A Dog-Eat-Dog Business...again

Waiting at the local carwash, my eye ran over a sheet of ads along one wall. Among notices for personal injury lawyers, pest control, acupuncturists, and pizzas was a photo of a smiling young man in a white coat carrying a doctor’s bag. According to the text, a phone call would bring him to your door at a fee less than an emergency room’s. All ads for housecalls deliver this cheerful boast, never mentioning that the average ER visit has passed $1500.    

My first instinct was to chuckle at the waste of money. Few customers at a carwash will pay the going rate for a housecall. My second instinct was to worry. This fellow was ambitious. His web site features the same photograph plus testimonials from rating sites such as Yelp describing him as a healer of Christ-like compassion.

My third instinct was to recall a visit to Le Petite Hermitage, a small boutique hotel off the Sunset Strip. The guest had spoken to this doctor the day before, decided against a visit, and expressed pleasure at finding me and my lower fee. Since Le Petite Hermitage was a regular, I assumed he’d gotten the name from the internet. Now I’m not so sure because this occurred early in the year, and hotel hasn’t called since.

In large hotels employees know me by sight and take for granted, even without an official announcement, that I’m the official doctor. Since it has only 80 rooms, I may not visit Le Petite Hermitage for months at a time, so I’m not a familiar face. As a result, when an entrepreneurial physician makes an appearance to extol the benefits of his service including, perhaps, an amenity for the employee who refers a guest, he makes an impression.

Addicted to Gratitude

“You saw me at the Marriott yesterday. I still don’t feel good.”

“I’m sorry,” I said. “I did mention that you’d be under the weather a few days.”

“I still have a temperature. The Tylenol only works a few hours. The cough medicine isn’t doing much. I need something stronger.”

“I would love to make you better, but, as I explained, there’s no cure for these respiratory viruses.”

“What if it’s bronchitis? My doctor tells me I have a lot of bronchitis.”

“‘Bronchitis’ is just another word for coughing. It’s a virus that runs its course.”

“I guess I just have to be sick. Thank you, Doctor Oppenheim,” she said before hanging up. There was sarcasm in her tone. I felt bad.

I also felt a surge of anger at my fellow doctors, most of whom prescribe antibiotics for viral infections. No doctor believes they work, but prescribing them guarantees a patient’s gratitude; doctors are addicted to your gratitude. 

My practice is to prescribe antibiotics when they’ll help and to not prescribe them when they won’t except when it’s clear that the patient will blow his top if I don’t. This turns out to work pretty well. About ninety percent of patients seem genuinely grateful. Most of the remainder are dissatisfied, but they remember their manners. Perhaps one percent make it clear that I have failed them.

The Superiority of American Medicine

Patriots boast that American medicine is the best in the world. My view is more nuanced, but let me take their point of view. You’ll be amazed at the dumb things foreign doctors do!

They don’t give antibiotics for ear infections! 

If a child suffers a painful ear infection, the doctor prescribes an antibiotic. In many European countries, doctors give medicines for pain and fever but no antibiotic. If you’re wondering what happens to these poor European children, the answer is: they get better. Even in America, many experts believe that antibiotics don’t work for ear infections. It will take a lot more than expert opinion to persuade American doctors to avoid antibiotics in ear infections. American doctors love antibiotics as much as American patients.

They don’t care for hysterectomies!

Many women develop lumpy growths on the uterus called fibroids which may cause pain and irregular menstrual bleeding. A gynecologist can cure this by removing the uterus. It’s the second most common operation American women undergo (after caesarians; America leads the world in both).

The French have the odd idea the world would be a better place if there were more Frenchmen, so French doctors don’t sterilize women if they can avoid it. Mostly, they perform an operation that cuts off the fibroids but leaves the uterus intact. The surgery is more complicated and takes longer than a simple hysterectomy. American gynecologists could do the same, but they don’t, and they rarely discuss it with patients because they know American women aren’t interested.

They don’t try to cure every patient.

American doctors order more tests and prescribe more antibiotics, chemotherapy, and other powerful drugs than foreign doctors. They also perform far more surgery. These extras don’t necessarily cure. Sometimes they make patients sicker, but the important thing is that we’re doing something. American like aggressive doctors.

Foreign doctors spend a great deal of time making patients feel better – for example by ordering physical therapy (massage, exercise, heat, baths). American doctors prescribe physical therapy to speed recovery after surgery or injuries. European doctors prescribe it after childbirth and for migraines, irritable bowels, arthritis, fatigue, depression – dozens of problems.

European doctors actually send patients to health spas for baths, massage, etc., and health insurance pays for it! If you believe this is a waste of money, American doctors agree. Patients may feel better after a spa treatment, they explain, but it’s psychosomatic (in other words, if someone feels better -- but it’s only psychosomatic -- that’s not good).

The Evils of Common Sense

Everyone yearns to understand their medical problem. In the absence of evidence, they use common sense which turns out to be a terrible way to get at the truth. It’s a good rule that any common sense explanation of a medical problem is wrong. Here are others that I hear all the time.

“I can walk on it, so I know it’s not broken.”

It turns out that the fibula, one of two bones in the lower leg, doesn’t bear weight. You walk on your tibia.

“I can move it, so I know it’s not broken.” You may know, but I’m not so sure.

“I have to let this run its course…”

Seeing smoke pour out of your car’s exhaust, no one explains that the engine is repairing itself by expelling bad things. Yet plenty of patients believe vomiting or diarrhea is the body’s attempt to cleanse itself. In fact, it’s a malfunction. It’s OK to suppress it although exceptions exist for a few serious diseases.

“Fever is your body’s way of fighting an infection.”

Google “does fever treatment help” for an avalanche of praise for fever's healing properties from doctors and medical sites as well as laymen – a good sign that it’s nonsense.

Here are questions that you might ask.

1. In what specific infections is lowering the fever harmful? I can’t think of any.

2. What infections do doctors treat by giving patients a fever?  The answer is none (doctors tried this about a century ago, but it wasn’t helpful).

3. Every day, across the world, a hundred million people take medicine for fever. How many end up at the doctor who explains that they made the problem worse?