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.

Hotel Visits I Don't Make

I try not to make housecalls for shortness of breath, chest pain, loss of consciousness, or severe abdominal pain.

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

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

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

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

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

Medical science has no cure for drunkenness, but hope springs eternal, so my phone continues to ring.

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.