Doing My Duty

“I can’t handle that in a hotel room,” I explained. “She probably needs an ultrasound.”

After consulting his superior, the dispatcher came back on the line to explain that he would like me to evaluate the guest, a flight attendant with abdominal pain and vaginal bleeding, and deliver a recommendation.

If the guest had called directly, I would have sent her to an emergency room or, during the day, to an obstetrician, but this request came from an agency that serves airline crew. It was paying the bill, and I had done my duty by warning that a housecall wasn’t appropriate. I was happy to make the visit. Once I confirmed her symptoms. I would simply call and report, and then send my bill.

A young man opened the door. I entered, expecting to see a girl friend or wife, but he was alone, and he identified himself as the patient. He had a sore throat.

I checked the name and date of birth on my invoice. It was identical. He spoke excellent English, so there was no chance of a misunderstanding.

After dealing with his problem, I phoned the agency. Was there another flight attendant with vaginal bleeding waiting for me? After a long consultation, he assured me that no one knew. It was probably a mistake.

You Don't Need a Better Medicine

“My doctor gave me amoxicillin a week ago, and my sinuses are still blocked. I need a stronger antibiotic,” said a guest.

If a medicine isn’t working the next step is never to find a better medicine but to discover why it isn’t working. Sometimes there’s a problem that medicine won’t help.

Sometimes the patient needs a better exam. Pain on urination usually means a urine infection, and I’ve seen several patients whose urine infection didn’t go away after a course of treatment. They didn’t have a urine infection but herpes. It was obvious when you looked, but the doctor hadn’t looked.

Sometimes the patient needs to wait. After rubbing cream on an insect bite, patients worry when it grows to an itchy patch several inches around. I explain that insect bites generally worsen for two days and then resolve over the following days.

Sometimes the next step is to stop taking medicine. Treating pinkeye with drops usually helps, but patients occasionally return to complain that they’re worse. That’s because the drop has begun to irritate the eye. A few days after stopping, they feel better.

My malpractice lawyer warns me to warn you to read this purely for your own amusement. Only in mathematics can a statement be 100 percent true.

So if a medicine isn’t working, don’t stay away from the doctor on the grounds that I said it was OK.

Whether You Want Me or Not

If you want a housecall in Los Angeles, you’re likely to get me even if you don’t ask for me.

I don’t have a web site, but searching the internet turns up several agencies and a few individuals that promise to send a doctor at a moment’s notice. Many rely on me.

They also solicit hotels. Recently a national housecall service informed me that a guest at the Marina International wanted a doctor. The Marina International is one of my regulars.

After I phoned the guest, he asked me to come. I made a mental calculation before quoting the fee. The housecall service took forty percent, so I added forty percent.

Since those who call directly pay less, you might wonder why hotels don’t make sure guests get the best price. The answer, of course, is that hotels don’t know what doctors charge, nor do they care. Guests regularly ask me, but hotels never do.

Eighty Gouty Patients

A man’s foot began hurting one evening. By the following morning pain was excruciating.

That sounded like gout, one of my favorite diseases. The diagnosis is easy, and I can quickly make it better. What’s not to like?

I carry a treatment for gout, but once I hand it over, I have to remember to restock my bag. So I went to my drug closet, made up another bottle of pills, and threw it in my pocket. 

Sometimes I’m surprised when I arrive at the hotel but not this time. He had gout. I produced the pills from my pocket, and everyone was satisfied.

It occurs to me that I’ve seen so many victims – this was my 80^th – that I can check the experts. They claim that it attacks men overwhelmingly. Sure enough, only seven of my patients were women. They say it’s a disease of older people. 67 cases were over 40, none under 30.

Until a few years ago, treatment was a powerful anti-inflammatory drug such as indomethacin which produced unpleasant side-effects. Then experts decided a large dose of cortisone for a short period worked as well with less unpleasantness. I already carry an identical course to treat severe poison ivy. Patients feel better within a day.

How Much Does an Emergency Room Cost?

A lady had been vomiting for three days. She had felt better that morning but then relapsed. She sounded weary.

This was tricky. Stomach viruses are the second leading ailment a hotel doctor encounters. I consider them good visits because they rarely last more than a day. I deliver advice as well as an injection and pills. The guest recovers and gives me the credit.

When vomiting persists, doctors worry about more ominous digestive disorders. Worse, three days of vomiting produces some dehydration. This is not dangerous in a healthy person, but drugs don’t work well in its presence and recovery slows. Victims perk up when dehydration is relieved. 

I explained that it was probably too late for a house call. She needed intravenous fluids. After agreeing to go to the local emergency room, she mentioned that she was Canadian and had no travel insurance. I repeated that she should go.

I’ve found that it’s a bad idea to tell guests to go to an ER and then tell them how much it might cost.

My restraint was in vain because she googled the subject, perhaps turning up http://www.theatlantic.com/health/archive/2013/02/how-much-does-it-cost-to-go-to-the-er/273599/ to read that the average was over $2,000. Giving IVs would take hours and cost extra.

When I called the hotel that evening, I learned that she hadn’t gone, and she was still ill. She admitted that the cost had shocked her. I sympathized but told her she had no choice.

When I called later to reinforce this advice, there was no answer. When I called the following morning, she had checked out.