Cheating

“Could you put my name on the bill?” asked a guest. “I have insurance for this trip, but my girl friend doesn’t.”

“I’m afraid that’s illegal,” I answered. I’m not sure that was true, but it seemed a painless way to decline. The guest didn’t seem offended. From his point of view, there was no harm in trying.

Guests occasionally ask me to cheat on their insurance. A carrier once called to question a charge of several thousand dollars. It turned out the guest had penciled in a zero when he submitted the bill.

People are more likely to cheat if there’s no chance of getting caught. I still remember my anger when, thirty years ago, I witnessed someone put a quarter into a newspaper dispenser, open the cover, pull out a newspaper and then pull out several more to give to friends. These dispensers are stocked by an independent vendor who buys the papers himself. I informed the man who hurried off, less concerned about his thievery than this stranger abusing him.

Irritating Customer Service

As soon as I entered the Hilton lobby, a young man approached.

“I’m the assistant front desk manager” he said. I’ll take you to Mr. Frank’s room.”

“Thanks, but I know how to get there.”

“He’s a VIP. We want to make sure everything goes smoothly.”

We took the elevator to the penthouse. The manager knocked. When the door opened, he announced the doctor’s arrival, waved me inside, and walked off.

It seems a no-brainer that when a hotel provides good customer service it should (a) provide the service and (b)… there is no “b.”

But hotels can’t leave well enough alone. They feel the irresistible urge to (a) provide the service and (b) MAKE SURE THE GUEST KNOWS IT!!!

For example, when I phone a hotel I want to reach my party quickly, but I’m forced to listen to something like, “Good morning. Welcome to the Del Mar, the premier choice for business and pleasure in Southern California. This is Roxanne. How may I serve your every need?” (I’m not making this up).

I’ve never understood why hotels order employees to greet everyone who passes. It’s supposed to be a friendly greeting, but no one can keep up the cheer after greeting a few hundred strangers, so I’m forced to respond to a string of bored salutations as I make my way to a guest’s room. The poor housekeepers (whose English may be limited to “good morning”) don’t look up from their work as I pass but dutifully follow orders.  

The Pantomime

“Ah! El Medico! Buenos dias!”

“Hello. I’m Doctor Oppenheim,”

I entered the room and listened as she explained her problem in Spanish. Most Latin Americans speak enough English to get along; in any case they travel in groups, and there’s usually someone to interpret.

“It sounds like you have a cough. What are your other symptoms?....”

She waved her hand to indicate noncomprehension and continued her recital. She was elderly and alone, a bad sign. Most people hate to stumble along in a foreign language. If I’m patient they often reveal some facility, but this lady stuck to Spanish, performing the usual pantomime, pointing to her throat and head, waving a bottle of medication under my nose.

“How many days have you been sick….?”

Another wave. What to do…. I could call her travel insurer, but interpreting over the phone is tedious. I could phone the front desk. The clerk would cheerfully agree to send up a Spanish-speaking employee, but he or she might not appear for fifteen minutes or half an hour if at all. I looked out the door, hoping to spy a housekeeper but no luck.

My spirits rose when a middle-aged lady arrived, but she merely joined the pantomime, tapping various parts of her companion’s body. Finally, an adolescent girl appeared. She had undoubtedly paid little attention during English class but had no objection to trying her hand. Her English was terrible but good enough for my purposes, and everything worked out. 

Stress Around the World

Experts claim that half of a doctor’s patients suffer stress. You may think this is medical science, but it’s really medical culture. “Stress” is America’s explanation for symptoms without a satisfying explanation. I rarely make the diagnosis, but patients make it for me. If a guest comes down with his fifth cold this year or a stubborn backache or upset stomach, he’ll inform me that he’s been under stress.

Unlike most doctors I see patients from around the world, and it turns out that other nations don’t suffer stress.

Germans suffer low blood pressure. It’s considered a genuine physiological disturbance. German doctors seek it out and treat it, often with drugs. Long ago, I was puzzled when young Germans with fatigue, headaches, indigestion, or flu symptoms wanted their blood pressure checked. Then I learned.

The French don’t have stress or low blood pressure. Perhaps because of the universal consumption of wine, French doctors believe that subtle liver disorders produce many distressing symptoms. 

Constipation was once the great English preoccupation and has not entirely disappeared. This was thought to produce “auto-intoxication” from retained waste that leaked toxins into the body. Many laymen still consider it beneficial to undergo a “colonic,” in which a technician inserts a tube into the anus and washes out all those toxins.

Traditional Chinese healing emphasizes a medicine for every condition. I’m sure you would be insulted (and so would any educated Asian) if I were to suggest that you expect a prescription every time you see us, but many doctors get that impression.

I regularly explain to puzzled Chinese parents why it isn’t necessary to treat every symptom of their sick child. On other occasions, when I explain that an adult’s illness will go away without treatment, I see him exchange a look with his wife that clearly means, “What bad luck! We go on a vacation. I get sick. Then I see this foreign doctor who does not know the proper medicine!”  

A Near Miss

No one came to the door after several knocks.

I had spoken to the guest an hour before and announced my arrival time. Taking for granted that doctors are never early, some guests wander off, but I wasn’t early. This was serious. Unlike the case when a travel insurer sends me, when guests call and vanish, I don’t get paid.

Some guest sleep soundly. I phoned the room; no one answered. I called the concierge to ask her help; before I could interrupt she cheerfully offered to phone the room and hung up. She came back on the line a minute later to announce that, sadly, the guest hadn’t answered, but she would be happy to take a message.

Sticking my business card in the door frame, I returned to the lobby and wandered about. Occasionally, for mysterious reasons, guests decide they must meet me downstairs. I look like a doctor in an old movie with a white beard, suit, and doctor’s bag, but no one took the bait.

I struck gold in the hotel restaurant where a man leapt up from a crowded table and hurried over. He began reciting his symptoms until I suggested we wait for some privacy.

When asked why he wasn’t in his room, he answered that he was hungry but that he had “told the hotel” where I could find him. He pointed to a desk clerk who was busy checking in a family.

Things I Don't Say to Patients

1. Get plenty of rest. 

Rest treats fatigue, but that’s all. I tell patients with minor illnesses to stay in bed only if that’s where they want to be.

2. Watch your diet. 

For minor illnesses, proper nutrition isn’t very helpful. If you have no appetite, forcing food down makes you feel worse without accomplishing anything useful.

3. Drink plenty of liquids. 

There are two problems here.

A.  More water evaporates during a fever, so replacing it is a good idea, but a healthy adult can safely ignore this for a day or two. If the fever lasts longer, a doctor’s first step is not to replace liquids but to find out what’s happening.

B.  Since the dawn of history, people have believed that a sick body is full of toxins. This is common sense (almost always wrong when applied to your health). Nineteenth century doctors prescribed drugs to produce vomiting or diarrhea, and patients knew this worked because they could see the smelly stuff pouring out. We no longer believe in “purges”, but enthusiasts (doctors among them) still believe that urinating expels toxins, so they advise you to drink 6 or 8 or 10 glasses of waters a day.

4. Be sure to take aspirin or Tylenol. 

“But then the fever came back,” patients tell me as if this were bad. In fact, these drugs wear off after a few hours. The fever of common infections won’t harm a healthy person, and aspirin or Tylenol won’t shorten the course of any ailment.  It’s all right to take them to feel better but not essential.

5. Keep warm.  Keep cool. 

We shiver when our tem­perature rises and sweat when it falls. That’s how the body warms up and cools down. Shivering or sweating are not necessarily ominous signs; nor is it good “when the fever breaks.”

Things I Say All the Time

Long experience has taught me that patients love to hear the following.

1.  “This isn’t a serious problem, and it never turns into a serious problem.”

Doctors know that many tiresome ailments such as hemorrhoids, bladder infections, migraine, or herpes don’t turn into something worse, but patients don’t know this. A doctor must tell them. 

2.  “I want you to call me any time.”

Doctors say this all the time, but you know what happens when you try. I show guests my cell phone and promise to answer in person. Naturally, I do this because I’m a compassionate physician, but there’s an element of self-interest. If guests aren’t getting better, I want them to tell me – not the hotel.

3.  “Staying in bed won’t make this go away faster.”

Travelers waste valuable days in a boring hotel room, so I try to take the pressure off. This myth is so universal that when I reassure non-English speaking guests, I ask them what I’ve just said. Almost always, they repeat it back minus the negative.

4.  “You’ll feel under the weather for a few days; then you’ll feel better.”

Guests may suffer for weeks, but once they see a doctor, they want things to move quickly. If I don’t explain that this might not happen, I may hear from them the next day.

5. “It’s not your fault.”

A baleful consequence of the popularity of alternative medical theories is that patients believe they’re responsible for getting sick. Mostly, they’re not.  

Neither Rain Nor Snow

My phone rang as I was driving to the Langham in Pasadena. Coris USA, a travel insurer, had another housecall. Since I was on the freeway, I couldn’t write, so I asked for the address, planning to collect the remaining information from the patient. I hate to be late, so I told the dispatcher I might not arrive for several hours. 

The Langham guest had a sore throat, an uncomplicated visit. I reached the Coris destination, a private house in Hollywood, an hour after the call. The gate in the surrounding fence was locked. The buzzer felt loose in its housing, giving the impression that it was broken. This seemed the case because no one appeared.

What to do… Usually I phone the patient, but I didn’t have a number. I considered phoning Coris, but whoever answered would ask for the patient’s name which I also didn’t have. She might or might not succeed in tracking down the original dispatcher, but it was guaranteed I’d spend a long time on hold in a chilly drizzle.

The railing was my height, and there were footholds. Passerbys certainly wondered at an elderly man in a suit struggling over a fence, but I succeeded without tearing my clothes.

The woman who answered the door denied that anyone wanted me. It turned out this was not a private house but a youth hostel. The woman consulted other residents; one remembered someone who wanted a doctor, but she had left. 

The resident didn’t have her phone number but offered to leave a message on Facebook. I called Coris to warn them that matters were not looking well.

Then the door burst open, revealing the patient, gasping for breath after running several blocks. The visit itself was uncomplicated. 

Three More Great Sins of the Medical Profession

4.  Doctors spend too little time explaining how to relieve stress.

     Probably… Stress makes everything worse but doesn’t cause anything. Seeing a doctor for stress results from what I call the “medicalization of society” - the notion that life’s difficulties (a hateful job, unsatisfying sex life, shyness) represent a medical problem. There’s no harm in this; a good doctor can listen sympathetically and make sensible suggestions which require no medical training.

5.  Doctors don’t pay much attention to diet, rest, exercise, and other natural methods of treating illnesses.

     True and proper. Diet, rest, etc. play an essential part in preventing disease but drop to minor roles once you get sick... A perfect example were tuberculosis sanitariums, the oldest government supported medical program. They began appearing in the nineteenth century. Patients received nutritious food and plenty of rest in a healthy, rural environment.  They were discharged (sometime after years) when their TB became inactive. No one was cured, and many relapsed. When drugs appeared after 1945 sanitariums vanished. Nowadays doctors encourage TB patients to eat a nutritious diet, but they’ll get better even if they don’t – provided they take their drugs.

6.  Doctors ignore alternative and folk medical practices.

     I notice enthusiasts treat folk medicine with respect, but no one advocates folk dentistry...

     In fact, many alternative practices work but less dramatically than advocates claim.  Acupuncture definitely relieves pain. Unfortunately, its action is unpredictable and not always complete. Despite vivid reports, Chinese surgeons rarely use it in place of anesthesia... Chiropractic manipulation relieves some backaches for a limited time.

     The better 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. Appendicitis is fatal; 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. Today no one searches for an alternative treatment of appendicitis. 

     On the other hand, doctors don’t do so well treating obesity, arthritis, aging, or senility. So if you want to find an alternative remedy that doctors have stupidly ignored, you’ll find plenty.  Good luck with them.

Three Great Sins of the Medical Profession

We’re guilty of them all, but there are extenuating circumstances.

1.  Doctors give treatments that relieve symptoms but don’t cure the underlying problem.

     Sometimes this is the best we can do.  The cure for severe menstrual cramps is menopause, hysterectomy, or pregnancy.  Drugs only relieve the pain, but patients appreciate them.  No doctor cures migraine, asthma, emphysema, osteoporosis, or the flu, but we relieve a great deal of misery.

2.  Doctors order too many tests and prescribe too many drugs.

     Correct, but partly we’re responding to pressure. Most patients with a painful injury assume they need an X-ray, but they don’t.  Those with a high fever, sore throat, swollen glands, cough, or clogged sinuses assume they need an antibiotic, but they usually don’t.  Doctors hate to disappoint patients, so they lean over backwards to “do” something like order a test or prescribe.

3.  Doctors order too few tests and prescribe too few drugs.

     We can’t win.  Some clinics, hospitals, and insurance plans restrict tests and drugs doctors can order.  This infuriates doctors as well as patients, but the sad fact is that experts set up these guidelines to discourage needless tests and wrong or unnecessarily expensive drugs. Mostly, guidelines fail. Even the guilty doctors agree that we do too much.

I’ll reveal three more sins next time.

Taking Things Out of an Ear

Cleaning his ear, a guest removed the Q-tip and discovered that the cotton tip had disappeared.

Extracting objects from an ear is a satisfying experience everyone involved. Over thirty years, I’ve removed ten cotton balls and one bug.

Mostly, of course, I remove wax. I’ve done this 110 times. Using a sharp curette, one can scoop it out in seconds. Ear-nose-threat specialists use a curette, but I don’t have the nerve, having seen bloody results from attempts by other GPs. I use a large syringe.

All hotel rooms have an ice bucket. I fill it with warm water and set it on the bathroom sink. Warned they are about to get wet, guests remove expensive clothing, drape a towel over their shoulders, and lean over. After filling the syringe, I pull the ear back, rest the tip just inside the opening, and squirt. Most impactions require a dozen attempts or less. A few specks flowing out herald the great moment, and the plug itself may pause coyly at the opening.

“Get ready for the big show!” I announce before delivering the final spray. Guest invariably recoil with horror as a soggy brown lump, often the size of a kidney bean, flies into the sink.

Sometimes I pay a heavy price. Guests who work hard with a Q-tip (a device designed for pushing wax) confront me with a solid wall of material resting deep inside. Time passes as I refill the bucket and work the syringe. Water drips from the guest. My thumb aches from pushing the plunger. At intervals I stop, either because the guest begs for a rest or to peer inside with my otoscope to check the waxy wall, now glistening but stubbornly immobile. I often joke that when doctors die and go to Hell, they receive a syringe and a patient with an ear sealed with concrete.

During training, doctors learn a rule for procedures that aren’t working (difficult spinal taps, searches for slivers): keep trying. So I persevere, ignoring my throbbing thumb. On two visits, I stopped at the guest’s request. All other ear washes succeeded although a few exceeded fifteen minutes.

Taking Things Out of an Eye

Few actions bring a hotel doctor more pleasure than removing something from a guest’s eye. Patients have kissed my feet in gratitude.

It’s easy. With one hand, I lay a Q-tip horizontally across the upper lid. With two fingers of the other hand, I grasp the eyelashes and fold the lid back over the Q-tip, exposing its underside. That’s usually where a speck lies. Experts warn never to try to remove something on the eyeball itself, but I’ve never encountered this. 

This agreeable experience doesn’t happen often: thirteen times according to my records. Mostly, guests who think they have something in their eye are suffering a corneal abrasion. This was the case fifty-four times.

The cornea is extremely sensitive; injuries produce intense discomfort, but minor ones heal in a day or two. I prescribed antibiotic drops and an oral pain remedy. Patients yearn for the anesthetic drops I use during the examination, but they damage the eye when used regularly. No doctor should prescribe them.

The Same Thing

“My wife had strep last week. Now I have the same thing.”

I receive one “same thing” phone call per week. Naturally, guests hope I’ll agree.

This is not the traditional warning against self-diagnosis, because the guests are usually right. If necessary, I’m happy to phone a pharmacy with the appropriate prescription.

Everyone with an upset stomach suspects food poisoning. If your dinner companions are also sick, it’s a possibility, but if you’re the only one, you probably suffer the common stomach virus which makes you miserable for a day or two. Most guests with vomiting or diarrhea don’t want to travel to a pharmacy. For those willing, I sometimes provide symptomatic remedies. Sadly, in the US no common intestinal infection is curable with antibiotics.

Other illnesses are tricky, but a young woman who’s had several bladder infections knows when she has another. This is perhaps the only infection where it’s acceptable to prescribe an antibiotic over the phone.

Inevitably, respiratory infections produce the most “same thing” calls. These are stressful calls because many guests proceed to tell me what they need, and they’re wrong.

As I repeat with boring regularity, many doctors, perhaps a majority, prescribe useless antibiotics for viral respiratory infections. That includes yours. That doesn’t mean you have a bad doctor; prescribing useless antibiotics is so common that competent doctors do it.

When, after hearing the symptoms, I explain that this doesn’t describe anything that antibiotics cure, guests assume there will be no antibiotic unless I make a housecall and collect a fat fee. In fact, I do everything possible to avoid a housecall because not giving an antibiotic guarantees an unhappy patient. If I yield to his entreaties, I hate myself.

A Doctor's Routine

“Under your tongue… under your tongue… close your mouth… don’t bite!”

Seeing a thermometer, the guest had unbuttoned his shirt and lifted his arm. Over much of the world, doctors take a temperature in the armpit. It’s often a struggle to make them understand.

Once the thermometer is in place, I announce that I will wash my hands. This produces minor panic, and someone rushes to the bathroom to tidy up. After returning and announcing the temperature, I sometimes take the blood pressure. It’s not useful for most ailments, but patients, especially the elderly, often expect it.

After the examination, I announce the diagnosis and hand over an appropriate medicine. Then I give advice. You probably think it differs from patient to patient, but this is only partly true. I give several bits of advice regularly. These include:

“Rest doesn’t make this go away any quicker.”

Despite the universal belief, this is true for almost every illness, and it’s miserable to be confined to a hotel room during a vacation. I encourage sick guests to get out.

“You’ll feel bad for a few days, and then you’ll feel better.”

Once a doctor performs his magic, patients often expect immediate results. I receive plenty of calls the next day from guests wondering why they’re still sick.

“If you call, I answer in person.”

I demonstrate by holding up my cell phone. Of course, your doctor also encourages you to call, but have you tried? You reach voicemail or, if you’re lucky, a receptionist, and then you leave a message and wait. I want to spare patients this hassle. But I also don’t want them to call the hotel to let them know they’re not feeling better.

Jumping to Conclusions

Midafternoon is a slow time, so I take a history class at UCLA, and I’m rarely disturbed. But my phone buzzed.

“This is International Assistance about the patient you saw today. She has begun to vomit and wants another visit.”

That morning I had given ibuprofen to a woman with a headache. She was in Hollywood, a tedious eight mile drive through city streets with the rush hour beginning. After twenty minutes of stop-and-go, a sense of unease grew. Ibuprofen shouldn’t cause such a violent reaction. Then I remembered that the Hollywood patient was not from International Assistance but World Assistance.

International Assistance had called the previous night at 1 a.m. and sent me to the Airport Hilton for a guest suffering a backache. I’d given an injection and left strong pain pills for later. I checked caller ID on my cell phone and, sure enough, I’d jumped to the wrong conclusion.

The Hilton was in the opposite direction. It took another twenty minutes to reach the freeway and join the rush hour creep. 

I Don't Like Coughing

“I’ve been hacking up stuff for a couple days, and it’s turning green.”

“It sounds like the virus that’s going around,” I said. “It’ll last three or four or five or six more days. Medical science doesn’t do anything dramatic.”

“At home I’d tough it out. But I have meetings all week, and I need something to knock it out. When can you get here?”

If you read this blog you know my heart sinks when I hear “I need something to knock it out….” It guarantees an unsatisfying visit. Either the guest will feel resentful if he doesn’t get an antibiotic, or I’ll give an antibiotic (if it seems like he’ll blow his top, and sometimes I’m too slow), and I’ll leave hating myself.

Now, readers, you’re probably thinking: “Yes, isn’t it disgraceful that doctors give useless antibiotics so often that patients expect them. But sometimes you need an antibiotic. How can you tell?...”  The answer is so surprising that you and your doctor may not believe it. In an otherwise healthy person (infants and the elderly excepted) the only common disease with a cough that antibiotics cure is pneumonia. Everything else is a virus. ..in my opinion (my lawyer insisted I add that).

I Like Vomiting

A businessman at the Standard had been throwing up since the wee hours. I assured him I’d arrive within the hour. It was nine a.m., so the usual half-hour drive downtown might last longer.

Before leaving, from my medication closet I extracted a syringe, a packet of antinausea pills, and an antivomiting suppository and dropped them into my pocket. This enabled me to avoid restocking my bag after returning home. Sometimes I forget.

The drive was tolerable. The guest was miserable, but he hadn’t vomited in two hours, so I suspected he was over the worst. I left feeling good. I like vomiting.

People chuckle to hear this, but in an otherwise healthy person, most episodes don’t last long, rarely more than a day. My medicines help symptoms but don’t speed recovery. When guests feel better, often by the time the medicine wears off, they believe I've cured them. He felt better by evening.

A Stressful Life

I’m running low on ondansetron, the best antinausea pill.

Unfortunately, I’m not low on many other supplies. I buy through an internet pharmaceutical company that charges a fat handling fee for orders under $200. Eight bottles of ondansetron, 240 pills, will cost $25. I could use more tongue depressors, but 500 at $5.24 is not much help. I dispense large quantities of  cough medicine and lidocaine gargle for sore throats, but those cost only a few dollars a piece. My bottle of 500 Amoxicillin capsules ($28) is half empty; stocking up would help but medicines have expiration dates, so one must be careful.

A few years ago, after thirty years of use, my blood pressure cuff broke, but I had a spare. Should I buy another? Will I be practicing when I’m 108?....

One of my boasts is that, unlike other hotel doctors, the fee I announce is the fee I collect. I don’t charge extra for anything. It turns out that pills, injectables, and supplies for common ailments are so cheap that I struggle to assemble an order exceeding $200. Life is tough.

Dealing With Buenos Aires

“Can you make a visit to Palo Alto?”

“That’s four hundred miles away!”

“How much would you charge?”

“I’m in Los Angeles. Do you understand?”

“Yes. How much would you charge?”

In fact, she didn’t understand. To save money, many travel insurers have closed their US offices, so this call originated from the patient’s home country. Inevitably, dispatchers in Buenos Aires don’t speak English as well as their former colleagues in Miami. I carefully explained that the distance made a visit impossible.

Unlike American travel insurers who require clients to pay up front and submit a claim, South American insurers send a doctor and pay me directly. I’ve made over two thousand visits for them. They’re among my favorites because patients who don’t pay directly are less demanding. Also, these insurers send me to hotels that don’t call or, even better, to my competitor’s hotels. A downside is that, if I don’t listen carefully, they send me to the wrong address. In Spanish “v” and “b” have identical sounds; so do “y” and “ll.”  

Then there was the time an insurer called at midnight.

“Can you make a visit to Culver City tomorrow?”

“Yes… But why did you call so late?”

“Because it says on your profile that you are available 24 hours.”

Traffic

Bending over, a guest at the Georgian felt stabbing pain in his back. He could barely move.

Acute back pain usually doesn’t last long, so, over the phone, I assured him that he would be disabled for a day and then gradually improve. I was not anxious to make this visit because it was 4 p.m. I would be driving to Santa Monica and back during the rush hour, a tedious experience. But he wanted a visit.

It was a tedious drive, not improved by the sight of immobile traffic on the opposite side of the freeway. The guest answered the door himself, always a good sign in someone with back pain. I examined him, repeated what I had said over the phone, and handed over pain medication; it was an easy visit.

Returning, I settled into the rear of a nearly motionless stream of cars. I was in no hurry; it was suppertime, but I wasn’t hungry. After ten minutes, my phone rang. A guest at the Crowne Plaza in Beverly Hills asked for a doctor. His wife was vomiting.

I often delay visits, but people who are vomiting hate to wait. This would normally be a quick drive because the Crowne Plaza was only five miles away, and I was headed in that direction. But it was the rush hour. I left the freeway and crept for thirty minutes along Pico Boulevard to the hotel. The visit went well, and the drive home was tolerable.

Going to Disneyland

A child at the Disneyland Hotel had a fever. Disneyland is forty miles away, but the call arrived Sunday morning. Freeway traffic was light; a perfect time for a long drive.

It was nearly noon when I greeted the parents and three other children. Being stuck in a hotel room with a sick child was not part of their plans, so all looked depressed. The child had a fever and cold symptoms but did not seem ill. I explained that children catch half a dozen viral infections every year; they last from a few days to a week or two; one can treat the symptoms, but there is no cure. Rest does not help.

“You mean we can go to Disneyland?” asked the father.

“Saying in bed doesn’t make it go away quicker.”

The family erupted in cheers and followed me out the door.   

A Delightful Bonus

The patient was a Brazilian two-year old who may or may not have had ear pain. Infants love everyone, and older toddlers are usually frightened enough to hold still, but from one to three years of age, children who don’t like doctors are uncontrollable. Taking a temperature in the armpit required the parents to hold her down. I dreaded the ear exam.

There was a knock on the door, and an elderly gentleman entered. This was the child’s grandfather, I learned as we shook hands, and he was a pediatrician. Immediately I held out my otoscope which he accepted with thanks. 

The entire family piled on; the child screamed and fought as the grandfather looked in her ears and forced open her mouth to examine her throat. He spoke little English but made it clear that nothing abnormal had turned up. He delivered an elaborate explanation to the family in Portuguese. I handed over a bottle of Tylenol, and everyone was happy.