Cheating

“Could you put my name on the bill?” asked a guest. “I have insurance for this trip, but my girl friend doesn’t.”

“I’m afraid that’s illegal,” I answered. I’m not sure that was true, but it seemed a painless way to decline. The guest didn’t seem offended. From his point of view, there was no harm in trying.

Guests occasionally ask me to cheat on their insurance. A carrier once called to question a charge of several thousand dollars. It turned out the guest had penciled in a zero when he submitted the bill.

People are more likely to cheat if there’s no chance of getting caught. I still remember my anger when, thirty years ago, I witnessed someone put a quarter into a newspaper dispenser, open the cover, pull out a newspaper and then pull out several more to give to friends. These dispensers are stocked by an independent vendor who buys the papers himself. I informed the man who hurried off, less concerned about his thievery than this stranger abusing him.

Irritating Customer Service

As soon as I entered the Hilton lobby, a young man approached.

“I’m the assistant front desk manager” he said. I’ll take you to Mr. Frank’s room.”

“Thanks, but I know how to get there.”

“He’s a VIP. We want to make sure everything goes smoothly.”

We took the elevator to the penthouse. The manager knocked. When the door opened, he announced the doctor’s arrival, waved me inside, and walked off.

It seems a no-brainer that when a hotel provides good customer service it should (a) provide the service and (b)… there is no “b.”

But hotels can’t leave well enough alone. They feel the irresistible urge to (a) provide the service and (b) MAKE SURE THE GUEST KNOWS IT!!!

For example, when I phone a hotel I want to reach my party quickly, but I’m forced to listen to something like, “Good morning. Welcome to the Del Mar, the premier choice for business and pleasure in Southern California. This is Roxanne. How may I serve your every need?” (I’m not making this up).

I’ve never understood why hotels order employees to greet everyone who passes. It’s supposed to be a friendly greeting, but no one can keep up the cheer after greeting a few hundred strangers, so I’m forced to respond to a string of bored salutations as I make my way to a guest’s room. The poor housekeepers (whose English may be limited to “good morning”) don’t look up from their work as I pass but dutifully follow orders.  

The Pantomime

“Ah! El Medico! Buenos dias!”

“Hello. I’m Doctor Oppenheim,”

I entered the room and listened as she explained her problem in Spanish. Most Latin Americans speak enough English to get along; in any case they travel in groups, and there’s usually someone to interpret.

“It sounds like you have a cough. What are your other symptoms?....”

She waved her hand to indicate noncomprehension and continued her recital. She was elderly and alone, a bad sign. Most people hate to stumble along in a foreign language. If I’m patient they often reveal some facility, but this lady stuck to Spanish, performing the usual pantomime, pointing to her throat and head, waving a bottle of medication under my nose.

“How many days have you been sick….?”

Another wave. What to do…. I could call her travel insurer, but interpreting over the phone is tedious. I could phone the front desk. The clerk would cheerfully agree to send up a Spanish-speaking employee, but he or she might not appear for fifteen minutes or half an hour if at all. I looked out the door, hoping to spy a housekeeper but no luck.

My spirits rose when a middle-aged lady arrived, but she merely joined the pantomime, tapping various parts of her companion’s body. Finally, an adolescent girl appeared. She had undoubtedly paid little attention during English class but had no objection to trying her hand. Her English was terrible but good enough for my purposes, and everything worked out. 

Stress Around the World

Experts claim that half of a doctor’s patients suffer stress. You may think this is medical science, but it’s really medical culture. “Stress” is America’s explanation for symptoms without a satisfying explanation. I rarely make the diagnosis, but patients make it for me. If a guest comes down with his fifth cold this year or a stubborn backache or upset stomach, he’ll inform me that he’s been under stress.

Unlike most doctors I see patients from around the world, and it turns out that other nations don’t suffer stress.

Germans suffer low blood pressure. It’s considered a genuine physiological disturbance. German doctors seek it out and treat it, often with drugs. Long ago, I was puzzled when young Germans with fatigue, headaches, indigestion, or flu symptoms wanted their blood pressure checked. Then I learned.

The French don’t have stress or low blood pressure. Perhaps because of the universal consumption of wine, French doctors believe that subtle liver disorders produce many distressing symptoms. 

Constipation was once the great English preoccupation and has not entirely disappeared. This was thought to produce “auto-intoxication” from retained waste that leaked toxins into the body. Many laymen still consider it beneficial to undergo a “colonic,” in which a technician inserts a tube into the anus and washes out all those toxins.

Traditional Chinese healing emphasizes a medicine for every condition. I’m sure you would be insulted (and so would any educated Asian) if I were to suggest that you expect a prescription every time you see us, but many doctors get that impression.

I regularly explain to puzzled Chinese parents why it isn’t necessary to treat every symptom of their sick child. On other occasions, when I explain that an adult’s illness will go away without treatment, I see him exchange a look with his wife that clearly means, “What bad luck! We go on a vacation. I get sick. Then I see this foreign doctor who does not know the proper medicine!”  

A Near Miss

No one came to the door after several knocks.

I had spoken to the guest an hour before and announced my arrival time. Taking for granted that doctors are never early, some guests wander off, but I wasn’t early. This was serious. Unlike the case when a travel insurer sends me, when guests call and vanish, I don’t get paid.

Some guest sleep soundly. I phoned the room; no one answered. I called the concierge to ask her help; before I could interrupt she cheerfully offered to phone the room and hung up. She came back on the line a minute later to announce that, sadly, the guest hadn’t answered, but she would be happy to take a message.

Sticking my business card in the door frame, I returned to the lobby and wandered about. Occasionally, for mysterious reasons, guests decide they must meet me downstairs. I look like a doctor in an old movie with a white beard, suit, and doctor’s bag, but no one took the bait.

I struck gold in the hotel restaurant where a man leapt up from a crowded table and hurried over. He began reciting his symptoms until I suggested we wait for some privacy.

When asked why he wasn’t in his room, he answered that he was hungry but that he had “told the hotel” where I could find him. He pointed to a desk clerk who was busy checking in a family.

Things I Don't Say to Patients

1. Get plenty of rest. 

Rest treats fatigue, but that’s all. I tell patients with minor illnesses to stay in bed only if that’s where they want to be.

2. Watch your diet. 

For minor illnesses, proper nutrition isn’t very helpful. If you have no appetite, forcing food down makes you feel worse without accomplishing anything useful.

3. Drink plenty of liquids. 

There are two problems here.

A.  More water evaporates during a fever, so replacing it is a good idea, but a healthy adult can safely ignore this for a day or two. If the fever lasts longer, a doctor’s first step is not to replace liquids but to find out what’s happening.

B.  Since the dawn of history, people have believed that a sick body is full of toxins. This is common sense (almost always wrong when applied to your health). Nineteenth century doctors prescribed drugs to produce vomiting or diarrhea, and patients knew this worked because they could see the smelly stuff pouring out. We no longer believe in “purges”, but enthusiasts (doctors among them) still believe that urinating expels toxins, so they advise you to drink 6 or 8 or 10 glasses of waters a day.

4. Be sure to take aspirin or Tylenol. 

“But then the fever came back,” patients tell me as if this were bad. In fact, these drugs wear off after a few hours. The fever of common infections won’t harm a healthy person, and aspirin or Tylenol won’t shorten the course of any ailment.  It’s all right to take them to feel better but not essential.

5. Keep warm.  Keep cool. 

We shiver when our tem­perature rises and sweat when it falls. That’s how the body warms up and cools down. Shivering or sweating are not necessarily ominous signs; nor is it good “when the fever breaks.”

Things I Say All the Time

Long experience has taught me that patients love to hear the following.

1.  “This isn’t a serious problem, and it never turns into a serious problem.”

Doctors know that many tiresome ailments such as hemorrhoids, bladder infections, migraine, or herpes don’t turn into something worse, but patients don’t know this. A doctor must tell them. 

2.  “I want you to call me any time.”

Doctors say this all the time, but you know what happens when you try. I show guests my cell phone and promise to answer in person. Naturally, I do this because I’m a compassionate physician, but there’s an element of self-interest. If guests aren’t getting better, I want them to tell me – not the hotel.

3.  “Staying in bed won’t make this go away faster.”

Travelers waste valuable days in a boring hotel room, so I try to take the pressure off. This myth is so universal that when I reassure non-English speaking guests, I ask them what I’ve just said. Almost always, they repeat it back minus the negative.

4.  “You’ll feel under the weather for a few days; then you’ll feel better.”

Guests may suffer for weeks, but once they see a doctor, they want things to move quickly. If I don’t explain that this might not happen, I may hear from them the next day.

5. “It’s not your fault.”

A baleful consequence of the popularity of alternative medical theories is that patients believe they’re responsible for getting sick. Mostly, they’re not.