Should I Make a Housecall?

Only half my callers require one.

As I repeat, I’m happy to phone a pharmacy when guests forget legitimate medication: blood pressure pills, heart pills, contraceptives, etc. I don’t do this for guests who tell me “I had the same thing last year, and my doctor prescribed……” 

Exceptions exist. If a caller has had gout I believe him. It’s acceptable to treat a young woman with a typical bladder infection over the phone. If you’re wondering about symptoms of a “typical” bladder infection, I’m not telling. You have to tell me. Most “my doctor prescribes...” calls concern upper respiratory infections where the guest has received the traditional placebo antibiotic and believes he needs another.

Guests with stuffy ears don’t object if told they need a housecall, but I resist the temptation because ordinary congestion causes bilateral ear discomfort without pain. Over the phone, I advise aggressive use of nasal spray before takeoff and before the plane descends.

Injuries can be tricky. A doctor’s exam rarely diagnoses a fracture, but most common injuries are not urgent, even when a fracture is present. If guests are willing to wait until business hours, I can send them to an orthopedist’s office, more civilized than an emergency room. For back pain, a housecall is better. If you go where there’s an x-ray, you’ll get one, and experts agree that back x-rays are almost never helpful.

Much of my decision on making a housecall depends on the law of averages. Chest pain in a fifty year-old is usually not serious, but it’s unwise to assume this. It’s less unwise in a twenty year-old. A sore throat in a child or adolescent might be strep which medical science can cure. After age fifty it’s almost unheard of. I’ve never seen a case.

Laborl Day

Everyone left town for the holiday including the local concierge doctors and at least one colleague, but plenty of travelers arrived, so I was busy.

A Virgin-Australia flight attendant was vomiting at the Warner Center Marriott twenty miles to the northwest. That midnight an Emirate Airline crewlady suffered the same symptom at the Hilton in Costa Mesa fifty miles southeast. My heart sank when I remembered that the freeway to Costa Mesa in Orange County closes from 11 p.m. to 5 a.m. for major construction, and the long detour is always jammed despite the wee hour. My heart leaped when, checking traffic, I learned that the shutdown was suspended for the holiday.  

The parade of upset stomachs continued at a home near the beach in Venice. This is a funky area that brings back memories because my wife lived there when I met her during the Ford administration. It’s packed with small houses and shops built before World War I, so no one has a garage. Everyone parks on the street, and on a holiday afternoon the beaches and shops are crowded. The rule on parking (like the rule on difficult spinal taps) is: keep trying. After fifteen minutes I found a spot less than half a mile away. 

I Just Got Back From Mexico...

One third of visitors to poor countries from rich countries get sick. Experts warn tourists to avoid uncooked food, street vendors, ice, and tap water. By obeying, they lower the risk of getting sick to… one third. The truth is that no one knows how to prevent traveler’s diarrhea. Poor sanitation seems essential, but travel itself must play a role. The Swiss get sick when they visit the US.

Tourists visiting the tropics worry unnecessarily about parasites. Germs and protozoa like malaria remain a problem, but larger creatures reproduce slowly. Victims must stay long enough and undergo repeated exposure before they accumulate enough to realize something is wrong. If you harbor a few dozen schistosomes, flukes, or hookworms, you won’t notice.

Having said this, I visited one horrified guest who had seen what looked like an earthworm swimming in the toilet after a bowel movement. Unfortunately for my education, he had flushed it down. This was undoubtedly an ascarid, a parasite that affects a billion people worldwide and an unknown number in the US. Unlike parasites such as hookworms which bite into the intestine and eat your blood, ascarids swim freely and eat what you eat. You can support a dozen without difficulty. Victims get into trouble when huge numbers cause an obstruction or when a single worm crawls into a duct and gets stuck. If you return from vacation with a small infestation, you have little to worry about. The females will mate, but their eggs only hatch outside the body in warm earth, so they disappear down the sewer, and the average ascarid dies after a year or two.

Amazing Medical Maxims

What many laymen believe are serious signs are not.  Here are examples.

1. Local pain is worrisome; widespread pain is reassuring.

When a guest suffers abdominal pain, I ask to see where it hurts. When he or she indicates the entire abdomen, I relax a little. The common stomach virus produces widespread pain. When the patient’s finger rests on a small area, I worry about conditions like gallstones, appendicitis, or diverticulitis whose pain is usually localized.

2. One allergy can be serious; many allergies: not so much.

An allergy is a specific immunological reaction that can be fatal, but most drug reactions are not allergies. If a medicine upsets your stomach or gives you a headache that’s usually what we call “drug intolerance.” If you’re willing, it’s OK to continue it, something we never do with an allergy. However, doctors use “allergy” indiscriminately, and laymen add their own diagnoses, so many patients confront us with a long list of forbidden drugs, foods, and environment stuff. The major consequence is not illness but expense. If you say you’re allergic to penicillin (90 percent of those who say so are wrong), for example, an alternative costs fifty times more.

3. Things don’t turn into other things.

Mostly this comes up with viral upper respiratory infection (cough, congestion, sore throat, fever).  Everyone knows that antibiotics are useless for viruses, but if a doctor diagnoses a virus, many patients believe they’ve wasted the trip. This is where the maxim comes into play.

“If I don’t get something it turns into… “bronchitis…strep…pneumonia…a bacterial infection….”  It doesn’t. In otherwise healthy people, illnesses don’t change into other illnesses, and experts persistently warn doctors that giving antibiotics to prevent complications is positively harmful. They wouldn’t keep warning us if we didn’t keep doing it.

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 disorders. 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 ask for more Adderall.

None sounded like drug-seekers. All were happy to pay my fee for a visit during which they assumed that I would check them out. Since there is no way that I can examine a guest and make a diagnosis of adult attention-deficit disorder, I told them I’d have to speak to his or her doctor. That never came to pass.

It’s been decades since I made a similar decision on narcotics. Guests occasionally forget their heart or blood pressure 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 seemed 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.

A Dog-Eat-Dog Business, Part 6

People ask what sort of contract I have with hotels. The answer is none. Staff call because I’m easy to reach and quick to respond. Once they’ve called a few times, they’re not inclined to change.

But hotel doctoring is a glamorous occupation, so plenty of doctors yearn to break in.

How can they do this? Guests who want help ask a concierge, desk clerk, operator, or bellman. You might think that they’re given the name of the house doctor, but there is often no such person. Except in luxury hotels, selecting a doctor is not a priority, so the choice may be up to the employee.

This is no secret, so entrepreneurial doctors know who to approach. But how can he phrase a sales pitch? Proclaiming that he is caring, compassionate, and skilled sounds creepy. Doctor web sites and housecall agencies always proclaim this, but you should be skeptical. I’ve worked for dozens; they may check my license and malpractice history but never my competence.

The new doctor might offer to charge less, but he never does. The free market doesn’t apply to a medical fee, and hotels don’t care about it.

So what’s left? Services selling to a hotel (florists, tours, masseurs, limousines) often pay a kickback, and there is a long tradition of hotel doctors doing the same. It’s illegal for a doctor to pay for a referral, and I hasten to admit that I have no evidence that anyone is doing that, but when I start hearing “have you forgotten something?....” hints from bellmen et al, I wonder if a new competitor is making the rounds.

A Big Tipper

Le Meredien in Beverly Hills has a firm policy against recommending a doctor. This does not mean that it never calls, only that a call from Le Meredien means a guest making trouble, and the harassed employee has chosen Doctor Oppenheim as the lesser of two evils, the greater being burdening his boss with the problem.

 “I’m here to see the gentleman in 499,” I informed the concierge. “Is there anything I should know?” 

She made a show of checking her computer. “That would be Prince Mahmel. He’s been asking for a doctor. Repeatedly. The Saudi consulate had your number.” 

Concealing my pleasure at that news, I thanked her and headed for the elevator. 499 stood at the end of the hall, the largest suite on the floor. Its door stood open. Knocking and then pushing it further, I encountered the smell of alcohol, never a good sign when the patient is Moslem. No one was in sight, but a doorway led to the bedroom and the prince, a small figure in a huge bed, covers drawn up to his chin. Balding and past forty, his disheveled hair was the single unkempt feature, and a goatee the only evidence of his foreignness

“Pain. Terrible pain,” he announced loudly.

“Where is the pain, Mr. Mahmel?”

“Kidney. I have kidney stones in my kidney.” He threw the covers to one side and pointed to his right flank. “My doctor prescribes Dihydroco, but I have no more.”

“That’s not a drug I’m familiar with.”

“It is from London. I live in London.”

“Do you just need a prescription?”

“Also a shot. The pain is unbearable.”

I examined the prince and tested his urine for blood. Everything was normal but this can happen with a kidney stone. I thumped his back over his kidneys, and he groaned. I was not convinced. Le Meredien wasn’t a potential client, so I could expect no advantage from pacifying the prince, and no damage from a complaint.

“I’ll give you a Toradol injection.” An excellent pain remedy, Toradol is similar to ibuprofen but probably not what he expected.

“Many thanks.”

Any doubt about the prince’s drug consumption vanished when my needle jerked to a halt half an inch beneath the skin. Fibrosis from hundreds of injections had given the prince’s buttock muscle the consistency of wood. I forced the syringe down and delivered the injection. Anticipating the pleasures ahead, the prince clutched my hand in gratitude.

Yanking open the drawer of the bedside table which turned out to be stuffed with hundred dollar bills, he snatched a handful and pushed them into my grasp.

Grateful the prince had forgotten his request for a prescription, I thanked him and hurried out. Later I counted fourteen bills. I gave them to my wife who bought a Chinese rug for our living room.

No Income Today

A guest dropped an ice bucket on her toe. Pain was excruciating, and blood oozed out. Holding the toe under the tap didn’t help.

Over the phone, I explained that running water won’t stop bleeding. She should apply pressure and add ice to dull the pain. When I called an hour later, she was having dinner in the hotel restaurant.

A man had developed a slight cough, in his opinion a prelude to full-blown bronchitis. He wanted something to knock it out. I explained that, in a healthy person, viruses cause almost all coughs. I could come, but I couldn’t promise an antibiotic. The man said he would get a second opinion.

A toddler bumped his head against a bedpost and developed a lump the size of an egg. He felt fine, but the parents asked that I check him for brain injury. That requires a CT scan, I explained. He would certainly get one if he went to an emergency room, but the injury didn’t seem serious enough for that. It was OK to wait.

A guest had missed his flight because of an upset stomach. He was well now but needed a doctor’s note to avoid an expensive ticket-exchange fee. These requests put me in a difficult position. I can’t write “The patient was unable to travel because of an upset stomach” because I don’t know if that’s true (sometimes the patient admits that it isn’t). So I offer to write the truth: “The patient states that he suffered an upset stomach and could not travel.” I sweeten the pot by offering to fax it to the hotel at no charge.

Guests usually accept. To date, no one has complained, so it’s possible that the note works.

How Much Does an Emergency Room Cost?

A lady had been vomiting for three days. She had felt better that morning but then relapsed. She sounded weary.

This was tricky. Stomach viruses are the second leading ailment a hotel doctor encounters. I consider them good visits because they rarely last more than a day. I deliver advice as well as an injection and pills. The guest recovers and gives me the credit.

When vomiting persists, doctors worry about more ominous digestive disorders. Worse, three days of vomiting produces some dehydration. This is not dangerous in a healthy person, but drugs don’t work well in its presence and recovery slows. Victims perk up when dehydration is relieved. 

I explained that it was probably too late for a house call. She needed intravenous fluids. After agreeing to go to the local emergency room, she mentioned that she was Canadian and had no travel insurance. I repeated that she should go.

I’ve found that it’s a bad idea to tell guests to go to an ER and then tell them how much it might cost.

My restraint was in vain because she googled the subject, perhaps turning up http://www.theatlantic.com/health/archive/2013/02/how-much-does-it-cost-to-go-to-the-er/273599/ to read that the average was over $2,000. Giving IVs would take hours and cost extra.

When I called the hotel that evening, I learned that she hadn’t gone, and she was still ill. She admitted that the cost had shocked her. I sympathized but told her she had no choice.

When I called later to reinforce this advice, there was no answer. When I called the following morning, she had checked out.

Losing the Chateau Marmont

The Chateau Marmont is a funky art-deco apartment converted to a hotel in the 1930s with nine nearby cottages acquired during the 1940s.  John Belushi died in a cottage in 1982, a few years before I became its doctor. 

I made 157 visits. My last, in 2002, was not at the request of the hotel but of a national house call agency, Concierge Care. Agencies pay me my usual fee, but they charge a good deal more. It rarely causes a problem because the guest has agreed to pay by the time I arrive.

Unfortunately, the dispatcher answering Concierge Care’s 800 number did not like to deliver bad news. As a result, he took down the caller’s information and cheerfully announced that a doctor would arrive but neglected to mention the fee.

The visit went well, but the guest’s jaw dropped when I handed her my invoice for $400. This was 2002 when the dollar was worth something. Hearing that I only earned $150 did not relieve her distress. Worse, she phoned the front desk to ask the hotel to put it on her bill, adding her displeasure at the size of “the hotel doctor’s” fee.

As the desk clerk counted out my money (probably more than his weekly pay), I explained that I was making this visit for a house call agency which was responsible for the fee. He nodded politely, but the Chateau Marmont has not called since.

Paramedics Versus Doctors

My personal encounter with paramedics occurred the day I fell (ironically during my morning health walk) and broke my leg. I might have lain there for some time because pedestrians in my middle-class neighborhood pay little attention to the occasional bearded old man lounging on the sidewalk. Luckily, I had taken a detour through an alley behind a restaurant where two Hispanic workers noticed and came to my aid.

I was not in great pain as long as the leg remained immobile. Any movement hurt terribly. When the paramedics approached with their gurney, I was frightened, but they scooped me up, drove to a hospital, and shifted me to another gurney with hardly a twinge. Never mind their medical skills; that showed talent.

While I admire paramedics, they have little use for me in my capacity as a hotel doctor. Paramedics almost never encounter a physician on their calls, and they don’t like it when they do. Most likely, they worry he might pull rank. As a result, when paramedics arrive at my hotels, I sit quietly, never speaking unless spoken to. In turn, they go about their business, pretending I’m not there.

Another Death

 “He’s over there! I think it’s an emergency!”

Emerging from the elevator, I did not want to hear this. Despite the impression left by television, cardiac arrests are usually fatal. Outside a hospital, between six and eleven percent survive.

The survival rate of the few I encountered is zero, and this did not look like an exception. An overweight security officer was kneeling clumsily on the bed, bouncing up and down as he pounded an old man’s chest. The guest’s false teeth had jarred loose and protruded from his mouth; I plucked them out.

Security officers learn CPR but rarely use it, so they forget the details. Cardiac massage on a soft bed doesn’t work. The officer should have dragged the guest onto the floor. One of his colleagues should have been giving mouth-to-mouth respiration, but it was almost impossible to persuade laymen to perform something they considered disgusting. Mouth to mouth respiration was essential until 2010 when experts decided that chest compression alone was OK.

I asked how much time had passed since the arrest.

“I don’t know. He was out when I got here.” gasped the officer.

I found no pulse, heartbeat, or respiration, and it was obvious the man had been dead for some time, so I told the officer to stop. Hearing this, an elderly lady in a nightgown hovering nearby burst into tears. At that moment, two paramedics and two firemen clumped noisily into the room accompanied by a man in a suit and a young woman, apparently the manager plus the concierge. Cardiac arrests attract too many people.

Observing the corpse and the weeping woman, the senior paramedic flipped through his clipboard. “Is that your husband, ma’am? Could you give me his name?”

She couldn’t. Disobeying my rule about staying out of the way in the presence of paramedics, I comforted her. Lowering his clipboard, he waited patiently. This is the single activity paramedics are happy to leave in the hands of a physician. After a few minutes, she became calmer.

Disposing of the dead guest took a while. Two police arrived and transcribed the wife’s story a second time. One by one, the staff left, followed by the police and paramedics. The medical examiner’s ambulance drove off with the body. The lady couldn’t find her sleeping pills, so I provided some. I left my phone number and promised to call in the morning.

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.    

A Better Shot

 “Is he a VIP?”

“All our citizens are VIPs” said the consul for Qatar, referring to a countryman at the Airport Hilton.

Sick guests from small nations often call the local consul. Asked to find a doctor, he usually phones the hotel.

Once a consul has my number, he tends to remember it, so these calls are good news. On the other hand, guests who phone the consul feel worse than usual.

A woman in a headscarf answered door, and indicated a young man, curled up in bed. It was their honeymoon. Back pain is usually an easy visit from my point of view. Most acute backs are not so bad after the first day, and they steadily improve.

Unfortunately, this was not the first day. Pain had come on three days earlier in Las Vegas. A hotel doctor had dispensed the usual remedies, and pain had diminished only to return the following day.

I delivered the largest injection and strongest pills in my possession, adding that he would need more evaluation if this didn’t work.

At midnight, he phoned to say that he had improved, but now pain made it difficult to sleep. He agreed to go to an ER but wanted to wait until morning. There was no answer when I called that morning or that afternoon.

The ER doctor had performed the usual tests and then given a shot, the guest said that evening, but it was not as good as mine. Desperate to return home, he had booked a flight. Would I give another shot before he checked out?

So I did. Handing over a business card, he urged me to visit if I came to Qatar. Then, supported by the wife and a cane, he hobbled off.

My Last Bad Check

A guest at the Hyatt had fallen ill and cancelled a flight. He had recovered, but the airline insisted on a doctor’s note before allowing him on board.

Determining if someone is healthy enough to fly usually requires only a few questions, but I do an exam. He delivered a steady patter as I worked, describing himself as a venture capitalist with an exciting but stressful life as he prepared for an important meeting in Japan.

As I composed the note, I saw him writing a check and immediately announced that I accept credit cards.

Apologizing, he told me that it would be a hassle unless payment came out of the company account. Seeing my hesitation, he added that he had credit cards and would give me a number in case there were a problem. He pulled one out and scribbled on my invoice, getting one number wrong. I noticed and made the correction. 

I’ve received a few dozen bad checks but only rarely after 2000 when I began accepting credit cards.

You can imagine my feeling later as I stood watching a teller fiddle at his computer…. and fiddle…. and fiddle… and finally explain that it wasn’t accepting the check.

Naturally, I felt stupid. Single males write almost all bad checks, and this guest fit the pattern.

Now came the tedious process of trying to recover the money which occasionally happens. As I expected, the address and phone number on the check were wrong. Asking the hotel for contact information sometimes helps, but in this case I learned that it must respect the guest’s privacy. The credit card was certainly worthless.

But it wasn’t! When I phoned the computer and entered the numbers, it approved. Some things are hard to explain.

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.

The Most Difficult Calls

I stopped chopping an onion when the phone rang. A young man at the Airport Hilton was vomiting.

For a hotel doctor, a difficult call refers not to an illness but to traffic conditions. It was four o’clock, so I would drive eight miles both ways during the freeway rush hour, returning hungry and with no dinner prepared. I delay some visits but not for acutely miserable symptoms.

Before I left, the phone rang again. I yearned to hear that it was another airport hotel, but the guest was downtown, fifteen miles in the opposite direction. Worse, she had a migraine, so I couldn’t delay.

Delivering medical care is sometimes challenging. Always challenging and the mark of a seasoned hotel doctor is the ability to remain serene in gridlock.

Certain rules apply. Unless lanes are closed, leaving the freeway for city streets is a bad idea. Another rule is that blocking a lane at any hour stops traffic cold. Steady movement, however slow, is simply a sign of congestion.

“I wonder if there’s an accident,” I thought a dozen times after several minutes of immobility, but I never saw one. So much for rules.

Two housecalls which normally take two hours took four and a half, but I maintained my serenity, sucking on the hard candy I bring along to dull my hunger and listening to a novel on my CD.

"Wow! Hotel Doctors Charge That Much?"

Guests don’t say that. Mostly I hear: “Could I talk to my husband and call you back.…..?”

Unlike the competition, I don’t confine myself to upscale hotels. Plenty of Holiday Inns, Ramadas, and motels call, and I quote fees less than the going rate. Colleagues complain but admit that it’s not a competitive advantage because hotels don’t care what the doctor charges. Still, counting driving time, a hotel visit rarely takes less than an hour, so it’s not cheap.

Helpless in a strange country and forewarned that medical care in America requires vast sums, foreign guests are easier to deal with.

America medical insurance takes a dim view of housecalls. No hotel doctor accepts it, so Americans, already disoriented at finding a doctor willing to make a housecall, learn that they must pay out of their pocket. It’s a shock.

Like all doctors, I like to present myself as a humanitarian, and I often reduce my fee if the guest feels too miserable to leave the room, but mostly, when Americans object, I send them to an urgent care clinic.

Walking through a clinic door costs around $100. While this is much less than a housecall, clinics charge extra for tests, procedures, shots, and supplies, and the patient must find a pharmacy and then pay for the prescription. I don’t charge extra for anything. Telling all this to guests sounds too much like a sales pitch, so I simply send them to a clinic. Insurance might pay part of their bill.

Disappointment

Loews guest was suffering flu symptoms, but mostly he worried about his temperature. I explained that the fever was not an ominous sign. If he wanted to check, he could buy a thermometer. Or I could come to the hotel. He opted for the visit. I told him how much it would cost.

“Oh… I thought it was free,” he said.

I’d heard that before. Your doctor doesn’t answer when you dial, but I do. Naïve guests think I’m downstairs awaiting their call.

He was from Chile. Did he buy travel insurance before coming to the US, I asked. He did. I explained that travel insurance pays for housecalls, and most insurance agencies call me. However, he must phone the insurance first to obtain approval. He promised to do so. 

Half an hour later my phone rang. It wasn’t Loews but the Doubletree. An elderly man had undergone electrical cardioversion for atrial fibrillation – an irregular heartbeat – a month earlier, and he was worried. His heart didn’t feel right. I asked him to count his beats; he counted 80 per minute. That is not particularly fast. I assured him that he wasn’t describing anything dangerous. He wanted me to check him.

These are the best visits. A guest is worried, and I’m already convinced that there’s nothing to worry about. Sure enough, the exam was normal. He was delighted at the news, and I was delighted to deliver it. Everyone was happy.

I was even more delighted to drive to the Doubletree because it’s only a few blocks from Loews. At any minute, I expected a call from the Loews guest’s insurance agency for another easy visit. But it never came.

My Career as a Diet Doctor

Long before taking up hotel doctoring, I answered an ad from a physician who offered “weight control.”

Every era has a weight loss miracle. During the 1970s it was human chorionic gonadotropin, HCG, a respectable hormone involved in reproduction. There were the usual flurry of bestsellers and HCG clinics, and then it went into a decline although it remains in the armamentarium at plenty of shady clinics.  

My doctor was a regular GP who merely made it known that he offered HCG. I doubt diet patients made up ten percent of the practice, but they provided an impressive cash flow. The women (only a rare male) came in weekly for a shot, a diet sheet, and a pep talk from the nurse. The doctor saw them monthly, but they paid the regular fee for every visit. He never claimed (to me) that HCG worked, only that patients believed in it, so it inspired them to stick to the diet.

But it didn’t inspire them. Any motivated patient who starts a diet, legitimate or silly, will lose ten or twenty pounds before the gnawing of hunger becomes tiresome. Losing more is much harder. This was no news to the HCG patients, but they were not paying good money to hear it. Their stubbornness amazed me. They signed up with the usual enthusiasm, came in for their shots, followed the diet, and lost their ten or twenty pounds. Then they stopped losing, but most continued to come in, month after month, taking the weekly shot and paying the fee.

Despite the universal opinion among the thin that dieters fail because they cheat, most of these women were trying hard. Alas, they were butting up against the ten-twenty pound limit. Losing more requires a tighter diet, self-denial, and regular exercise, a difficult feat.

Dropping that initial weight turns out to be a good thing. Ninety percent of dieting’s health benefits (reduced risk of diabetes, lower cholesterol, less heart disease) are achieved by a ten percent weight loss. Alas, few patients thrilled to that knowledge because better health was not their goal. Many asked if the shot worked. At first, loyal to my employer, I admitted that opinion was divided. Eventually my answers grew blunt. This never offended the patients who were already suspicious. Many did not even drop out, but the news got back to my boss.