You Think I Have a Soft Job

The phone rang at 1:10 a.m. An international housecall agency had a visit in Anaheim, forty miles away. I agreed to go but quoted a larger fee because of the hour and distance. The dispatcher, in Miami, said she would ask for approval and get back to me.

I dressed and waited. After ten minutes I called to ask about the delay.

“I’m sorry. We’re waiting for the E-mail.”

“E-mail!! Can’t you phone them?”

Apparently not. Approval had to come from Madrid or Buenos Aires. I waited another fifteen minutes before calling again. Learning that the E-mail still hadn’t arrived, I told the dispatcher I had changed my mind and went back to bed.

Humor in Medicine

I had cared for a ten year-old with fever who had vomited twice. It was the usual stomach virus that might last a day. I reassured his mother and gave anti-nausea pills.

“I’m concerned about his fever. How often should I measure it?”

“Whenever you want.”

“I’m not comfortable with that. How often?”

“Are you worried about his fever?” I asked.

“Of course.”

“In that case don’t take his temperature.”

This is my usual drole response to patients frightened by fevers. It startles them, but my explanation reassures them. This lady was not startled but offended.

“I work in the medical profession, doctor, and that is dangerous advice.”

“Actually not.” I explained that when otherwise healthy people get seriously sick, they look sick. If they don’t look sick, they’re probably not sick, and having a fever doesn’t change matters. Infants and the elderly are exceptions; otherwise this is a good rule. People worry too much about fevers.

“I’ve heard different. Fever can kill.”

“You see life-threatening fevers in diseases like meningitis and rabies, but these patients look very bad. I haven’t seen a life-threatening fever in thirty years. Sick people look sick. Make your decision on calling a doctor on that basis. Never mind the fever.”

“We’re done here.” She held out her credit card.  

Why Doctor Oppenheim Isn't Rich

The better we conventional doctors handle a problem, the less you’ll read about “alternative” treatments. Your local health food store doesn’t sell an herbal remedy for appendicitis. Don’t laugh. Until a century ago victims died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. This is one of many genuine medical miracles we take for granted. Some of us remember the herpes panic of the late seventies. The AIDS panic that followed overshadowed it, but Time magazine and Newsweek published cover stories on herpes, and the New York Times described it as the twentieth century bubonic plague. Alternative remedies were everywhere, not a few sold by entrepreneurial doctors. Then a good drug appeared, and the market for herpes cures dried up.

On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. If you want a superb treatment that conventional doctors ignore, check the internet or a bookstore. You’ll find plenty.

Many alternative healers are M.D.’s like me. They have names like Deepak Chopra and Andrew Weil and Mehmet Oz. They agree that scientific medicine has much to offer but insist that it is merely one of many routes to healing. 

They assert that it’s equally important to tap our spiritual energies, maintain a healthy optimism, promote natural healing with balanced and pure nutrients available through their web sites, and keep an open mind to cures wrought by eastern religion, nonwestern medicine, and pioneering researchers ignored by the establishment.

It is my belief that this is not true and that they are quacks. In my opinion (my lawyer insists that I add this). But as someone convinced that science is the road to truth, I’m obligated to present evidence. So….

I write an obscure blog. Weil, Oz, and Chopra write bestsellers. My books never sold much (I’ve written five, all commercially published). There are no ads on my blog. Weil, Oz, and Chopra have plenty. They sell wonderful stuff on their web sites. They appear on TV all the time. No one asks for Doctor O.

It doesn’t look good for me. 

Three More Great Sins of the Medical Profession

 4. Doctors order too many tests and prescribe too many drugs.

Correct. We love tests, but so you. Most patients with a painful injury assume they need an X-ray, but they don’t.  Those with a high fever (“flu”), sore throat (“tonsillitis”), cough (“bronchitis”), or stuffiness (“sinus infection”) assume they need an antibiotic, but they usually don’t. Doctors hate to disappoint patients, so they lean over backwards to “do” something like order a test or prescribe.

 5. Doctors order too few tests and prescribe too few drugs.

We can’t win.  Some clinic directors and insurance plans restrict the tests and drugs we can order. This infuriates doctors as well as patients, but the sad fact is that experts set up guidelines to discourage useless tests and wrong or unnecessarily expensive drugs. They sometimes work.

6.  Doctors ignore alternative and folk medical practices.

I notice enthusiasts treat folk medicine with respect, but no one advocates folk dentistry...  It turns out that many alternative practices work but less dramatically than advocates claim.  Acupuncture definitely relieves pain. Unfortunately, its action is unpredictable and not always complete. Despite vivid reports, Chinese surgeons rarely use it for anesthesia. Chiropractic manipulation relieves some backaches for a limited time.

Three Great Sins of the Medical Profession

Critics regularly denounce us for certain practices. These denunciations are more or less correct, but they miss the point.  Examples -

1. Doctors give treatments that relieve symptoms but don’t cure the underlying problem.

Right, but sometimes this is the best we can do. The cure for severe menstrual cramps is menopause, hysterectomy, or pregnancy. Drugs only relieve the pain, but patients appreciate it. No doctor cures migraine, asthma, emphysema, osteoporosis, or the flu, but we relieve a great deal of misery.

2. Doctors don’t pay much attention to diet, liquid intake, rest, and other natural treatments.

We don’t, and it’s the right thing to do.  Diet, rest, etc. help prevent disease but don’t do much once you get sick... A perfect example were tuberculosis sanitariums, the oldest government supported medical program. They began appearing in the nineteenth century. Patients received nutritious food and plenty of rest in a healthy, rural environment. They were discharged (sometime after years) when their TB became inactive. No one was cured, and many relapsed. When drugs appeared after 1945 sanitariums closed. Nowadays doctors encourage TB patients to adopt a healthy life-style, but they’ll get better if they don’t – provided they take their drugs.

3. Doctors spend too little time explaining how to relieve stress.

Perhaps....  Stress makes everything worse but doesn’t cause anything. Seeing a doctor for stress results from what I call the “medicalization of society” - the notion that life’s difficulties (a hateful job, unsatisfying sex life, shyness) represent a medical problem. There’s no harm in this; a good doctor can listen sympathetically and make sensible suggestions which require no medical training.

More Guests I Didn't Help

A travel insurer asked me to see nine sick hotel guests. My first thought was food poisoning, but their symptoms turned out to be coughing and sore throat.

I love multiple visits at the same hotel, but I wouldn’t love these. I visualized the scenario: a large group arrives for an expensive vacation where many fall ill, and in America you need a prescription for an antibiotic. Luckily, they tell themselves, we have travel insurance. The doctor will come and give us our Amoxicillin, and we’ll be fine.

My philosophy on antibiotics is that I prescribe them if they’ll help, and I don’t prescribe them if they won’t. This puts me at odds with doctors around the world not excluding the US.

When I see victims of a respiratory infections (fifteen percent of a family doctor’s business) I do my best. Almost all seem satisfied, but a few make it clear that I have failed them.

Luckily, there was a nearby walk-in clinic where these guests would get their antibiotics.

A Guest I Didn't Help

A flight attendant at the Airport Holiday Inn was suffering an allergy attack. She couldn’t fly because of the congestion, and her airline required a doctor’s exam and note. This is a common request which I fulfill regularly, but I couldn’t fulfill hers because she was American.

When a British Air, Virgin-Atlantic, Emirate, Singapore, or Cathay-Pacific crew member falls ill, the local supervisor calls a national housecall service who calls me, and the airline pays. US airlines never do this. Their employees are on their own in a strange city with no transportation and their American insurance which is deeply suspicious of housecalls. 

I occasionally make a charity visit to an American flight attendant too sick to leave the room but not sick enough for the paramedics. Mostly I refer them to an urgent care clinic.

Caring for Celebrities

Searching my housecall database (over 18,000 visits) for “celebrity” turns up 92 hits although that includes wives and children.

You recently read about my encounter with a famous person. I mentioned him by name because I was never his doctor, but I’m sure you don’t expect stories about celebrities I cared for. Unfortunately, literary agents do expect it. News that it’s forbidden has proven the kiss of death for my memoirs.

Most celebrities are nice, but over forty years I’ve cared plenty of misbehaving luminaries including several who died under dramatic circumstances. Agents have assured me that “you can’t libel the dead.” This turns out to be a legal fact, but the dead’s loved ones have been known to sue after reading unflattering remarks.

Why You Get Sick, Part 2

You do get sick because:

        1.  No one is perfect.  The healthiest human is full of clumsy design defects.  Our back muscles are too weak, so even normal activity can injure them.  Human veins are too flabby to resist a normal blood pressure; that’s why we get hemorrhoids and varicose veins.  Roughage may be good for you, but humans can’t digest some carbohydrates.  That’s why a high fiber diet causes gas.

        2.  Your “resistance” is too strong.  Don’t blame a fever on that infection you caught.  Your body itself generates extra heat whenever an invader is present.  Some experts claim fever is good for you, but the evidence is thin.

        The human immune system is too strong for its own good - and trigger happy!  Allergies occur when it tries to defend you against an innocent pollen, drug, or food.  Even worse, it may decide one of your own organs is the enemy.  Thyroiditis, the most common cause of thyroid deficiency, is an “autoimmune” disease.  An overactive immune system may also assault the heart (rheumatic fever), liver (autoimmune hepatitis), kidney (glomerulonephritis), joints (rheumatoid arthritis), or skin (eczema, hives).

        3.  Nature plays no favorites.  It assumes germs and viruses have as much right to exist as you.  Catching the flu, for example, is not a sign of weakness.  Most healthy people exposed to a new flu virus get sick.  Then they recover, but this is not a defeat for the virus.  Multiplying during the illness, many escape into the air to infect others.  The flu virus normally infects a victim for a week or so, then moves on.  That’s the role it plays in nature.  Your role is to get the flu now and then.

        Medical science works to give humans an advantage in this competition, and we’ve done pretty well.  But nature is impartial.

Why You Get Sick

When I walk into a hotel room, guests often tell me why they fell ill. They also blame themselves. In both cases they’re usually wrong.

You don’t get sick because:

        1.  Your “resistance” is low.  You got that cold because another person gave it to you.  If it’s your fifth cold of the year, this is a sign of what we in the medical profession call bad luck.  It’s not a defect in your immune system.  People with poor resistance suffer terrible diseases.  There is no immune defect that gives victims too many minor infections.

        2.  Your diet is missing something.  Americans suffer plenty of nutrition-related ailments, but most result from too much rather than too little of some element.  Examples are obesity, high blood pressure, coronary artery disease, and tooth decay.

        3.  You don’t get enough (sleep, exercise, water, leisure).  Researchers have proved beyond a doubt that lack of sleep makes you sleepy.  Subjects kept awake for days become very drowsy.  They don’t get sick.  Exercise improves your sense of well-being and strengthens muscle and bone, and it probably slows osteoporosis.  Vigorous, long-term activity may protect against coronary artery disease and prolong life.  Among younger people, sloth is not responsible for any disease.  Drinking x glasses of water a day is a harmless folk remedy. Doctors often suggest it to prevent bladder infections, but that’s common sense (i.e. it sounds good, but there’s no evidence that it works).   

The Time I Didn't Care for Woody Allen

“Woody Allen needs a doctor. How quickly can you get here?” The caller was the concierge from the J.W. Marriott.

                                                                                                                 

“Ten minutes,” I replied. The J.W. Marriott was in Century City, near Beverly Hills, a five minute drive.

“I don’t know….” She seemed doubtful. “I guess you should come.”

That sounded strange. How many doctors would appear at your door that quickly…? I threw on my suit and raced to my car. Turning into the hotel entrance drive, I encountered a sight that made my heart sink: a paramedic ambulance.

                                                                                                                 

“We couldn’t wait,” the concierge called out as I hurried past. There was still a chance. Most 911 calls are not emergencies. Long ago, paramedics declined to transport anyone who didn’t seem seriously ill. Sadly, they were burned in several cases when someone died after they left. Thereafter, their refusal rate plummeted, but I never lost hope.

Leaving the elevator, I headed for the inevitable crowd. As I approached, it parted providing a fleeting glimpse of Woody Allen rolling past on a gurney. I returned home, disappointed and unpaid.

                                                                                                                 

My experience with movie stars is that their screen personality owes much to reality, so I theorized that he had suffered an anxiety attack. Agitated guests make hotel employees nervous, so they’re quick to call paramedics, but this is overkill. I have a soothing manner, white hair, and a white beard (less white when I saw Woody Allen in 1993). Once I arrive and settle into a chair, I rarely fail to calm a panicky guest. Phoned in the middle of the night, I do the same without getting out of bed. Woody Allen should have waited for me.

Having the Proper Credentials

A Brazilian woman suffered abdominal pain, but her doctor in Rio found nothing wrong. It went away, so she flew to the US where it recurred.

Her host lived in the Hollywood Hills and spoke excellent English. She may have been a show business personality because her walls were covered with celebrity photographs and posters. After examining the guest, I explained that she needed a further evaluation, perhaps including an ultrasound, because one possible diagnosis was gallstones.

Her host spoke up. “You are ordering an ultrasound? Where must we go?”

I explained that I wasn’t ordering an ultrasound but referring her to a doctor who could do whatever tests were necessary. I added that my next step was to go home, fax my report to the insurer’s American office in Miami, and follow it up with a call to alert the dispatcher. He would phone doctors in Los Angeles, preferably the ones I recommended, until he found one willing to accept the Brazilian insurance and then call her. It might take a few hours.

“I have a fax machine. Why not do it now?”

I didn’t know the insurer’s fax number. It was at home.

“Then I will call.” Examining her guest’s insurance papers, she found a phone number, but it looked foreign. As she dialed, I warned that the Brazilian office probably didn’t handle referrals, but she waved me off. 

There followed a long conversation in Portuguese. Afterward, she explained that she had laid out the problem. They promised to get back to her.

I returned home, faxed my report, and called the Miami office. Before I could report back to the Brazilian lady, she called me.

“What is your license number?” she asked.

“Why do you want that?”

“Brazil never called, so we came to Cedars-Sinai. The ultrasound department needs your license for the test.”

“Don’t do that!” I said. “The first step is to see a specialist. And the test will be very expensive unless the insurance approves.”

I phoned the Miami office to urge them to settle matters with Cedars-Sinai. Within minutes my phone rang. It was the Brazilian lady again.

“There is something serious…. Cedars-Sinai has no record of you.”

“I’m not on their staff.”

“They cannot find your name. I am very disturbed.”

I assured her I was a real doctor.

“How do I know that? When I called for a doctor, you came in an hour.”

She could Google me, I suggested.

I phoned Miami to warn that the patient had gone to Cedars. The dispatcher delivered equally bad news. He had phoned Brazil to obtain approval for the expense. Unfortunately, the Brazilian office had had an earful from the Brazilian host who emphasized her friend’s past suffering. This provided an irresistible excuse to claim a pre-existing condition and deny approval. 

After hearing this news, the patient and her host went home. I warned that she still needed an evaluation and offered to refer her to a colleague. The Brazilian host remained polite but informed me that the next doctor she consulted would have to have better credentials.

Long Time No See

 Hey, Doctor! It’s been a while.”

I love it when parking valets recognize me. That was the good news. The ‘it’s been a while’ was not so good. This was my first visit of the year to Le Parc, an upscale West Hollywood hotel. It was once a regular, calling 20 to 40 times per year since 1993.

Hotel doctoring is viciously competitive, and another doctor had worked his magic. But hope springs eternal; hotels occasionally realize their mistake and return to the fold. Maybe this was a sign.

The guest had injured her leg five days earlier. X-rays in an emergency room were negative, but since yesterday her pain had worsened. I didn’t find anything abnormal except for a huge black-and-blue mark. This may have been normal healing, but she needed another X-ray.

“Doctor O! How’s business!” The desk clerk also recognized me. When I ask why a hotel has stopped calling, employees always respond that no one has been sick, so I’ve stopped asking. But I couldn’t resist. The desk clerk assured me that no one had been sick.

Not Being a Bad Person

On a plane returning to Los Angeles, a flight attendant asked if a doctor were on board. Reluctantly, I raised my hand.

Walking up the aisle, I relieved my fears by recalling that hotel employees who tell me a guest is seriously ill are usually wrong. 

The passenger complained of a tight chest and difficulty breathing. He was forty with no medical problems, and his only medication was a tranquilizer which he didn’t have. He had no objection to my diagnosis of anxiety attack; he’d had them before. I reassured him and reassured the flight attendant that he’d be OK until the plane arrived. This turned out to be true.

Hearing the story, my wife said that she expected no less of me because I’m a caring, compassionate doctor. She often says things like that.

In fact, I raised my hand because I believe that a physician asked for help has a moral obligation to respond. If he doesn’t, he’s a bad person. Responding did not make me feel good, but not responding would feel worse.

Plenty of doctors keep quiet under those circumstances and comfort themselves with excellent reasons. It was unlikely that I could handle a genuine emergency. I haven’t performed CPR in decades; in any case doing so in that packed cabin was impossible. Standing by helplessly would make me look foolish. Doctors hate that. The passenger might sue. This has happened. You’ve probably heard of the “good Samaritan” law, but any competent lawyer can find a reason it doesn’t apply.

More Easy Visits

“A bee stung my wife. That was two days ago, but today it’s more swollen.”

I explained that bee stings usually get worse for 48 hours before they improve.

“We catch a plane tomorrow, so we’d like to see a doctor.”

Before I left, the phone rang again. A man’s ears had become plugged when his plane descended the previous day. He worried about an infection. I explained that pressure changes while flying don’t cause infections, and the discomfort often persists for a day or two. I suggested a decongestant, but he wanted someone to look in his ears.

A visit from the hotel doctor is not cheap, and I’m liberal with phone advice. Only about half my calls turn into a visit. Now and then I have the delightful experience of making a housecall because the guest wants one despite my assurance that it’s not necessary. In this blog, I’ve recounted occasions where what seemed like a no-brainer turned out to be no such thing. That rarely happens, and it didn’t happen this time.

The bee sting turned out to be a bee sting, and the guest’s ears looked normal. Sometimes hotel doctoring is a snap.

A Not-So-Easy Visit

A Biltmore guest with a sore foot had a meeting after breakfast. Could I come now?

I rise early, so the 5:50 a.m. call found me writing this blog. Reaching the Biltmore, ten miles distant downtown, is no problem if traffic is moving, but it wouldn’t be moving soon, and I hate driving during the rush hour.

I considered sending him to a nearby 24-hour clinic. But a sore foot was an easy visit (i.e. not serious and not a respiratory infection). If I hurried, I might escape gridlock, so I told him to expect me around 6:30. 

I left my car at the entrance and hurried to the room. As expected, it was an easy visit. Leaving the hotel, I saw that my car had vanished. Most Biltmore parking valets recognize me; this one hadn’t, so I had delivered my mantra (“I’m the hotel doctor. I’ll be here twenty minutes. They hold my car.”) He nodded and smiled and then proceeded to follow orders and drive my car deep into the building. Then he dropped my keys off at the parking kiosk whose attendant demanded the usual spectacular fee.

I returned to the lobby to track down a manager willing to overrule the attendant. Following this, I waited my turn for the valet to retrieve my car. Those delays pushed me past a critical point, morphing the half hour drive downtown into more than an hour to return.

A Good Call

A singer felt a sore throat coming on, his manager explained. He needed a shot of cortisone. I’ve given many; singers seem to think they work, and they’re harmless.

These are good calls. I drive to a hotel, give an injection, collect money, and return home. What’s not to like?

The manager added that the singer would need his shot the day of his performance the following Saturday. Early Saturday he phoned to inform me that the singer was free at midday. He would call to give an hour’s notice. Midday passed without a call.

As I prepared for dinner at six p.m. the manager phoned to announce that his client was ready. But there was a hitch. The singer was not in Los Angeles but at a resort hotel in La Puente thirty-five miles away. Although weekend freeways are usually fast, this trip took an hour. The resort was hosting an event called The Urban Music Festival; it was packed with black people, the women in dazzling gowns, the men dressed as gangsters.

No one answered when I knocked on the singer’s door. I phoned the singer’s manager and heard voicemail. I paced the hall for fifteen minutes, knocking and phoning now and then. I checked with the concierge who obligingly offered to call the room.

My phone rang as I was driving off. I retraced my steps to the room, now packed with the singer’s colorful entourage. I gave the shot, collected my money, and returned home to supper.

Catching the Flight Home

A tour leader informed me that a 70 year-old in his group had severe abdominal pain.

I explained that this was probably not something a housecall would solve. He would almost certainly need an emergency room visit.

“They understand,” said the tour leader. “But they want a doctor to come to make sure.”

He was not being honest, as I discovered. Anxious to avoid accompanying the man and his wife to the hospital, he had insisted on a housecall hoping that I would make the problem go away.

He had also not passed on my suspicions, so the couple was shocked when, after an examination, I repeated it. The husband refused to go, pointing out that their return flight left the following day. He added that he was merely constipated. Telephoned, his doctor at home had agreed and recommended an enema.

I responded that being on the spot gave me priority. The guest assured me he would think it over and go to an ER if the pain persisted.

I passed a worried night. In the morning, the wife declared that her husband felt a littler better. Feeling “a little better” in response to a doctor’s query means “no better.” I warned them not to board the plane if the husband had any abdominal pain. Two hours later the wife phoned to announce that he was entirely better, and they were leaving for the airport.

The Miracle Game

A guest’s ankle injury didn’t seem serious, so I told her we’d wait a day before deciding on an x-ray. At her request, I wrapped the ankle in an elastic bandage while explaining that orthopedists believe that elastic bandages accomplish little. 

As I wrapped, I mused on the superiority of western medicine. I have little respect for alternative, complementary, holistic, herbal, or natural healing systems, but I admit that all popular and media doctors disagree, and they enjoy a far larger audience than this obscure blog.

My reasons have something to do with the fact that we genuinely help patients, but I prefer to stress how often we don’t. Alternative healers never say: “This treatment could be better…” or “We thought we understood this disease, but we were wrong…” or “We screwed up…” Scientific training hasn’t prevented me from making mistakes, but I hope I learn from them. 

When I’m feeling particularly hostile, I challenge alternative medicine fans to play the miracle game. I’ll name one of our miracles; then it's your turn. No fair using a secret cure. It has to be something we all agree on.   

My first western medicine miracle: the appendectomy. Appendicitis victims once died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. We take this for granted, but it’s a miracle that's saved millions of lives. Now let’s hear yours….

Getting Their Money's Worth

Dentists don’t make housecalls, and many disappear after office hours, so I hear about problems for which I am not trained.

During a weekend, a woman explained that her daughter had undergone dental work before they left town two days earlier. She was still in pain, and her jaw was swollen. She needed a visit.

So I felt stress driving to the hotel. I don’t like making a housecall where I might not solve a problem.

The daughter’s jaw didn’t appear swollen, but any painful part of the body looks abnormal to the sufferer. The tension rose as I washed my hands after putting a thermometer in her mouth. What would I say if I didn’t know what was happening?

Those situations have occurred but not this time. When I peered at the affected tooth, it looked normal, but on the nearby gum I saw an angry half-centimeter ulceration. She had a canker sore. They’re excruciating, but they heal in a week. I used to suffer them after accidentally striking my gum while brushing my teeth, so her dental work might have provoked it.

I reassured the parents and handed over a bottle of liquid Lidocaine to alleviate the pain.

“I’m sorry I called you out over something so trivial,” said the father as he paid me.

Men often feel they’re not getting their money’s worth if the problem turns out to be minor.