Various Way in Which I Didn't Get Paid -- Part 3

Four times I arrived to discover another doctor in the room. The hotel had summoned another doctor. After waiting a few hours, the guest complained, so the hotel summoned me without mentioning the other call.

Eighteen guests gave me a bad check. Almost all were single males, and these occurred before I accepted credit cards. While everyone I managed to contact expressed surprise and promised to correct matters, this was not always a lie. In six other cases, guests sent a second, good check.

I mailed a refund to three guests on Medicare. Early in my career, I simply informed elderly American guests that I was not a Medicare doctor. Most assured me that was no problem, but it turned out many believed I meant only that I didn’t bill Medicare myself. When Medicare rejected their bill, they were outraged. Since then I explain in more detail that they can collect nothing from Medicare or any Medicare supplement insurance. Some agree to a visit; others accept my directions to an urgent care clinic.

I also reimbursed a guest who was unhappy to hear that an antibiotic would not help his flu. He went to an urgent care clinic later that day, received the traditional antibiotic, and felt better as soon as he swallowed the first pill. The hotel manager who passed on his complaint expressed sympathy, but I felt it best to make a refund.

Various Way in Which I Didn't Get Paid -- Part 2

Over the past thirty years, twenty-four guests cancelled. I don’t count those that arrive before I leave the house, so all occurred while I was on my way. To this I must add eighteen no-shows: guests who weren’t in the room when I knocked. This always annoys me because I tell guests when I’ll arrive. In my younger, passive-aggressive days, I would phone later. Guests would swear they had told the hotel and express outrage that the employee had failed to pass on the message. After hearing the same excuse every time, I stopped calling.

Fifty database files appeared under “No Pay,” meaning I wanted to collect but couldn’t. A minority were blunt refusals from guests who never intended to pay; a dozen were clearly mentally ill. Four guests had called the paramedics before I arrived, and they were already on the scene.

“No way!... Take it up with the manager” caused trouble until I saw the light. Hotels often pay if guests are injured on the premises, find bugs in the room, or believe they’re poisoned by hotel food. Unfortunately, sometimes the hotel refuses, and it’s a bad idea to argue. After leaving unpaid several times, I learned to stay alert during the initial phone call for situations when guests blame the hotel. If so, I tell them to discuss matters with management before I leave the house.

Various Way in Which I Didn't Get Paid -- Part 1

In my database of over 16,000 visits, entering zero for my fee and searching turns up 789 files, but this includes 529 when colleagues covered. That leaves over 200 where I collected nothing.

On nearly 100 occasions, this was my decision. 50 patients were hotel employees whom I don’t charge even if they’re willing to pay. Most can’t afford the fee, and I’m happy at the thought that they’ll tell their co-workers about the experience.

In 19 cases, I arrived and realized immediately that the guest needed a referral, either to a specialist or an emergency room. I try to detect these during the phone call before the visit, because I feel guilty accepting a fee and then sending the guest off to pay a second fee. In four additional cases, I had decided to call the paramedics, and I remained in the room until they arrived. Naturally, these were distressing events. Everyone was preoccupied, and I felt inhibited about mentioning my fee. In other cases, the guest or his companions remembered, but these were the times they didn’t.

Poor people rarely stay in hotels, but a few cheap motels and youth hostels have my number, and college-age travelers often arrive in the US without health insurance. As a result, I sometime trim my fee and occasionally charge nothing if they come to my home. I’ve done that a few dozen times.

One guest was dead when I arrived. I didn't collect from his wife.

Why I Love Arabs

Examining a Danish hotel guest last month, I became uncomfortably aware of sweat dripping down my back. I hadn’t experienced this since the previous autumn.

Summer doesn’t arrive in Los Angeles until mid-June, and it was an average day with temperatures in the 80s. The hotel lobby and corridors felt comfortable, but a wave of hot air greeted me as the guest opened his door.

Entering, I recalled why I like Arabs so much. They appreciate air conditioning as much as Americans. Citizens of all other nations believe it spreads disease. They tolerate it as one of the perils of foreign travel, but when someone falls ill, the air conditioning stays off. Hip young hotel doctors dress in shirtsleeves, but hipness is a distant memory for me, so I wear a suit and tie. During a long summer visit, it’s debatable if I or the patient is suffering more.

I always explain that the machine that cools air in an air conditioner is identical to that in your refrigerator, and no one worries about disease from refrigerator air. This convinces no one, college graduates included.

The room stood at the end of the hall, the largest suite on the floor. Through the half-open door I smelled alcohol and cigarette smoke, never a good sign. At my knock a voice urged me to enter. The room was empty, but this was the sitting room. A doorway led to the bedroom containing 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. He was Prince Abdul-Aziz from Saudi Arabia. Arabian princes are more common than you’d think.

“I have pain,” he announced.

“Where is the pain, Mr. Aziz?”

“Kidney. I have kidney stones in my kidney.” He threw the covers to one side and pointed to his right flank. “My doctor prescribes Dihydrolex.”

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

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

“Do you need a prescription?”

“Yes, but also a shot.”

I examined the prince’s abdomen and tested his urine for blood. Both exams were normal but this can happen with a stone. I thumped his back in the kidney area, and he groaned.

“I’ll give you a Toradol injection, but if the pain comes back, you’ll have to go where they can do some tests.”

“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 his gluteus the consistency of a block of wood. I forced the syringe down a further inch and delivered the injection. Anticipating the pleasures ahead, the prince whirled to thank me, clasping my hand in gratitude.

“Remember what I said if the pain returns…” I repeated. “Should I ask the hotel to pay and put it on your bill?”

“No, no no. I pay!” Keeping a grip on my hand, he yanked open the drawer of the bedside table which turned out to be stuffed with hundred dollar bills. He snatched a handful and held them out.

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

The following day a rival hotel doctor phoned. “The Nikko wants me to see a guest,” he said. “Apparently you saw him yesterday, but you don’t want to see him again. Naturally I’m curious to know why.”

“I’m pretty sure he’s a drug abuser.”

“They said he was difficult. Is there any reason for me to see him?”

“He’s a big tipper.”

A guest at a Beverly Hills hotel was sitting in the hotel restaurant when her chair collapsed. Unfortunately, her hand was resting underneath. The desk clerk asked if I could come immediately.

During my early years, I often hurried over, took care of the problem, and presented my bill only to have the guest insist that the hotel was responsible. Management sometimes disagreed, leaving me unpaid, so I quickly learned to settle matters over the phone.

“Who’s responsible for the bill?” I asked. “If it’s the guest, I have to talk to her.”

The clerk hadn’t thought of this, so she put me on hold, returning to announce that the hotel would take care of it. This would be my 139th medicolegal visit, my name for a housecall when the hotel pays. The majority involve minor injuries that occur on the premises. There were also thirteen upset stomachs, purportedly from hotel food, and nine insect bites, always bedbugs according to the guest.

I arrived at the restaurant to greet a pleasant young Englishwoman, her hand in a bowl of ice. My examination revealed a torn and bloody middle fingernail but no laceration that required suturing. I explained that her nail might fall off but that another would grow. Unfortunately her ring finger, while not bloody, was exquisitely painful. She needed an x-ray.

If there were a fracture, an emergency room or perhaps even a family doctor would refer her to an orthopedist, so I decided to send her directly. If someone needs a referral, I want to make sure that they go, so I make the appointment myself. I didn’t know anyone locally, so I found an orthopedic group on the internet and phoned. When the receptionist asked about insurance, I said she would be a cash patient, a rare phenomenon even in Beverly Hills.

“An initial visit is $500,” the receptionist said. “She should have it when she comes in.”

“Wow!” said the patient when I passed this on. This was probably not a comment on the size of the fee (which the hotel would pay) but the traditional European amazement-cum-horror at American doctors’ preoccupation with money.

Both fingertips were fractured, she announced over the phone the next day before asking how long the pain would last. I sympathized; fingers are sensitive. She should apply ice and take ibuprofen and see her doctor in a few days. She planned to fly home.