What Antibiotics Do To Your Body

When I started out in the 1980s, pharmaceutical companies sold pills labeled “placebo.” They don’t do that today, so a doctor who wants to prescribe one uses a real drug.

Today’s most popular placebos have names like amoxicillin and Z-pak (azithromycin). These help many conditions but not the respiratory infections for which most are prescribed.

Swallowing any antibiotic kills trillions of germs inside your body. If it’s a placebo, those germs are not causing your problem. Other germs immediately move in. Of course, those are germs that can grow in the presence of that antibiotic. If, in the future, they decide to make trouble, another course of that antibiotic might not discourage them. Do you want that?

Experts have been denouncing placebo antibiotics for decades, but their arguments are feeble. They warn about side-effects and allergies, but these are rare. Most antibiotics, useful or not, are safe over the short term.  
  
The long-term consequences are catastrophic. Soaking the environment with unnecessary antibiotics is giving rise to extraordinarily resistant bacteria. Even today about 40,000 Americans die of infections no antibiotic can treat, and this increases every year.

But who cares? It’s a fact that people with a short-term problem don’t take the long view. That might include your doctor.

Another Free Service

Her child’s nose was bleeding, explained the mother. Could I come?

I was tempted. Once in the hotel room, I would ask questions. I would take out my otoscope and peer up the child’s nose. In the end I would reassure the mother and tell her to pinch the nose and wait. The bleeding would probably stop. Persistent nosebleeds are rare and require expert attention. Then I would collect my fee and leave. 

Over the phone, the mother revealed that the child was in good health and suffering a cold.  Respiratory infections occasionally produce a nosebleed. I reassured the mother and told her to pinch the nose and wait. When I phoned later, the bleeding had stopped. 

The End is in Sight

I keep an eye on Craigslist and the internet for new competitors on the housecall scene, and they turn up regularly. Other hotel doctors gnash their teeth, but I send off my C.V.

Being experienced and available 24 hours a day is an appealing quality, so they often respond. Working for competitors is sometimes painful if they send me to one of my hotels. There’s little I can do because I can’t match their marketing techniques (my lawyer warns me not to be more specific).

Mostly I take for granted that this younger, aggressive, social-media savvy, ethically challenged generation will drive us older hotel doctors out of business. Luckily, I’m already collecting from my retirement savings and social security, so I work because I enjoy it.

Getting Help, Part 2

My relations with other Los Angeles housecall doctors are civilized but not close. As a result, when I leave town there’s only one colleague I trust to cover. Mostly this works out. I schedule my trips so they don’t conflict with his.

When I’m in town I’m always available. That includes after bedtime, in the movies and restaurants, and during social events. It includes concerts and live theater, but I sit on the aisle, so I can hurry to the lobby when my phone buzzes. None of this bothers me greatly (my wife is another matter).  

One event causes problems: baseball games. One of my brothers has Dodger season tickets, and we attend a dozen times during the season. We go to a restaurant and then the game: almost the only time we get together; I love it and don’t want to be interrupted. I’m out of commission only about six hours, and occasionally my colleague can’t cover.

I could continue to answer the phone, but crowd noise in the stadium makes conversation difficult. It also reveals that I’m having fun, and patients hate disturbing a doctor during his leisure time. My solution is to change my phone message to announce that I’m unavailable until (whatever time the game ends) and then turn off the phone. Genuine emergencies are very rare in a hotel doctor’s practice, and so far it’s turned out all right. But I’m always looking for help.

Girls Are the Best

 “...allo!!” shouted a little girl from her bed as I walked in, but that was her only English. Her French parents had called because she was running a 101 fever.

She seemed delighted to see me and jumped to sit on the edge for her exam. Smiling happily she waited as I quizzed the parents, opened her mouth widely when asked and made no complaint when I poked my otoscope into her ears.

I found everything normal. She had a virus that might last a few days and required only Tylenol. Staying in bed was not necessary. Everyone seemed pleased, the child most of all; she waved goodbye as I left.

I loved that visit. Readers are familiar with my admirable qualities, but I admit that I am not the sort of jovial physician who enchants young children. Mostly I do fine, but I’ve endured plenty of encounters with apologetic parents and a screaming, struggling toddler.

These are almost all boys. Adult male pugnaciousness has not made the world a comfortable place, and it works equally badly in children. They get the exam regardless, but it’s drawn out and painful. The parents are embarrassed, the doctor relieved when it’s over.

Little girls rarely make a scene. If frightened, they keep quiet. If not, they realize, almost from birth, that charm works wonders. Everyone relaxes and takes care of business. Women should run the world.   

A Dog-Eat-Dog Business, Part 10

My last post reported a housecall service that charged an unbelievable fee. By an odd coincidence within a week I came across another new service with an even more unbelievable fee: $99.

A high-tech startup similar to Airbnb, Uber, and Lyft, Heal is clearly the wave of the future. You download its app. If illness strikes, you click on it, enter information, and (according to the web site) a doctor arrives within an hour. Business was brisk, its medical director assured me.

With a “medical assistant,” driving, Heal’s doctors care for acute illnesses, performing complex procedures that I don’t do such as suturing, injecting joints, and even complete physical exams.

Paying the doctor, driver, staff, and investors at $99 per housecall seems impossible, especially since the web site emphasizes that there are no extra charges. On the other hand, taxi companies complain bitterly about Uber, and hotels denounce Airbnb, yet both are prospering. Financial acumen is not my strong point, so it’s possible that Heal will drive me and my more expensive colleagues out of business.

If so, I might to work for them. Pay is low for a doctor but acceptable to me. Having a driver would relieve a major stress, and I might enjoy not being on-call 24 hours a day. This blog would vanish, but you could read Heal’s. It lacks my whimsy, being mostly earnest medical advice and public relatoins, but $99 will not include entertaining literary diversions.

Let me know if it works for you.

Lost in Translation, Part 2

5:30 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher I would be at the hotel in an hour.

The freeway was clear. Parking, even downtown, would be easy. My phone rang as I drove. It was the guest’s travel insurer warning that there was no answer when he phoned to tell her when I’d arrive. When guests call directly and then vanish, I don’t get paid, but this is not the case with travel insurers, so I drove on. It was unlikely she had left the hotel.

At this hour, I check at the desk to make sure I don’t knock at the wrong door. The clerk confirmed the room, called, and reported that someone had answered and then hung up.

It was good news that she was present, not so good that she had immediately hung up. That’s a sign that a guest’s English is not good. 

A young Japanese woman greeted me at the door, ushered me inside, consulted her Ipad, then announced in triumph: “......stomach!!....”

One advantage of travel insurance is that dispatchers will interpret. Despite my admonition, they prefer to edit, abridge, and summarize rather than simply translate; their English is often rudimentary, and passing the phone back and forth makes for a long, tedious visit.

On the plus side, hotel guests usually have uncomplicated problems. It worked out fine.