Doctors Earn a Lot, Part 1

The average family doctor earns about $220,000 per year. My peak income came nowhere near, but I’m not complaining. When friends suggest that we earn a great deal, I agree that America pays doctors generously. 

There’s no need to defend myself. Among problems of our health system that upset Americans, the size of our incomes is well down the list. 

Other doctors insist that they’re underpaid, and I wish they’d shut up. Their excuses sound whiny. Every complaining doctor beats two dead horses.

The first is what I call the Oprah Winfrey defense.

“Oprah Winfrey (or Tom Hanks or the chairman of Disney) makes. . .  How many lives do they save?”

Similar excuses include:

“A plumber charges. . .”

And the traditional:

“Lawyers make three hundred dollars an hour, so. . .”

Doctors aren’t the only ones comparing themselves to lawyers, plumbers, and celebrities. Everyone does. Worse, almost everyone who uses this argument earns less than I do. People who feel underpaid for their own honest labor are unlikely to agree that doctors are in the same boat.

Number two, equally feeble, is the trash compactor defense.

       

 “The average American pays more for alcoholic beverages than. . .” 

       

“My last malpractice premium was. . .”

“The consumer price index proves that doctors incomes haven’t. . .”

       

“Ten years ago, Medicare paid ... for a cataract operation.  This year it paid a mere. . .”

The trash compactor is a machine that converts a hundred pounds of trash into a hundred pounds of trash. A physician using this defense doesn’t grow less prosperous.

My blogging book says that readers lose interest when posts are long, so I’ll stop here and finish next time when I explain why we deserve a high income.

The Five Actions of a Hotel Doctor

After the door opens and an exchange of greetings, my first action is to look down at the floor. If I see a pile of shoes, I remove mine. You may think this is a quaint foreign custom, but some Americans have adopted it. When you consider what people and animals deposit outside, it seems terribly unsanitary track it onto anyone’s rugs.

My second action, on entering the room, is to identify the patient. A doctor making a housecall is an exotic event even for Americans, so I often encounter a large, attentive audience.

My third is to brush off apologies as guests rush to clear a space for my bag, clipboard, and buttocks. Apparently no one reads or writes while traveling, so desk and chairs are piled with belongings.

My fourth action is to suggest that someone turn off the television. Time and again, a patient begins talking – and I can’t hear. Guests often seem startled at this request – and occasionally miffed. What’s the problem?.....

It’s surprising how many people around the world turn the TV on before breakfast and leave it on. It’s the background to their daily life.

My fifth, after listening to the patient and before the examination, is to announce that I will wash my hands. This produces more apologies as guests rush to tidy up the bathroom.

I hope this held your attention. You should realize that any competent blogger must write at least once a week, or his audience drifts off. Being a hotel doctor may be a great job, but it’s not always exciting.

It's Just a Stomach Virus

“I’m worried about sunstroke,” said a guest at Maison 140. Her husband was vomiting, and they had returned from a walking tour of Beverly Hills. The temperature was in the 90s.

Sunstroke is life-threatening, and it takes more than a hot afternoon walk in Los Angeles to bring it on. I’ve never made the diagnosis, but hotel guests worry about it.

“I think someone put something into my drink.”

You’d think no one outside of a B movie would say this, but I hear it perhaps once a year. It’s alarming to fall violently ill after a night on the town, and Los Angeles is an exotic locale to many travelers, so anything can happen.

“The sushi tasted funny…”

It’s common sense that food your stomach rejects must be noxious, but if you’ve been paying attention you know that using common sense to explain an illness is proof that you don’t know what’s going on.

Food poisoning is not rare, but the responsible toxins are tasteless. Also, infections such as Salmonella and hepatitis are not the result of spoilage but contamination of perfectly good food with feces.

It’s almost impossible to diagnose food poisoning unless more than one person is sick. Almost everyone blames an upset stomach on the previous meal, but it’s most likely a virus. Google “viral gastroenteritis.”

Being Awakened Twice

 "How quick can you be in Costa Mesa?” asked the dispatcher for Expressdoc, a housecall agency. The call had gotten me out of bed at 11 p.m.

“In about an hour.” 

“Can’t you make it earlier?”

“Costa Mesa is forty miles away. How sick is he?”

“He has back pain. He wants to go to an emergency room, but we said we could send a doctor. Let me see if he’ll wait.”

After fifteen minutes had passed, I phoned the agency.

“I’ve been trying to reach him, but it looks like he’s gone to the hospital. If he comes back, is it OK to call you?”

“No. If he comes back, tell him I’ll be happy to see him in the morning.”

I have no objection to being awakened to make a housecall, but I don’t want to be awakened twice. After breakfast, I phoned the guest. He hadn’t gone to the emergency room, but he was feeling better.

Nearing the End of the Road

I have never denied being America’s most successful hotel doctor. No one has made as many visits – over 18,000 -- or works at it exclusively. All others do it as a sideline.

Yet time is passing. I’m not the only Los Angeles hotel doctor collecting social security. A new generation is muscling in, displaying the energy of youth, fierce marketing skills, and a priceless absence of ethics. All are concierge doctors, building cash-only practices that serve patients willing to pay to have a physician at their beck and call.

Even in Los Angeles, such patients are a limited resource, so concierge doctors have cast an eye on hotels, a major source of cash-payers.

“I guess no one’s been sick,” is the lie I hear when an employee explains why her hotel isn’t calling. I’ve been hearing it lately.

Partly it’s because my field is consolidating. National housecall services are expanding, and almost all use me. This is no news to my competitors, but marketing to these services presents difficulties for a concierge doctor.

One obstacle is their spectacular fees: double, triple, or quadruple mine. This may strike you as terrible business practice, but it’s no problem with hotels. Hotels don’t care what a doctor charges unless guests complain. They rarely do.

In addition, when concierge doctors introduce themselves to a hotel employee, extol their virtues, and offer an amenity for every referral, they have a receptive audience. It’s illegal for a doctor to pay for a referral, but no one is complaining. 

On the bright side, concierge doctors are young and busy. Immediate 24-hour service is their mantra, but providing it is impossible for anyone with a practice and social life. My leisure activities are reading and writing.

The result is that concierge doctors ask my help regularly. They send me to their patients who are increasingly guests at my hotels and those of competitors. When I retire, it won’t be because business is declining. 

A Plug for a Book

Try to find The Hotel, A Week in the Life of the Plaza by Sonny Kleinfeld. Published in 1989, it’s long out of print, but you’ll love it. Kleinfeld is a journalist who spent a week in the famous New York hotel and wrote about twenty chapters describing every position from the doorman, desk clerk and laundry worker to the kitchen staff, concierge, security, bellhops, housekeeping, and management.

I was impressed at the difficulty of keeping such an institution running smoothly and satisfying demanding guests. If you want to know the hardest job in a hotel, there’s no contest. It’s the housekeeper’s. 

The book includes a chapter on the hotel doctor that kept me scratching my head. Mostly, he complains.

It infuriates him that guests wake him up at 1 a.m. with a bad cold. I’d be thrilled by a call from an exclusive Los Angeles hotel at any hour. Why was he upset? Did he volunteer for the job? Is he working for free? I have no problem seeing guests who aren’t very sick no matter what the hour.

I take for granted that doctors go into medicine because they want to help people, and unlike other helping professions (clergyman, fireman, social worker) we’re paid very well. Almost no one calls me during wee hours unless they feel bad. That may represent poor judgment, but who thinks clearly when they’re miserable?

A Weird Letter from My Doctor

I take good care of myself, but the best life-style only postpones the inevitable.

I was seeing a cardiologist at the Pacific Heart Institute in Santa Monica. He was excellent. I would be seeing him still but for a strange letter I received.

Insurance companies and Medicare have been reducing payments, the letter began, and more cuts are threatened. In response other cardiology groups were lowering the quality of their care. Pacific Heart Institute vowed to maintain its standards. But how to do that while continuing to accept insurance?

The solution, according to Pacific Heart Institute, was an “Enhanced Access Program.” An accompanying sign-up sheet listed three levels of benefits.

For an extra $500 a year I could choose the “SELECT” level. Among its features were priority in appointments, prompt notification of test results, waiver of miscellaneous office fees, a special internet portal, and a customized wallet card with my EKG tracing.

$1800 per year would bump me to “PREMIER” status: same day appointments, direct e-mail and phone access to my cardiologist, and a free vascular risk assessment (whatever that is…).

At $7,500 a year (that’s not a typo), the deluxe “CONCIERGE” level gives 24 hour access to my “personal” cardiologist, same day visits, same day tests, and a call from my personal cardiologist to discuss results.

I could check a fourth box that merely stated “I choose not to participate… No fee.” The doctor would continue to see me if I decided not to pay up. It didn’t say he would consider me a cheapskate, but why wouldn’t he?

Paying extra to get the doctor’s attention is routine where doctor incomes are low. It was the norm in the old Soviet Union and remains so in Russia, China, and Eastern Europe.

American doctors are the world’s richest, but they didn’t get that way by ignoring sources of income. If you follow the news, you know that cash-only or “concierge” practices are a growing niche. They’re so popular that professional organizations such as the AMA have set up ethical guidelines. This strikes me as similar to setting up ethical guidelines for operating a Mexican cancer clinic, but mine is a minority view.

Seriously Burned

I awoke at my usual time, wrote for a few hours, ate breakfast, and went back to bed. Having made a wee-hour visit to a distant hotel, I was sleepy.

When business is slow, I take actions that encourage calls such as going to a movie or trying to take a nap. Unfortunately, this works when I don’t want it to, so the phone rang as I drifted off. It was a lady at the Custom hotel whom I’d seen the day before for a bad stomach virus. She was better and desperate to return home, but her insurance insisted on another exam before allowing her to travel. Making visits to guests who aren’t sick is a perk of hotel doctoring, and I was happy to comply.

Returning home I headed straight for bed, but the phone rang as my head touched the pillow. A lady at Le Parc explained that had undergone eyebrow waxing, and a clumsy cosmetologist had inflicted serious burns. I suggested that serious burns around the eye require more care than I could deliver on a housecall, but she demanded a visit.

I consoled myself with the knowledge that guests often exaggerate their problems. This proved to be the case when she showed me several pink spots over her forehead. These were mild, first-degree burns, I explained, similar to sunburn. I handed over a tube of soothing cream and assured her that they would heal completely in a week.

I was wrong, she insisted. Because of her extremely delicate skin, she would be scarred for life.

An Odd Foreign Custom

When I finish caring for American guests, I accept their thanks and money and then leave. With guests from another country, I often find myself discouraging them from accompanying me to the elevator or down to the lobby or (if it’s a private house) to my car.

I mentioned this excessive politeness to a colleague from South America.

“They probably thought you were in a hurry to get away,” he said.

When I protested, he explained.

“When I first came to the US and visited an acquaintance, I was disturbed when he shut the door behind me after I left. Did I offend him, I wondered. Is he happy to get rid of me….? In my country, you always accompany an honored guest when he leaves and make sure he is safely on his way. To stay behind is not courteous. But this is what Americans do.”      

Another Freebie

A guest at the Georgian hotel in Santa Monica wanted a housecall, said the desk clerk. She had a urine infection.

That was good news. The Georgian was not far, and urine infections are easy.

“The guest has gone to dinner,” the clerk added. “She’d like you to come at 9 o’clock.”

I hate it when hotels make an appointment without consulting me. I want to talk to guests before a visit. They need to know how much I charge and that they’ll have to pay directly. Learning this, some guests reconsider. A few guests assume the doctor is in the hotel, so it’s no big deal if they’re late or decide to skip the consultation entirely. Finally, it’s stressful to kill time at home, hoping another call doesn’t arrive to complicate matters.

Sure enough, at 8:30, as I was about to leave, the phone rang. A guest at the Airport Hilton was vomiting. Vomiters don’t like to wait. There was no way to contact the Georgian guest to suggest a delay, but I decided I could make the visit and reach the Hilton in an hour. I hurried off.

Freeway traffic stopped cold at my exit. Santa Monica was holding an arts festival. The streets were jammed.  Normally, I would park and walk the six blocks to the hotel, but this would make me outrageously late for the poor vomiter at the Hilton.

Guests usually agree to wait when I explain the problem. The Georgian guest was back in her room.

“I just flew in from London. There’s no way I can stay awake,” she said on hearing that I’d like to return later that evening.

In the end, I phoned a prescription for a urine infection into a nearby pharmacy and then drove to the airport.

Major and Minor Tranquilizers

Guests often ask for something to calm them, and I try to comply by stocking Valium.

Tranquilizers relieve anxiety but not the pain of a terrible event such as a family death. Unhappy victims regularly ask for something to “put me to sleep,” but only general anesthesia does that. Even sleeping pills merely produce drowsiness; if you’re miserable, sleep comes hard.

I give a Valium injection if asked, but I have a low opinion of its tranquilizing properties. Valium pills work better because the more you take, the drowsier you get. The effect of the maximum Valium injection does not impress me. I prefer Thorazine.

Valium and its relatives are minor tranquilizers; the Thorazine family belongs to the major tranquilizers. “Major” and “minor” have nothing to do with strength; they refer to the seriousness of problem they treat. Thorazine helps schizophrenia, a major mental illness. The first of a numerous class of drugs called phenothiazines, its US approval in 1954 marked a huge advance because it calmed schizophrenics enough so most could leave mental hospitals and live on the street, thus saving tax money.

People who deny that schizophrenia is a brain disease claim Thorazine works because it makes patients somnolent. In fact, many newer phenothiazines aren’t sedating but work as well. Thorazine and its family turn off the positive symptoms of schizophrenia:  hallucinations, delusions, bizarre behavior. Movie schizophrenics seem to enjoy themselves, but hearing a voice inside your head frightens most people even if it’s God.

Despite their dramatic effects, phenothiazines don’t cure schizophrenia because they don’t eliminate the negative symptoms such as apathy, social withdrawal, and self-neglect. Being around a well-behaved schizophrenic remains an uncomfortable experience. Something is missing.

Isn't Science Wonderful - Continued

As I wrote last time, doctors treat strep throat with an antibiotic. Does it work?

That seems a no-brainer because antibiotics definitely kill strep bacteria. But the answer turns out to be….maybe. In scientific studies, giving antibiotics to patients with strep throat is not dramatically effective. Some doctors suspect they don’t work. This contrasts vividly with treating strep infections in other areas such as the skin where it’s often obviously lifesaving.

“Wait a minute!!” assert experts including my professors in medical school. It’s true that strep throat goes away in three to five days even if not treated, but doctors must treat in order to prevent rheumatic fever, a disease that can produce devastating heart disease. Scientists don’t understand why, but a small percentage of strep victims go on to develop rheumatic fever. Antibiotics lower the risk.

Are they right? Again science delivers the answer: maybe. Evidence for preventing rheumatic fever in America comes from a study conducted sixty-five years ago when rheumatic fever was common. It’s rare now. I’ve never seen a case. Everyone agrees it wasn’t a terrific study.

Some doctors believe that rheumatic fever is so rare in the US that giving an antibiotic is more likely to cause harm (yes, antibiotics can cause harm) than benefit.

While it’s fun to make controversial statements in this blog, with patients I stick to the standard of practice. This means I sometimes give treatments whose scientific basis is weak. If you prefer therapy that’s guaranteed, you must stop seeing scientific practitioners like me and seek out alternative or complementary healers. Google “alternative medicine.”  You’ll notice that their treatments always work.

Isn't Science Wonderful!

“He has pus on his tonsils, so it’s probably strep,” said a guest, calling about her teenage son. I hear this phrase regularly. It causes me some stress because I know that later I might find myself delivering a why-antibiotics-won’t-help explanation to a sullen audience. 

One popular (i.e. wrong) medical belief is that pus on tonsils is a sign of strep throat. In fact, this is true only about ten percent of the time. Viral infections produce identical exudates.

Arriving in the room, I discovered that the boy had pus on his tonsils but also a fever, swollen, painful glands in his neck, and no cough. Good scientific studies show that the presence of these four signs: pus on tonsils, fever, swollen neck glands, and NO cough raise the odds of strep to over fifty percent, so prescribing an antibiotic is appropriate. I prescribed an antibiotic. The family made it clear they were in the presence of a doctor who knew his business.

Isn’t science wonderful? It is. But it’s wonderful in ways that are often not satisfying. More in my next post.

Easy Visits, More or Less

My phone rang as I walked into the gym. A guest at the Sunset Plaza wanted a doctor to “check out” her 9 year-old daughter who’d awoken with a fever and vomited once. This was a good call. Multiple vomits can be worrisome, but one is OK. I jumped at the chance to skip my morning exercise.

Sunset Plaza parking is indoors and free, a bonus on a hot day and on the Sunset Strip where street parking is impossible. The daughter was recovering, so I reassured the parents, a pleasure for everyone.

As I returned to my car, the phone rang again. This was a perfect time for a second call. Lunch was two hours away. Late morning traffic is the day’s thinnest. I could thrill the guest by announcing a speedy arrival.

The caller was a national housecall service. The patient was a Quantas flight attendant at the Hilton. While there is a Hilton at Los Angeles airport, this one was in Costa Mesa, 45 miles away. This was not so good, but there were compensations.

As I’ve written, in the old days airlines called me directly, and I billed them directly. No airline does that now. They call a national housecall service which, of course, calls me. I’m happy to work for the service because, being a better marketer, it’s acquired far more airlines, so I receive more calls. It also pays much more. This is possible because it charges airlines triple my former fee. You may wonder why airlines are willing to pay so much more, but I don’t. I’ve long since stopped believing that bad decisions by people who seem intelligent have a good explanation.  

Another Perk of Hotel Doctoring

A travel insurer sent me to visit a woman complaining of asthma. When I arrived, she admitted that she had a little wheezing. She didn’t seem ill, and my exam was negative. She added casually that she had left home without her asthma inhaler, so I wrote a prescription for another.

When guests phone me directly because they’ve forgotten a medicine, I call a pharmacy to replace it at no charge. Guests who phone their travel insurance are often reluctant to admit their mistake, so they claim they’re ill. These are easy visits.

I Resist Temptation

A businessman at the Hilton-Garden Inn asked a pharmacist to recommend a cream for his insect bites. To his alarm, the pharmacist informed him that what looked like insect bites might be Lyme disease and that he should consult a physician.

This provided another delicious temptation in the life of a hotel doctor. I could make a housecall, assure the man he did not have Lyme disease, and collect my fee. He would feel vastly relieved and grateful. Everyone would be happy.

The businessman described half a dozen itchy pimples around his ankles. Even over the phone, it was obvious that they were insect bites. I reassured him, and he was relieved and grateful, but no money changed hands.

We Yearn to Help

If a prescription gave you diarrhea or made you vomit, you might complain. But until well into the twentieth century, the average American looked on a good “purge” as a way to expel disease. Physicians took pride in their cathartics, and when patients discussed a doctor’s skill, they gave high marks for the violence of his purges.

Nowadays Americans frown upon purging, but we seem to expect a medicine. It should be one only a doctor can prescribe; over-the-counter drugs don’t count. Pills are good, but an injection is better. Of course, modern drugs often work, but this is a minor matter compared to the deep human desire that a doctor do something.

I apologize if this sounds mildly insulting; I suspect most of you will deny expecting a drug. You want whatever will help. If nothing will help, you want to know.

Such sensible patients do appear, but no day passes when I don’t see disappointment in a patient’s eyes when he or she realizes I don’t plan to “give them something.” 

Doctors genuinely want to help you, and we feel bad when we can’t. We also feel bad when we do our best, and it’s obvious a patient doesn’t feel “helped.” So many of us add a prescription to convince you that we’re doing what a proper doctor should do.

I Prefer Vomiting and Diarrhea

Two women at the Holiday Inn were ill. The mother suffered low abdominal pain with vomiting and diarrhea. It seemed like the usual stomach flu. I assured her it wouldn’t last long and gave medication.

Her adult daughter also complained of low abdominal pain but without other symptoms. Viral gastroenteritis can occur without vomiting or diarrhea, but I feel reassured when they’re present. It’s a good rule that when two members of a family are ill at the same time, it’s the same illness, but no rule is absolute.

The problem is that isolated low abdominal pain in a young woman can indicate an urgent problem such as ectopic pregnancy or twisted ovary. This seemed unlikely, but I couldn’t rule it out. If she weren’t better in a few hours, I explained, she must go to the local emergency room. She did not object.

When I phoned a few hours later, the mother’s symptoms had vanished, and the daughter told me she felt a little better. Patient tend to tell doctors what they believe we want to hear, so “…a little better,” does not reassure me. Pressed, she admitted that she wasn’t feeling better. When urged to go to the emergency room, she worried about her lack of insurance and the late hour but promised to give it serious consideration.

I passed a restless night. When I phoned the next morning, she had recovered.

The World's Worst Travel Insurer

International Medical Assistance has a terrible reputation despite being my leading source of business. It often calls over a hundred times per year. Almost every doctor who knows IMA including the colleague who covers when I’m away, refuses its calls because it’s so hard to get paid.

Most travel insurers pay within a month or two. If they don’t, a call to the claims department corrects matters.

IMA never pays within two months. When I call, the claims department assures me that a check will be mailed in the near future or that my invoice never arrived. When I call a week later, I might hear the same explanation.

IMA was in business when I took up hotel doctoring in the 1980s and, for obvious reasons, happy to send patients. It didn’t take long for me to grow annoyed. Payment could take six month and required persistent phone calls. In 1993, with my practice prospering, I began refusing its calls.

In 1998, IMA changed ownership. A representative called to apologize for past difficulties and promise that it would now pay promptly.

But nothing changed. Checks didn’t arrive. I resumed pestering the billing department. By that time hotel doctoring was catching on so I had several competitors. IMA was irritating to deal with, but it provided plenty of business and – eventually – paid.

My frustration tolerance has diminished with age. In 2012 I was considering dropping IMA when a representative called to announce that it was again under new management. Payment would now be made every month directly into my checking account.

Sure enough, in January 2013, December’s payments appeared – minus several visits. Wearily, I picked up the phone. The problem remained when the February payment appeared, also for too little. The March payment was too much but it didn’t even out. April’s payment was also excessive; now I owed them. The May payment again missed several visits. By 2014 IMA had given up bank deposits and was back to sending checks. Slowly. That’s when I realized that IMA is cheap and stupid but probably not dishonest. Delaying payments saves money in the short run, but the P.R. damage far outweighs it. On the other hand, I have no competition for its business in Los Angeles.

More Worry

At the end of a hotel visit, a guest handed over her credit card. I wrote its number at the bottom of my medical record form. Seeing this, the guest frowned.

“Do you shred that after you use it?” she asked.

I shook my head no. “It goes into my files.”  I keep it in case of a problem with payment, although so far that’s not happened.

She scowled at this answer. I phoned the credit card company and began entering my answers to its computer’s questions. She hovered, staring anxiously at my form.

“So you don’t shred my number... I thought everyone shredded credit card numbers…”

The computer announced its approval. After hanging up, I tore off the bottom of my form and handed it back. She seemed vastly relieved.

Doctor Oppenheim Explains the Meaning of Life

I believe that things happen because they happen. We weren’t put on Earth for a purpose. You’re born, you do your best, you die.

This is not a popular point of view. Every writer and TV personality you’ve heard of disagrees, including several with a medical degree. Yet I’m convinced that searching for an explanation is the best way to understand natural phenomena but useless as a personal philosophy.  

“I’ve got cancer!...  Why me?” This is the first question every victim asks. If you believe the universe (God for those less cool) cares about you, everything happens for a reason, so this question has an answer.

But now the cancer victim has an extra job. Besides confronting the disease, he must look deep inside and learn how this is part of the plan. If he’s successful, he’ll feel better. Or she.

You’ve read essays by people who have (1) gotten cancer, (2) reexamined their lives, and (3) achieved inner peace. I’m sure this happens, but in my experience most of us do not find misfortune a chance for spiritual growth.

Exhorting patients to find themselves only adds to their burden. I especially dislike media doctors who urge victims to fight their disease, asserting that a positive attitude aids healing. Be happy or die.

Most cancer patients pull themselves together and deal with immediate problems. That’s the best they can do, and it’s not bad. 

You Think I Have a Soft Job

The phone rang at 1:10 a.m. An international housecall agency had a visit in Anaheim, forty miles away. I agreed to go but quoted a larger fee because of the hour and distance. The dispatcher, in Miami, said she would ask for approval and get back to me.

I dressed and waited. After ten minutes I called to ask about the delay.

“I’m sorry. We’re waiting for the E-mail.”

“E-mail!! Can’t you phone them?”

Apparently not. Approval had to come from Madrid or Buenos Aires. I waited another fifteen minutes before calling again. Learning that the E-mail still hadn’t arrived, I told the dispatcher I had changed my mind and went back to bed.

Humor in Medicine

I had cared for a ten year-old with fever who had vomited twice. It was the usual stomach virus that might last a day. I reassured his mother and gave anti-nausea pills.

“I’m concerned about his fever. How often should I measure it?”

“Whenever you want.”

“I’m not comfortable with that. How often?”

“Are you worried about his fever?” I asked.

“Of course.”

“In that case don’t take his temperature.”

This is my usual drole response to patients frightened by fevers. It startles them, but my explanation reassures them. This lady was not startled but offended.

“I work in the medical profession, doctor, and that is dangerous advice.”

“Actually not.” I explained that when otherwise healthy people get seriously sick, they look sick. If they don’t look sick, they’re probably not sick, and having a fever doesn’t change matters. Infants and the elderly are exceptions; otherwise this is a good rule. People worry too much about fevers.

“I’ve heard different. Fever can kill.”

“You see life-threatening fevers in diseases like meningitis and rabies, but these patients look very bad. I haven’t seen a life-threatening fever in thirty years. Sick people look sick. Make your decision on calling a doctor on that basis. Never mind the fever.”

“We’re done here.” She held out her credit card.  

Why Doctor Oppenheim Isn't Rich

The better we conventional doctors handle a problem, the less you’ll read about “alternative” treatments. Your local health food store doesn’t sell an herbal remedy for appendicitis. Don’t laugh. Until a century ago victims died after weeks of agony. Then we discovered that snipping off the appendix (something any bright high school student can do) cured it. This is one of many genuine medical miracles we take for granted. Some of us remember the herpes panic of the late seventies. The AIDS panic that followed overshadowed it, but Time magazine and Newsweek published cover stories on herpes, and the New York Times described it as the twentieth century bubonic plague. Alternative remedies were everywhere, not a few sold by entrepreneurial doctors. Then a good drug appeared, and the market for herpes cures dried up.

On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. If you want a superb treatment that conventional doctors ignore, check the internet or a bookstore. You’ll find plenty.

Many alternative healers are M.D.’s like me. They have names like Deepak Chopra and Andrew Weil and Mehmet Oz. They agree that scientific medicine has much to offer but insist that it is merely one of many routes to healing. 

They assert that it’s equally important to tap our spiritual energies, maintain a healthy optimism, promote natural healing with balanced and pure nutrients available through their web sites, and keep an open mind to cures wrought by eastern religion, nonwestern medicine, and pioneering researchers ignored by the establishment.

It is my belief that this is not true and that they are quacks. In my opinion (my lawyer insists that I add this). But as someone convinced that science is the road to truth, I’m obligated to present evidence. So….

I write an obscure blog. Weil, Oz, and Chopra write bestsellers. My books never sold much (I’ve written five, all commercially published). There are no ads on my blog. Weil, Oz, and Chopra have plenty. They sell wonderful stuff on their web sites. They appear on TV all the time. No one asks for Doctor O.

It doesn’t look good for me.