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.

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.

Things Patients Tell Us That Are Almost Never True, Part 1

“I need something stronger….”

It’s common sense that if a drug isn’t working, the doctor should prescribe a better drug. In fact, the usual reason a drug doesn’t work is that you have a problem a drug won’t solve. Mostly, when hotel guests make this statement, they’re taking an antibiotic for their bronchitis. A week or two has passed, and they’re still coughing. I have to explain that these illnesses last a week or two no matter what medicine you take. Similarly most “pinkeye” doesn’t respond to drops, and doctors still debate whether antibiotics help middle ear infections.     

“I’m allergic to….”

As I wrote on March 23, almost everyone who believes they’re allergic is wrong. Another large group claims that they’re allergic to a drug that upsets their stomach. In fact, this is not an allergy – meaning that it’s never fatal. This is important because you should never take a drug to which you are (genuinely) allergic. If a drug upsets your stomach but an alternative is more expensive or less effective, you might choose to feel sick for a while.

Doctors Should Keep Their Mouths Shut

A teenager at a downtown hotel had strep throat. Unlike most other bacteria, strep remains as sensitive to penicillin as it was seventy years ago. This is good news because penicillin is a terrific drug. It doesn’t upset your stomach, it has few side effects, it’s cheap….

“He’s allergic to penicillin,” said the mother.

“How do you know?” I asked.

She thought for a while. “The doctor told us. I think he had a rash…”

Once you’re branded as allergic to penicillin, no doctor in his right mind will prescribe it. This was bad news because I carry amoxicillin, a form of penicillin, and hand it out gratis. I don’t carry a substitute, so the mother had to find an open pharmacy and pay about twenty times amoxicillin’s price.

Ten percent of the population believes they’re allergic to penicillin and almost all are wrong. Ninety percent wrong is the usual figure, but some studies find almost zero genuine penicillin allergies.

What happened in this case? Chances are, years earlier the doctor prescribed a penicillin either to treat an infection or as a placebo, and the patient’s mother noticed a rash a few days later. Everyone knows that chicken pox and measles and rubella produce a rash, but any viral infection, including the common cold, can produce a pink, spotty eruption. To make matters worse, five or ten percent of everyone who takes amoxicillin or Augmentin (which contains amoxicillin) develops a similar rash. It’s harmless and disappears in a few days. Stopping the antibiotic doesn’t speed this up.

Experts agree that none of these are allergies.  

But why take a chance? Laymen worry. It’s 100 percent safe (and much quicker) to diagnose an allergy.

If a doctor had told you to flush $1000 down the toilet, you’d object, but that’s the equivalent if you go through life with a nonexistent penicillin allergy. If you’re lucky!... Rarely, you could be in serious trouble.

Skin tests are accurate, so you might want to see an allergist. It costs a few hundred dollars which insurance might not cover.