Bringing the Housecall into the Twenty-First Century, Part 2

My July 2 post concerned Medicast, a service that arrived in Los Angeles with the goal of bringing the housecall into the internet age. Anyone can download the Medicast app. Clicking connects you to a dispatcher who records your credit card information and sends a text message to the doctor on-call who arrives at your “home, office, or hotel” within two hours. You can Google Medicast.

Its fees are less than those of traditional hotel doctors (who don’t advertise) and much less than the entrepreneurial concierge doctors who do.

Always alert to competition, I contacted Medicast whose directors expressed delight at my experience and welcomed me aboard. I attended an orientation where doctors learned to deal with their software. We left carrying an iPad.

Over thirty years, a dozen national housecall services have come to Los Angeles and, mostly, gone. Size is their great obstacle. When I collect a fee, I keep it all. After paying the doctor, a service has other people to pay. Success requires either a high patient volume or high fees.

My maximum volume has been about 2,000 calls per year, and I have never grossed more than $130,000 – a great deal to most of you but peanuts for a doctor. It’s unlikely any organization can match my volume.

One national housecall service has operated since the 1990s. Its site emphasizes the quality of its doctors, and this was certainly true when I was one. It called 26 times between 2000 and 2002 when I stopped working for them. I collected my usual fee. The service charged three times more, but dispatchers often failed to tell guests how much. As a result, when I handed over my invoice they expressed shock. Worse, they blamed me for the fee and did not hesitate to express their displeasure to the hotel. This cause me some difficulty. I'm sorry not to mention its name, but I'm as paranoid about being sued as the average doctor.

Getting back to the present, over the next two months, I received 16 calls from Medicast, the last in mid-July. Last week a director phoned to explain that calls were increasing but not to the extent they expected, so they were adopting a different business plan. Two days later, a courier arrived to reclaim the iPad.

Hotel Visits I Don't Make

I don’t make housecalls for certain symptoms: shortness of breath, chest pain, loss of consciousness, and severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, but possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you’ll sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when he guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind.  

Medical science has no cure for drunkenness, but hope springs eternal, so hotel staff continue to call.

How Can I Break Into Hotel Doctoring?

My first response is always: read my blog. Begun in 2009, it contains everything you need to know about hotel doctoring including how I started.

While it’s entertaining, it might not help. I began in 1983 when there was little competition. I do no marketing except an occasional letter to general managers. I have no web site; this blog, as I chronically complain, has never attracted a customer. I don’t pay hotel employees when they refer a guest (illegal but a long tradition). Yet I do fine. My database, so old it’s a DOS program, contains nearly 18,000 visits. No one will ever match that.

The quickest way to break in is to buy another doctor’s practice. Buying an office practice is bad business because patients drift away, but a doctor selling a hotel practice simply transfers the phone number. As long as the buyer responds to calls, he’ll keep every client because hotels rarely pay close attention to their house doctor.

This is no idle theory because a veteran colleague will soon retire. Another physician has purchased his clientele, a dozen of Los Angeles' and Beverly Hills’ most luxurious hotels. I have heard only good things about the buyer, but he is not an established hotel physician or a friend, so I plan to benefit.

Despite collecting Social Security for ten years, I have no plans to retire, but it’s hard to imagine me working beyond a few more years. I might entertain an offer.