D as in "Dog"

A travel insurer sent me to Koreatown, an older area of Los Angeles, home to a mixture of Koreans and Hispanics. It’s a colorful neighborhood, and like all colorful neighborhoods, parking is a chore. I found a spot several blocks away from the apartment.

Travel insurance patients are subletting or visiting friends, so searching the directory near the locked entrance never reveals their name. Phoning her number, I heard a voicemail message. That was not bad news because insurance services pay for no-shows, but I had to make an effort. I phoned the agency to explain. The dispatcher urged me to wait while she tried to contact the client. I waited. After five minutes, a resident entered the building; I followed and knocked on apartment 1D. The lady who answered denied that anyone needed a doctor.

After another ten minutes, I decided I’d done my duty and returned to my car. My phone rang as I arrived.

The client was taking a shower, said the dispatcher. She was now ready to receive me. I recounted my experience at apartment 1D, but 1B turned out to be the correct number. In my defense, during the original call I confirmed that the patient was in 1D as in “dog.” But English was not the first language for both guest and dispatcher.

A Light at the End of the Tunnel

I’ve been warning that this blog may vanish on January 15 when my E-mail provider, Physicians On-Line, goes out of business. Google could make it easy for bloggers to change their primary E-mail, but it turns out to be nearly impossible. However, Google does allow us to invite another person to join the blog and share all contributing and editing privileges.

So I sent an invitation to myself which I accepted. Google apparently has no objection to two Mike Oppenheim’s hosting a blog, identical in all areas except E-mail. I keep my fingers crossed that one will remain after the 15th.  

Warning: This Blog May Vanish

I suspect this blog will disappear on January 15, 2013. That’s when Medscape shuts down its E-mail which I’ve been using since the 1990s. At first, I assumed this would be no problem. I would log on using my other E-mail addresses, but they don’t work.

Innocently, I went to a Google forum to ask how to transfer the blog to another E-mail. Almost immediately a responder explained that I must use the permissions wizard – “carefully.” My heart sank as I read an entire page of instructions, links, and warnings plus the suggestion that it works best using two computers and two browsers. I didn’t understand.

My current plan is to recreate the blog which will probably require a different name, so keep your eyes peeled.

Bad Credit Cards

A member of an Argentine soccer team fell while roller staking, wrenching his ankle.  A doctor from their travel insurer in Buenos Aires determined that he needed an orthopedist but that this could wait until office hours the following day. However, the doctor wanted someone to examine him that evening, so my phone rang.

The team was staying in Long Beach, 35 miles away, but the rush-hour had passed, and the agency did not object to the extra fee. This was International Assistance. I’ve made 896 of its visits, but after an ownership change, it became extremely slow to pay. Losing patience, I insisted it give me a credit card number, so I could pay myself. This is always a critical request, because some agencies refuse and disappear from my radar. But International Assistance agreed.

As soon as I hung up, I remembered that IA’s current credit card had expired in August. When I called back, the dispatcher put me on hold to consult her superior. After a few minutes, she returned with a new number.

I phoned the credit card company and entered my identification and the credit card number only to hear the computer declare: “Do not honor! Do not honor!” I phoned IA again, awaited the consultation, and received another card. “Do not honor!” intoned the computer a second time.

“Invalid credit card number” I heard on my third attempt. This turned out to be my mistake; in my increasing frustration, I made an error entering her third number. After correcting it, I heard the satisfying: “Approved” following by a confirmation number. Insurance agencies often give me bad credit cards. I suspect their business is as competitive as mine, so many are in perilous financial condition.

My patient was reclining on a couch, an ice pack on his ankle, his teammates gathered around. The ankle was massively swollen, and he was in pain. Waiting would not have caused permanent harm, but people with painful injuries deserve quick attention.

Fortunately, IA is an agency that takes my advice even when it costs money, so his companions took him to an emergency room to deal with fractures of both leg bones. 

Adventures in Parking

In parts of Los Angeles, especially downtown and the Sunset Strip, street parking is impossible. I dislike turning my car over to an attendant because it can take fifteen minutes to retrieve it from the parking garage. Also, although it’s irrational, I’m willing to pay $15 for a movie or book but not for twenty minutes of parking. I try to leave my car near the entrance, a small area where only VIPs are permitted. When the attendant doesn’t recognize me (“Welcome to the Biltmore; are you checking in?...”), I do not accept the voucher he holds out, explaining “I’m the hotel doctor visiting a sick guest. They let me park.” This sometimes works, but if he insists, I take it. Sometimes the hotel will validate, but it’s unpredictable.

Searching for a spot on the street, I follow the position of the sun as closely as a sailor because I must park in shade. I keep extra supplies in the car, and an hour in blazing sun will melt my pills and ruin batteries. I don’t mind walking a few blocks if I find free street parking (and I know all the secret places), but since I wear a suit and tie, hot weather discourages this. Rain does the same because carrying an umbrella is awkward in addition to my doctor bag and clipboard.

One advantage of wee-hour calls is that parking restrictions vanish and valets grow somnolent or disappear entirely. I’ve never felt in danger, but downtown parking remains problematic because homeless men invariably rush up and offer to watch my car.

My most upsetting parking experience occurred during a visit to the Ramada in Culver City at 4 a.m. I left my car at the deserted entrance, cared for the guest, and returned to find a parking ticket on my windshield. The hotel’s driveway was private property, so ticketing a car requires phoning the police. Looking around the lobby I noticed a security officer looking innocently away. There was nothing to be done.

Why I Am a Patriot

Hot summer days remind me of why I love America. We appreciate air conditioning. Citizens of most other nations consider it unhealthy. They tolerate it as an exotic American quirk, but as soon as someone in the party falls ill, the air conditioning goes off.

Wearing a suit and tie, I conduct my business in suffocatingly hot hotel rooms. When I extol the benefits of machine-cooled air to foreigners, they listen politely with an expression identical to that of Americans hearing me explain that antibiotics will not cure their bronchitis.

Satisfying and Unsatisfying Problems

A guest interrupted my questioning to dash into the bathroom, and I heard the sounds of gagging as she vomited.

While waiting, I took a vial of ondansetron from my bag and began filling a syringe. After a few minutes I heard the toilet flush.

“Why don’t I give the vomiting injection now?” I said when she reappeared. “You’ll probably want one.” She agreed with enthusiasm.

I finished my exam, made a diagnosis – the common stomach virus – and delivered advice and a packet of pills. I also went to the ice machine down the corridor and filled her ice bucket, so that she could suck on the chips for the next few hours. She was very grateful and equally grateful the following morning when I phoned to learn she had recovered. Most stomach viruses don’t last long, a day or so.

Vomiting and diarrhea are usually satisfying problems for a doctor. Most skin problems are easy. I rarely have a problem with earaches, backaches, minor injuries, common eye inflammations, even most urinary and gynecological complaints. A hotel doctor’s patients are healthier than average, but serious problems occur. It turns out that these are not necessarily “hard.” When I encounter someone with chest pain, eye pain, sudden weakness, difficulty breathing, or an injury that may be serious I know what to do. At the end patients receive the care they should receive, and we both know it. That’s a satisfying feeling.

What is the most unsatisfying problem a doctor faces? Rare diseases? Puzzling symptoms? Neurotics? Drug addiction? None of these. Most doctors would agree that it’s the common viral upper respiratory infection. About twenty percent of everyone who consults a doctor suffers. Hotel guests are no exception. No one tries to educate me about heart attacks, but everyone is an expert on these. Patients tell me how they acquired theirs (“I got caught in the rain”), or why (“I’m not eating right; my resistance is low”), the proper treatment (“my doctor gives me a Z-pak”), and what will happen if I disagree (“It’ll go to my chest”). These explanations are always wrong.

You catch a virus from another person. The illness lasts from a few days to a few weeks. If you see a doctor, he or she will prescribe an antibiotic at least half the time. The antibiotic is useless. Doctors know this but prescribe them anyway.

No patient agrees. “I have a good doctor,” they reply. “He would never do that.”

My response is that prescribing useless antibiotics is not necessarily a sign of incompetence. It’s so common that good doctors do it. One expert calls this avalanche of unnecessary antibiotics one of our greatest environmental pollutants. It’s producing a growing race of “superbugs:” germs resistant to all antibiotics.

Here’s a professional secret. When doctors chat among themselves, we often bring up the subject. Challenged by colleagues like me, prescribers never claim that antibiotics cure these infections. They know they’re a placebo, but they respond with a powerful argument. “When I’m finished, I want patients to be happy, and they are happy. One hundred percent. What’s your experience?”

It’s not as good. When I deliver sympathy, advice, and perhaps a cough remedy to patients with a respiratory infection, most seem genuinely grateful, but a solid minority drop hints (“Isn’t there something to knock this out….?” “My regular doctor gives me…..” “I have a meeting tomorrow, and I can’t be sick…”).

Doctors love helping patients. That’s why we went into medicine. Equally important, we want you to feel “helped,” and we are super-sensitive to your gratitude. Almost everyone is too polite to argue with a doctor, but we can detect the tiniest trace of disappointment as you leave. It hurts us. Every doctor knows that he can eliminate this pain and produce heartfelt gratitude by prescribing an antibiotic. This is terribly tempting, and after a few dozen or few hundred or few thousand disappointed patients, most doctors give in.