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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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.

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.

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.

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.

Treating Drunks

Medical science has no cure for drunkenness, but hotels regularly phone for help. I always ask if the guest wants a doctor. The answer is never yes and always followed by assurance that the hotel would pay my fee. A doctor is not supposed to care for someone who doesn’t want a doctor, but when a hotel appeals for help I do not like to refuse. Suggesting calling the police never works because (like calling paramedics) their arrival ruffles the businesslike atmosphere hotels prefer. Also, arrested guests rarely turn into repeat customers.


Confronting drunks, I enjoy certain advantages. I’m old. conservatively dressed in a suit and tie, and obviously a physician. These qualities inhibit abuse, but they work best in people who think rationally. Drunks are not impervious to my charisma, but they’re unpredictable. Obstreperous drunks nurse a grievance against someone: the staff, a lover, or life in general. Providing an attentive audience helps, so I try to get them talking. Success gives me a sense of accomplishment after the fact but no pleasure at the time. Drunks are boring.


To illustrate, an executive staying at a downtown hotel learned he had been fired. After drinking too much, he phoned his boss to discuss the matter only to learn the boss was also in Los Angeles. Efforts to get a room number from the front desk failed, probably because his boss was in a different hotel. Drunks do not discourage easily; his increasingly loud appearances at the front desk made the staff nervous, so they consulted me.


Drunks obsess about their grievances because no one wants to listen, so they cheer up when someone expresses interest. He followed me to a quiet corner of the lobby, and I composed myself to look attentive as he explained that his dismissal was inexplicable and possibly an error because his last performance review had been entirely positive. Having a copy in his possession, he read the review to me. I agreed it was flattering. He reread it aloud and then asked why a company would dismiss someone it clearly valued. I agreed this sounded unreasonable. Then I made the usual mistake of those speaking to the deranged and asked a logical question: what might have happened since the review to upset his superiors.


Consulting the review, he decided to read it to me again. Suddenly there was silence. The lobby was deserted. A housekeeper was operating a vacuum cleaner at the far end; the drunk gentleman lay back in his chair, snoring. I had fallen asleep, too. Feeling pleased at a tedious job well-done, I proceeded to the front desk for gratitude and payment. Unfortunately, at that time the Marriott was not a regular client where everyone knew me. During the change of shift, the day manager had mentioned calling a doctor to deal with a drunk but failed to add that the hotel had agreed to pay, so the night manager told me to take up the matter during the day.

A Spanish lady wanted her ears checked because she had an ear infection last week and flies tomorrow. So I drove eight miles to Hollywood and examined her ears. They were fine. I collected my money and returned. Sometimes hotel doctoring is easy.

Advice

Note: I originally wrote this for hotel general managers, but any reader will learn a great deal.

Having a house doctor may be the best service you provide that doesn’t cost the hotel anything. Except… how do you know guests are getting good service? How much control can you exert over a doctor? The answer is: a great deal. You would never dream of setting your family doctor’s fees, choosing his office hours, or insisting he respond immediately when you call. Not only can you influence all these factors, you should. If you’re reluctant, here are some questions whose answers might unsettle you.

1. Is your doctor charging $600 a visit? It happens, and guests pay. But they don’t like it.

2. Is he liberal with phone advice, and how much does he charge? The answers may not be yes and zero, but they should.

3. How does he respond at 2 a.m.? Is he a bit testy? Does he send everyone to an ER or suggest they wait till morning? Does he tell your staff to summon paramedics even if there’s no emergency? You don’t want that.

4. Does the doctor, as he leaves, slip $20 to a bellman or concierge? That’s illegal but a tradition among hotel doctors. Your employees will never mention this, but you may not want them to choose your guests’ doctor according to the size of his kickback.

THE NATURE OF HOTEL DOCTORING

When I began during the 1980s, only luxury hotels had a “house doctor,” usually a local practitioner who did it as a sideline. Nowadays, in a large city even the lowliest motel receives blandishments from a dozen individuals plus several agencies that send moonlighting doctors if they can find one. “Hotel” doctors often acquire hotels by dropping by to extol their virtues to front desk personnel, perhaps with the promise of a tip. I got my start in Los Angeles writing letters to general managers, but this was 1983 when no doctor served chain hotels (Hiltons, Holiday Inns, Ramadas, Sheratons). Despite this, responses were slow; it was 1992 before I became a full-time hotel doctor, and there will never be another.

During the 1990s, half a dozen housecall services sprang up. Working from a central office with an 800 number, they accepted calls from around the US and then phoned a local doctor to make the visit. At that time, their base fee was about $200. The doctor received half but could keep whatever extra he charged for drugs and injections. Finding someone willing to make a housecall on the spur of the moment turned out to be difficult. Agencies quickly learned about me, so I made hundreds of visits for organizations with names like Hoteldocs, Expressdoc, Travel Med, and Medical Express. An agency that clears $100 per visit requires an immense volume to make a profit, so most have vanished. I once made visits for AMPM Housecalls which charged $350 per visit around 2001-2. AMPM Housecalls remains in business.

Since GMs hear about only the most disruptive problems, they underestimate how often guests want medical attention. A hotel generates one to three requests for a doctor per month for every hundred rooms. As an example, my records over recent years show that the Ritz-Carlton in Los Angeles (304 rooms) called me 77, 84, 83, 77, 100, and 66 times.

Guests who ask for a doctor want a doctor. They don’t want directions to the nearest emergency room or a list of clinics. In my long experience, about ten percent of Los Angeles hotels refuse to name a doctor because of liability fears. The hotel lawyer has explained that when a guest sues the doctor, he’ll also sue the hotel that recommended him. That’s right, but it doesn’t matter! Having a good hotel doctor doesn’t cause liability problems, it prevents them.

Here’s the scenario. A guest feels ill, consults the staff, receives a list of clinics, returns to his room to think matters over, and dies. Under this circumstance, lawyers will fall over themselves in their eagerness to sue the hotel. After all, the guest asked for help and didn’t get it. When I visit guests who need urgent care (it’s not always obvious), I take them to my car, drive (gratis) to a clinic or ER and usher them inside. This is not only good medicine, it’s self-defense. I’m responsible for that guest, but once he settles into another facility, I’m off the hook. Your staff could offer the same service, but they lack a doctor’s authority. When I decide a guest needs to go somewhere, I don’t take no for an answer.

THE RELATIONSHIP

In the old days, hotel staff summoned a doctor in the same way they summoned a prostitute. A bellman made a phone call, and the lady arrived. Departing, she stopped by the bell desk to leave a portion of her fee. This custom has not vanished. In my regular hotels, I was always aware of a few employees who called competitors because they wanted the tip.

Even in the old days, a European hotel’s doctor was not an employee, but these things were managed better overseas where general managers chose the doctor. This is clearly not the case in the US because I recall only half a dozen interviews in thirty years. Of course, hotels that chose me sight-unseen never had cause to regret it, but this was not invariably the case. Google Jules Lusman.

An encounter with a doctor sticks in a guest’s mind, so you should do your best to ensure it’s a positive experience. This means an interview and a check of credentials. To find candidates, phone other hotels to ask who they use. Any experienced concierge or bellman can provide names if approached tactfully. Asking your family doctor might help, but most doctors hate doing housecalls, and you wouldn’t want someone with a busy practice. Internet searches are skimpy (“housecall doctor” works better than “hotel doctor”). Your mail may turn up publicity from housecall agencies, but these are a crapshoot because they employ an ever-changing cast of moonlighters.

Determining a doctor’s competence is essentially impossible (fortunately most are OK), but you want to make sure there are no skeletons in his closet. Don’t spend money on internet companies that claim to uncover a doctor’s background. Simply do a search for “(your state) medical board complaints” to find a site where you can enter the doctor’s name and learn if he has come to the board’s attention. In California, this turns up http://www.medbd.ca.gov/Lookup.htm where you can check me out.

Then you or a trusted colleague should ask him to drop in. The interview shouldn’t take long; your guests will form an opinion based on a quick first impression, so why shouldn’t you? It’s a good idea to keep in mind the following.

WHAT GUESTS WANT WHEN THEY WANT A DOCTOR

1. When guests call the doctor, they should reach the doctor.

I’m amazed that physicians still use numbers that reach answering services, beepers, and receptionists. Mine reaches my cell phone. Guests love that I answer in person. Other doctors express horror that anyone can call my “home number.” I point out that hotel doctoring is a luxury service and expensive. Guests should get what they pay for. Since it’s also highly competitive, a GM should have no trouble persuading a doctor to respond quickly. It’s something you can check on by dialing the number now and then.

3. Phone advice should be free.

Lawyers agree unanimously that doctors should never, never give advice over the phone. Some obey, but you don’t want one to serve your hotel. More than half of guests who call me don’t require a visit, so this is no minor matter. Here you’re out of luck if you use a commercial housecall service, because the guest will speak to a dispatcher whose sole duty is scheduling a visit.

Every few months a guest will unpack and realize his or her heart medication or birth control pills are at home. They will be in despair, because they assume getting a replacement will be a tiresome, expensive process. They love hearing that the house doctor will simply phone a local pharmacy. I do that regularly, and I don’t charge.

4. When the doctor agrees to come, he should come.

Since competition moved in, my greatest source of new clients is doctors who take hours to show up. Patients will fume quietly in a waiting room, but hotel guests are quick to complain. Staff then call the doctor’s number, reaching the answering service who promises to page him. After a while they call me. In thirty years, no one has called to wonder where I am because I always tell a guest when I’ll arrive and call again to apologize if I’m delayed. This is such common courtesy that you should be deeply suspicious of any doctor who gets complaints. If asked about housecalls during the wee hours, all candidates will proclaim their eagerness, but your staff should keep a record of guests who ask for help late at night. You’ll soon learn if the doctor doesn’t like to get out of bed.

5. He should not charge an arm and a leg.

I charge $200-$250 during most of the day plus $50 for calls that get me out of bed. Guests at cheap hotels pay less. My only extra is for distant hotels which varies according to the distance and how reluctant I am to make the drive. I don’t charge for supplies or medication, and that includes injections. These turn out to be surprisingly cheap; I rarely give out anything that costs me over $10, and most guests get everything they need. My housecall fee is less than the going rate which is probably around $300 plus medication. Don’t assume this is because of my deep humanitarian instincts; it’s a rate that I feel comfortable quoting, and I’ll certainly raise it as time goes by. But it does cause resentment even among rival hotel doctors with whom I’m on speaking terms. They probably think I’m trying to steal hotels, but, if pressed, they’ll admit that hotel management doesn’t care what the doctor charges and most probably don’t know his fee. As long as patients aren’t complaining, management doesn’t don’t care. I’ve never acquired a hotel because my fee is lower.

Don’t be reluctant to tell the doctor how to run his business. An office practice may have several thousand patients. At my busiest I had forty regular clients and twice that many who called irregularly, so a single hotel represented a major source of income. No sensible doctor will ignore your suggestions. Here’s one that worked. Long ago, I charged $100 for a visit, but expenses were rising, so I decided it was time for an increase. Shortly after, I visited the JW Marriott in Century City, a regular. All upscale hotels and many chains will pay my fee, adding it to the guest’s bill (a good idea; guests like it, and it enables you to keep track). When I handed my invoice to the concierge, she examined it, hesitated, then said: “I see you’ve gone up to $120… Doctor Lusman stopped by a few weeks ago. He said he’d see guests for $100.” What could I do? Thereafter, guests at the JW Marriott continued to pay $100. Guests everywhere else paid more. Wasn’t that easy?

At midnight in the hotel restaurant, a guest asked the waiter to light her cigarette. When he complied, her finger burst into flame. She had recently applied acrylic nails, and the cement is flammable. The guest was drunk and abusive, and she refused to go to an emergency room… I’ll save that story for an essay in which I recount times I’ve saved a hotel’s bacon. This won’t happen often, but you’ll thank your lucky stars when it does.

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