What Makes Travelers Sick

 American water.

Travelers worry that our fierce advocacy of the free market includes opposition to government meddling in the water supply. I regularly assure them that all American tap water is drinkable.

American food.

No one believes that Taco Bell or McDonald’s sell healthy food, but foreigners worry that these exotic, colorful substances are toxic. We Americans are warned about eating in nations with poor sanitation; about one in three American tourists in these areas get sick. If we’re careful, our sickness rate drops to… Actually, it doesn’t drop. No one knows how to prevent traveler’s diarrhea. The Swiss get sick when they come to the US.

Air conditioning

Americans accept air conditioning with even more enthusiasm than personal firearms, but most of the world has never caught on. They tolerate it as an odd American custom but believe that air from a machine is unhealthy whether it’s automobile exhaust or a box in a window. When someone gets sick, they turn it off. I wear a suit, so caring for foreign tourists during the summer is a painful experience.

Air Travel

Travelers blame the airline for any illness that occurs within a week of flying. This is not so for aches and pains and unlikely for an upset stomach but true for respiratory infections.

Stress

Vacations are stressful, particularly if children are involved. They miss their friends; they hate the food; they prefer watching TV to sight-seeing; they refuse to adjust their sleeping hours.  It turns out that stress makes everything worse, but it doesn’t cause anything, so there’s no reason for the parents to get sick. When they do, it’s a respiratory infection, usually the children’s fault.

Three Great Sins of the Medical Profession

Critics regularly denounce us for certain practices. These denunciations are more or less correct, but they miss the point.  Examples -

1. Doctors give treatments that relieve symptoms but don’t cure the underlying problem.

Right, but sometimes this is the best we can do. The cure for severe menstrual cramps is menopause, hysterectomy, or pregnancy. Drugs only relieve the pain, but patients appreciate it. No doctor cures migraine, asthma, emphysema, osteoporosis, or the flu, but we relieve a great deal of misery.

2. Doctors don’t pay much attention to diet, liquid intake, rest, and other natural treatments.

We don’t, and it’s the right thing to do.  Diet, rest, etc. help prevent disease but don’t do much once you get sick... A perfect example were tuberculosis sanitariums, the oldest government supported medical program. They began appearing in the nineteenth century. Patients received nutritious food and plenty of rest in a healthy, rural environment. They were discharged (sometime after years) when their TB became inactive. No one was cured, and many relapsed. When drugs appeared after 1945 sanitariums closed. Nowadays doctors encourage TB patients to adopt a healthy life-style, but they’ll get better if they don’t – provided they take their drugs.

3. Doctors spend too little time explaining how to relieve stress.

Perhaps....  Stress makes everything worse but doesn’t cause anything. Seeing a doctor for stress results from what I call the “medicalization of society” - the notion that life’s difficulties (a hateful job, unsatisfying sex life, shyness) represent a medical problem. There’s no harm in this; a good doctor can listen sympathetically and make sensible suggestions which require no medical training.

Stress Around the World

Experts claim that half of a doctor’s patients suffer stress. You may think this is medical science, but it’s really medical culture. “Stress” is America’s explanation for symptoms without a satisfying explanation. I rarely make the diagnosis, but patients make it for me. If a guest comes down with his fifth cold this year or a stubborn backache or upset stomach, he’ll inform me that he’s been under stress.

Unlike most doctors I see patients from around the world, and it turns out that other nations don’t suffer stress.

Germans suffer low blood pressure. It’s considered a genuine physiological disturbance. German doctors seek it out and treat it, often with drugs. Long ago, I was puzzled when young Germans with fatigue, headaches, indigestion, or flu symptoms wanted their blood pressure checked. Then I learned.

The French don’t have stress or low blood pressure. Perhaps because of the universal consumption of wine, French doctors believe that subtle liver disorders produce many distressing symptoms. 

Constipation was once the great English preoccupation and has not entirely disappeared. This was thought to produce “auto-intoxication” from retained waste that leaked toxins into the body. Many laymen still consider it beneficial to undergo a “colonic,” in which a technician inserts a tube into the anus and washes out all those toxins.

Traditional Chinese healing emphasizes a medicine for every condition. I’m sure you would be insulted (and so would any educated Asian) if I were to suggest that you expect a prescription every time you see us, but many doctors get that impression.

I regularly explain to puzzled Chinese parents why it isn’t necessary to treat every symptom of their sick child. On other occasions, when I explain that an adult’s illness will go away without treatment, I see him exchange a look with his wife that clearly means, “What bad luck! We go on a vacation. I get sick. Then I see this foreign doctor who does not know the proper medicine!”  

Stressful and Nonstressful Visits

Driving to a hotel can be stressful. I talk to guests by phone beforehand, eliminating obvious emergencies and unreasonable requests, but plenty of worrisome possibilities remain.

Sick babies make some hotel doctors nervous. I see them but some don’t. If, over the phone, the doctor tells you to take your baby to an emergency room, ask politely if he prefers not to see infants. If he admits this is so, try to find another hotel doctor before going off.

Elderly patients can be challenging. They seem fragile, so a doctor may lean over backwards to treat illnesses that don’t require treatment or refer to a hospital more quickly than he would a younger person. I consider eighty the beginning of fragility; other doctors begin at seventy, but this is clearly wrong because I am over seventy and not fragile at all.

If a patient has a bellyache, I worry. Without tests or x-rays I have to decide if it’s safe to wait. When I decide it’s safe, I’m almost always right, but I send guests to emergency rooms if uncertainty remains. Many endure a long, tedious, expensive experience only to learn that nothing abnormal has turned up. Some consider this good news, but others wonder why, having summoned me and paid my fee, I didn’t save them the trouble.

I’m always uneasy before seeing guests suffering an ordinary respiratory infection because a large percentage – perhaps a quarter – are obviously disappointed if I don’t prescribe an antibiotic. We feel bad when a patient believes we haven’t helped.

On the bright side, I often drive off knowing the diagnosis, knowing I’ll help, and certain the guest will deliver a satisfying dose of gratitude. Relaxing drives include those for simple urine infections, eye infections, ear infections, and rashes. I generally diagnose chicken pox, shingles, hives, and the common cold over the phone. Isolated abdominal pain is tricky, but I feel better if vomiting or diarrhea accompany it because they usually indicate a short-lived stomach virus. Guests who want their blood pressure checked rarely worry me. High blood pressure doesn’t cause symptoms, so those who make this request have other problems, generally anxiety-related.

Lost in Translation Again

As I stepped out of the elevator, a Japanese man was waiting. “Are you the doctor for the hotel?” he asked.

I was pleased. “Yes. Are you going to interpret for me?”

He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the father, and the patient.

The patient had complained of fatigue the previous day. He was otherwise in good health with no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in a child. I suspected an emotional problem, perhaps from the stress of foreign travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.

Luckily these were Japanese, so they listened with unfailing courtesy, through the interpreter, to my reassurance and advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted), nodding approval, and thanking me effusively as I left.

More Humor

"Can you go to Pasadena?” asked a dispatcher from Expressdoc, a housecall service. I could.

“Bloating and nausea,” was the reply when I asked for the patient’s symptoms. Once I arrived at the Pasadena Hilton, I learned that, besides bloating and nausea, the guest was suffering hot and cold flashes, difficulty breathing, dizziness, and blurred vision.

My diagnosis was an anxiety attack. She agreed that this was reasonable. She remembered similar episodes.

“I don’t have more stress than most people, but obviously I’m not handling it well. Why is this happening?”

“Because no one is perfect.”

She laughed, but I believe this. I explained that an anxiety attack is a tiresome body malfunction like a backache or allergy. You suffer, deal with it, and feel better, but it’s likely to recur. Almost everyone believes that stress causes anxiety. When it becomes chronic, victims undergo psychotherapy which sometimes works. I treat it as a simple malfunction; this also works pretty well.