Easy Money

A Brazilian traveler had left her medication at home. Could I drive to Hermosa Beach and write some prescriptions? The caller was the guest’s travel insurer.

When hotel guests call directly, I tell them to go to a pharmacy and explain what they need. I would approve over the phone. It’s free; everyone is happy.

Before I could offer to do the same, the dispatcher informed me that, as a new service, the insurance would pay for visits to replace prescriptions. I could not turn down easy money.

It turned out not to be so easy. Helpfully, the traveler’s family doctor had faxed his prescriptions, but the writing was illegible and in Portuguese. There followed half an hour of phone calls to pharmacies and to Brazil and Google searches before I found the American equivalent of three of the four. The fourth never turned up, but it was probably an herbal remedy.

 

Running Out of Medication

A guest at the Doubletree had run out of insulin. I could have made a housecall, written a prescription, and a pharmacist would have filled it. Instead I explained that insulin doesn’t require a prescription. She should go to the pharmacy and ask for it. The same is true for the morning-after pill, another request that arrives now and then.

An Italian guest at the Four Seasons brought a migraine prescription from her doctor. Pharmacies wouldn’t accept it. Could I come and write an American prescription? I told her to have the pharmacist phone, and I would approve it.

When national housecall services or competitors send me to guests who need a prescription, I write it, collect money, and leave. Those are easy visits, but guests are never grateful. Americans look sullen; foreigners understand that American doctors require immense fees for any service. When guests call me directly, I handle these requests over the phone, gratis. It’s no great sacrifice and good public relations.

It may even be good business. Long ago, when I returned from a day off, the doctor who covered told me a guest at the Casa Del Mar had phoned. That was exciting news; this was an upscale Santa Monica beach hotel which had never called. The guest obviously had a bladder infection, so the doctor had phoned a prescription to a pharmacy. I nodded. Treating an infection over the phone is not a good idea, but simple bladder infections are an exception. He added that he had charged $30 for the service. I mention this only because it happened during the 1990s, and I haven’t heard from the Casa del Mar since.

When Everything Works Out

A call arrived as I was eating dinner at the home of friends. A gentleman at the Biltmore needed a doctor. The meal was ending, so I took my leave.

Driving the twelve miles downtown, I parked and opened the trunk to retrieve my black bag. Dismayed, I realized I had left it at home.

I usually keep the bag in my car. My driveway is outside, and during hot weather I take the bag into the house to keep the heat from melting my pills. Getting a housecall jogs my memory, and I retrieve the bag, but I had driven to friends without giving it a thought.

I phoned the guest to explain that I’d have to return home. Before I could apologize, the guest apologized, explaining that he had run out of his blood pressure pills and only needed a refill. He knew his travel insurance would not pay for this, so he claimed to feel ill. He wasn’t ill. I phoned a prescription to a pharmacy and went home.

This blog is full of incidents whose entertainment value is based on things going wrong. But sometimes everything works out.

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.    

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.

Drugs are Cheap

A least they’re cheap for common problems your doctor encounters in the office which are the same as I see in hotels. Here are examples from my favorite internet supplier as of 2018.

Some drugs cost almost nothing, less than a penny a pill. A thousand hydrochlorothiazide (the most popular diuretic and blood pressure pill) costs $6.34. Valium 5mg is over a penny: $12.20 for a thousand. I can buy a thousand Benadryl, an antihistamine, for $11.28.

An excellent prescription pain remedy, Tramadol, costs $1.69 for a hundred; $15.11 for a thousand.

Long ago states began requiring doctors to file a report each time they hand out narcotic pain pills, so I gave it up. Despite the impressive street price of the most popular drug of abuse, Oxycontin, a bottle of a hundred costs $8.77.

Cortisone cream: $0.99 per tube.

Antibiotic eye drops for conjunctivitis: $2.25

Antibiotic ear drops for swimmer’s ear used to be about twice as expensive, but they’ve shot up to over $20. Luckily, it’s considered OK to use antibiotic eye drops for ear infections, so that’s what I do. 

The three day Bactrim antibiotic treatment for urinary infection (six tablets) is about 35 cents. A hundred costs $5.40.

Ten day treatment for strep throat, twenty amoxicillin 500mg: $1.30.

Ten day treatment for pneumonia, twenty doxycycline, is about $1.70.

A big attraction of injections is that a doctor can charge for them. If he writes a prescription, the pharmacy gets the money. Don’t assume common injectables are expensive. To begin, a disposable syringe costs twenty cents.

For allergies and itching, a vial containing thirty doses of injectable cortisone (Decadron 4mg) costs $11.06. That’s about 40 cents a shot.

For pain, a shot of morphine costs about $2.30 if the doctor buys single-dose vials, but that’s an expensive form. Multiple dose vials cost less than half as much per dose if he or she can find them.

Within the past five years, ondansetron has replaced Compazine and Phenergan as the leading treatment of vomiting. One shot costs 15 cents. A vial of ten doses is $1.54

Plain old Valium injectable has skyrocketed. This happens when some companies stop making a drug and the others realize they have little competition. Five years ago I paid $5.04 for a vial of ten shots; it’s now $51.00.

No Good Deed Goes Unpunished

An Austrian lady had left home without her medication. Could I come and write some prescriptions?

These requests arrive regularly. In the past, I offered to phone a pharmacy, but this took a long time as guests scrambled to find the name, dose, and instructions. Nowadays I tell them to go to a pharmacy, explain exactly what they need, and give my number. I would approve over the phone.

Guests are pleased that it is so simple and more pleased to learn that I don’t charge for this.

Later, a caller explained that he was the tour leader for an Austrian group. “You gave a prescription for one of our members. Could you tell me where is the pharmacy?”

The lady’s English was poor, so she had misheard me. I repeated that the guest had to go to the pharmacy and describe precisely what she needed. An hour later, I answered another call from the tour leader. He was at a pharmacy near the hotel; he had given the names of the lady’s medication, but they had refused to accept them. Again, I explained that the lady had to tell the pharmacist precisely what she needed.

An hour later, a pharmacist informed me that a foreign customer was requesting several medications. He wanted to know the dose and instructions. I told him that he would have to get this information from the guest.

Several hours passed before the pharmacy called again because the lady had had to phone her doctor in Austria. One of her drugs was not available in the US. What would I advise?... I had no idea but suggested that he probably knew an equivalent. After some research, he found one and called back. I agreed with his suggestion.

Don’t forget to pack your pills.

Free Services

A few years ago, Quantas abruptly cancelled flights after an engine exploded. Other airlines followed.

Passengers were stuck in hotels. Within days calls began arriving from guests running out of heart or blood pressure or diabetes medication. They had brought only enough for their trip or the bottles were packed in luggage which the airlines refused to release.

Aware of horror stories about America’s medical system, they were counting their money, hoping to have enough for the necessary king’s ransom. The lucky ones (those in my hotels) were pleased to hear that I don’t charge for replacing legitimate prescriptions.

Most drugs are available worldwide but in different formulations and with different names. Rather than try to figure things out, I tell guests to go to a drug store where the pharmacist will research the matter and phone for my approval.

Guests regularly forget to pack medication, so I do this routinely. My record occurred after 9/11 when all flights stopped, and hotels were packed. Some travelers also fell ill, so my paying business jumped for several weeks. Then everyone returned home, and tourism plunged for a year. That was a bad time for hotel doctors, too. 

Free Medical Care

When guests ask my fee, I tell them and then steer the conversation to their problem. Half the time, they don’t need a visit. If so, they’re grateful for the advice, especially after learning that I don’t charge for phone calls. It’s good public relations, but I also don’t like to make a housecall and collect money for a trivial service.

If you google “house call doctor” plenty of eager individuals and national housecall services turn up but not me. None deliver free care, so the caller has the choice of a paying visit or nothing. A doctor (sometimes me if you call a national service) may come, hand over a prescription for a medicine you accidentally left at home, and then collect several hundred dollars.

Tooting My Horn

Would I see a lady at the Airport Hilton with an eye problem?

I asked the dispatcher from Amerilink, a travel insurance agency, for details, but she couldn’t provide them.

It turned out that the lady had no complaints. Apologizing, she explained that she had neglected to pack her glaucoma drops. Would I write a prescription? I was happy to comply. Amerilink would pay my usual fee.

These delightful visits are not rare. Travelers with insurance who forget a medicine often lie because they suspect, correctly, that the carrier will not pay for the truth.

When a hotel calls directly, I always speak to the guest. If he or she has forgotten a legitimate medication, I phone a pharmacy to replace it, gratis. I don’t have the gall to collect a fee for delivering a prescription.

Readers of this blog know what a humble physician I am, but this is one time I will boast. Many competing hotel doctors charge for any service they perform over the phone, including simple advice. If a guest calls the 800 number of one of the half-dozen national housecall services that advertise widely, he or she will have choice of (1) a paying visit, (2) going to an emergency room, or (3) nothing.

I Don't Do Adderall

“A guest at the Century Plaza wants his Adderall refilled. Can you go?” asked someone from the office of a local concierge doctor.

“I can go, but I don’t do Adderall,” I said.

“No problem.” She would find another doctor. Prescription refills are easy house calls.

You’ve heard of childhood attention-deficit disorder. Recently psychiatrists have discovered that it also affects adults. Treatment is the same. That includes drugs related to amphetamines; the most popular for adults is Adderall. As a hotel doctor my only experience with attention-deficit disorder comes from guests who need more Adderall.

None sounded like drug-seekers. All were happy to pay my fee for a visit during which I would check them out. Since there is no way that I can examine a guest and determine if he or she suffers adult attention-deficit disorder, I told them I’d have to speak to his or her doctor. None ever called.

It’s been decades since I made a similar decision on narcotics. Guests occasionally forget their heart pills, but soon after becoming a hotel doctor, I grew puzzled at how many needed more Vicodin or Oxycontin. Some sounded suspicious from the start, but many were clearly in great pain. Their distress tore at my heart, and they often produced a sheaf of X-rays and letters from a doctor. With no reliable way to tell the fakes from the genuine, I gave up on narcotics.