How a Hotel Doctor is Like a Prostitute

I make the majority of my calls at the request of national housecall agencies, international travel insurers, airlines, and a sprinkling of miscellaneous sources including other hotel doctors. That’s fine with me.

A few dozen Los Angeles area hotels call me exclusively. That leaves over a hundred, all of whom have my number but who call another doctor or no doctor and sometimes me. Competition for these hotels has become so cutthroat that I’m happy to leave it to others.

If you’ve followed my posts you’ve learned about my excellent skills and low fees. Why would a hotel bother with anyone else? The answer is that service and price are useless marketing tools in medicine where the law of supply and demand doesn’t work. 

Providing a doctor produces no revenue for the hotel, and guests don’t demand one, so most general managers pay no attention. Asked for help by a guest, employees are on their own. 

They may simply give out a number, but many prefer the traditional arrangement once used to summon a prostitute. A bellman made a phone call. As the lady left, she stopped at the bell desk to drop off a portion of her fee.

It’s illegal for a doctor to pay for a referral, but what are the options for someone yearning to break in to the glamorous and lucrative world of hotel doctoring? Claiming to deliver superior medical care sounds weird. Advertising a low fee is vulgar. Whoring works better.

Good Doctors Do It

“I’m coughing my head off. My head is plugged. I have a fever. I’m on vacation, and I need something.”

I’ve seen over 4,000 guests with respiratory infections. To the average hotel doctor, this is an easy visit. He arrives, performs the traditional exam, prescribes the traditional antibiotic, and accepts his fee and the guest’s thanks. What’s not to like?

That the antibiotic is unnecessary doesn’t bother the doctor, but it would bother me. Despite my colleagues’ insistence that patients demand an antibiotic, most of mine don’t. A small minority appear disappointed when I don’t prescribe one, and a tiny number make it painfully clear that I’ve missed the boat.

For decades, solemn editorials in medical journals have urged us to stop prescribing useless antibiotics, warning that they’re poisoning the environment, producing nasty, drug-resistant germs that are already killing thousands. 

Despite this, giving antibiotics for viral respiratory infections remains almost universal. Almost every doctor whose prescribing habits I know – admittedly a limited sample – does it. None believe they help. All tell me that patients expect them.

“I don’t want an antibiotic if I don’t need it,” patients often tell me. “But how do I know?”

“You don’t, but bacterial respiratory infections are rare in healthy people.”

“What if it’s bronchitis? I get that a lot.”

“Antibiotics don’t help bronchitis.”

“That’s what my doctor gives me. Are implying he’s incompetent?”

“No. Prescribing unnecessary antibiotics is so common that one could call it the standard of practice – meaning competent doctors do it.”

Easy Visits, Mostly

Every day a thousand airline flight crew spend the night in a Los Angeles hotel. Sometimes they get sick and call their supervisor. If they’re American, he tells them to take their American medical insurance and find a clinic. If they’re foreign, he tells them to stay put and wait for the doctor.

That will probably be me. I average half a dozen of these visits per month. I enjoy them because airline crew are young and healthy. Three-quarters suffer respiratory infections and upset stomachs. Since a doctor must certify if they’re fit to fly, I see plenty of ordinary colds.

A minor drawback is two pages of forms to fill out in addition to my medical record. A more serious problem is vomiting: the most common symptom. I hate driving during the rush hour, but vomiters don’t like to wait, so I often find myself creeping on the freeway.

Recovering From Cocaine

He had turned bright red, a frightened guest informed me. His search of the internet revealed that this indicated dangerously high blood pressure. Could I come…?

This was as accurate as most internet medical advice, so I was not alarmed. In response to my questions, he admitted using cocaine earlier but emphasized that he had never turned red before. His heart was pounding, his skin tingling, and his head pulsating but he denied having a headache or chest pain. Could I come?

What to do…. Allergic reactions turn patients red, but this is accompanied by itching which he didn’t have. Otherwise, his symptoms were typical of cocaine use. They didn’t sound life-threatening, but it’s a bad idea for a doctor to dismiss the possibility.

I do not like to make housecalls to frightened hotel guests. Waiting often becomes intolerable, so they dash off to an emergency room or call the paramedics before I arrive. When I suggested these possibilities, he refused, urging me to come quickly. I asked him to count his pulse. It was 100:  not terribly fast. I kept him talking, and he grew more calm.

A hotel doctor’s nightmare is a guest dying after he leaves the room, but dying before he arrives may be worse. It was a stressful drive.

When he opened the door, he didn’t appear bright red, perhaps faintly pink. When I took him to a mirror, he agreed that he had improved. His blood pressure was high, but not too high. His heart sounded normal. He was recovering from the cocaine.

A Sad Story

A Chinese caller wanted a medicine to take back home. He gave the name which, through his thick accent, sounded like “desitin,” an over-the-counter treatment for diaper rash.

That didn’t seem right, so I coaxed him through the spelling (“S as in Shanghai….? “T as in Taiwan…?). The result was “dasatinib.” This turns out to be a treatment for leukemia, FDA approved a few years ago and superior to other treatments. A sick friend in China had asked the guest to obtain some.

I fulfill these requests if they sound legitimate, and this qualified. I made sure he understood that he must find a pharmacy and explain exactly what his friend needed including the dose and instructions. This sometimes involves phoning back to the home country. The pharmacist would then call me, and I would approve. A trip to the hotel wasn’t necessary.

The guest had phoned in the evening and mentioned that he was returning to China the following morning. When the day passed with no call, I had the sinking feeling that, by delaying till his departure day, the guest had waited too long. The average CVS or Walgreens might not stock these high-tech, chemotherapeutic drugs, so the pharmacist might have to order it or send him to another specialized pharmacy. This might take hours. With a plane to catch, the guest probably realized that there wasn’t time. 

Sticking With the Errant Doctor

A guest had a flight in a few hours, explained the front desk manager of the Marina Marriott. His wife was ill and needed a doctor’s note to reschedule. How fast could I get there?

“Very fast,” I said. It was Saturday evening, and I was reading a book.

The Marriott had called regularly for decades before falling silent a few years before. Hotels occasionally do that, and this call gave me hope.

My competitors enjoy an active social life. It was the weekend, and hotels often turn to me when the regular doctor is hard to reach. After caring for the guest, I returned to the lobby and tracked down the manager who shook my hand.

“Thank you so much for coming,” he said. “We have your card.”

I drove off in a happy mood. These urgent requests arrive several times a year, and my prompt response has won me new clients.

But not often. Few hotels give a high priority to providing medical services. The Marina Marriott reverted to silence.

Still, I have fond memories. Twenty years ago, Loews in Santa Monica phoned when its regular doctor hadn’t appeared after several hours. I hurried, but when I knocked on the guest’s door, it was the regular doctor who answered. The embarassed manager promised to make it up to me and kept his word.

Rashes Are Easy, Part 2

His client had developed redness over her eyelids. Could I come?

As I wrote last time, rashes are easy, and eyelid rashes mostly turn out to be one of two or three diagnoses. I asked for the room number.

The guest was in a meeting, the caller responded. When I arrived, I should ask the concierge to fetch her.

So I did. The concierge phoned and informed me that the meeting would end shortly. I waited half an hour.

As expected, the eyelid rash was no problem. After accepting a tube of cream, she mentioned that her knee had hurt since her run the previous day. I examined the knee and reassured her. Then we talked about her husband who had a sore shoulder but refused to see a doctor.

Rashes are Easy, Part 1

A woman at a Sunset Strip hotel had seen a doctor for an allergic rash, and now she wasn’t feeling right. Rashes are easy, and her symptoms were probably medication side-effects, so I expected no problem. That seemed to be the case,, and she agreed to stop the medicine.

She handed me her credit card. I took out my cell phone, dialed the credit card company’s computer, and entered a series of numbers at its request. It denied approval. This is often the result of a typing error, so I entered the numbers again. Another denial.

In the distant past, guests would apologize and promise to send a check once they returned home. Some kept the promise, but I soon decided it was better to collect on the spot.

The guest seemed genuinely puzzled. She wondered if the hotel was responsible. At check-in, a hotel often places a hold on a large sum from the guest’s credit card to ensure that it gets paid. She wondered if this exceeded her limit. She phoned the front desk, and this proved true. There followed a long series of calls, referrals, consultations, and arguments before hotel management agreed to remove the hold. It worked. The computer reversed itself and approved.

Googling a Hotel Doctor

If you get sick in a local hotel, you might google “Los Angeles hotel doctor.” My name turns up but only with links to this blog. I don’t have a web site. Nor do my long-established competitors.

However, several young doctors eagerly offer their services. All promise to arrive promptly and deliver superior care. Don’t take their word for it. Rating services such as Yelp are unanimously enthusiastic. Five out of five stars.

In fact, sick guests are more likely to appeal to the hotel than the internet, but these doctors have also been working their charms on bellmen, concierges, and desk clerks.

All this takes money and work, but it’s not going to waste. Veteran hotel doctors possess an exquisite ability to detect an interloper, and these whippersnappers are definitely setting foot in my territory. Listening to my colleagues grumble, I know they are not immune.

As I complain regularly, only a minority of general managers have the good sense to designate an individual, usually me, as the house doctor. I have never solicited hotel employees. It wasn’t necessary when I began because there was no competition. I’m too shy or perhaps too lazy to begin. It would probably be a good idea. 

More Competition

A caller from the Airport Hilton asked how much I charged.

This is often the first question I hear. If I answer immediately, the guest is likely to thank me and hang up. So my first response is that phone calls are free and might be all he or she needs. What’s the problem?....

He wasn’t a guest, the caller replied. Hilton management was checking on what hotel doctors charged. There had been an unpleasant incident…. Hearing that I charged $300 most of the time, $350 for a call that got me out of bed, he responded that this was a big improvement and that he would pass along this information.

When I asked about the other doctor, the caller gave me an 800 number. I called it and learned that I was speaking to Doctors Housecalls. When I asked for the medical director, the person who answered said he was the owner.

When the owner answers the phone, that doesn’t suggest a prosperous business. I introduced myself as a long-standing Los Angeles hotel doctor. He immediately went into PR mode and told me of his burgeoning nationwide service. When I pointed out that I’d only learned of his existence today, he admitted that he was just getting started in the city. He asked me to send my CV.

I Have Syphilis

Those were the first words from a young flight attendant as soon as we had exchanged greetings.

Earlier, he had told his supervisor of a groin rash. I had popped a tube of antifungal cream into my bag and driven off, expecting an uncomplicated visit.

I asked how he knew this, confident that he had searched the internet and received the usual terrifying and incorrect information.

“My boy friend has the same sore. He went to a clinic. They did a test and said he had syphilis and gave him a shot of penicillin.”

I couldn’t argue with that. He would need the same test and injection. Since he was flying back the next day, he could take care of it then.

“I can’t!” he pleaded. “I don’t go to Australia for two weeks.”

His destination was Cairo because he worked for an Egyptian airline. On sexual matters Arabs are less easy-going than Australians, and he was frightened of the consequences if his employer found out.

I encounter this now and then. Even in the US where discrimination is illegal, employees worry. I never encounter syphilis, so I don’t carry injectable penicillin, but I handed over an approved alternative treatment, and he promised to follow up with his doctor in Australia. Later, writing my medical report for the employer, I worked hard to write an accurate if ambiguous description of a bacterial groin infection. 

Doctors Earn a Lot, Part 2

The best justification of our income lies in what we do:  we save lives, relieve suffering, and comfort the afflicted. Most of the time. I look on medicine as a noble, humanitarian calling, perhaps the noblest. Patients acknowledge this. So what’s the problem?

It’s that humanitarians shouldn’t make a lot of money. Few laymen believe clergymen, nurses, social workers, paramedics, teachers, policemen, or firemen are overpaid. They are less certain about doctors, but it doesn’t upset them if they have good insurance and enough money. Those without it rarely speak out or appear in the waiting room.

What are we doing about those who can’t afford us? Some doctors volunteer an afternoon or two. A few genuine humanitarians work full-time with the poor at an unacceptable salary. Most of us do little.

That statement produces an avalanche of disagreement. Poverty is no barrier in their practice, a chorus of doctors insists, but it is. Few doctors would refuse a patient who pleads for charity, but this doesn’t happen often.

Why don’t the needy call? They don’t hesitate to consult clergymen, social workers et al. I believe it’s because we are so powerful and prosperous and (ironically) because no influential group objects to this. In the debate over caring for the uninsured, no one wants doctors to shoulder the burden. Repeated cuts from insurers, Medicare, and Medicaid have had minimal effect on our income. Whatever changes occur in the years ahead, there’s no chance a physician’s income will come to equal that of, say, a teacher.

Doctors enjoy the best of both worlds. We care for the afflicted. For this we are widely admired and well paid. Sacrifices are expected - but only of our time and mental health. It’s hard to feel guilty because almost no one wants us to feel guilty. 

Doctors Earn a Lot, Part 1

The average family doctor earns about $220,000 per year. My peak income came nowhere near, but I’m not complaining. When friends suggest that we earn a great deal, I agree that America pays doctors generously. 

There’s no need to defend myself. Among problems of our health system that upset Americans, the size of our incomes is well down the list. 

Other doctors insist that they’re underpaid, and I wish they’d shut up. Their excuses sound whiny. Every complaining doctor beats two dead horses.

The first is what I call the Oprah Winfrey defense.

“Oprah Winfrey (or Tom Hanks or the chairman of Disney) makes. . .  How many lives do they save?”

Similar excuses include:

“A plumber charges. . .”

And the traditional:

“Lawyers make three hundred dollars an hour, so. . .”

Doctors aren’t the only ones comparing themselves to lawyers, plumbers, and celebrities. Everyone does. Worse, almost everyone who uses this argument earns less than I do. People who feel underpaid for their own honest labor are unlikely to agree that doctors are in the same boat.

Number two, equally feeble, is the trash compactor defense.

       

 “The average American pays more for alcoholic beverages than. . .” 

       

“My last malpractice premium was. . .”

“The consumer price index proves that doctors incomes haven’t. . .”

       

“Ten years ago, Medicare paid ... for a cataract operation.  This year it paid a mere. . .”

The trash compactor is a machine that converts a hundred pounds of trash into a hundred pounds of trash. A physician using this defense doesn’t grow less prosperous.

My blogging book says that readers lose interest when posts are long, so I’ll stop here and finish next time when I explain why we deserve a high income.

The Five Actions of a Hotel Doctor

After the door opens and an exchange of greetings, my first action is to look down at the floor. If I see a pile of shoes, I remove mine. You may think this is a quaint foreign custom, but some Americans have adopted it. When you consider what people and animals deposit outside, it seems terribly unsanitary track it onto anyone’s rugs.

My second action, on entering the room, is to identify the patient. A doctor making a housecall is an exotic event even for Americans, so I often encounter a large, attentive audience.

My third is to brush off apologies as guests rush to clear a space for my bag, clipboard, and buttocks. Apparently no one reads or writes while traveling, so desk and chairs are piled with belongings.

My fourth action is to suggest that someone turn off the television. Time and again, a patient begins talking – and I can’t hear. Guests often seem startled at this request – and occasionally miffed. What’s the problem?.....

It’s surprising how many people around the world turn the TV on before breakfast and leave it on. It’s the background to their daily life.

My fifth, after listening to the patient and before the examination, is to announce that I will wash my hands. This produces more apologies as guests rush to tidy up the bathroom.

I hope this held your attention. You should realize that any competent blogger must write at least once a week, or his audience drifts off. Being a hotel doctor may be a great job, but it’s not always exciting.

It's Just a Stomach Virus

“I’m worried about sunstroke,” said a guest at Maison 140. Her husband was vomiting, and they had returned from a walking tour of Beverly Hills. The temperature was in the 90s.

Sunstroke is life-threatening, and it takes more than a hot afternoon walk in Los Angeles to bring it on. I’ve never made the diagnosis, but hotel guests worry about it.

“I think someone put something into my drink.”

You’d think no one outside of a B movie would say this, but I hear it perhaps once a year. It’s alarming to fall violently ill after a night on the town, and Los Angeles is an exotic locale to many travelers, so anything can happen.

“The sushi tasted funny…”

It’s common sense that food your stomach rejects must be noxious, but if you’ve been paying attention you know that using common sense to explain an illness is proof that you don’t know what’s going on.

Food poisoning is not rare, but the responsible toxins are tasteless. Also, infections such as Salmonella and hepatitis are not the result of spoilage but contamination of perfectly good food with feces.

It’s almost impossible to diagnose food poisoning unless more than one person is sick. Almost everyone blames an upset stomach on the previous meal, but it’s most likely a virus. Google “viral gastroenteritis.”

Being Awakened Twice

 "How quick can you be in Costa Mesa?” asked the dispatcher for Expressdoc, a housecall agency. The call had gotten me out of bed at 11 p.m.

“In about an hour.” 

“Can’t you make it earlier?”

“Costa Mesa is forty miles away. How sick is he?”

“He has back pain. He wants to go to an emergency room, but we said we could send a doctor. Let me see if he’ll wait.”

After fifteen minutes had passed, I phoned the agency.

“I’ve been trying to reach him, but it looks like he’s gone to the hospital. If he comes back, is it OK to call you?”

“No. If he comes back, tell him I’ll be happy to see him in the morning.”

I have no objection to being awakened to make a housecall, but I don’t want to be awakened twice. After breakfast, I phoned the guest. He hadn’t gone to the emergency room, but he was feeling better.

Nearing the End of the Road

I have never denied being America’s most successful hotel doctor. No one has made as many visits – over 18,000 -- or works at it exclusively. All others do it as a sideline.

Yet time is passing. I’m not the only Los Angeles hotel doctor collecting social security. A new generation is muscling in, displaying the energy of youth, fierce marketing skills, and a priceless absence of ethics. All are concierge doctors, building cash-only practices that serve patients willing to pay to have a physician at their beck and call.

Even in Los Angeles, such patients are a limited resource, so concierge doctors have cast an eye on hotels, a major source of cash-payers.

“I guess no one’s been sick,” is the lie I hear when an employee explains why her hotel isn’t calling. I’ve been hearing it lately.

Partly it’s because my field is consolidating. National housecall services are expanding, and almost all use me. This is no news to my competitors, but marketing to these services presents difficulties for a concierge doctor.

One obstacle is their spectacular fees: double, triple, or quadruple mine. This may strike you as terrible business practice, but it’s no problem with hotels. Hotels don’t care what a doctor charges unless guests complain. They rarely do.

In addition, when concierge doctors introduce themselves to a hotel employee, extol their virtues, and offer an amenity for every referral, they have a receptive audience. It’s illegal for a doctor to pay for a referral, but no one is complaining. 

On the bright side, concierge doctors are young and busy. Immediate 24-hour service is their mantra, but providing it is impossible for anyone with a practice and social life. My leisure activities are reading and writing.

The result is that concierge doctors ask my help regularly. They send me to their patients who are increasingly guests at my hotels and those of competitors. When I retire, it won’t be because business is declining. 

A Plug for a Book

Try to find The Hotel, A Week in the Life of the Plaza by Sonny Kleinfeld. Published in 1989, it’s long out of print, but you’ll love it. Kleinfeld is a journalist who spent a week in the famous New York hotel and wrote about twenty chapters describing every position from the doorman, desk clerk and laundry worker to the kitchen staff, concierge, security, bellhops, housekeeping, and management.

I was impressed at the difficulty of keeping such an institution running smoothly and satisfying demanding guests. If you want to know the hardest job in a hotel, there’s no contest. It’s the housekeeper’s. 

The book includes a chapter on the hotel doctor that kept me scratching my head. Mostly, he complains.

It infuriates him that guests wake him up at 1 a.m. with a bad cold. I’d be thrilled by a call from an exclusive Los Angeles hotel at any hour. Why was he upset? Did he volunteer for the job? Is he working for free? I have no problem seeing guests who aren’t very sick no matter what the hour.

I take for granted that doctors go into medicine because they want to help people, and unlike other helping professions (clergyman, fireman, social worker) we’re paid very well. Almost no one calls me during wee hours unless they feel bad. That may represent poor judgment, but who thinks clearly when they’re miserable?

A Weird Letter from My Doctor

I take good care of myself, but the best life-style only postpones the inevitable.

I was seeing a cardiologist at the Pacific Heart Institute in Santa Monica. He was excellent. I would be seeing him still but for a strange letter I received.

Insurance companies and Medicare have been reducing payments, the letter began, and more cuts are threatened. In response other cardiology groups were lowering the quality of their care. Pacific Heart Institute vowed to maintain its standards. But how to do that while continuing to accept insurance?

The solution, according to Pacific Heart Institute, was an “Enhanced Access Program.” An accompanying sign-up sheet listed three levels of benefits.

For an extra $500 a year I could choose the “SELECT” level. Among its features were priority in appointments, prompt notification of test results, waiver of miscellaneous office fees, a special internet portal, and a customized wallet card with my EKG tracing.

$1800 per year would bump me to “PREMIER” status: same day appointments, direct e-mail and phone access to my cardiologist, and a free vascular risk assessment (whatever that is…).

At $7,500 a year (that’s not a typo), the deluxe “CONCIERGE” level gives 24 hour access to my “personal” cardiologist, same day visits, same day tests, and a call from my personal cardiologist to discuss results.

I could check a fourth box that merely stated “I choose not to participate… No fee.” The doctor would continue to see me if I decided not to pay up. It didn’t say he would consider me a cheapskate, but why wouldn’t he?

Paying extra to get the doctor’s attention is routine where doctor incomes are low. It was the norm in the old Soviet Union and remains so in Russia, China, and Eastern Europe.

American doctors are the world’s richest, but they didn’t get that way by ignoring sources of income. If you follow the news, you know that cash-only or “concierge” practices are a growing niche. They’re so popular that professional organizations such as the AMA have set up ethical guidelines. This strikes me as similar to setting up ethical guidelines for operating a Mexican cancer clinic, but mine is a minority view.

Seriously Burned

I awoke at my usual time, wrote for a few hours, ate breakfast, and went back to bed. Having made a wee-hour visit to a distant hotel, I was sleepy.

When business is slow, I take actions that encourage calls such as going to a movie or trying to take a nap. Unfortunately, this works when I don’t want it to, so the phone rang as I drifted off. It was a lady at the Custom hotel whom I’d seen the day before for a bad stomach virus. She was better and desperate to return home, but her insurance insisted on another exam before allowing her to travel. Making visits to guests who aren’t sick is a perk of hotel doctoring, and I was happy to comply.

Returning home I headed straight for bed, but the phone rang as my head touched the pillow. A lady at Le Parc explained that had undergone eyebrow waxing, and a clumsy cosmetologist had inflicted serious burns. I suggested that serious burns around the eye require more care than I could deliver on a housecall, but she demanded a visit.

I consoled myself with the knowledge that guests often exaggerate their problems. This proved to be the case when she showed me several pink spots over her forehead. These were mild, first-degree burns, I explained, similar to sunburn. I handed over a tube of soothing cream and assured her that they would heal completely in a week.

I was wrong, she insisted. Because of her extremely delicate skin, she would be scarred for life.