When Stupidity Takes Over

In 2002 I had the satisfying experience of reading a front page story about my leading rival hotel doctor.  The California Medical Board had lifted his license, and he was in serious trouble for providing narcotics to more than one celebrity. You can google it.

Most drug abusers must take to the streets and run risks, but a few are rich enough to pay a doctor to make housecall to give a single shot of whatever they prefer.  A doctor for luxury hotels gets such request regularly (“My back went out, and I have a meeting I can’t miss...”).  If a doctor is quick with the needle, the word gets out.  Calls pour in.  Money pours in.  Most likely the doctor realizes he can charge a good deal more for this service and related services. Stupidity takes over.

Eventually, prescriptions labeled with this doctor’s name are sitting in medicine cabinets, purses, and glove compartments throughout the city. Their owners are fairly careless. This doctor is doomed.

Yearning for a Rare Disease

When I was an intern, a young man came to our emergency room with fever, body aches, and general miseries.  It seemed routine until we noticed a spotty rash on his hand and feet.  Then everyone perked up.  Rash-on-hands-and-feet is a medical puzzle with plenty of answers.  We racked our brains for diseases that qualified.

“Rocky Mountain Spotted Fever,” said an intern.

“It could be secondary syphilis,” said a resident.

“Maybe typhus,” another suggested.

An old professor arrived, looked over the patient, and then turned to us. “Those are all possibilities, but any virus can produce that rash,” he explained. “It’s probably the flu.” Sadly, from our point of view, he was right.

It's the Law!!

Every sick hotel guest should contact his or her family doctor before calling me. The doctor, being familiar with the patient, is more likely to deal with the problem over the phone and prevent an expensive housecall.  

When I suggest this, almost everyone assures me that their doctor is “unavailable,” especially if they’re calling after business hours.

I point out that, if so, their doctor is breaking the law. Every state requires a doctor (or someone covering) to be available at all times. Not being available is called “abandonment,” and it’s illegal. If you write your state medical board, he’ll get into trouble (or at least they’ll contact him; nowadays medical boards respond to complaints).  

Paying for Paramedics

Hotel guests, Americans above all, do not like paying for a housecall. Many, if they are feeling bad, decide to “call an ambulance.”

Paramedics know their business. If the guest requires urgent attention, they’ll take him to a hospital. If not, they might still transport him because they don’t like to take chances. If the situation is clearly not urgent, they’ll tell him to consult a doctor. Sometimes I end up making the visit.

Paramedics are city employees, so their services are free. But for reasons unclear to me, transportation in an ambulance is not free. If paramedics take you to a hospital, the city will send you a bill. Like all medical services in America, the cost will take your breath away.

Dodging Another Bullet

People don’t like to disturb doctors, so a woman with abdominal pain suffered through the night before calling at 6 a.m. I was about eat breakfast, but I would have changed into my suit and arrived in half an hour if she hadn’t told me that the pain was diminishing.

I told her I’d be there in an hour. After breakfast, I drove to the Airport Marriott and knocked. No one answered. I knocked several more times and then confirmed that this was the correct room. I was about to call Security when the door swung open. No one was there.

Looking down, I saw a woman lying flat on her face. She had crawled across the room to open the door. I dragged her to the bed and called the paramedics who took her to the hospital where she underwent emergency surgery for a ruptured ectopic pregnancy. If I’d dawdled over breakfast, she might have bled to death.

Why Americans Don't Eat Horse Meat

Doctors grumble at the popularity of alternative medicine, but the truth is that we still have a monopoly. This is not so in other civilized nations. In France and Germany, for example, herbal medicine is mainstream - i.e. health insurance pays for it.

When Americans get sick, almost all head straight for a medical doctor. From a doctor’s view, that’s the right decision. Scientific medicine works. But that’s not the reason. The idea that scientific explanations are the best has always been a minority view, and recent nutty events haven’t changed matters. In a free election, ghosts would win and evolution lose -- by a landslide.       

Americans mostly prefer medical doctors just as we prefer baseball and big cars. It’s an American thing. We don’t eat horse meat because…well, we don’t.

That Special Drug

Sick people yearn to get better, but hotel guests seem particularly impatient. Many are taking an expensive vacation or business trip, so illness is especially inconvenient.

After hearing how I plan to treat his bronchitis or laryngitis or upset stomach or rash, the guest often expresses gratitude but then makes it clear that this is an urgent situation. Really, really urgent….!

In the guest’s mind, if this plea succeeds, I’ll to say to myself: “Wait a minute…. This is not the usual case. This man needs the special, powerful drug I keep in reserve for deserving patients who absolutely must get better.”

Security

Cheap hotels skimp on security. I park, enter, and wander about at any hour, and no one bothers me. Luxury hotels also make my life easy. Visiting the Beverly Hills Hotel, I park on the street nearby and walk toward the nearest door which remains unlocked even during wee hours. When I press a button on the elevator, it obeys.

In between lies trouble. A Marriott, Hyatt, Hilton, or Holiday Inn has innumerable doors because fire regulations require them. But if I want the door to open, it’s the main entrance or nothing. The elevator requires a room key card before it responds. In the past I waited for a guest to enter, but technology is improving, so that often doesn’t work. 

A desk clerk who decides I’m not a suspicious character will make me a card, but I’ve whiled away many hours waiting for a security officer to escort me to the room, and it may take a firm effort to prevent him from following me inside.

Things Patients Tell Us That Are Almost Never True, Part 2

“It tasted funny….”

Everyone with an upset stomach blames their last meal, and some are right. But the toxins that make you sick quickly (mostly staphylococcal) and the bacteria that made you sick after a few days (salmonella, shigella, campylobacter) have no taste.

“My pressure is up.”

Calls from guests to “check my pressure” arrive regularly. I can’t remember a visit in which high blood pressure was the problem because high blood pressure doesn’t cause symptoms. I won’t mention the symptoms it doesn’t cause because no one believes me.

Things Patients Tell Us That Are Almost Never True, Part 1

“I need something stronger….”

It’s common sense that if a drug isn’t working, the doctor should prescribe a better drug. In fact, the usual reason a drug doesn’t work is that you have a problem a drug won’t solve. Mostly, when hotel guests make this statement, they’re taking an antibiotic for their bronchitis. A week or two has passed, and they’re still coughing. I have to explain that these illnesses last a week or two no matter what medicine you take. Similarly most “pinkeye” doesn’t respond to drops, and doctors still debate whether antibiotics help middle ear infections.     

“I’m allergic to….”

As I wrote on March 23, almost everyone who believes they’re allergic is wrong. Another large group claims that they’re allergic to a drug that upsets their stomach. In fact, this is not an allergy – meaning that it’s never fatal. This is important because you should never take a drug to which you are (genuinely) allergic. If a drug upsets your stomach but an alternative is more expensive or less effective, you might choose to feel sick for a while.

Always Pack a Flashlight

A guest searching for the bathroom at night stubbed his toe. Pain was excruciating.

Vomiting at 2 a.m. is good housecall. Chest pain at 2 a.m. is usually not a housecall. But some decisions when the phone rings at 2 a.m. are tricky.

Nothing about an injured toe is urgent except for the pain. Even if it’s fractured, the only treatment is to splint the toe by taping it to its neighbor.

Having told this to the guest, I hoped that he wouldn’t insist on a housecall. Once in the room, there is no problem, but I often never get there. After half an hour, while I’m still on the freeway, the guest may realize that the pain is tolerable and that he is on the hook for substantial cash (hotel doctors charge more during wee hours).

As often as not, the guest goes back to bed after asking the hotel operator to phone me and cancel. If I’m lucky, the operator makes the call.

Irritating Things that Movie Doctors Do

Give miracle shots. Whenever a movie character is crazy or really upset, a doctor delivers a shot that calms him. I wish I knew what it contained… Movie doctors are always putting characters to sleep, but no shot does that. An anesthetic delivered intravenously makes you unconscious, but that’s dangerous outside an operating room as Michael Jackson’s doctor learned.

Livesaving pills. I see this less often today, but in older movies a character would suddenly be dying. He wouldn’t have “his pills.” Everyone would look frantically for “his pills.” Someone would find them. He would take one and recover. I can’t think what disease does that.

Movie doctors are always saying “You have six months to live.”  We can predict average life expectancy for a fatal disease by tracking a few hundred victims, but that’s meaningless for an individual who could live a week or years.

“Tests show that you have incurable cancer.” Movie doctors who say this are never portrayed as incompetent, although they are. Delivering bad news is a skill no different from diagnosing a heart murmur. A movie buff will explain that the screenwriter can’t spend the time required for a realistic interchange, and I agree on the problem. But here’s the solution: a better writer. A bad writer uses these dumb shortcuts.

“You need plenty of rest and absolute calm.” This is so Victorian…. Bed rest is wildly unhealthy. Bones dissolve. Blood clots. The bowel falls silent. Today patients are dragged out of bed a day or two after major surgery. Doctors once believed that excitement damaged the heart. Intense emotion might cause a heart attack, so people with heart disease should stay calm. We don’t believe that anymore.

The Yearning for Drops

“I’ve been using them for a week, and the eye is getting worse.”

Hearing this over the phone, I’m usually not concerned. While there’s always the possibility of severe disease, the odds are that the eyedrops themselves have begun to irritate the eye.

Sure enough, that was my diagnosis. If you see a doctor with an eye problem, he’ll prescribe drops whether or not you need them. Many types of “pinkeye” don’t require treatment, but doctors believe (correctly) that patients with eye problems take for granted that they need drops.

Most people will not argue with a doctor, but it was clear (in retrospect) that the guest didn’t like what he heard. I told him to stop the drops and that the eye would feel better in a few days.

He was thinking:  “I have pinkeye, but this doctor says I don’t need drops. Obviously that’s because he doesn’t know what drops I need. I have to find a smarter doctor.”

When I phoned the next day I learned that he had gone off to an ophthalmologist.

This happened a long time ago. Nowadays I tell guests to use a harmless over-the-counter drop until the eye feels better.

More Perils of Common Sense

Fifteen years ago, I broke my leg. After I recovered, the doctor ordered a bone scan that revealed osteoporosis. That’s more frequent in women, but anyone skinny and elderly is at risk.

I began taking a drug for osteoporosis. Every year, I had another bone scan. Sometimes it showed a little improvement, sometimes a little deterioration. After ten years of not much change and a few different drugs, I grew discouraged.

“It looks like this isn’t working,” I said.

The doctor could have been honest (“these drugs usually help, but sometimes they don’t; we’re doing our best”) but instead I heard –

“If you hadn’t taken them, you’d be worse.”

That’s common sense. As I write regularly, if you hear common sense from a doctor it means he doesn’t understand what’s going on. 

It’s no different from the famous ad for a quack remedy: “Cures all but the incurable!”

Real Money

Foreign guests take time counting out my fee because all American bills look alike. Around the world, denominations vary by color, so a quick glance reveals their value. I think America is the only nation with monochromatic money.

When guests mention their difficulty, I explain that we consider colored bills frivolous, like Monopoly money. Real money is green.

I Know It's Not Broken...

“I can walk on it, so it’s not broken…” “I can move it, so it’s not broken….”  Never forget that popular health beliefs are generally wrong. I walked on a painful foot for a week before an X-ray that revealed the fracture.

My greatest service to injured hotel guests is not in diagnosing fractures which is usually impossible but saving them the misery of spending hours in an emergency room. Doctors do little for cracked ribs and broken toes except to relieve pain, so X-rays aren’t necessary. All bets are off with the elderly, but it requires a good deal of violence to break a young bone. Lifting a heavy suitcase won’t do it; experts urge doctors in vain not to order spinal x-rays for minor injuries.

Most injuries are not emergencies, even if a bone is fractured. If guests are willing to wait, I can send them to the more civilized atmosphere of an orthopedist’s office.