sinks when I hear this because it precedes a request that I’m not likely to fulfill.

Thursday, June 15, 2017

When Guests Drop Hints - Part 1

Here are some phrases that I have to interpret.

Guest:  “You’re the doctor.”

This means “You’re wrong.”  Other hints that I’m off base include:
“I wonder if I need something stronger…”
“My regular doctor always gives me...”
“My husband had the same thing, and the doctor said it was...”

Guest:  “If I don’t get something it turns into (...bronchitis, strep, walking pneumonia, a sinus infection...).”

This guest is saying:  “I want an antibiotic.”
Patients often work hard to convince me that their cough, congestion, or sore throat has a special feature that requires an antibiotic.  They tell me that -
“I have an important meeting, and I can’t afford to be sick.”
“I have a tendency to strep.”
“It’s not a cold.  It’s bronchitis!”
“If I don’t catch it quick, it goes to my chest.”
Plus the old favorite:  “My regular doctor always gives me...”

Guest:  “Are you sure I need this?”

This means the guest won’t fill my prescription.
Similar hints include:
“I don’t take medicine unless it’s absolutely necessary.”
“My mother is allergic to this.”
“I have a sensitive stomach.”