Good Insurance

The caller spoke with a Hispanic accent, so I assumed he was a travel insurer, and I was right. It was StandbyMD, one of the good insurers. It phones; I make the visit; I fax an invoice; it sends a check. Latin Americans make up most of its clients, but anyone can sign up.

A guest at the Sheraton Four Points had been awake all night with an earache. The call arrived at 4:30 a.m., but that’s almost my time of rising, so I was not unhappy. Freeway traffic was light. I was at his room in half an hour.

One thing seemed strange. His name sounded American. This is not rare in Latin American countries, but he also spoke flawless English. He told me his pain began soon after he boarded a plane in Managua.

“So you live in Nicaragua?” I asked.

“No. Vancouver,” he said.

The light dawned.

“Of course,” I added. “You’re Canadian. No American would have such good insurance.”

American travelers buy American travel insurance. When they fall ill, they obtain care and then submit a claim to the insurer which pays as much as their fee schedule pays. Our insurers take a dim view of housecalls, so their reimbursement is not generous.  I can’t remember caring for an American hotel guest and then billing one of the dozen travel insurers that use me.   

 

More Evidence of America's Leadership

 Opening an envelope from an international travel insurer, I expected a check but found only a form letter containing a dozen boxes, each listing a reason why payment was denied. An “X” through one box revealed that I had not submitted my invoice on an HCFA-1500.

That’s the claim form American doctors send to American health insurers. It’s complex, full of codes, questions, boxes, and charges – far longer than my simple invoice. Despite this, it’s badly organized. One must enter today’s date three times.

I found an HCFA form and filled it out, leaving many cryptic questions blank, guessing answers where I wasn’t certain, and including a fictional breakdown of services because I charge a flat fee. An American insurance clerk would post it on the office bulletin board for general amusement.

Two weeks later, a check arrived. Foreign insurers are not up to speed, but they’re trying.

 

 

Ultimatums Are Risky

 Could I see a gentleman at the Omni with an upset stomach?

The dispatcher for International Assistance was delighted to learn that I could. In most cities, dispatchers work hard to find a doctor willing to make a housecall but not in Los Angeles.

I copied the guest’s name, age, room, and insurance I.D. I quoted a fee. That was acceptable. I said I would arrive within an hour. He was pleased to hear that. Then I dropped the bomb. I would need a credit card number.

I could hear the air go out of his balloon.

“We always send a guarantee of payment.”

“You do. But then you don’t pay.”

Many travel insurers pay promptly. Others require repeated phone calls. Pestering a billing department relentlessly usually works, but sometimes I run out of patience, and many visits for International Assistance remained unpaid after six months.

“I’m not sure we have a credit card.”

“Yes, you do. Ask your supervisor.”

All travel insurers have company credit cards but they vary greatly in their willingness to give them out. Some do it routinely. Others require an ultimatum. I hated hearing from Universal Assistance until they coughed up a credit card number. Now I love it when they phone.

But ultimatums are risky. The dispatcher agreed to consult his supervisor and call me back, but I never heard from him.

 

 

 

 

A Rash During the Rush Hour

 A guest in Long Beach had broken out in red spots.

This looked like a terrific visit; skin problems are easy. A sudden rash is frightening but hardly ever indicates something serious. I have no objection to making a diagnosis over the phone, but guests are terrible at describing a rash’s appearance. In any case, most want the doctor to look at it.

My only problem was that the call arrived at 5 p.m. on a Friday, and Long Beach is thirty miles away. I avoid long drives during the rush hour, so I told him I could come around 9.

That wouldn’t work, he replied. He had a long business engagement that evening. But he’d be happy to see me the following morning.

Saturday morning drives are easy, but a rash that arrives quickly often departs quickly. I wanted this visit, so I told him I would be there in an hour. Or two. 

 

Hitting the Jackpot

A call arrived during breakfast. Half an hour later the phone rang again. I was pleased because it was an ideal time for multiple housecalls.

I exercise before noon because later the gym becomes crowded. Two morning housecalls makes arriving before noon impossible. This doesn’t happen often, so I reward myself by skipping the gym without feeling the usual guilt. An hour of exercise is as exciting as an hour brushing your teeth, and I’m deeply suspicious of anyone who claims to enjoy it.

Even better, the second patient was at the same hotel, a rare treat! A downside was that both seemed to be suffering my least favorite illness: a viral respiratory infection. You’ve heard plenty about my reluctance to give antibiotics when they won’t help.

My good luck held. The first guest had a cough and high fever, probably pneumonia because listening to her lungs revealed abnormal noises. In an otherwise healthy person, pneumonia is the only common chest infection that medical science can cure. So I cured her.

On another floor, I examined a middle-aged man who explained that he had bronchiectasis. This is an uncommon condition in which a small area of the lung becomes obstructed, causing frequent infections. This was another, so I gave him antibiotics in good conscience.

These were satisfying encounters, but there was a downside. Because both were at the same hotel, I finished before 11 o’clock, too early to skip my workout.

 

 

Broken Glasses

 An elderly lady gestured me to come in. As I followed, she remained silent, a sign that she spoke no English. If someone doesn’t know “hello” comprehension is generally poor. 

“Portuguese.” she said.  “Speak Spanish?”

When I shook my head, she took up her cell phone. The first number didn’t answer. The second, after a short conversation in Portuguese, proved unfruitful. She continued dialing. She was Brazilian, and most South American travelers have travel insurance. If I phone the insurance agency’s 800 number, someone will interpret. Unfortunately, my call hadn’t come from a travel insurer but a national housecall service, Expressdoc.

I could phone Expressdoc and ask for the agency’s number, but that makes them uncomfortable. Housecalls is a viciously competitive business.

The lady finally found a multilingual friend, and we proceeded with the consultation, passing the phone back and forth. As usual, delivering medical care was the easiest part. She had broken her glasses. She complained of a headache, but it was clear that she wanted a doctor’s note so insurance would pay for a replacement.

 

A Prominent Scam

A guest at the Luxe explained that he was in town for six weeks and needed a disabled parking pass. I told him that was not something I handled. He added that he had the Department of Motor Vehicles form. All he needed was a signature.

I offered to come to the hotel, but – even at half my usual fee – he didn’t want to pay. I could have politely withdrawn, but he might then ask the hotel to recommend another doctor, never a good idea. As I do when it’s an easy service, I told him I would sign the form gratis if he came to my house.

After hanging up, I felt uneasy. Eleven percent of Los Angeles drivers have a disabled parking pass; it’s clearly a scam, and I didn’t want to add to it. What if I had to refuse him? When guests complain after I refuse narcotics, hotel management takes this with a grain of salt, but a parking pass….

You can imagine my relief when I answered his knock and saw that he had only one leg.  

 

 

The Year of Viagra

 National FDAs in Europe and Asia approve new drugs after deciding that the benefits outweigh the risks. Aware that bad side-effects produce an avalanche of lawsuits, America’s FDA takes more care. No matter how many lives a new drug will save, it wants the risk to be minuscule. This is hard, so our FDA takes a long time to make up its mind.

As a result, other nations often have access to new treatments years before America. Doctors complain all the time, but no one expects the FDA to change.

There was a delightful exception: Viagra, discovered in Britain but first released in the US. It’s my impression that no foreign businessman in 1998 considered his US trip a success unless he returned home with a bottle. My records show forty hotel guests who summoned me with this in mind.

I love visiting guests who aren’t sick. While I have no objection to filling certain prescriptions over the phone, Viagra is a powerful drug with serious side-effects. Experts advise us to examine and educate everyone who wants it.

No one objected to paying for a visit, so I came and asked about the guest’s medical history, performed an exam, and delivered my Viagra education. It doesn’t enlarge the penis; it’s not an aphrodisiac, it won’t prolong intercourse or delay ejaculation. It only encourages an erection. No one failed my exam. One gentleman from Indonesia asked for 5,000 tablets. Suspecting these were for resale, I worried about the legality, but this was no problem insisted the happy pharmacist who called me to confirm.  

Tricky Problems

 It upsets me to collect a fee and then send a patient to a clinic or emergency room for care I can’t provide in a housecall. I try to anticipate these.

Many guests phone after a painful accident, hoping I can do an exam and tell them whether or not they have a fracture. Sadly, unless it’s visible to the naked eye, I can’t. It turns out that medical science does little for broken toes, ribs, or noses, and most common fractures (arms, wrist, hand, finger, foot, ankle) are not emergencies. If a guest is willing to wait till office hours, I can make them an appointment with an orthopedist.

Upset stomachs make up the second most common ailment that I hear about. These usually don’t last long, and I carry medicines that help. Stoics often prefer to wait. This is not unreasonable, but the longer symptoms – usually vomiting – last, the less likely that medicine will help. After about a day of vomiting this becomes so unlikely that I send the guest to where they can receive IV fluids.

Abdominal pain is usually benign in a young person but less so as the years pass, and it’s tricky. Entire books have been written on it. I recommend the shortest:  Early Diagnosis of the Acute Abdomen by Zachary Cope, a British surgeon. He wrote it in 1921, and revised it every few years till he died in 1971. 

You can download it free. He’s a droll and witty writer, easy for laymen to understand.

When the Doctor Needs Your Help

 Almost every hotel guest that I see is working or taking an expensive vacation, so illness is more inconvenient than usual. Everyone agrees that doctors have no magical powers…. except… maybe… if you really need magic…..

What if you’re scheduled to deliver an important speech or attend a wedding or visit Disneyland, and you absolutely can’t be sick? In that urgent situation, a smart doctor might come up with a cure that he or she keeps in reserve for such situations.

Doctors love to help you, but they also want you to feel helped. If we do our best, but you’re unhappy, that hurts more than you realize.

So if you want the doctor to prescribe a placebo make it absolutely clear that you will be disappointed unless you get “something.” This happens so often that many doctors assume every patient yearns for magic. That’s why, for example, giving useless antibiotics for respiratory infections is not a sign of incompetence. Even good doctors do it.

Really, I don’t hold anything back for especially deserving patients. It sounds odd, but if you don’t want a placebo, let the doctor know. Say something like “I just want to know what’s going on. If a prescription won’t help, that’s fine with me.”

That sounds like you’re telling the doctor how to do his job, but many need your help.

Not Again! Again.

I was minding my own business on a plane returning to Los Angeles when I heard the elderly man in the adjacent middle-seat say:  “Victoria... Victoria?.... Victoria?...    VICTORIA!!...” Turning, I saw that he was shaking his wife who had passed out.

I informed the flight attendants who produced the traditional oxygen bottle plus a stethoscope and blood pressure cuff and made the usual request for any doctor on the plane. The wife began responding, if groggily. Her blood pressure was undetectable, but engine noise made listening difficult.

By this time, another doctor arrived. She was about forty years younger than I and anxious to be involved. She suspected it might be necessary to land the plane. This is not a decision airlines make lightly. Headphones and a long cord appeared, and, after some delay, she spoke to a doctor on the ground who advised taking the wife to the rear of the plane, laying her on the floor, starting an intravenous line, and observing. With the other doctor leading the way, everyone trundled up the aisle. I wasn’t required.

The couple returned to their seats when the plane began its approach two hours later. The wife seemed all right although she had no memory of what had happened. Paramedics came on board at the gate and led the couple away.

I waved off the flight attendants’ thanks, but they insisted on giving me five thousand frequent flier miles.     

What Makes Travelers Sick

 American water.

Travelers worry that our fierce advocacy of the free market includes opposition to government meddling in the water supply. I regularly assure them that all American tap water is drinkable.

American food.

No one believes that Taco Bell or McDonald’s sell healthy food, but foreigners worry that these exotic, colorful substances are toxic. We Americans are warned about eating in nations with poor sanitation; about one in three American tourists in these areas get sick. If we’re careful, our sickness rate drops to… Actually, it doesn’t drop. No one knows how to prevent traveler’s diarrhea. The Swiss get sick when they come to the US.

Air conditioning

Americans accept air conditioning with even more enthusiasm than personal firearms, but most of the world has never caught on. They tolerate it as an odd American custom but believe that air from a machine is unhealthy whether it’s automobile exhaust or a box in a window. When someone gets sick, they turn it off. I wear a suit, so caring for foreign tourists during the summer is a painful experience.

Air Travel

Travelers blame the airline for any illness that occurs within a week of flying. This is not so for aches and pains and unlikely for an upset stomach but true for respiratory infections.

Stress

Vacations are stressful, particularly if children are involved. They miss their friends; they hate the food; they prefer watching TV to sight-seeing; they refuse to adjust their sleeping hours.  It turns out that stress makes everything worse, but it doesn’t cause anything, so there’s no reason for the parents to get sick. When they do, it’s a respiratory infection, usually the children’s fault.

Keeping a Child Safe

 On days I don’t go to the gym, I take a brisk one hour walk through my neighborhood.

One route passes an elementary school a mile away. Except for dog-walkers, the streets are deserted at this early hour, but a few blocks from the school the sidewalks gradually fill with children in their colorful outfits and backpacks accompanied by a parent. Passing the school I overtake the adults, often in chatty groups, as they head home.

Parents taking their children to school…. When did that start?...

I entered first grade in Cleveland, Ohio, in 1946. The school was three blocks away. My mother dressed me and showed me the door and, even in the dead of winter, I walked alone. I met friends along the way. I never saw an adult.

No big deal. But halfway through the year I took a test. Afterward my parents agreed that I could attend a special school for gifted children.

It required a six block walk and then a long streetcar ride. I made the trip alone every day. The school had a cafeteria, but, for reasons lost in history, I left the campus at noon and ate lunch, usually a hamburger, at a nearby diner. It cost a dime. Remember, I was six years old. I never regarded this as odd, and no adult I encountered gave me trouble except once on the streetcar when the conductor accused me of not paying the fare (I’m sure I did). When I burst into tears he did not pursue the matter.   

It was not all smooth sailing. Years later in Los Angeles on the way to junior high, I encountered a bully my own age who cuffed me around painfully. But it was only one episode.

Another Spiked Drink

 It was one a.m. as I drove Santa Monica Boulevard, but crowds packed the sidewalks in West Hollywood, lining up to hear the latest band. A few blocks beyond, I parked at the Ramada.

A guest led me to the bathroom where her companion lay in the empty tub, clutching a towel and moaning. This was not the first time I cared for a patient in a bathtub or even the tenth.

“We’ve been out drinking,” explained the guest. “But not more than usual, and she didn’t have more than me. Do you think they put something in her drink?”

This was not the first time I heard that – or the tenth. I’m puzzled at how often guests suspect foul play when someone becomes violently ill after drinking.

I examined the patient as best I could without moving her because she insisted she could not move. Afterward I explained that alcohol is a toxin that messes up the brain, usually in pleasant ways but occasionally not. After delivering medication for vomiting, I told her to suck on ice chips and phone if she wasn’t better in a few hours. So far everyone has recovered.     

An Exotic Travel Destination

 Tourists come to America expecting a strange foreign land. They usually leave satisfied, but encountering an American doctor is an unexpected bonus, so everyone on the tour gathers round, and I often go about my business in front of a large attentive audience. 

My largest consisted of the entire company of the Chinese Peking Opera lined up along the wall of a ballroom in the Hollywood Roosevelt. One of its members had begun behaving bizarrely. I concluded he was suffering an anxiety attack which a tranquilizer might help.

 This took place well before Chairman Mao’s influence became passé, so it was likely the Opera’s resident physician had no Western training. Etiquette demanded I treat him as a colleague, so I presented my advice as a suggestion.

 After consulting other senior figures, he gave his approval. No one except the interpreter spoke English, so many subtleties were lost, but everyone seemed satisfied, and the entire troupe lined up to shake my hand.

 

Doctors Are Always Late

At 6 p.m. on a Friday, I learned that a flight attendant in Costa Mesa had a cold. I prefer not to drive 46 miles during the rush hour, so I promised to be there between nine and ten. That was acceptable. Airline crew are not demanding.

Five minutes later a guest at the downtown Doubletree asked for a visit. This was a bad juxtaposition. Scheduling it for after Costa Mesa meant an arrival time near midnight.

Reluctantly I told her to expect me at around eight. I gave myself over an hour for a 25 minute drive, but traffic was not so bad, and I arrived early, but she was there. The freeway to Costa Mesa was also not so bad, and this time no one answered my knock at 8:30. The front desk was unhelpful. 

Airlines have strict rules about sick crew, so this guest required a visit. If I waited an hour and then left, I might get a call on the way home. If she was out partying, I might get it several hours later. I did not acquire my peerless reputation by refusing calls, so I’d have to make the return trip.

As I fumed and paced, the guest returned. I expressed relief, but she did not apologize. She was present at the appointed time, and no one expects a doctor to be early.

 

Medicine is Easy; Parking is Hard, Part 1

 A foreign student at the University of California had bronchitis. I live three miles from UCLA but this was the University of California at Irvine, 52 miles away. I quoted a fee that took this into account and was not overjoyed when it was accepted.

Navigating inside a huge campus is tricky, but Siri directed me to the correct address. It was, as I suspected, the administration building. No one lived there. I phoned the student to ask where he was and where to park because the streets were forbidden. He said he would come out and direct me.

When I phoned again in ten minutes, he assured me he was on his way. He arrived and guided me through winding streets to a parking lot with signs threatening serious consequences to anyone without a permit. He swore that it was OK. It was August; the campus was deserted, so I took the chance.

He wore shorts and t-shirt, appropriate for a hot summer day. Sweating in my suit, I trudged at his heels for several blocks, passing building after building until we reached his. It was a student dormitory, so there was no air conditioning. The visit went fine.   

Girls Are the Best

 “’allo!” a little girl shouted from her bed as I walked into the room, but that was her only English. Her French parents had called because she was running a 101 fever.

She seemed delighted to see me and jumped to sit on the edge for her exam. Smiling happily she waited as I quizzed the parents, opened her mouth widely at my request and made no complaint when I poked my otoscope into her ears.

I found everything normal. She had a virus that might last a few days and required only Tylenol. Staying in bed was not necessary. Everyone seemed pleased, the child most of all; she waved goodbye as I left.

I enjoyed that visit. Readers are familiar with my admirable qualities, but I admit that I am not the sort of jovial physician who enchants young children. Mostly I do fine, but I’ve endured plenty of encounters with apologetic parents and a screaming, struggling toddler.

These are almost all boys. Adult male pugnaciousness has not made the world a comfortable place, and it works equally badly in children. They get the exam regardless, but it’s drawn out and painful. The parents are embarrassed, the doctor relieved when it’s over.

Little girls rarely make a scene. If frightened, they keep quiet. If not, they realize, almost from birth, that charm works wonders. Everyone relaxes and takes care of business. Women should run the world.  

A Dog-Eat-Dog Business, Part 9

I keep an eye on the competition, searching the internet for various combinations of “hotel doctor,” “house call doctor,” “housecall,” etc.

Once I came upon International Medical Services which promised to send a highly qualified doctor to a home, office, or hotel at a moment’s notice. When I phoned, its medical director knew my name, having dealt with me at previous jobs.

Like all new arrivals, he insisted that business was thriving. In fact, as we spoke, a hotel guest needed a visit, and I was welcome to go. I asked about the fee.

“We charge between $1600 and $2000. The doctor gets half.”

“Guests won’t pay that!”

“We don’t have trouble. These are generally foreigners with travel insurance. Foreign travel insurance knows about American doctors.”

He suggested I quote $1200 and then add a few hundred dollars for medicines and supplies. That was his doctors’ routine.

I visited a young woman at the Hampton Inn with a simple urine infection. She handed over her credit card without complaint.

That felt creepy. I mailed $600 with a note asking him not to call again.

The Hampton Inn is not an upscale hotel. How did he persuade its staff to refer guests? My legal advisor warns me not to speculate.

 

Another Incident in a Hotel Doctor's Glamorous Life

Younger, cooler, more expensive doctors own the franchise on Los Angeles film shoots, but I go now and then.

A European director staying at the Langham in Pasadena asked for my services and then went off to work.

After driving miles through suburbs I encountered the usual cluster of trailers, street barriers, and police. It was a hot summer day in Los Angeles, but Pasadena is always ten degrees hotter.

Workers hurried about, but I was the only one wearing a suit, so I stood only a few minutes baking in the sun before an assistant approached. Like every aide I’ve met on film sets, she was young and beautiful. I hate to imagine the hiring procedures of production companies. 

She led me into a trailer, thankfully air-conditioned, where I waited fifteen minutes until the director made time. He showed me a rash and worried about bed bugs.

Many foreigners believe Americans fall below civilized standards of cleanliness. We think of personal hygiene in terms of body odor, but they notice that we allow dogs free run of our houses, and we don’t take off our shoes when we come inside. That the Langham is very expensive does not rule out bedbugs, but I diagnosed hives, an allergic reaction.

I’m not sure my reassurance convinced him, but he was a workaholic like so many of my patients. He hurried back to the set with the box of pills I handed out, and I considered it likely that he put it out of his mind.

Lost in Translation Again

 6 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher that I would be at the hotel in an hour.

The freeway was clear. Parking, even downtown, would be easy. My phone rang as I drove. It was the guest’s travel insurer warning that there was no answer when he phoned to tell her when I’d arrive. When guests request my services directly and then vanish, I don’t get paid, but this is not the case with travel insurers, so I drove on. It was unlikely she had left the hotel.

At this hour, I check at the desk to make sure I don’t knock at the wrong door. The clerk confirmed the room, called, and reported that someone had answered and then hung up.

It was good news that she was present, not so good that she had immediately hung up. That’s a sign that a guest doesn’t speak English. 

A young Japanese woman greeted me at the door, ushered me inside, consulted her Ipad, then announced in triumph: “......stomach!!....”

One advantage of travel insurance is that dispatchers will interpret. Despite my admonition, they prefer to edit, abridge, and summarize rather than simply translate; their English is often rudimentary, and passing the phone back and forth makes for a long, tedious visit.

On the plus side, these guests usually have uncomplicated problems. It worked out. 

A Black Spot

  “You’ve got a black spot,” said my wife when I asked her to scratch my back.

“Black as the tar in the road?” I asked. She confirmed this, but as I quizzed her she realized that a black spot was bad and began retreating. Maybe it was dark brown.

She took a picture with her cell phone. It was half an inch in diameter, dark, and lumpy but not obviously malignant looking. Wives are always discovering things on their husbands which, being men, they ignore. Later the husbands die.

I decided I needed to see an expert. It was Friday, and I didn’t want to spend an anxious weekend, so it had to be today.

My favorite dermatologist in Los Angeles is Pamela Rand. She does not accept insurance, Medicare included, so I use others for routine skin problems. She was on vacation.

I like the doctor I see at the UCLA dermatology clinic in Santa Monica, but the clerk reported no openings until Tuesday. When I pressed, she transferred me to a nurse who, after consulting for several minutes, reported she could move me up to Monday. I would have tried to pull rank as a physician had I been really frightened, but I was only uneasy.

A few dermatologists phoned at random were not helpful. I phoned the main UCLA clinic in Westwood and learned that there were no openings except in distant suburban facilities. Thousand Oaks and Westlake were about forty miles; Porter Ranch seemed closer.

The drive was long, but parking was free. The dermatologist took a quick look and told me it was benign. I sat patiently as she educated me on seborrheic keratoses (age spots) and accepted her handout. Doctors don’t learn that I’m a physician unless they ask. It doesn’t get me better medical care, and some doctors feel uncomfortable having one as a patient. 

 

A Pure Source of Natural Energy

 A yoga instructor was attending a convention of like-minded devotees when one vendor gave him a sample of a natural energy pill. Within half an hour, he became certain that his blood pressure was out of control.

Patients who believe they know when their blood pressure is high are wrong because high blood pressure causes no symptoms. But he was certainly jittery.

In fact, his pressure was higher than I’d like in a 43 year-old man, but he admitted that his family doctor had also found this. He had been trying to control it through yoga.

I read the label on the bottle. Each pill contained a mixture of herbals and vitamins and a large dose of caffeine. I never drank coffee, and my first experience with caffeine – in a wake-up pill in college – was dramatic. I loved feeling super-alert, but I understand why a more mellow personality might not.

The effect was already wearing off, and he had no objection to my explanation. When I suggested that it was time to treat his hypertension, he promised to ramp up his yoga. 

A Medicolegal Housecall

Stepping out of the shower, a Doubletree guest stumbled and cut his leg. He had paid little attention, but now, two days later, the wound had grown painful.

That sounded like a good visit until he delivered the bad news: the hotel would pay my fee.

I label these “medicolegal” visits and I don’t collect. When a hotel offers to pay, it’s usually because the guest is making a fuss, and management has already agreed to other expenses such as comping the bill.

I don’t want to be part of the problem, and it’s a chance to remind upper management of my value. During my usual visits I never see a general manager. Most managers are only vaguely aware of my existence, and a few are surprised to learn that the hotel can call a doctor.

The guest’s shallow, one-inch, laceration was healing normally. I doubt he would have called if he had had to pay. I reassured him.

I shook hands with the general manager and assured him that there was no significant problem. I added that, as the hotel’s doctor, I was always available, and he should feel free to consult me under any circumstance. I waved off his offer to pay. He expressed gratitude.

Don’t assume that this guarantees a hotel’s loyalty. It’s been years since Loews in Hollywood and the Adventure hotel called. My last visits to both were medicolegal freebies.

A Better Medicine

A 2 year-old was ill with vomiting, diarrhea, fever, and a rash. That sounded bad.

I know a pediatrician who makes housecalls, and I considered sending him. But the news came from the guest’s travel insurer, and their pronouncements are often exaggerated. I decided to go.

The guest greeted me at the door with a cheerful toddler at his side. That, to my relief, was the patient. He still had diarrhea, and a spotty rash was present but fading.

Suffering a respiratory infection, the child had seen the family doctor and received the traditional antibiotic. Instead of amoxicillin (the world’s most popular antibiotic for people who don’t need an antibiotic), he had prescribed Augmentin, excellent when necessary but a legendary stomach upsetter.

The parents took for granted that the solution was a better medicine and something for his rash and diarrhea. But this was one of those situations where stopping everything works best. 

Disaster Averted

“We have a situation with a guest…” explained the manager of the Georgian.

I love doing favors for hotel management, but this sort of announcement is not promising. Medical science cannot calm drunk, stoned, or disruptive guests, but hope springs eternal among hotel staff.

This turned out to be not so bad. A guest was taking an injectable medicine for rheumatoid arthritis. It required refrigeration, and the hotel had agreed to store it. Unfortunately, for unclear reasons, someone had left it on top of the refrigerator all night. What should he tell the guest? Could I call a pharmacy to replace it?

The medicine was Humira, a high-tech, genetically engineered monoclonal antibody. The internet pharmaceutical supplier that I patronize would sell me two doses for $7,000.

I did a Google search to find the manufacturer’s medication guide. While Humira should be kept in cold storage, leaving it at room temperature for a few days is OK. You can bet the manager was grateful for this news.

Easy Money

A Brazilian traveler had left her medication at home. Could I drive to Hermosa Beach and write some prescriptions? The caller was the guest’s travel insurer.

When hotel guests call directly, I tell them to go to a pharmacy and explain what they need. I would approve over the phone. It’s free; everyone is happy.

Before I could offer to do the same, the dispatcher informed me that, as a new service, the insurance would pay for visits to replace prescriptions. I could not turn down easy money.

It turned out not to be so easy. Helpfully, the traveler’s family doctor had faxed his prescriptions, but the writing was illegible and in Portuguese. There followed half an hour of phone calls to pharmacies and to Brazil and Google searches before I found the American equivalent of three of the four. The fourth never turned up, but it was probably an herbal remedy.

 

Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him to check and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.

Sickness Makes You Sick

“Normally I wouldn’t bother with this cough, but when I started to bring up green mucus I knew I had to do something…..”    

Hotel guests tell me this regularly, and it’s wrong. Everyone’s respiratory tract makes a quart of mucus a day. When the respiratory tract is irritated, it makes more, and the mucus may turn yellow or green. In an otherwise healthy person, this has no ominous significance.

No one stares at their throat when they feel fine, and a sore throat always looks suspicious. Everyone knows that white spots on your tonsils are a sign of Strep that requires urgent attention. In fact, plenty of ordinary viral infections make tonsils look bad.

 “The fever came back,” guests tell me as if this were a serious development. But Tylenol or aspirin only work for a few hours, and then you must take more. When patients tell me that they worry about a fever, my advice is “then don’t take your temperature.” They treat this as a joke, but the truth is that fever is just another symptom.

 All bets are off if you suffer a chronic illness or serious immune deficiency or are extremely old or extremely young, but this is not the case with almost everyone I see. When people in good health get sick, they feel sick.

 

 

Luckless Americans

 Ailing US airline crew are out of luck. They must travel to a clinic in a strange city, present their insurance card, and hope for the best.

 Foreign airlines do better, sending a doctor to care for crew when they lay over. In Los Angeles that’s often me. Being young, crews suffer common ailments. Even better, company rules forbid work if they have a cold, a digestive upset, or a minor injury.

 On my own, I often handle minor ailments over the phone, but airlines demand a doctor on the spot to confirm the ailment and name a date when the employee may fly again. I enjoy those visits. These patients are never demanding; their priority is getting home. They hate being stuck in a hotel room. Airlines permit them to return as passengers, and I’m liberal about allowing them, so those visits usually end happily for both of us.   

 

The Decline of Civilization

The desk clerk tried to hand back my parking slip, but I made no move to accept it.

“We are unable to validate” she said. “It’s twenty dollars. You pay at the cashier’s window.”

“As I explained, I’m the hotel doctor. They let me park.”

“Unfortunately, the hotel doesn’t own our parking service, so we have no control over the charges.”

“That’s true for most hotels, but they let me park.”

“Let me speak to my manager.”

It was a stretch to call myself that hotel’s doctor. The Mondrian was not a regular although I’d been there a dozen times over the years with no problem. Several minutes passed before the clerk returned.

“Regretfully, my manager says we’re unable to validate. The hotel doesn’t own our parking service, so we have no control over the charges.”

Not willing to hassle hotel staff, I took the slip. I’m not poor, but paying twenty dollars at a fraction of my hotel visits per year, say a hundred, is serious money. This is happening more often.

A Doctor Gets Sick

Years ago I suffered a stomach virus, not a serious illness but unpleasant. I was resting after a night of vomiting when the Beverly Garland called. I could have stalled or asked a colleague to make the visit, but symptoms were improving.

I had not entirely recovered, so my wife agreed to drive. As we approached the hotel, my nausea returned. It grew intense by the time the guest opened his door.

I remain proud of delivering an Academy Award-worthy performance, sitting quietly, focusing entirely on the guest, not hurrying, providing sympathy, advice, and medication as well as collecting my fee.

As soon as the door closed behind me, I dived into the nearest rest room and resumed vomiting. Several guests entered, saw my distress, and fled. But I got better. Most sick people get better.

Sometimes a Thankless Job

A three year-old at the Ramada was fussy and congested, but my exam was normal. She had a cold, I explained. It might last a few days, and staying in bed wouldn’t make it go away quicker. They were already giving Tylenol for the fever, and that was fine. They should try to enjoy themselves.

“So she doesn’t need anything,” said the father. I assured him she didn’t.

They thanked me as I left, but I was not fooled.

Understand their point of view. They were in a strange city on an expensive vacation, and their child was sick. Naturally, all fun was cancelled, and the doctor summoned fix things.

Had I written a prescription, I would be doing what a proper doctor does. They would have given the medicine and waited. Not giving “anything” meant that I considered the illness trivial.

Mind you, I had carefully explained that the child would feel under the weather for several days. They had listened and nodded.

I intended to call in 24 hours, but the following morning their travel insurer phoned to say the parents were requesting another visit. I explained that that wasn’t necessary. I would call.

“She’s the same. The cough hasn’t gone away,” said the mother.

I repeated that this was to be expected and that she should wait. She thanked me for calling.

No one answered when I phoned the next day. The insurance agency dispatcher explained that the mother had called earlier to demand another visit, so he had sent her to an urgent care clinic.

The child had barely swallowed the first spoonful of Amoxicillin when she began to improve. By the following day she was fine, and the parents were congratulating themselves. Who knows what might have happened if they hadn’t found a competent doctor? 

A Hotel Doctor Has His Car Serviced

I scheduled it for 8 a.m., hoping it wouldn’t be out of commission for long because my wife and her car were out of town. I cancelled the appointment when a hotel called at 7 a.m.

I delivered my car to the shop at 8 a.m. the following day. A hotel called at 10. The service manager said my car wouldn’t be available till the afternoon, but he would be happy to provide a loaner.

Auto shops pay little attention to loaners. Mine was a battered 1999 Volvo station wagon with 176,000 miles, the gas needle on empty, and an automatic transmission that paused for a few seconds before delivering power. Driving was a frightening experience compared to my tiny, nimble Honda.  

I bought gas and lumbered onto the freeway, praying that Swedish engineering deserved its reputation. VIP parking at a downtown hotel was out of the question because valets refused to believe that an important person would arrive in such a disreputable vehicle. But everything worked out.

No hotel doctor should live alone.

Caring for the King

The Airport Marriott is not a hotel that comes to mind at the mention of royalty, but that was where I saw the King of Tonga whose entourage took up the entire top floor.

Tonga is a group of Polynesian islands, an independent country and UN member. It contributed a few dozen troops to President Bush’s “Coalition of the Willing” that invaded Iraq in 2003. It’s also one of the few remaining hereditary monarchies, and the king is a person of influence and great wealth.

Everyone in the room wore Western clothes. The king himself was tall and fat but otherwise unremarkable, and he spoke English. Still, he was a royalty.

I'm Under a Doctor's Care

“I parked illegally, and they towed my car. It’s in an impound lot, and, wouldn’t you know.….”

Tales of misfortune (as opposed to complaints of illness) at one a.m. are a routine tactic of drug abusers.

“…My prescriptions were in the glove compartment. I don’t know when I can get them. I’m under a doctor’s care for….”

I declined his request for Oxycontin. The call had come from the desk clerk who had immediately handed the phone to the guest. As a result, when I hung up, I knew the guest might inform clerk of his disappointment with the hotel doctor. 

Under those circumstances, I phone the clerk and explain that the guest has made a request that I cannot, in good conscience, grant. Remembering his manners, the clerk expressed sympathy, but you never know…. 

Why I Hate Appointments, Part 2

“I need you to look at a rash,” said a Loews guest. “But I have meetings all day and dinner tonight. Could you be at my room at 9?”

He meant 9 p.m. His call arrived at 9 a.m. Appointments more than a few hours ahead end badly more often than not, so I avoid them.

“I’m always available,” I said. “But we’re both busy people. Phone just before you get to your room, and I’ll come over.”

He phoned at 7 p.m. to say he’d be delayed till 10. I waited at home. He phoned at 9:30 to say he was on his way. I arrived at 10. No one answered when I knocked. He appeared at 10:20 with apologies.

As If I Didn't Need Reminding

She was a model, a Ritz-Carlton guest informed me. The previous week she had undergone half a dozen plastic surgery procedures on her buttocks and lower abdomen. Now she needed the sutures removed. After she asked for “an appointment,” I told her when I would arrive. 

“Well… OK….” she said. I could sense her reluctance. She had assumed I’d see her in my office. If guests ask for an office visit, I know colleagues who will accommodate them. But I love visits for suture removals. They’re easy, and guests appreciate the convenience. 

When the door opened, I saw a tall, slim, strikingly beautiful woman who nearly jumped with joy when she saw me. 

“Oh, good!” she exclaimed with relief. “I’m glad you’re not one of those young doctors!”

Unsettling News

The guest I had seen the previous day was found dead, I learned from the manager of a downtown hotel.

A hotel doctor’s worst nightmare is a patient dying in the room after he leaves. This has never happened to me although several died soon after I sent them to the hospital. It turned out that this guest was not my first.

She was an elderly lady complaining of palpitations whom I had seen the night before. On my examination, her heart was beating too rapidly, so I took her to an emergency room. After the usual delays, the emergency room doctor found the heart beating normally, so he told her to mention it to her family doctor and then sent her back to the hotel where she died.

Frustration

An Emirate Airline flight attendant was suffering severe back pain. 

Emirate crew stay the Hilton in Costa Mesa, 46 miles away in Orange County. There is an Orange county doctor, but she had not responded. It was 2:40 a.m.

I didn’t complain. Freeway traffic is light. I have no office hours, so I can go back to bed if I want. I earn extra for long drives and late hours. The Orange County doctor enjoys a rich social life, so she’s often unavailable. I made 42 housecalls to her territory in a single year.

I dressed and drove off. As I entered the freeway my phone rang. The visit was cancelled. The Orange County doctor had checked in and reported that she was on her way. 

I pointed out that once the agency assigns a doctor, he or she should take priority. The dispatcher agreed and promised that it would not happen again

Another Celebrity Injection

A VIP was flying in from San Francisco. He was under the weather and needed a shot before the night’s performance. 

Someone else has the Los Angeles franchise on celebrity injections, but I handle the occasional request.

There were the usual inconveniences. I was told to be at the hotel at 2 p.m. but his flight was delayed. The new time was 3 p.m. I waited at home. It was 3:20 when a phone call announced that he was on his way, so I drove off.

He was a singer but not an A-list. I’ve long since forgotten his name. I met him in a suite at an upscale (but not luxury) hotel on the Sunset Strip accompanied by only three assistants. Unlike international stars, he shook my hand, thanked me for coming, and allowed me to ask about his illness and examine him. Major celebrities nod a greeting and then resume communing with their entourage, pausing momentarily for the injection. 

He had a cough, and his doctor had recommended cortisone. Unlike B12, the traditional celebrity injection, cortisone works but probably not by the time of his performance in a few hours.