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Friday, November 19, 2010

Things I Don't Charge For

Quantas and other airlines recently canceled flights after an engine exploded, stranding a large number of passengers in hotel rooms. Within days I began receiving calls from guests running out of their heart or diabetes medication. They had brought only enough for their trip or the bottles were packed in luggage which the airlines refused to release. Aware of terrifying stories about America’s medical system, they were counting their money, hoping to have enough for the necessary king’s ransom. They were pleased to hear that I don’t charge for replacing legitimate prescriptions.

Most American drugs are available in other countries, but often in different formulations and with different names. Rather than try to figure things out, I tell guests to go to a drug store where the pharmacist will research the matter and phone. I’ll approve whatever he determines. Guests regularly forget to pack medication or find their trip unexpectedly extended, so I do this routinely. My record for replacing prescriptions occurred after 9/11 when all flights stopped, and hotels were packed. Some travelers also fell ill, so my paying business jumped for a few weeks. Then everyone returned home, and tourism plunged for almost a year. That was a bad time for hotel doctors, too.

I deliver plenty of free services. I don’t charge for anything I do over the phone. I don’t charge hotel staff. I’m happy when they consult; it’s a sign they know about me and, after the consultation, they might tell colleagues about the experience. As I’ve mentioned before, no hotel employs a house doctor. Even at my regulars, I don’t occupy an official position, so many employees have never heard of me. “Are you our doctor? I didn’t know we had a doctor” is something I hear even at hotels that have called for decades. This is not good because when guests ask for help, they usually accept the first answer.

Since I am the world’s most successful hotel doctor, you might assume I command respect in my profession. There is some truth in this, but it’s not unanimous. Delivering free care upsets many doctors. Those I know personally don’t mind, but I also belong to internet physician forums whose members feel differently. Although the forums exclude nonphysicians, any clever person can figure out how to join, but I advise against it because you don’t want to hear what doctors say when they believe you’re not listening. I enjoy their medical discussions but avoid threads on business and politics. As in most forums, contributors with strong opinions dominate. I find it unsettling that the longest, angriest discussions concern money. The most energetic participants tend to work in private practice where their income depends on patients or insurance. They detest not getting paid; they suspect most poor people are deadbeats; they hate insurance, the government, President Obama, and healthcare reform.

Recently I contributed a funny story. You may have read it earlier on this blog. An Israeli man at a Beverly Hills hotel needed a doctor’s signature on his request for a disabled parking pass but didn’t want to pay my fee. Since it was a trivial task, I told him I’d sign it gratis if he came to my home. After hanging up, I began to worry. Obtaining disabled parking permits is a scandal in California; eleven percent of drivers have one. If I didn’t believe this man was disabled, I planned to refuse to sign thereby risking an unpleasant scene. I passed an uncomfortable half hour until I heard the sound of someone approaching. Opening the door, I saw a man, one arm around a young woman (his daughter) hopping up the steps to my house. He had one leg. That was a relief.

I posted the story and awaited expressions of amusement. Almost immediately a doctor wrote angrily that I had prostituted my profession, undoubtedly to curry favor with the hotel. Doctors provide a service for which they deserve a fee, he added. Any Beverly Hills hotel guest could afford it; that I blithely gave him a free ride showed that, in my degraded state, I didn’t realize how this damaged hardworking physicians with bills to pay. Other responders agreed, and then, as happens on forums, they wandered off-topic and exchanged of anecdotes about being stiffed: by obnoxious patients, welfare patients, dissatisfied patients, insurance carriers, Medicaid, Medicare, the government. Doctors on doctor forums spend a good deal of time fuming over not getting paid.

Tuesday, June 22, 2010

A Relatively Easy Housecall

Before driving home, I answered a message from the Embassy Suites at the airport. The previous evening, a Canadair stewardess had phoned, confined to bed with a backache. Many foreign airlines call me to see sick crew members; I bill their central office. American air crew with their American insurance are out of luck. Billing an American insurance carrier – and for a housecall! – guarantees torment and aggravation, and I’ve long since given it up. Billing a foreign airline is no simple matter (“my manager says send your bill to the main office” never works), but once we’ve agreed on a formal arrangement, matters work smoothly. Sadly, I have no arrangement with Canadair. I explained this to the flight attendant, and she agreed to consult her supervisor. When I answered my message, I was delighted to hear her explain that Canadair had faxed an approval for my visit and its credit card number. Her backache had improved, and all she needed was a doctor’s note approving travel home as a passenger. I expected an easy visit.

After a short consultation and the note, I presented myself to the front desk where I discovered my optimism was premature. The number on the Canadair fax belonged to an American Express card. American Express charges more, so many credit card services, including mine, don’t cover them. I explained this to the desk clerk who summoned her manager who apologized, phoned Canadair, and learned that the airline did not have a Visa or Master card, a situation I’ve never encountered. No problem, the manager assured me. The hotel would mail me a check and bill Canadair. This seemed a bad idea because hotels don’t normally do that, and long experience has taught that expecting a hotel to do something it doesn’t normally do leads to frustration. But my rule is to never hassle a hotel, so I smiled and agreed. An hour later, the manager phoned to say that, rather than mail a check, the hotel would pay cash on my next visit. Naturally, I agreed.

Two days later, picking up my wife at the airport, I stopped by the Embassy Suites. I wouldn’t be writing this if matters went smoothly, but the desk clerks looked mystified when I explained my purpose. They phoned the manager who was tied up in an important meeting. I waited half an hour, but when my wife called. I departed after leaving a polite message on his cell phone. He was off duty when I returned the next day, and the desk clerks remained puzzled. There is no great lesson here, and I’ll eventually collect, although I suspect I’ll have to phone Canadair a few times, fax a few forms to Canada, and wait a few months.
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Tuesday, August 11, 2009

Caring for Airline Crew

Every night in every big city, several hundred commercial airline flight crew lay over. Lacking transportation, they have trouble finding medical care. Airlines in Los Angeles soon learned about me, and I’ve made 618 visits, mostly to flight attendants, and sent my bill to the airline. Flight crew are young and healthy with uncomplicated illnesses, so visits tend to be easy. On the other hand, airlines switch hotels when they obtain a better rate. Since I’m reluctant to give up business, I find myself traveling farther than I like.

As in other aspects of health care, foreign nations have a better system. When American crew need a doctor, they can go wherever they want and use their insurance. The combination of no transportation and huge deductibles mean they usually go nowhere. Since many call the front desk to ask if there is a doctor, I dealt with their pitiful calls. American pilots occasionally bit the bullet, but flight attendants couldn’t afford me unless I cut my fees. I give free advice and, if necessary, direct them to the nearest 24-hour clinic.

Then I have to decide if they’ll go. Once anyone calls me, I become his or her doctor. I think this is the law, but it’s certainly how some doctors feel, and it’s the reason lawyers (American lawyers) warn us never to give phone advice. If a patient disobeys my instructions, I’m still responsible, and I hate hanging up and worrying, so I occasionally make a housecall to an American flight attendant. My fee for a charity visit was $30 or $40. Afterward, I always feel virtuous, so there are compensations. Foreigners never required charity.

I’ve been the doctor for a dozen foreign airlines including Alitalia, El-Al, Virgin-Atlantic, Aer Lingus, Japan Airlines, and Cathay Pacific. Two provided a fascinating contrast. Conveniently (for this discussion) they laid over a few hundred yards apart: Virgin-Atlantic at the Torrance Hilton, Cathay Pacific across the street at the Torrance Marriott. These were seventeen miles from my house, over a half-hour drive when traffic moved smoothly.

If a guest at the Park Hyatt, a mile away, wants a housecall, I go, but I’m liberal at giving free advice over the phone. I don’t claim immunity from human nature, so my willingness to handle an illness over the phone grows with the driving time. A check of my computer reveals a visit on 56 percent of calls from the Park Hyatt. When the Warner Center Marriott in distant Woodland Hills phones, I make the trip 29 percent of the time. I also lean over backwards to avoid a visit if the guest might find the fee painful: 63 percent to the upscale Bel Air Summit versus 43 to the Airport Holiday Inn.

Foreign airline crew do not pay, but I have no objection to giving phone advice to guests in faraway Torrance. That’s when the English proved again why they’re the world’s best patients. If I explained that their illness didn’t require a visit, they understood. If I didn’t give a prescription, they didn’t point out the oversight.

Matters were different with Cathay-Pacific. Based in Taiwan, its flight attendants came mostly from Southeast Asia: Thailand, Malaysia, Singapore, Indonesia, the Philippines as well as Taiwan. These cultures have a different view of a doctor’s powers.

Although most Americans would deny it, they believe doctors – invariably doctors they like – possess healing powers that go beyond scientific medicine. It’s my impression southeast Asians take this more literally, and they also believe employing such powers require a doctor’s presence. When Cathay-Pacific crew called they rarely welcomed advice.

Hotel guests generally love to learn they suffer an ailment too minor to require a doctor, so I dispense a great deal of instructions on self-care. The common cold makes up fifteen percent of all human illnesses including those of Cathay-Pacific flight attendants, but my expertise seemed lost on them. I deliver an excellent explanation of stuffy nose treatment. Since foreigners need names of American over-the-counter medicine, I always asked them to get a pencil. Time and again, the phone remained silent for several seconds before I heard: “When you come?...”

Everyone who flies worries about ear damage when they have a cold, so I discussed it. Everything you’ve heard is either worthless or positively harmful. Never pinch your nose and blow. Over-the-counter decongestants aren’t strong enough. Everyone who flies with a cold should buy a nasal spray such as Afrin or Neo-synephrine. While you’re sitting in the plane before it takes off, spray each nostril thoroughly. Wait ten minutes for the spray to work, then repeat. That carries the spray far back into your nasopharynx to the exit of the eustachian tube, the only connection between your middle ear and the outside world. Even if your nose is clear, swelling of mucus membranes can block this opening. If the flight lasts more than a few hours, repeat this as the plane begins its descent, an hour before landing.

Too polite to interrupt, Cathay-Pacific crew waited until I finished before speaking words that made my heart sink.

“You come?... When you come?”

My database confirms what I always believed: that I made visits on about half my callers. Cathay-Pacific held first place among my clients with 82 percent.
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Friday, June 26, 2009

Michael Jackson's Doctor

According to the Los Angeles Times, police are looking for Michael Jackson’s doctor. That brings back memories. In 2001, I received a call from a concierge at the Beverly Hills Hotel asking if I could see a celebrity. When a concierge speaks of a "celebrity" instead of giving the name, it means she suspects there might be a problem. So I asked if it were Michael Jackson. She admitted it was. I told her that I had some experience with him, and during my last visit we had agreed that he wouldn't call any more. I told her I planned to hold him to that agreement. She was entirely sympathetic, but that was the last call I received from the Beverly Hills Hotel.

Tuesday, June 16, 2009

How I Became America's Only Fulltime Hotel Doctor

Every few years I open my Los Angeles Times to learn the paper has, once again, discovered the housecall. Americans yearn for it, I read, and a clever doctor is about to satisfy that need.

The reporter interviews an entrepreneurial physician (different every time) who describes the sufferings of hotel guests forced to stumble through unfamiliar streets searching for an emergency room or the hardship of the housebound elderly. He and his physician recruits will scurry about the city delivering care to a grateful clientele. Despite charging a fraction of an emergency room’s fee, they plan to make a great deal of money.

We take for granted the news is accurate, so it’s a shock to read about something we’ve experienced personally – and realize the reporter has gotten it all wrong. None of these articles mention me. Yet I am not only the busiest hotel doctor in Los Angeles, I’ve made more visits than my competitors combined; over 15,000.

I know how these articles come to be written. Given his assignment, the reporter consults the avalanche of public relations material that pours into every newspaper. Finding a release about a doctor who makes housecalls (there’s always one) he phones its subject, does the interview, and writes. Sometimes reporting is easy.

Had he worked harder, querying local hotels and travel agencies, he would have learned about me; he might not have heard his subject’s name at all. After every Times article, I write the reporter to announce my existence and point out his errors (the fees quoted are purely imaginary; housecall doctors do not visit the uninsured), adding that I can provide more interesting stories as well as information that is actually accurate. No reporter responds, and in a few years another article features the same fanciful material from the mouth of a different doctor who is never me.

I began making hotel visits around 1980, but I was not an overnight success. 1990 had passed by the time I acquired enough clients to quit my other jobs. I was the only fulltime hotel doctor in the country, and there will never be another. This achievement owes something to my kindly bedside manner, nothing to business acumen, but most to the absence of competition. Until I arrived on the scene, hotel doctors confined themselves to luxury establishments such as the Bel Air or Beverly Hills Hotel. While it’s fun to visit rich and famous people in exclusive hotels, these doctors did it as a sideline, so all gave priority to their office practice. They also enjoyed a normal social life. Since calls invariably arrived when they were doing something else, old-time hotel doctors charged breathtaking fees to compensate for the aggravation.

I never had my own practice, and reading is my major leisure activity. I also enjoy writing about health; by the 1970s magazines were buying my articles, so stopping whatever I was doing to make a housecall was no inconvenience. Even that bane of a doctor’s life, the middle-of-the night call, didn’t bother me. With no office patients waiting, I could sleep late. Traffic was light. Parking was easy. Guests were grateful.

Mostly, however, they weren’t rich because I was soliciting the great mass of mid-level hotels. That was no problem; my needs were modest. I had bought a small house in West Los Angeles before the 1970s explosion in real estate prices; my mortgage cost $418 a month, which I could earn in two eight-hour shifts in an urgent-care clinic. My wife and I drove Honda Civics.

You might think the combination of lower fees and quick response ensured my success, but I faced a problem that still exists: hotel management doesn’t care. Providing a doctor produces no revenue for the hotel; in any case Americans don’t demand one. Calling 911 takes care of guests who seem seriously ill. The remainder rarely complain if told to go to an emergency room.

My marketing also lacked urgency. I was too shy to tour hotel lobbies, dispensing my card and the promise of a tip. Being a writer, I wrote: dignified letters on deluxe stationery offering my service twenty-four hours a day to about 150 general managers. I wrote every few months, addressing every manager by name (this meant I had to phone every hotel beforehand), working hard to rephrase and personalize each letter. It was boring work, but I had plenty of free time.

Mostly, the letters vanished into a void, but now and then they caught a manager’s attention. By the end of the eighties a dozen hotels called regularly. Then something happened. Maybe a critical mass of hotel employees grew familiar with me, or general managers decided a house doctor was a good idea. Within a few years, calls quadrupled to over two thousand a year. I stopped taking clinic jobs to pay my bills.

I was a fulltime hotel doctor. Like most life changes, it did not so much solve my problems as exchange them for others. Local doctors began to notice this mass of potential patients, none of whom were poor. Entrepreneurs across the nation decided they could make themselves known to big city hotels, send moonlighters to care for guests, and prosper by keeping part of the fee. Competition arrived. My income rose, but so did my stress level.

Friday, May 29, 2009

Why Doctor Oppenheim Isn't Rich

Being a fulltime hotel doctor isn’t fulltime work, so I have plenty to leisure during which I’ve become a successful writer. I’ve written five popular health books plus several hundred magazine articles – 35 for Woman’s Day, for example, more than any other doctor. So why haven’t you heard of me? More important, why aren’t I rich? Part of the answer is that I’m not a media personality. Doctors who write make big money only if they appear on TV and radio regularly. I did this a few times long ago and hated it.

But I still hope. I wrote a novel about a hotel doctor. Fiction is a hard sell, and it’s still making the rounds. Everyone who learns I work in Los Angeles insists my memoirs would be a gold mine. So I wrote memoirs. Every time I contact an agent, he or she is thrilled.

“That sounds like a great book. I bet you’ve seen plenty of celebrities.”
“So I have.”
“I bet you have great stories about them.”
“I do.”
“Tell me one.”
“I’m a doctor. I can’t do that.”

That ends the conversation. Agencies are still considering “Hotel Doctor to the Stars,” but my inability to include celebrity scandal seems to be a deal killer.

Tuesday, May 5, 2009

A Freebie

“This is Franklin De Forest. We’re staying at the Hilton. I wonder if you could help us.” There was a pause although the caller hadn’t asked a question. His voice quavered, so I knew he was elderly. American guests over sixty-five were awkward because Medicare paid a pittance for housecalls and forbade doctors from collecting the difference from the patient. I tried to avoid Medicare housecalls. Knowing the reason, many guests offered to paying the fee directly, promising not to send the bill on the Medicare. I think this is also illegal.

I heard muffled sounds, and then a female voice came on the line. Elderly men invariably handed the phone to their wives. “We just flew in from Chicago, and we leave for Tahiti in three hours. I feel so stupid... We went off without our medicine. Is there any way you could see us and write some prescriptions?”

Tourists regularly forgot their pills or lost them or packed them in luggage that disappeared. Authorities discourage doctors from prescribing without a thorough evaluation. Housecall agencies virtuously explained this, then sent a doctor who wrote prescriptions for heart pills, cholesterol pills, diabetes pills et al, then collected a few hundred dollars. I could not bring myself to charge for writing prescriptions.

“If they’re medications you take regularly, I’ll phone a pharmacy, and tell them to give you some more.”
“That’s so nice. My husband takes Lanoxin.”
“And what dose?”
“What dose, Frank…? He says the usual.”
“Point two five milligrams?”
“Point two five milligrams, Frank…? He says that’s probably right.”
“How many do you want?”
“Just enough till we get back.” The woman paused either to calculate or simply because she felt I was psychic. I repeated the question. “Say fifteen. He also needs Glyburide for his diabetes.”
“What’s the milligrams?”
“What milligrams, Frank…? He’s not sure, but it’s a little green pill.”

The man required three prescriptions, his wife four. Their recollections of dose and dosing schedule were vague. I determined several by consulting the Physician’s Desk Reference, but details of the wife’s “for my stomach” pill remained a puzzle, so I chose one that seemed harmless. I compromised on two other uncertainties by prescribing the lowest dose. The elderly take so many medicines there’s a good chance many are unnecessary. The call took fifteen minutes.

“We’re so grateful for your help, doctor. How can we pay?”
“No charge. But I’d like you to tell the manager how nice I was. This is a competitive business.”
The woman laughed. “I’ll do it first thing.”

Asked about payment after providing phone help, I always refused, then suggested the guest praise me to the hotel staff, and the guest always treated it as a joke. It was a joke, mostly, but I hoped a few would obey.