The Kiss of Death

Malpractice insurers look with suspicion on doctors who operate pain clinics or diet clinics or who perform botox injections or liposuction. My brother saved $12,000 on his premium when he gave up obstetrics – and that was thirty years ago. Doctors pay a fat surcharge if they engage in controversial practices, perform legitimate if risky procedures, or have personal difficulties such as numerous malpractice suits.

None of this applied to me. From a malpractice carrier’s viewpoint, I was easy money. I saw perhaps one fifth as many patients as an office doctor. Being travelers, they were younger and healthier than average. Even better, most were foreigners who don’t sue.

Except writing for a large check every year, I ignored this area until a letter arrived in 2003 from my malpractice carrier. It was a routine survey with questions about the nature of my practice: hours of operation, employees, office locations, number of patients, hospital affiliations, procedures.

I made certain they understood that I was a full-time housecall doctor who cared for a small number of healthy, nonlitigious patients.

A few weeks later I opened a certified letter cancelling my insurance. It was a terrible shock. When I applied to other carriers, all turned me down. I contacted an insurance agent who was very helpful and obtained a policy from a company in Illinois that specializes in difficult cases. It cost three times what I had been paying.

Each year when she applied to the regular malpractice carriers, they declined. They won’t insure a housecall doctor, she explained.

How did this affect my competitors? It didn’t. They cared for hotels as a sideline, usually from an office practice. If asked, none would deny that they make housecalls, but no carrier forbids them, and they’re so uncommon that applications for malpractice insurance don’t ask about them.

Boasting that I was America’s only fulltime housecall doctor produced flattering feedback but got me the kiss of death from my malpractice carrier. Perhaps they remember celebrities from Michael Jackson to Elvis Presley whose lurid final moments involved a doctor who made home visits.

A Hotel Doctor's Contract

People ask about my contract with hotels, but there is none. Concierges, operators, and bellmen call because they know me. 

Guests sometimes praise me, and their praise goes to concierges et al. If they decide to complain, usually because I’ve declined to give them something they wanted, they go to the general manager, often galvanizing him into one of several upsetting actions.

Referring the complainer to a competitor is tiresome. Anxious to make a good impression on his first call from Doctor Oppenheim’s hotel, he may relax his standards. 

If the manager consults the hotel lawyer, he always hears that he must never help a sick guest because guests who sue the doctor will also sue the hotel that suggested him. At any given time, about ten percent of hotels are in this my-lips-are-sealed mode, but it’s a changing ten percent because guests persist; employees want to help, and most competing hotels have doctors, so it’s bad public relations. 

Some managers make up a list, instructing staff to hand it to guests but to never recommend an individual. They believe (incorrectly) that this eliminates their liability. The employee who makes up the list mostly confines her research to the internet and in no particular order. As a result, it includes doctors who don’t make housecalls and walk-in clinics with limited hours. Fortunately once the list is made the hotel forgets about it. As years pass, it gradually becomes out-of-date, but my number remains.

A Serious Liability

After shaving, a guest at the Ramada in Beverly Hills reached for a hairbrush and struck his nose on a clothes hook with enough force to bring tears to his eyes and blood to his nose. He noticed that the hook had been installed at nose level -- clearly a poor design decision and dangerous. A hotel that tolerated such an unsafe condition was irresponsible and perhaps legally liable. The guest was, of course, a lawyer.

As I entered the general manager’s office, the guest interrupted a harangue as we exchanged introductions.

This was awkward. My sole obligation is to my patient, but it was obvious the manager wanted help in fending off the furious guest. When I suggested privacy for our consultation the guest told me to take care of things on the spot.

Young doctors love to blurt out a diagnosis as soon as the patient walks through the door (which is possible more often than you think). Not only do patients find this offensive, they don’t believe it, so doctors learn to give the impression they are thinking deeply before announcing an opinion.

I examined the nose from several angles. I carefully palpated it. I pulled out my otoscope and peered up his nostrils. Finally I announced that he had suffered a nasal contusion that, fortunately, had done no harm. He needed no X-ray, no treatment. He could go about his business.

According to the law, a person has no grounds to sue unless he has suffered damage, but a competent lawyer can discover damage in any situation. I doubt visions of profit had brought the guest to the manager’s office. He was upset at his pain and wanted sympathy. The manager had offered to comp the guest’s bill but had maintained his dignity when a humble apology would have worked better.

Still fuming, the guest asked my opinion of the danger in installing clothes hooks at precisely nose level. I agreed the matter deserved attention but added that noses come at many levels.

Listomania

I once made sixty to eighty visits per year to the Crowne Plaza at the airport. Then they dropped to about five.

During a recent visit I noticed a printed handout on a bedside table, a long list of clinics and doctors which the reader was invited to peruse. Given a list, guests tend to call the first number first and then work down. My name was sixth.

When consulted, hotel lawyers always forbid staff from recommending a doctor. Should a guest ask for help, they insist, an employee should silently hand over a list, the longer the better. In this way, when the guest sues the doctor, he or she won’t sue the hotel. Lawyers admit that this doesn’t work, but they can’t help themselves. 

Told to make up a list, employees take the easy route by consulting the internet where they find clinics, local practices, and entrepreneurial physicians who charge spectacular fees. They won’t find me, so it’s a crapshoot where on the list I’ll end up.

Having produced the list, management forgets about it. Lists always contains doctors and clinics that don’t make housecalls. As time passes, some numbers no longer work; for the rest, guests who want to speak to a doctor end up speaking to an answering service or receptionist.

It might take years for calls to return to normal, but I am patient. 

Is Murder Cost-Effective?

At a medical conference, a speaker came up with a radical proposal.

People regularly come to an emergency room complaining of chest pain, he said. Most are not having a heart attack, but doctors do a careful exam and many tests and often observe them for hours. Even if little turns up, doctors lean over backwards to admit someone with a possible heart attack. In the end, some are so obviously not having a heart attack that the doctor sends them home.

But medicine is not perfect, he added. Three percent of those sent home are having a heart attack. They sue the hospital and win.

Over the years, hospitals have become more liberal about admitting patients with chest pain. But, in the end, some are sent home.

No matter. Three percent are having a heart attack, and they sue. The average payout is over $400,000.

“It’s an impossible situation. What can a hospital do?” asked the speaker. He went on to suggest a tactic for a doctor who decides that a patient isn’t having a heart attack and can be sent home. Current hit-man rates are $10,000 per.

“Do the math,” he said.  

Caring for Celebrities

Searching my housecall database (over 18,000 visits) for “celebrity” turns up 92 hits although that includes wives and children.

You recently read about my encounter with a famous person. I mentioned him by name because I was never his doctor, but I’m sure you don’t expect stories about celebrities I cared for. Unfortunately, literary agents do expect it. News that it’s forbidden has proven the kiss of death for my memoirs.

Most celebrities are nice, but over forty years I’ve cared plenty of misbehaving luminaries including several who died under dramatic circumstances. Agents have assured me that “you can’t libel the dead.” This turns out to be a legal fact, but the dead’s loved ones have been known to sue after reading unflattering remarks.

Suitophobia, Part 2

The only American doctors who don’t worry about malpractice suits are fresh out of training. They believe that practicing good medicine will keep them safe. Once they are sued, they join the worriers.

Fifteen percent of surgeons are sued every year. It’s twenty percent for high-risk subspecialties like neurosurgery and cardiac surgery. Family doctors like me do better -- only five percent per year. This means that every doctor is sued sooner or later. Mostly we win, and almost no one pays a penny even if we lose, but it’s a miserable experience. I work hard to find material for this blog, but you’ll never read about my suit.

One reason doctors are sued for malpractice is malpractice, but plenty of other reasons exist.

Hollywood generally presents doctors in a good light, but in the dozen or so movies about medical malpractice, the doctor character is always evil. Hollywood generally presents lawyers in a bad light, but in those same movies about malpractice, the victim's lawyer is always the hero. 

I once wrote a courtroom drama about a surgeon who was committing malpractice – doing hysterectomies strictly for the money. But he had a pleasant personality, so patients liked him (in the movies these doctors are always sleazy); he was a skillful surgeon, so there were no pitiful victims to testify, and he had a smart lawyer, so he won. I thought the story was deliciously ironic, but the number of editors who agree is holding steady at zero.

Suitophobia

“I’m Doctor Oppenheim….”

“Welcome to the Intercontinental, Doctor Oppenheim. Are you checking in?”

Damn. Another employee who doesn’t recognize me. This happens in hotels that have called for decades. Who knows what she’ll tell a guest who asks for help?

I don’t market myself, but years ago I decided to hand a copy of my latest book to general managers of my regular hotels and explain, modestly, that writing allowed me free time to serve their guests. They listened politely, made flattering comments, and went back to work. It was clear many had no idea who I was. My tenth visit, to the downtown Hilton, was my last. 

“What do you mean ‘serve our guests?’” snapped the GM. “We don’t have a hotel doctor. We don’t want a hotel doctor. You’re going to get a letter from our lawyer!” He snatched my book and marched off. I was a familiar figure to Hilton staff, having made over 100 visits, but I never made another.

That was my first encounter with the epidemic of suitophobia that rages among hotel managers, compelling them to forbid staff from helping sick guests except by getting them off the premises. At any given time, about ten percent are affected. Most recover after a few years, but in the meantime both guests and hotel doctors suffer. I made over 600 visits to the J.W. Marriott in Century City before calls abruptly stopped. I learned the reason from concierges who swore me to secrecy when they snuck me in to see a particularly demanding guest.  

Fear

Leafing through mail revealed a letter from a law office. I broke into a sweat and then calmed myself. Malpractice suit announcements rarely arrive in ordinary US mail. Sure enough it was simple request for records. Someone was having trouble with an insurance company. I get these once or twice a year, and they never fail to upset me.

Whether they win or lose, sued doctors rarely pay a penny, but it’s a horrible experience which they all dread. Doctors worry if something is not going right – say a patient who should get well is not getting well or seems dissatisfied. We all want to do better, but never absent from a doctor’s thoughts is that he doesn’t want to be sued.

You may wonder about the odds that this will happen. The answer: a hundred percent. Five percent of American family doctors are sued each year. The highest risk specialties are neurosurgery and cardiac surgery: 19 per cent sued each year.

To make sure your doctor has never been sued, find one who has just entered practice. If you want to investigate, most states make it easy. You can look me up at the California Medical Board site by entering my name. Feel free to do so. I’m clean.

But state boards are not terribly efficient, and many have time limits – say ten years – after which they drop the information.

Every bad thing that’s happened to a doctor is in the National Practitioners Data Bank in Washington. Hospitals and clinics query it when they’re checking out a doctor. When they don’t, you often read the results on the front page. 

The NPDB is off limits to the general public. Activists yearn to change this, but every professional organization would fall upon any legislator who agreed.