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Friday, March 30, 2012

Avoiding the Rush Hour

A guest with a respiratory infection was staying in a Whittier hotel, thirty miles away. The call arrived at 5:00. Driving sixty miles in rush hour traffic is an experience I prefer to avoid if the problem isn’t urgent. I told the insurance dispatcher I would arrive between 8 and 9.

Usually I explain that “I won’t get out of the office till 7.” That’s an excuse patients usually accept. This time I slipped up and merely explained that I didn’t want to get caught in the rush hour. This is less acceptable and, sure enough, the patient cancelled in favor of going to an emergency room. I felt bad, but that turned out to save me from a difficult evening.

At 6 o’clock, a guest in West Hollywood announced that he was having a gout attack. The rush hour was in full swing, but West Hollywood is only five miles away. Before I walked out the door, the phone rang again, and I agreed to see a Swede suffering flu symptoms at the Sheraton in Santa Monica. The Sheraton is ten miles from West Hollywood and not a convenient drive, but I hoped traffic would have diminished.

Gout is an easy visit, and I carry the treatment, so the visit ended happily for everyone. After a passable drive, I arrived at the Sheraton where I answered a call from the Hong Kong office of Cathay-Pacific Airlines. I care for their crew in Los Angeles, and they are a joy to work with. Being young, they suffer simple ailments; all are Asian but speak good English; best of all, every request comes with a credit card number, so I don’t have to send a bill. A mild downside is that every visit also comes with a sheaf of documents evaluating the employee’s fitness to work.

After caring for the Swede’s flu, I drove ten miles to the Airport Hilton to treat a flight attendant’s sore leg and fill out paperwork. I arrived home at 10:30, weary but pleased at the night’s work. No sooner had I taken my phone off call-forwarding than it rang with news that an elderly lady at a Sunset Strip hotel was ill. Not everyone who wants a doctor needs a doctor, and I often convince guests that a visit isn’t necessary. I yearned to do that in this case, but she was vomiting, not a symptom patients can tolerate.

In the room, I was prepared to diagnose a routine stomach virus until I pulled back the covers and saw her swollen abdomen.

“Is this how your stomach usually looks?” I asked.

She denied it. She also had more pain than I expected, and I heard loud intestinal noises through my stethoscope. It seemed like a bowel obstruction, I explained. She needed to go to the hospital. Immediately she reconsidered my question, remembering that she was constipated, a condition that often made her abdomen swell.

Hearing they must go to the hospital, guests often work hard to change my mind, but I persisted. She went off in an ambulance, and I left hoping I’d made the right decision (doctors worry about these things). I phoned the next day to learn she had been admitted to Cedars-Sinai where she remained several days.

Thursday, March 1, 2012

Loyalty

As long as they do good work, doctors assume patients will remain loyal, but hotel doctors learn not to be so trusting. Helping sick guests produces no income for the hotel. Ninety percent are not terribly ill; if rebuffed they rarely make a fuss, so the manager never hears about them. Paramedics deal with emergencies. Years may pass before a GM encounters an imbroglio that only a doctor on the spot can defuse; I’ve recounted a few. Although the best marketing tool, they never happen when I need them.

So how does a doctor keep a hotel’s loyalty? You might think that practicing good medicine is the best P.R. That’s not necessarily so because, ironically, people take for granted that doctors are good. In fact, most are competent, and that includes my competitors. Patients are usually grateful after seeing me, and over thirty years I’ve acquired plenty of flattering letters, but when patients feel the urge to tell the world about a doctor, they are generally less happy. When a GM hears from a guest, it’s almost always a complaint.

Assuring bellmen and concierges of $20 for every referral is a long tradition. It’s illegal, and my last competitor who definitely took advantage lost his license in 2003, but hotel staff continue to drop hints.

Other doctors tour hotels to extol their virtues to the staff, but I don’t. Three or four times a year I write to a hundred GMs but stop once a hotel starts calling. I dislike merchants who keep telling me how much they love my business, so I assume this feeling is general. Perhaps fifty hotels call during a typical year, but I doubt if five GMs know me by sight.

In 1994, I bumped into the doctor who serves a dozen crème de la crème luxury hotels around Beverly Hills. As we talked shop, he mentioned that he knew most of his general managers since he encountered them at social engagements. That’s a marketing tool I can’t match. It turns out that, when a hotel opens, he chats up the manager, and matters are settled. I send my usual letter of introduction, but I never acquire a new hotel in his territory.

During that conversation, he grumbled that a colleague who covered for him recently had left a business card at every hotel. I sympathized, adding that I’d be happy to cover, and I promised not to solicit afterward. Since my leisure time activities are reading and writing, I rarely decline his calls, so we’re both pleased with the arrangement. I still have no answer to the question at the beginning, but at least someone else is responsible for keeping the loyalty of many hotels I visit.

Sunday, February 19, 2012

"Welcome to the Biltmore. Are You Checking In?"

That is not my favorite greeting, because it means the valet doesn’t recognize me. My response is always: “I’m the hotel doctor. I’ll be here twenty minutes. They hold my car.”

That’s my mantra to parking attendants, delivered a thousand times and followed by a moment of tension. Will he smile, accept my key, and park my car nearby? Or will he hand over a voucher, jump behind the wheel, and drive off into the bowels of the parking structure?

I have no problem tipping attendants, but I hate paying ten to twenty dollars to park. Accepting the voucher makes that a possibility, so I repeat the mantra, hoping he will reconsider or appeal to his boss who might know me or decide an elderly doctor with his bag deserves VIP status.

Once I accept, my next step, after caring for a guest, is to ask the desk clerk or concierge to validate. Sometimes they comply, but now and then…

“Sorry. The hotel doesn’t handle parking. It’s a separate company.” Hotels often outsource parking, but luxury hotels always accommodate me. Chains are unpredictable, even those where I go regularly. But once I hear this, I pay because I have a rule against arguing with hotel staff. Validation sometimes requires only that the employee scribble “comp – hotel doctor” on the voucher. Once, when refused, I scribbled it myself, and it worked, but I don’t do it. The chance of getting caught is very low, but the consequences are so humiliating that it’s not worth the risk.

After thirty years, I know the nearest street parking for every hotel; if it isn’t hot or raining, I’m willing to walk a few blocks. Downtown is a problem because, even during wee hours, homeless men hurry up, offering to watch my car. In the immense wasteland near the airport and hip entertainment sections of the Sunset Strip and Hollywood, street parking is often impossible. As with so many amenities, Beverly Hills is a pleasant exception.

I loved the temporary handicapped pass I used for six months after breaking my leg in 2003. Its benefits are no secret to the able-bodied; it turns out that eleven percent of Los Angeles drivers have one including not a few running the treadmills at my gym.

Wednesday, February 8, 2012

Human Nature, Part 2

Cynicism is a cheap substitute for sophistication, but I find it as tempting as most people... The lady just phoned, full of apologies, and we're working on ways to get the money. It hasn't arrived, but I assume it will.

Tuesday, February 7, 2012

Human Nature

An elderly Mexican psychoanalyst was attending a psychoanalytic convention, but a cold was making her so miserable that she wanted to return home early.

This seemed an excellent call in many ways. It arrived during the evening rush hour, but the Royal Palace was only two miles away. It was my first visit to that hotel, always a delight, and I planned to introduce myself to the management. Finally, the lady’s stuffy ears dominated her concerns, so she probably wouldn’t demand useless antibiotics which Latin American doctors prescribe for colds as often as we do.

Everything proceeded smoothly. I finished my traditional lecture on preventing ear pain when flying (generous use of nasal sprays); she expressed gratitude and laid down an American Express card.

American Express charges a larger service fee than other credit cards, so some companies that handle transactions don’t cover them. That includes mine, but I wasn’t concerned. So far everyone has had cash or another credit card, but on learning that I only accept Visa or Master Card, she expressed dismay. She only used American Express, she explained. Her plane left the next morning, and all she had was cab fare.

While I considered my next move, she snatched the phone, dialed the front desk, and poured out her distress. The doctor they recommended wouldn’t take her credit card; she had no money, and she needed help. I cringed at this terrible P.R. She wasn’t complaining about me, but it’s never good for a hotel to hear a guest having problems with the doctor. Luxury hotels will advance money and add it to the bill, but the Royal Palace, while comfortable, was not in that class. The desk clerk suggested she find an ATM.

Long ago, I drove a guest in search of an ATM, and I’ll never do it again. Begging my forgiveness, she swore that when she returned to Mexico City she would phone with the number of an acceptable credit card. I had no other suggestion, so I brushed off her apologies, and we parted on good terms.

That was several weeks ago; I don’t expect to hear from her.

My practice where almost no one see me a second time and everyone lives far away is a supreme test of integrity, and it’s discouraging how few measure up. Guests have already agreed on the fee before I arrive, so it’s rare that I leave unpaid. When this happens, guests are invariably upset and embarrassed. Once home and aware that there will be no unpleasant consequences if they don’t pay, only about twenty percent come across.

Friday, January 20, 2012

A No-lunch Day

The Langham called 11 a.m., a perfect time. I was finishing at the gym; I could shower, make the visit, and return home for lunch.

The gym is near the 405 freeway, a few miles from my home. It’s not my usual route for the 25 mile drive to Pasadena, being slightly further, but I decided to experiment. A mile after I set out, traffic stopped cold as far as the eye could see.

That’s when I remembered we are adding a single northbound lane to the 405 through Sepulveda Pass. There’s no room, so workers must rebuild every overpass, carve out and reinforce cliffs, and heap up dirt to widen the roadway. This six-mile addition will cost a billion dollars. I cannot think how much mass transportation a billion dollars would buy if there were any political support.

After fifteen minutes of creeping, I reached an exit and took old Sepulveda Boulevard past the construction. While driving, I answered a call from an insurance service and agreed to see a Brazilian boy with a fever in Huntington Beach. Huntington Beach is in Orange County, forty-five miles from my house. It could have been worse; it’s the same distance from Pasadena.

The Langham guest was a Washington Post reporter with a respiratory infection. He was covering a local convention, so the paper was paying for his room at the very posh Langham, but it wasn’t paying his medical expenses, so he had phoned several times before deciding on a visit. I delivered advice and medication before proceeding on my way.

The knowledge that I’ll miss a meal stimulates my appetite, so I suck on hard candy from a supply I carry. I never grab a bite at a hotel because I love eating and prefer to remain hungry and take care of obligations, so I can relax and enjoy it.

After shaking my hand, the Brazilian father reminded me that I had visited him a month earlier. Over most of the US, travel insurers send clients to clinics or emergency rooms. Having a doctor appear at their door is more pleasant, so Los Angeles travelers lose their inhibitions about asking for help, and I see many repeat customers. After examining his son, I explained this it wasn’t necessary to give him a cold shower for his 101 temperature. He would feel bad for a few days and then recover; I handed out four packets of Tylenol.

It was after 3 when I pulled into my garage and answered a call from the Westin at the airport. This was one of those what-might-have-been calls because I’d passed the freeway exit only blocks from the Westin half an hour earlier. I retraced the route to care for a lady with a painful eye, returning in time for supper.

Saturday, January 7, 2012

The American Way

“This is AXA insurance about the patient you saw last month, Mrs. Diaz. We are asking you to accept a lower payment. In exchange, we list you as a preferred provider.” The offer was for less than half what I billed. I declined. AXA would eventually pay my regular rate although a few months would pass.

AXA sells travel insurance to Latin Americans. Its US agency and a dozen others phone me to make housecalls. Afterward, I fax my invoice, and (here American doctors will recoil in amazement) the carrier sends a check for the full amount. I’ve made thousands of such visits.

Working alone, I can’t accept American medical insurance with its complex requirements and unreliable reimbursement. The universal American claim form (called the HICF 1500) is cryptic and ambiguous, requiring mysterious codes and far, far more writing than the form I use. Thus, mine has a single space for today’s date; a HICF form requires today’s date in four or five places. Under “place of service” there is no box to check for “housecall.”

Not accepting American insurance is no problem for me, but I’m a special case. As soon as the average doctor opens an office, every American carrier makes an offer he can’t refuse. If he agrees to become a “preferred provider” and accept a reduced fee, the insurer will send patients. If not….

While foreigners look with horror on our medical care system, foreign insurance carriers have long admired their American counterpart’s techniques for saving money. Inevitably, the temptation has grown irresistible. I’ve long since stopped explaining that, including travel, a housecall may take ten times as long as a clinic visit. These callers are not negotiating; they want a “yes” or “no” answer. They lump all doctor visits together, so housecalls get no special treatment.

American doctors have not taken this lying down. One advantage of the Byzantine American billing system is that a resourceful doctor can tack on charges for tests, injections, medication, dressings, complexity-of-visit, length-of-visit, etc. so that he ends up collecting what he thinks he deserves. After decades of dueling with insurers, the typical American medical bill has become a purely fictional creation.

I quote my fee on the initial phone call. It’s larger if the call gets me out of bed or requires a long drive but never changes once I set off. I’ve made 700 housecalls for AXA over twenty-five years but only four during 2011. This is less tragic than it seems.

Confronted by my refusal to become a preferred provider, AXA and a few other travel insurers transfer their business to one of the national housecall services with names like Expressdoc, Hoteldocs, Travel-Med, AM-PM Doc. All boast that they can send a doctor on a housecall in any US city. Since none employ doctors, when a request arrives, their dispatchers consult a list of moonlighters and begin phoning. Tracking down a doctor willing to make a housecall can be a tedious business except in Los Angeles where calling me always succeeds. I’ve made thousands of visits for these services.

I quote my usual fee. To make a profit these services must bill AXA et al several hundred dollars more. If this seems illogical, you should realize that every insurance carrier knows that the “preferred provider” policy saves money, so no one questions it.