When the Doctor Needs Your Help

 Almost every hotel guest that I see is working or taking an expensive vacation, so illness is more inconvenient than usual. Everyone agrees that doctors have no magical powers…. except… maybe… if you really need magic…..

What if you’re scheduled to deliver an important speech or attend a wedding or visit Disneyland, and you absolutely can’t be sick? In that urgent situation, a smart doctor might come up with a cure that he or she keeps in reserve for such situations.

Doctors love to help you, but they also want you to feel helped. If we do our best, but you’re unhappy, that hurts more than you realize.

So if you want the doctor to prescribe a placebo make it absolutely clear that you will be disappointed unless you get “something.” This happens so often that many doctors assume every patient yearns for magic. That’s why, for example, giving useless antibiotics for respiratory infections is not a sign of incompetence. Even good doctors do it.

Really, I don’t hold anything back for especially deserving patients. It sounds odd, but if you don’t want a placebo, let the doctor know. Say something like “I just want to know what’s going on. If a prescription won’t help, that’s fine with me.”

That sounds like you’re telling the doctor how to do his job, but many need your help.

Worry, Part 2

I drove to the Magic hotel in Hollywood where a Danish couple’s 18 month-old was vomiting. He looked fine, and looking is essential:  sick children look sick. Nothing abnormal turned up on an exam, so my diagnosis was a common stomach virus. I told the parents it might last a few days and gave the usual dietary advice.

I check on patients before going to bed, but the Danish parents beat me to it. The child had vomited once again, they reported. He was still in no distress, so I told them it was OK to wait.

My assurance was proper, but patients occasionally deliver unpleasant surprises, so I worried a little as I went to bed.

I phoned the Danes the following day to learn that the child hadn’t vomited but was now feverish. This was to be expected, I explained, and I approved their decision to give Tylenol.

The Danish child was still feverish, his parents reported the next day, and now he had diarrhea. I gave dietary advice.

There was no answer the following morning. From the front desk I learned that they had checked out. I had just returned from seeing a young man with abdominal pain at a youth hostel. He was worried about appendicitis; my exam made that unlikely. Since he had no health insurance, I did not want to make my life easier by sending him to an emergency room where a workup including CT scans would run to about $5,000. His symptoms hadn’t improved when I called, but they still didn’t seem like appendicitis. He promised to phone if there was any change. I worried a little as I went to bed.