How to Find a Good Doctor

Readers of these posts occasionally ask me to be their doctor. Since I’m long past retirement age and make housecalls exclusively, I can’t be anyone’s family doctor.

These requests bring up a serious problem:  how do you find a good doctor? Searching the internet turns up an avalanche of physicians yearning to care for you.

All seem humane, state of the art, eager to serve. Why isn’t the choice easy? The answer, of course, is that these are advertisements: fawning and phony.

It’s impossible for doctors to advertise without appearing shifty. They invariably point out their expertise, but you take that for granted. They extol their compassion. That sounds creepy, but they can’t resist. 

I’m not after your business. I give medical advice but only if it contradicts what you hear elsewhere or seems amusing.

I enjoy describing life as a hotel doctor and delivering opinions on the world, mostly as it relates to medicine. I write what I want although my wife exerts a modest influence (almost always by saying “you can’t post that...”).

I’m often the hero of my stories, but they’re mostly day-to-day events, some of which I wish hadn’t happened. The result is that I come across as a real human being. Why shouldn’t I? I’m a good writer. Most doctors can’t write; neither can their advertising agencies.

Terrific doctors aren’t rare. Their patients know who they are, so the best way to find one is to poll people you know. Asking doctors is OK, because they’re unlikely to name anyone bad, but they tend to prefer their friends. The only terrific doctors I know are those I’ve seen in action – most often caring for me. Ask around.

Amazing Facts on Nutrition, Part 2

Here are questions I often hear often.

“How can I make sure my diet is nourishing?”

Answer:  “Eat a variety of food. By consuming a good mixture of vegetables, fruits, grains, proteins, and dairy products, you’ll get everything you need.”

“How will I know if I’m missing something?  For example, how can I get enough riboflavin?  What foods have riboflavin?”

Answer:  “I don’t know.”

“You’re a doctor, and you don’t know the foods with riboflavin?”

Answer:  “I could look it up. It’s not important. Eating a variety is important.”

“I haven’t had much energy lately. Is it because I’m not eating right?”

Answer:  “Probably not.”

What should you do first if you're anemic?

Answer:  Find out where you’re bleeding. The most common anemia is the result of blood loss.

Amazing Facts on Nutrition

Although a third of the world would be better off on the typical American diet, it’s not ideal, but the defects are not what you believe.

What should you worry about?

Protein?  Not a problem.  Most adults consume more than they need. There’s no advantage to a high protein diet but not much harm either. Your body will use as much as it needs and turn the rest into fat.

Carbohydrates?  Americans should eat more. They’re high in roughage.  Americans need more roughage.

Fats?  Fat is OK. Vegetable fat is probably better than animal fat for lowering your cholesterol. Dieters should be careful about choosing low fat foods. They’re not necessarily low in calories; in fact, manufacturers add sugar to make them taste better.  

Sugar?  Americans consider sugar sinful. Like sin, it’s probably not good for you. Sugar certainly contributes to obesity and tooth decay but doesn’t cause serious diseases such as diabetes or heart attacks.

Preservatives?  They may do more good than harm. In poor countries a leading killer of children is diarrhea, often from spoiled food. This was also true in the U.S. during the nineteenth century. Refrigeration and canning makes this less of a problem today, but considering how careless we are storing and preparing food, preservatives still prevent disease. 

Should I Make a Housecall?

Only half my callers require one.

As I repeat, I’m happy to phone a pharmacy when guests forget legitimate medication: blood pressure pills, heart pills, contraceptives, etc. I don’t do this for guests who tell me “I had the same thing last year, and my doctor prescribed……” 

Exceptions exist. If a caller has had gout I believe him. It’s acceptable to treat a young woman with a typical bladder infection over the phone. If you’re wondering about symptoms of a “typical” bladder infection, I’m not telling. You have to tell me. Most “my doctor prescribes...” calls concern upper respiratory infections where the guest has received the traditional placebo antibiotic and believes he needs another.

Guests with stuffy ears don’t object if told they need a housecall, but I resist the temptation because ordinary congestion causes bilateral ear discomfort without pain. Over the phone, I advise aggressive use of nasal spray before takeoff and before the plane descends.

Injuries can be tricky. A doctor’s exam rarely diagnoses a fracture, but most common injuries are not urgent, even when a fracture is present. If guests are willing to wait until business hours, I can send them to an orthopedist’s office, more civilized than an emergency room. For back pain, a housecall is better. If you go where there’s an x-ray, you’ll get one, and experts agree that back x-rays are almost never helpful.

Much of my decision on making a housecall depends on the law of averages. Chest pain in a fifty year-old is usually not serious, but it’s unwise to assume this. It’s less unwise in a twenty year-old. A sore throat in a child or adolescent might be strep which medical science can cure. After age fifty it’s almost unheard of. I’ve never seen a case.

Laborl Day

Everyone left town for the holiday including the local concierge doctors and at least one colleague, but plenty of travelers arrived, so I was busy.

A Virgin-Australia flight attendant was vomiting at the Warner Center Marriott twenty miles to the northwest. That midnight an Emirate Airline crewlady suffered the same symptom at the Hilton in Costa Mesa fifty miles southeast. My heart sank when I remembered that the freeway to Costa Mesa in Orange County closes from 11 p.m. to 5 a.m. for major construction, and the long detour is always jammed despite the wee hour. My heart leaped when, checking traffic, I learned that the shutdown was suspended for the holiday.  

The parade of upset stomachs continued at a home near the beach in Venice. This is a funky area that brings back memories because my wife lived there when I met her during the Ford administration. It’s packed with small houses and shops built before World War I, so no one has a garage. Everyone parks on the street, and on a holiday afternoon the beaches and shops are crowded. The rule on parking (like the rule on difficult spinal taps) is: keep trying. After fifteen minutes I found a spot less than half a mile away. 

I Just Got Back From Mexico...

One third of visitors to poor countries from rich countries get sick. Experts warn tourists to avoid uncooked food, street vendors, ice, and tap water. By obeying, they lower the risk of getting sick to… one third. The truth is that no one knows how to prevent traveler’s diarrhea. Poor sanitation seems essential, but travel itself must play a role. The Swiss get sick when they visit the US.

Tourists visiting the tropics worry unnecessarily about parasites. Germs and protozoa like malaria remain a problem, but larger creatures reproduce slowly. Victims must stay long enough and undergo repeated exposure before they accumulate enough to realize something is wrong. If you harbor a few dozen schistosomes, flukes, or hookworms, you won’t notice.

Having said this, I visited one horrified guest who had seen what looked like an earthworm swimming in the toilet after a bowel movement. Unfortunately for my education, he had flushed it down. This was undoubtedly an ascarid, a parasite that affects a billion people worldwide and an unknown number in the US. Unlike parasites such as hookworms which bite into the intestine and eat your blood, ascarids swim freely and eat what you eat. You can support a dozen without difficulty. Victims get into trouble when huge numbers cause an obstruction or when a single worm crawls into a duct and gets stuck. If you return from vacation with a small infestation, you have little to worry about. The females will mate, but their eggs only hatch outside the body in warm earth, so they disappear down the sewer, and the average ascarid dies after a year or two.

Amazing Medical Maxims

What many laymen believe are serious signs are not.  Here are examples.

1. Local pain is worrisome; widespread pain is reassuring.

When a guest suffers abdominal pain, I ask to see where it hurts. When he or she indicates the entire abdomen, I relax a little. The common stomach virus produces widespread pain. When the patient’s finger rests on a small area, I worry about conditions like gallstones, appendicitis, or diverticulitis whose pain is usually localized.

2. One allergy can be serious; many allergies: not so much.

An allergy is a specific immunological reaction that can be fatal, but most drug reactions are not allergies. If a medicine upsets your stomach or gives you a headache that’s usually what we call “drug intolerance.” If you’re willing, it’s OK to continue it, something we never do with an allergy. However, doctors use “allergy” indiscriminately, and laymen add their own diagnoses, so many patients confront us with a long list of forbidden drugs, foods, and environment stuff. The major consequence is not illness but expense. If you say you’re allergic to penicillin (90 percent of those who say so are wrong), for example, an alternative costs fifty times more.

3. Things don’t turn into other things.

Mostly this comes up with viral upper respiratory infection (cough, congestion, sore throat, fever).  Everyone knows that antibiotics are useless for viruses, but if a doctor diagnoses a virus, many patients believe they’ve wasted the trip. This is where the maxim comes into play.

“If I don’t get something it turns into… “bronchitis…strep…pneumonia…a bacterial infection….”  It doesn’t. In otherwise healthy people, illnesses don’t change into other illnesses, and experts persistently warn doctors that giving antibiotics to prevent complications is positively harmful. They wouldn’t keep warning us if we didn’t keep doing it.

I Don't Do Adderall

“A guest at the Century Plaza wants his Adderall refilled. Can you go?” asked someone from the office of a local concierge doctor.

“I can go, but I don’t do Adderall,” I said.

“No problem.” She would find another doctor. Prescription refills are easy house calls.

You’ve heard of childhood attention-deficit disorders. Recently psychiatrists have discovered that it also affects adults. Treatment is the same. That includes drugs related to amphetamines; the most popular for adults is Adderall. As a hotel doctor my only experience with attention-deficit disorder comes from guests who ask for more Adderall.

None sounded like drug-seekers. All were happy to pay my fee for a visit during which they assumed that I would check them out. Since there is no way that I can examine a guest and make a diagnosis of adult attention-deficit disorder, I told them I’d have to speak to his or her doctor. That never came to pass.

It’s been decades since I made a similar decision on narcotics. Guests occasionally forget their heart or blood pressure pills, but soon after becoming a hotel doctor, I grew puzzled at how many needed more Vicodin or Oxycontin. Some sounded suspicious from the start, but many seemed in great pain. Their distress tore at my heart, and they often produced a sheaf of X-rays and letters from a doctor. With no reliable way to tell the fakes from the genuine, I gave up on narcotics.