Noise is Everywhere

“Could you please turn down the television?”

“Huh…?”

I repeated the question – not because the guest didn’t hear but because the request seemed to strike him as peculiar. He turned down the volume but not a great deal.

This happens routinely. Families from around the world check into a single hotel room, turn on the TV, and go about their business. Some watch, others ignore it. All would consider it rude to talk while I interview a patient but most make no move to the yammering television unless I mention it.

When an Antibiotic Helps

If you receive an antibiotic for a respiratory infection, it’s probably a placebo because almost all respiratory infections are viruses.

If you receive an antibiotic for a skin infection, there’s a chance you have a bacterial infection that an antibiotic won’t help. A boil or other collection of pus will heal if the pus is drained. If the doctor gives an antibiotic but doesn’t drain the pus, it will also heal. That’s because most infections, boils included, eventually heal.

You’ll get an antibiotic if your doctor diagnoses an ear or sinus infection. It’s a bad idea to ask if this will help because (if he’s honest), he’ll admit that no one knows. In experiment after experiment, when researchers compare patients given and not given antibiotics for ear or sinus infections, the results are never dramatic. Often there’s no difference. Sometimes they help a little. Doctors in some nations don’t treat these with antibiotics.

That’s why urine infections are my favorites. It’s not controversial that antibiotics help. For infections in young women, help comes quickly, usually within a day. These are satisfying encounters for everyone concerned.

Another Free Service

A caller in Huntington Beach was having a panic attack. He had had them before, and he needed a doctor to come and make sure he wasn’t dying.

This was a bad call in many ways. Waking me at midnight was not one, because I don’t consider that a big deal. Making a housecall for a panic attack is risky because victims often improve while I’m driving and cancel, and Huntington Beach is 45 miles away. There’s not much a doctor on the spot can do with medicine for a panic attack  (“a shot” doesn’t exist).

Finally, the caller didn’t know the fee; I would have to tell him.

In his distress, he had searched the internet and found a national housecall agency. Most such agencies tell callers the fee, so by the time I hear from them, they’ve agreed to pay. But this particular agency specializes in foreign airline crew and tourists with travel insurance where the fee is already arranged. On the rare occasion when an American contacts the agency’s answering service directly, it simply passes the call onto me.

I knew that my fee to Huntington Beach at midnight including a 40 percent cut for the service would never pass. Worse, once I mentioned it the horrified patient would quickly get off the phone.  

That wouldn’t bother an operator, but once someone asks a doctor for help, he or she is obligated to help (ethically obligated; in reality maybe not). So I held off delivering the bad news and kept the conversation going. 

After forty minutes of soothing and reassurance he began running out of gas and admitted that maybe this wasn’t an emergency. He agreed to keep my number and call if he changed his mind.

More Unsatisfied Guests

The son of two Viceroy guests was suffering a severe sore throat and fever.

I drove off in a good mood because it sounded like an easy visit. This combination often indicates “strep” which an antibiotic cures. Patients like that, so I like it, too.

In fact, sore throat and fever in a grown-up is usually a simple viral infection, my least favorite illness. Strep is overwhelmingly a disease of children and adolescents, but this patient was fourteen, so my hopes were high.

They were dashed when the boy admitted that he had a cough. Strep is strictly a throat infection; coughing is not part of the picture. Sure enough, his throat looked normal.

Rummaging thoughtfully in my bag, I pulled out a packet of acetaminophen (Tylenol), handed it to the parents, and explained that this would help his fever. I extracted a plastic bottle of Lidocaine, a gargle intended to relieve his throat pain. I gave them a cough medicine is similar to the popular Robitussin but in an immense eight-ounce bottle.

I assured them that bed rest would not help, so he should try to enjoy himself. He could eat whatever he wanted. But it was likely that he’d feel under the weather for a few days before recovering.

The parents seemed happy to receive the medicine. They expressed gratitude for my service, and thanked me effusively as I left, but I knew that this was mostly good manners.  They were on vacation. The doctor had come, given some not-very-powerful medicine, and told them the child would continue to be sick. Did the doctor realize how important this trip was to them? Maybe if he had tried harder…. Or if they’d called a better one…. 

Two For the Price of Two

An insurance service informed me that two sick children awaited in Orange. It’s a rule that if one child is sick, there’s a small chance it’s serious; for two children, never. They almost always have a simple virus.

The major difficulty was the distance, nearly fifty miles, and the fact that my wife was preparing dinner. To my delight she offered to delay it and accompany me on the visit, something she rarely does. We had a pleasant hour’s drive to Orange where I cared for two children with a simple virus, and we ate dinner at the hotel.

Twilight of the Hotel Doctor

Uber is driving taxi companies out of business. Air Bnb is putting stress on hotels. A stream of retail chains are declaring bankruptcy in the face of online competition. No one doubts that this trend will continue. Online services are cheaper if sometimes inferior. Uber drivers earn less than traditional cabbies – not a notably prosperous profession. But customers aren’t complaining. They like cheap.

It’s absolutely certain that housecall doctors like me are doomed. We’re expensive and often – at least in my case – the quality of our service is too good.

Los Angeles residents already have a choice of two phone apps. Tap either one, enter your credit card information, and a doctor will arrive within hours. The fee will be less than mine – and I charge less than the typical hotel doctor.

One consequence of a low fee is that they pay doctors less than the going rate. As a result, they attract residents in training or just beginning practice, but these seem adequate.

As you know I work for everyone, and I worked for both. I didn’t care for the low pay, but I’d still be working if it weren’t that I had no control over the patients I saw.

When hotel guests phone, I always talk to them. If the problem is minor, I give advice and suggest that a housecall isn’t necessary. If it requires a simple service such as a prescription, I take care of it over the phone. If it requires a test, x-ray, or emergency room visit, I can usually determine that.

If the guest has unrealistic expectations, I can avoid an unsatisfying encounter. I can warn a hoarse singer that she probably won’t be better by evening.

Many callers request treatments that they don’t need. You might think of narcotics, but mostly it’s an antibiotic for their respiratory illness. I only prescribe an antibiotic if it will help which puts me at odds with most of the medical profession, so many patients will be disappointed and a few upset if I don’t treat their “bronchitis” or “sinus infection” as their doctors do. When this seems likely I direct them to a local clinic where they’ll get their antibiotic or (if they stumble on a competent doctor) express their disappointment to someone else.

When hotels phone, I make a housecall less than half the time. Guests love the free service. Even better, when I drive off, I know that I’ll be able to help, and – no less important – the guest will feel helped.

Working for these Uber services, I had to make every visit they assigned. All I learned was a symptom (“cough” “allergy”). The result is that I walked into situations where a housecall was not appropriate (“granny hasn’t seen a doctor in thirty years; would you check her out?...”). Many had problems I could have handled over the phone; others required more than a housecall could provide. And there were the usual unreasonable requests.

My faithful readers know that hotel visits don’t always work out. I’d estimate that five percent are less than satisfactory. Working for housecall services, the percentage was much higher. I didn’t like the stress of wondering what I would encounter.

But I see the writing on the wall. Hotels that emphasize superior service (i.e. expensive ones) will continue to refer guests to a specific doctor. Otherwise, ironically, the old days will return. When I began in 1983, motels and chains (Holiday Inn, Ramada, Hilton, Best Western…) had no interest in a hotel doctor. At least in Los Angeles, I was the first to approach them. By the 1990s, they were calling me and an increasing number of competitors, but managers of these hotels still pay little attention, so employees are on their own when guests ask for help.

Although my faithful clients continue to call, I’ve noticed a decline from the great mass of hotels that never called regularly. But I already collect Social Security, and I’ll be fine when I retire.

Relentless Time

Melrose Avenue is hip and upscale as it passes through West Hollywood. Further east, toward downtown, businesses tend toward pawnbrokers, bodegas, and Kentucky Fried Chicken. At least that’s how I remembered it.

If you live long enough, everything familiar vanishes, and I parked among a chic collection of freshly painted boutiques, restaurants, and fashionable clothing shops. Plus a beautiful new hotel that I’d never heard of.    

It was the Hollywood Historic Hotel, converted from a 1920s apartment a few years ago, I learned from the desk clerk. He insisted that I was the first doctor that had appeared, and he seemed happy accept my card.

Even better, there was no answer when I knocked. Since I’d come at the request of a travel insurer, I’d be paid. I tell the insurer that if the guest wants to drive to my home, I’ll take care of him at no charge. No one has taken me up on it.

A Dangerous Occupation

As I entered the room, half a dozen family members stood and bowed. When Japanese bow, it means no one speaks English, so I phoned the Japanese insurance agency that sent me.

Passing my cell phone back and forth to the patient, I asked the usual questions and listened to the dispatcher’s interpretation. After the exam, I phoned the agency again to deliver my conclusions.

The guest had the flu. 

Everyone gathered and bowed as I left. Even as the door closed, I was worrying.

Doctors are casual about washing their hands. If your doctor skips it, his hands carry whatever infection they picked up from previous patients. Remind him.

I usually come directly from home where I don’t handle sick people, but I always wash my hands before seeing a guest; afterwards I do the same. I do this partly though habit but also to protect myself.

As I walked down the hall, I was aware that I couldn’t disinfect my phone which the guest had handled repeatedly. Over the coming week, I’ll learn whether or not I’ll catch her flu.

A Real-Life Stereotype

A diamond dealer from Israel, a guest at the L.A. Marriott, fell violently ill with a stomach virus. He went to an emergency room, remaining overnight for IVs and tests. Returning to the hotel, he felt better except for some diarrhea. I examined him and reassured him and handed over anti-diarrhea pills.

“Are you Jewish,” he asked.

“I’m a doctor,” I said.

He thought for a while and then asked “Would you give me a discount on the bill?”

I gave him a discount.

After another pause he asked “Would you keep the old fee on the invoice that I give to my insurance?”

I told him I’d already made the change.

“But the insurance charged too much: $90 just for a week in America!” he complained.

“Are you kidding?... You should kiss the feet of whoever sold you the insurance. Wait till you see the bill from the emergency room. It’ll be about $5,000.”

He didn’t believe me.

The Pinnacle of Success

Walking toward the entrance of the Viceroy, a luxury Santa Monica hotel, I noticed half a dozen parking valets gathered around their supervisor who was giving instructions. As I passed, he paused and pointed: “Look at him. That’s our hotel doctor. You let him park wherever he wants.”

This happened in July of 2003, but I still remember the pleasure it gave me. When the parking valets grant you a free pass, there are no more worlds to conquer.

My Fifteen Minutes of Fame

Every five years or so, the Los Angeles Times discovers the housecall and publishes an enthusiastic article that doesn’t mention me, the nation’s leading housecall doctor.

Another appeared two days ago. As always, I wrote the reporter to point out his error. To my surprise, he phoned yesterday, interviewed me for half an hour, and wrote another article in today’s Times. You can find it at:

http://www.latimes.com/business/hiltzik/la-fi-mh-is-the-house-call-really-dead-20160202-column.html

How Doctor Oppenheim Met His Wife

In 1975 I and a friend were fresh out of internship. He had a job at a Los Angeles clinic that remained open during the weekend. Few patients came, so I often visited, and we sat talking. The only other employee, a nurse – really a young woman who wore a white coat and acted as receptionist -- joined us. After a few visits I got up the nerve to ask her on a date.

She was committed, she explained. But she worked at the Woman’s Building, a flourishing feminist arts center. She offered to give me some phone numbers.

I declined. I was too shy to call women I didn’t know.

“Then what’s the solution?” she asked.

“Maybe they could call me.” I meant this as a joke and forgot about it until a week later when a woman phoned. I did my duty by asking her to dinner, and it proved an excellent decision.

There is more to it. It turns out that she and the nurse were candidates for a college art teaching position in Oakland. Both flew up for an interview. My future wife later learned that the nurse had already sewn up the job, so there was no point in the interview. During the plane ride, she had given me an enthusiastic recommendation, perhaps as a consolation prize. 

When we discussed how our lives and the nurse’s had progressed over the years, we agreed that my wife had gotten the better deal. 

Christmas Season

In the Pasadena Sheraton last Sunday, my phone rang for a visit in Irvine. Pasadena is twenty miles from home, Irvine fifty miles. I would miss supper by several hours, but the month before Christmas is slow, so I was pleased at another visit.

I often drive to Irvine but not from Pasadena, so I consulted Siri from my I-Phone. She directed me toward the nearest freeway but told me to turn off as I reached it. That didn’t seem right, but disobeying Siri is usually a bad idea. A drive through city streets to the Long Beach Freeway saved several miles but probably not much time.

I settled down for the trip before realizing with a shock that she was directing me toward the Santa Ana freeway. No one takes the Santa Ana freeway. It’s always jammed. Sure enough, as soon as I drove on, traffic slowed to a crawl.

I arrived after 1½ hours to face another irritation. The address, 2120 Waterbury, wasn’t a street address but suite 2120 at the Waterbury Apartments. Siri found the complex but getting to 2120 among the buildings was my job.

It was night. The guest was a traveler and unfamiliar with the area. There was no parking except in locked underground garages, so I couldn’t wander far from my car. Also (and I’m not making this up) it was raining. In the end, she came out and searched the streets until we encountered each other. The visit, as usual, was the easy part.

Leaving, I drove to the San Diego freeway, the sensible, if not the shortest, route from my house to Irvine. To my dismay, traffic was crawling. Weekends are usually OK, but I should have remembered that this was the Sunday before Christmas.

How to Get the Best of Both Worlds

A lady with a cold phoned for a doctor at 4 p.m. on a Tuesday.

From my home to hers in the Hollywood Hills required a thirteen mile drive through city streets (twice that on the freeway). I go during the rush hour but only for patients a good deal sicker. In her case, I would schedule a visit for 9 or 10 p.m.

Sadly, the lady hadn’t called me but Get Heal, a new service that promises a housecall within an hour and charges a flat $99.

It pays doctors $75 an hour, lower than the going rate, but provides a medical assistant who drives, a delightful perk. Unfortunately, the dispatcher explained, the medical assistant lived near my destination. Would I make the drive myself? Heal would pay extra. If not, Heal would send a cab.

I chose a cab. Fifteen minutes later an Uber car pulled up. We crept through traffic. The medical assistant was there when we arrived. I cared for the patient. We crept back.

Heal earned $99 for my two hours’ work, but I earned $150. The Uber driver earned half that. The driver, dispatcher, and a dozen other employees collected their salaries. Get Heal has an office in Santa Monica and an impressive web site.

Everyone agrees that $99 for a housecall is a money-loser. Perhaps this patient was an outlier, but none of the eight Heal housecalls I’ve made has taken less than an hour door-to-door.

If you need a housecall in Los Angeles, phone Get Heal and ask for Doctor Oppenheim. You’ll get the best of both worlds until one of us goes out of business.

Discovering a Normal Part of your Body

A young woman at the Georgian Hotel felt a cold coming on, so she inspected her throat and discovered a dozen bumps on the far end of her tongue. I reassured her, but she wanted a doctor to see them.

I love housecalls where I know the diagnosis as soon as I hang up the phone. This qualified because the guest had discovered a normal part of her body. When you examine your tongue in the mirror, it seems smooth. People rarely stick it out far enough to reveal a clump of wart-like taste buds deep inside.

I also love telling a fearful patient that he or she has nothing to worry about, so this was a satisfying encounter for both of us.

It may save you some anxiety to memorize the following normal parts of your body.

- Put a finger inside your mouth and feel the gums behind your lower teeth. Moving just to the left and right reveals two hard lumps which may not be the same size. These are part of your mandible, the jawbone.

- With thumb and forefinger, pinch your neck just below the jaw to feel two lumps that mark either end of the hyoid bone that circles the front of your windpipe. You can wiggle them from side to side.

- Run your finger down the middle of your breastbone to an inch beyond the lower end, then push. You’ll feel a hard mass. That’s another bone, the xyphoid process. One guest was certain had a stomach tumor.

- Feel your major lymph node areas (neck, armpit, groin), and remember what you find. Part of the immune system, lymph nodes swell in response to an infection then shrink after it passes - except sometimes a node or two won’t shrink but remains forever as a pea-sized, moveable granule beneath the skin.

Another Free Service

Her child’s nose was bleeding, explained the mother. Could I come?

I was tempted. Once in the hotel room, I would ask questions. I would take out my otoscope and peer up the child’s nose. In the end I would reassure the mother and tell her to pinch the nose and wait. The bleeding would probably stop. Persistent nosebleeds are rare and require expert attention. Then I would collect my fee and leave. 

Over the phone, the mother revealed that the child was in good health and suffering a cold.  Respiratory infections occasionally produce a nosebleed. I reassured the mother and told her to pinch the nose and wait. When I phoned later, the bleeding had stopped. 

A Medicolegal Housecall

Stepping out of the shower, a Doubletree guest stumbled and nicked 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 the usual visit I never see a general manager. Most 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 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 these circumstances. 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.