Another Death

 “He’s over there! I think it’s an emergency!”

Emerging from the elevator, I did not want to hear this. Despite the impression left by television, cardiac arrests are usually fatal. Outside a hospital, between six and eleven percent survive.

The survival rate of the few I encountered is zero, and this did not look like an exception. An overweight security officer was kneeling clumsily on the bed, bouncing up and down as he pounded an old man’s chest. The guest’s false teeth had jarred loose and protruded from his mouth; I plucked them out.

Security officers learn CPR but rarely use it, so they forget the details. Cardiac massage on a soft bed doesn’t work. The officer should have dragged the guest onto the floor. One of his colleagues should have been giving mouth-to-mouth respiration, but it was almost impossible to persuade laymen to perform something they considered disgusting. Mouth to mouth respiration was essential until 2010 when experts decided that chest compression alone was OK.

I asked how much time had passed since the arrest.

“I don’t know. He was out when I got here.” gasped the officer.

I found no pulse, heartbeat, or respiration, and it was obvious the man had been dead for some time, so I told the officer to stop. Hearing this, an elderly lady in a nightgown hovering nearby burst into tears. At that moment, two paramedics and two firemen clumped noisily into the room accompanied by a man in a suit and a young woman, apparently the manager plus the concierge. Cardiac arrests attract too many people.

Observing the corpse and the weeping woman, the senior paramedic flipped through his clipboard. “Is that your husband, ma’am? Could you give me his name?”

She couldn’t. Disobeying my rule about staying out of the way in the presence of paramedics, I comforted her. Lowering his clipboard, he waited patiently. This is the single activity paramedics are happy to leave in the hands of a physician. After a few minutes, she became calmer.

Disposing of the dead guest took a while. Two police arrived and transcribed the wife’s story a second time. One by one, the staff left, followed by the police and paramedics. The medical examiner’s ambulance drove off with the body. The lady couldn’t find her sleeping pills, so I provided some. I left my phone number and promised to call in the morning.

A Bad Year for Conjunctivitis

At one point years ago, I had to discard half a dozen bottles of antibiotic eye drops when they reached their expiration date.

I carry thirty-two drugs. I don’t like to send guests searching for a pharmacy in a strange city, so I hand out whatever they need whether it’s a week of antibiotics or a tube of cream. I’m also generous with cough medicines, decongestants, expectorants, laxatives, and other over-the-counter remedies. I know that many patients including you don’t expect medicine whenever you see a doctor, but we in the profession get that impression.

When I restock, my order must be large to avoid a big handling fee. This becomes awkward when I run low on a critical drug such as prescription eye drops. I can’t allow myself to run out, and I can’t order other essentials such as antibiotics or injectables until I need them because of the expiration date. 

This is where useless drugs come in handy (I’m stretching a point; it’s not certain that cough remedies, decongestants, expectorants et al don’t work, but researchers who conduct studies have trouble showing that they’re superior to placebos).

As I run low on important drugs, I become more generous with these. This is easy because respiratory infections are every family doctor’s most common ailment. For weeks, I loaded up guests with sniffles, colds, “sinus,” “bronchitis,” flu, and similar bugs with every elixir, gargle, capsule, or lozenge in my possession. Soon I ran low on enough medication to eliminate the handling fee when I restocked.    

A Better Shot

 “Is he a VIP?”

“All our citizens are VIPs” said the consul for Qatar, referring to a countryman at the Airport Hilton.

Sick guests from small nations often call the local consul. Asked to find a doctor, he usually phones the hotel.

Once a consul has my number, he tends to remember it, so these calls are good news. On the other hand, guests who phone the consul feel worse than usual.

A woman in a headscarf answered door, and indicated a young man, curled up in bed. It was their honeymoon. Back pain is usually an easy visit from my point of view. Most acute backs are not so bad after the first day, and they steadily improve.

Unfortunately, this was not the first day. Pain had come on three days earlier in Las Vegas. A hotel doctor had dispensed the usual remedies, and pain had diminished only to return the following day.

I delivered the largest injection and strongest pills in my possession, adding that he would need more evaluation if this didn’t work.

At midnight, he phoned to say that he had improved, but now pain made it difficult to sleep. He agreed to go to an ER but wanted to wait until morning. There was no answer when I called that morning or that afternoon.

The ER doctor had performed the usual tests and then given a shot, the guest said that evening, but it was not as good as mine. Desperate to return home, he had booked a flight. Would I give another shot before he checked out?

So I did. Handing over a business card, he urged me to visit if I came to Qatar. Then, supported by the wife and a cane, he hobbled off.

My Last Bad Check

A guest at the Hyatt had fallen ill and cancelled a flight. He had recovered, but the airline insisted on a doctor’s note before allowing him on board.

Determining if someone is healthy enough to fly usually requires only a few questions, but I do an exam. He delivered a steady patter as I worked, describing himself as a venture capitalist with an exciting but stressful life as he prepared for an important meeting in Japan.

As I composed the note, I saw him writing a check and immediately announced that I accept credit cards.

Apologizing, he told me that it would be a hassle unless payment came out of the company account. Seeing my hesitation, he added that he had credit cards and would give me a number in case there were a problem. He pulled one out and scribbled on my invoice, getting one number wrong. I noticed and made the correction. 

I’ve received a few dozen bad checks but only rarely after 2000 when I began accepting credit cards.

You can imagine my feeling later as I stood watching a teller fiddle at his computer…. and fiddle…. and fiddle… and finally explain that it wasn’t accepting the check.

Naturally, I felt stupid. Single males write almost all bad checks, and this guest fit the pattern.

Now came the tedious process of trying to recover the money which occasionally happens. As I expected, the address and phone number on the check were wrong. Asking the hotel for contact information sometimes helps, but in this case I learned that it must respect the guest’s privacy. The credit card was certainly worthless.

But it wasn’t! When I phoned the computer and entered the numbers, it approved. Some things are hard to explain.

The Occasional Surprise

A travel insurer asked me to see a lady in Mission Hills complaining of high blood pressure.

I drove off confident that this wasn’t her problem because high blood pressure causes no symptoms. Mostly patients are suffering a headache or anxiety or dizziness.

Now and then I’m surprised. In hotel doctoring, surprises are generally unpleasant but not in this case.

She didn’t have high blood pressure, admitted the lady apologetically. She’d lost her thyroid pills and only needed a prescription.

When I learn that a hotel guest needs a legitimate medicine, I phone a pharmacy to replace it, and I don’t charge. Guests with travel insurance don’t call me but their agency’s 800 number. Embarrassed to use insurance for a trivial problem, they lie. Sometimes hotel doctoring is easy.

The Most Difficult Calls

I stopped chopping an onion when the phone rang. A young man at the Airport Hilton was vomiting.

For a hotel doctor, a difficult call refers not to an illness but to traffic conditions. It was four o’clock, so I would drive eight miles both ways during the freeway rush hour, returning hungry and with no dinner prepared. I delay some visits but not for acutely miserable symptoms.

Before I left, the phone rang again. I yearned to hear that it was another airport hotel, but the guest was downtown, fifteen miles in the opposite direction. Worse, she had a migraine, so I couldn’t delay.

Delivering medical care is sometimes challenging. Always challenging and the mark of a seasoned hotel doctor is the ability to remain serene in gridlock.

Certain rules apply. Unless lanes are closed, leaving the freeway for city streets is a bad idea. Another rule is that blocking a lane at any hour stops traffic cold. Steady movement, however slow, is simply a sign of congestion.

“I wonder if there’s an accident,” I thought a dozen times after several minutes of immobility, but I never saw one. So much for rules.

Two housecalls which normally take two hours took four and a half, but I maintained my serenity, sucking on the hard candy I bring along to dull my hunger and listening to a novel on my CD.

"Wow! Hotel Doctors Charge That Much?"

Guests don’t say that. Mostly I hear: “Could I talk to my husband and call you back.…..?”

Unlike the competition, I don’t confine myself to upscale hotels. Plenty of Holiday Inns, Ramadas, and motels call, and I quote fees less than the going rate. Colleagues complain but admit that it’s not a competitive advantage because hotels don’t care what the doctor charges. Still, counting driving time, a hotel visit rarely takes less than an hour, so it’s not cheap.

Helpless in a strange country and forewarned that medical care in America requires vast sums, foreign guests are easier to deal with.

America medical insurance takes a dim view of housecalls. No hotel doctor accepts it, so Americans, already disoriented at finding a doctor willing to make a housecall, learn that they must pay out of their pocket. It’s a shock.

Like all doctors, I like to present myself as a humanitarian, and I often reduce my fee if the guest feels too miserable to leave the room, but mostly, when Americans object, I send them to an urgent care clinic.

Walking through a clinic door costs around $100. While this is much less than a housecall, clinics charge extra for tests, procedures, shots, and supplies, and the patient must find a pharmacy and then pay for the prescription. I don’t charge extra for anything. Telling all this to guests sounds too much like a sales pitch, so I simply send them to a clinic. Insurance might pay part of their bill.

Disappointment

Loews guest was suffering flu symptoms, but mostly he worried about his temperature. I explained that the fever was not an ominous sign. If he wanted to check, he could buy a thermometer. Or I could come to the hotel. He opted for the visit. I told him how much it would cost.

“Oh… I thought it was free,” he said.

I’d heard that before. Your doctor doesn’t answer when you dial, but I do. Naïve guests think I’m downstairs awaiting their call.

He was from Chile. Did he buy travel insurance before coming to the US, I asked. He did. I explained that travel insurance pays for housecalls, and most insurance agencies call me. However, he must phone the insurance first to obtain approval. He promised to do so. 

Half an hour later my phone rang. It wasn’t Loews but the Doubletree. An elderly man had undergone electrical cardioversion for atrial fibrillation – an irregular heartbeat – a month earlier, and he was worried. His heart didn’t feel right. I asked him to count his beats; he counted 80 per minute. That is not particularly fast. I assured him that he wasn’t describing anything dangerous. He wanted me to check him.

These are the best visits. A guest is worried, and I’m already convinced that there’s nothing to worry about. Sure enough, the exam was normal. He was delighted at the news, and I was delighted to deliver it. Everyone was happy.

I was even more delighted to drive to the Doubletree because it’s only a few blocks from Loews. At any minute, I expected a call from the Loews guest’s insurance agency for another easy visit. But it never came.

My Career as a Diet Doctor

Long before taking up hotel doctoring, I answered an ad from a physician who offered “weight control.”

Every era has a weight loss miracle. During the 1970s it was human chorionic gonadotropin, HCG, a respectable hormone involved in reproduction. There were the usual flurry of bestsellers and HCG clinics, and then it went into a decline although it remains in the armamentarium at plenty of shady clinics.  

My doctor was a regular GP who merely made it known that he offered HCG. I doubt diet patients made up ten percent of the practice, but they provided an impressive cash flow. The women (only a rare male) came in weekly for a shot, a diet sheet, and a pep talk from the nurse. The doctor saw them monthly, but they paid the regular fee for every visit. He never claimed (to me) that HCG worked, only that patients believed in it, so it inspired them to stick to the diet.

But it didn’t inspire them. Any motivated patient who starts a diet, legitimate or silly, will lose ten or twenty pounds before the gnawing of hunger becomes tiresome. Losing more is much harder. This was no news to the HCG patients, but they were not paying good money to hear it. Their stubbornness amazed me. They signed up with the usual enthusiasm, came in for their shots, followed the diet, and lost their ten or twenty pounds. Then they stopped losing, but most continued to come in, month after month, taking the weekly shot and paying the fee.

Despite the universal opinion among the thin that dieters fail because they cheat, most of these women were trying hard. Alas, they were butting up against the ten-twenty pound limit. Losing more requires a tighter diet, self-denial, and regular exercise, a difficult feat.

Dropping that initial weight turns out to be a good thing. Ninety percent of dieting’s health benefits (reduced risk of diabetes, lower cholesterol, less heart disease) are achieved by a ten percent weight loss. Alas, few patients thrilled to that knowledge because better health was not their goal. Many asked if the shot worked. At first, loyal to my employer, I admitted that opinion was divided. Eventually my answers grew blunt. This never offended the patients who were already suspicious. Many did not even drop out, but the news got back to my boss.

A Disorder I've Never Seen

“I’ve been trying to pick up stuff, and I can’t,” said a Ramada guest over the phone.

“You mean your arm is weak?” I asked.

“No. Once I grab it, it’s OK.”

“Is it numb?”

“It feels fine. But when I reach out for something, I miss it. It’s weird.”

The guest was elderly but in good health. I suspected I knew the problem.

“Take your forefinger and touch your nose,” I suggested. “Can you do it?”

“No,” he said. “I keep hitting my face.”

This was something I’d never encountered but luckily I remembered medical school neurology. This lady had suffered a cutoff of blood to her cerebellum, a structure at the base of the brain that controls coordination.

When you reach out, the brain instructs muscles to move your arm in the general direction of your goal. That’s the best it can do. The last few inches don’t require strength or mobility but fine, precise movements. That’s where the cerebellum takes over.

With the cerebellum out of action, you’d have normal consciousness, strength, and sensation but no coordination. You could walk but only slowly with a clumsy, wide-based gait. If you reached for something, your hand would wobble wildly as it approached. The classic test is to ask a patient to put a finger on her nose. With the cerebellum out of action, it’s almost impossible.

It could have been a temporary loss of blood supply, a “transient ischemic attack” (TIA) or a permanent loss, a stroke. Waiting to see which would be unwise, so I urged her to go to a hospital.

A Dog-Eat-Dog Business, Part 5

I was attending a guest at Le Mondrian when there was a knock. The guest was not dressed, so I opened the door to find myself eye-to-eye with another doctor. I recognized him as one of the new concierge physicians eager to serve hotels, including mine.

Hotels occasionally summon a second doctor when the first is slow arriving. The sight of this doctor meant that Le Mondrian had called him first, unsettling news.

“Looks like a communications slip-up,” he said cheerfully. “It’s nobody’s fault,” he added. “But it’s only fair, since we both made the trip, that we split the fee.”

I closed the door in his face and went back to work. When I returned to the lobby, the concierge apologized for the mix up, blaming the impatient guest.

She handed me an envelope. A few luxury hotels prefer paying me directly and adding it to the guest’s bill. When I counted the money later, I saw it was too little. She had given half to the other doctor. If she hadn’t, I realized, she wouldn’t have received her referral fee.

The Free Market Strikes Again!

I spend less than $1,000 a year for supplies, so giving them out gratis is no sacrifice. Two or three times a year, I place an order at a pharmaceutical web site. It’s easy, but sometimes I get a jolt.  

I hand out doxycycline, an old antibiotic and the recommended treatment for the most common pneumonia and the most common sexually transmitted disease. In 2012 I paid $50 for a bottle of five hundred. That’s twenty-five treatments which works out to $2.00 for each. When I ran low in 2014 I decided to reorder. Checking the web revealed that five hundred seemed to cost $1,655. That couldn’t be right, so I looked around, but it wasn’t a typo. So I ordered azithromycin, effective and about $4.00 per treatment.

This happens regularly. Remember penicillin? You may think it’s obsolete, but it remains a superb antibiotic and the best treatment for common infections from strep throat to syphilis. Twenty years ago it was as cheap as aspirin. I could buy a thousand for $30. Now the price is $130 and rising.

Here’s what happens. As a drug gets older and older, it gets cheaper and cheaper. But doctors like newer drugs. Everyone (you included) believes they are immune to advertising, but you’re not, and doctors are no different.

It’s a good rule that any drug in an ad is wildly expensive and not superior. Look at the ad: if it doesn’t say the drug is the best, it isn’t. A few years ago Avelox or Levoquin would cure your pneumonia as well as doxycycline at forty times the cost. Doxycycline at $1655 a bottle still costs less but not by as much.

As doctors incline toward a new drug, they prescribe the older one less. Pharmacies buy less. Pharmaceutical companies stop making it. Eventually the remaining companies notice the absence of competition, and the free market works its magic.   

Cheating Medicare

Hearing my fee, the guest announced that he was on Medicare. I explained that I am not a Medicare doctor, so he would have to pay me up front. Unlike most elderly callers, he preferred another source of care, so I gave directions to a local clinic.

Medicare pays less than the going rate for all medical services. I don’t know any hotel doctor who accepts it. Among the ninety percent of office physicians who bill Medicare, many work hard to tack on extra charges for tests and procedures and length-of-visit to compensate for the low reimbursement. This is cheating, but doctors routinely cheat Medicare. After all, they point out, Medicare cheats them.

Most doctors are conservative, so they blame Medicare’s behavior on government bureaucrats. Being liberal, I blame society. The U.S. is a democracy, and most Americans don’t want to pay enough taxes to finance Medicare adequately. No elected representative, Republican or Democrat, would dream of forcing them.

As a result, a Medicare bureaucrat behaves like any intelligent person required to pay bills without enough money. He quibbles, quarrels, delays, discovers errors in the invoice, makes partial payments and sometimes no payment at all. This infuriates doctors but allows the Medicare budget to last out the year. Paying bills promptly would exhaust the money early, infuriating the bureaucrat’s boss. 

A Dog-Eat-Dog Business, Part 4

Danielle, chief concierge of the Ritz-Carlton, calls when her allergies are acting up, but this wasn’t the reason. It was an awkward situation, she explained, but she hoped I’d understand. A guest has complained, I thought. I racked my brain to think who it might be.

If it were up to her, she added, I would be the Ritz-Carlton’s doctor no matter what. Unfortunately, other concierges were putting pressure on her. Another hotel doctor had approached, offering thirty dollars for every referral. She had brushed him off, but her colleagues objected. They reminded her that vendors who want a hotel’s business (limousine services, tours, florists, masseurs) routinely tip the concierges. Why should doctors be exempt?

Here’s a suggestion, she said. Why didn’t I simply match his offer?

I told her that I’m happy to provide free care to hotel staff, but it’s unethical for a doctor to pay for a referral. It’s also illegal. No problem, she assured me. I would still be the Ritz-Carlton’s doctor.

Danielle might continue to call, but I’m less certain about her colleagues.

This exchange reminded me that I hadn’t written the California Medical Board in a few years, so I sent off another letter complaining about other hotel doctors paying referral fees. I’ve sent several. The board is legally obligated to respond to every complaint, and it duly responded, assuring me that it was aware of the problem.

It has never taken action, probably because the Medical Board gives priority to protecting patients from doctors. It shows less interest in protecting doctors from each other.

A Miracle Drug

Handing me a vial of an injectable medication, a guest explained that he needed a refill. Its label was in Spanish, but technical terms are recognizable in any language, so I had no trouble deciphering its mixture of vitamins and minerals. And cortisone.

That was disturbing. The guest’s wife’s rheumatoid arthritis occasionally flared up, and her doctor in Argentina wanted to make sure this didn’t spoil their vacation.

Discovered in the 1940s, cortisone seemed miraculous. Patients crippled with arthritis saw their pain melt away. Ugly psoriatic plaques disappeared. Hay fever vanished. Eczema victims who had been scratching for years stopped after a few doses of cortisone.

A cure for cancer could not have produced more excitement. The Nobel committee, which prefers to wait decades, rewarded cortisone in 1950 - just as doctors were realizing that symptoms return with a vengeance when the effect wears off, and repeated use produced disastrous side-effects.

Creams are fairly safe, and cortisone taken internally remains a life-saver for many serious diseases but a bad idea for ongoing symptoms (generalized pain, itching, inflammation). Large amounts for a short period are safe provided the problem is also short-lived. I give a huge dose for poison ivy but stop after two weeks. By that time the poison ivy has run its course.

A rare shot is probably OK for arthritis, but this family’s G.P. used it generously, a common tactic because the short-term effect is so good. There are no benign treatments for rheumatoid arthritis, but many are safer than cortisone. I prescribed enough for one shot.  

A Treatment Better Than the Best

She had a fourteen hour flight to Australia, explained a woman with a thick French accent. Unfortunately, she had thrown her back out again. Would I come and give something to relax her muscles for that long journey?

I don’t know any medicine that does that, but she was certain that, in the past, her French doctor had prescribed something that did the trick. 

She was already taking the usual pain remedies, so there was no point in a housecall. The woman agreed, but she was clearly disappointed. I know she wondered if I was truly on the ball.

It’s a popular medical belief (remember reader: all popular medical beliefs are wrong) that if you are sick, the doctor will do his best. But if you absolutely must feel well – you have a vacation, important business, a wedding – a smart physician will make a special effort and come up with something even better.   

As a hotel doctor, I deal with this yearning all the time. Since doctors are tenderhearted, it’s tempting to prescribe a placebo if no useful medicine exists. Placebos work although not as dramatically as enthusiasts claim.

The problem is that they’re not available. Decades ago, drug companies sold pills labeled “placebo,” but, perhaps for medicolegal reasons, they stopped. The result is that when a doctor decides you need a placebo, he prescribes a real medicine in the full knowledge that he’s doing something wrong. As I’ve written repeatedly, the advantage of alternative, folk, holistic, and herbal healing is that their medicines are a hundred percent safe. Medicines from real doctors have side-effects, so we’re not supposed to prescribe them unless they’ll help.

Life is easier for doctors who ignore this, so many do.

An Unwelcome Visitor from the Past

A young man at the Chateau Marmont had been coughing for two weeks. He had a fever, and my stethoscope revealed lung noises typical of pneumonia.

I enjoy diagnosing pneumonia because, in an otherwise healthy person, it’s the only common illness with a cough that doctors can cure. Everything else is a virus. 

I didn’t like this particular diagnosis. It takes a tough germ to cause pneumonia in most people, so unpleasant symptoms begin quickly. This man’s cough had persisted for some time. Furthermore, he was gay and admitted to having unprotected sex. I suspected that he had a pneumocystis infection. Pneumocystis is a fungus so benign that it lives in the lungs of most of us, causing no trouble.

Until forty years ago, it was rare, affecting patients already sick with cancer or serious diseases requiring drugs that suppressed immunity. Doctors were mystified when Pneumocystis began attacking previously healthy young men during the 1980s. It turned out to be the most common sign of AIDS.

It’s rare again today because we track immune cells of HIV patients and prescribe preventive drugs when the numbers drop. This young man had not been tested, but he was no fool. He cut short his visit and returned home.

The Glamorous Life of the Call Girl

At one a.m. in 1994, I received a call from Le Montrose, a boutique hotel in West Hollywood. The guest told me the problem was “personal.”

The man who opened the door was past sixty, short, plump, balding, and tieless, wearing a rumpled suit which I suspected he’d put on to greet me. Across the room, wearing a bathrobe, a young woman sat on the bed, staring sullenly at the floor.

“There’s been an accident,” he said.

Neither guest seemed injured, so I knew I wasn’t going to get off easy. This proved true as he explained that his friend seemed to have an object in her rectum. He provided no details.

Bizarre incidents fascinate doctors no less than laymen. Around the cafeteria table, interns compete in relating the latest. Outside of working hours, they remain a mainstay for impressing girls at parties.

Central to this adolescent obsession is the genre of things-that-end-up-in-people’s-rectums. I no longer find these amusing, not only because I’m a grown-up but because they make me nervous. I hate situations that I might not be able to handle. Removing something from the rectum often requires tools such as a proctoscope which I didn’t carry. Also practice. I had never done it.

But I had to try. After introducing myself to the woman, I put on a rubber glove and went to work. There is more space than you’d think inside a rectum; I felt a hard object touch my fingertip and then drift away. When something lies out of reach, it’s natural to stretch, and my desperate efforts caused her to groan with pain.

Suddenly, I snagged something and pulled out a shot glass. I almost danced with joy and relief. Although I expected an outpouring of gratitude, none appeared. Gathering up her clothes, the woman disappeared into the bathroom. The man nodded agreeably as if this were routine business. Filling out my invoice, I asked the woman’s name.

“Elizabeth Anderson.” He hesitated before answering, revealing that he had invented the name. Call girls lead a glamorous life in the movies, but the reality is often miserable. I handed him the invoice. He examined it thoughtfully. “That’s a lot of money,” he said. “You only spent five minutes here.”

In 1994 my fee for a wee-hour call was $180. He had not objected when I had informed him over the phone. When guests balk, I say I’ll accept whatever they consider fair. They often reconsider and pay my regular fee.

I told him I’d accept whatever he considered fair. He handed over $80. I don’t want to think how the woman made out.

Lost in Translation Again

“Bom dia” said the woman who opened the door.

“Bomn dia,” I responded. That’s the limit of my conversational Portuguese. My heart sank as I looked around the room which contained a toddler but no adult male. When I see a couple from a foreign country, the husband is likely to speak some English.

The mother pointed at her child, made coughing noises, tapped his chest, and produced a thermometer which she waved significantly. Once she understood that I needed more information, she took up her cell phone. 

After some effort because her husband was in a meeting she delivered a long recitation before handing me the phone.

I heard “He have cough. He have flu. He need medicine.”

In response to my question, the father insisted that this was everything she had said, but I knew he was summarizing. I asked more questions and received short versions of her long answers. The child looked happy and not at all sick, and my examination was normal. He had a cold. He’d coughed for four days and might cough for a few more, I explained. She was already giving him Tylenol, and no other medicine is safe for a two year-old. Luckily, he didn’t need medicine or bed rest or a special diet. It wasn’t even necessary to stay in the room.

If I had handed over a bottle of medicine, every mother from Fiji to Mongolia to Nigeria would understand that I was behaving like a doctor. But I wasn’t. What was going on?

I’ve encountered this hundreds of times, so I work very, very hard to communicate that the child has a minor illness (husband’s translation: “Doctor says child is OK…”), that no treatment will help (husband’s translation: “Doctor does not want to give medicine…”) and that being stuck in a hotel room is boring, so she should try to enjoy herself (husband’s translation: “Doctor says go out; child is OK…”).

Tap, tap, tap…. The mother beat a tattoo on he child’s chest in a wordless appeal. Everyone knows that a sick child must be confined and given medicine. Why did the doctor keep saying that he wasn’t sick?

I repeated my reassurance, and the husband translated. When, at the end, I asked if she understood she knew the proper answer: yes. She remembered her manners as I left and thanked me effusively.

I left feeling as discouraged as the woman. She was in a strange country, trapped in a hotel room with a sick child. Despite her best efforts, the foreign doctor didn’t understand that her son needed help.

I've Quit Doing Telemedicine

Organizations like Amwell or Teladoc or Doctor on Demand pay doctors to answer phone calls. Sitting at home, we can earn $40 for a conversation that lasts a few minutes. It’s easy money, and I’ve had many satisfying experiences answering questions, helping with minor illnesses, assuring callers that something that seems ominous is not ominous, or sending them for medical care if they need it.

What spoils the experience is that nearly half of these callers are suffering a respiratory infection: cough, sore throat, congestion, “sinus,” “bronchitis.” Since their doctors routinely prescribe antibiotics, these callers know what they need. Phoning saves a trip to the office. What a convenience!

When, after discussing their symptoms, I give my diagnosis and explain how to help, many are puzzled. When, in answer to their hints, I assure them that antibiotics don’t help, most remember their manners, but they don’t believe me. Some point out that their family doctor takes their illness more seriously. A few question my competence or suspect they’ve fallen for another internet scam (“Are you a real doctor?.... What am I paying this money for?!!...).

When guests at my hotels phone, respiratory infections are also the leading complaint. But phone calls to me are free, and I spend a good deal of time answering questions and giving advice. By the time guests agree to a housecall, they understand that I know my business. If they don’t understand, I direct them to another source of care.

Telemedicine guidelines forbid doctors from prescribing narcotics and tranquilizers but say nothing about antibiotics which are far more toxic. If you sign up for one of these services and want an antibiotic but have the bad luck to reach a doctor like me, simply thank him, hang up, call again, and tell whomever answers that you want a different doctor. That should work.