You Must See "The Dallas Buyer's Club"

Everyone agrees it’s one 2013’s outstanding films. On Rotten Tomato’s site, a spectacular 42 of 42 reviewers approve. Matthew McConaughey delivers an Oscar-winning performance as a homophobic Texas good-old-boy who learns that he has AIDS in 1985.

Defying his doctor, who announces that he has thirty days to live and that no treatment exists, he pulls himself together, searches for treatments in places beyond the influence of the medical establishment (Mexico, for instance), smuggles them into the USA, and distributes them to AIDS victims despite government persecution.

Although I recommend The Dallas Buyer’s Club, I left halfway through. I couldn’t bear it because it contains every dumb Hollywood cliché about physicians and science.

Every doctor is a jerk except (a) the beautiful young woman doctor who finds Matthew McConaughey cool and (b) the seedy, unshaven doctor whom McConaughey stumbles upon running a Mexican clinic. After announcing that he has lost his US license (undoubtedly for being too compassionate), this doctor explains that his regimen of vitamins and immune boosters will help.

I am not one of those tiresome people who insist that movies stick to facts. History is boring and complicated. American movies must tell a coherent story with an upbeat ending and an admirable hero (Matthew McConaughey has flaws, but they are cute flaws: he is oversexed, a spendthrift, rude, and he lies – but only to bad people).

At that time, a hundred Mexican clinics sold AIDS treatments. None worked. Everyone who took them died. No American audience would accept Matthew McConaughey passing out fake drugs, so the screenwriters tweak the historical facts. In the movie, the drugs work.

I’m puzzled why conservatives denounce Hollywood for turning out liberal propaganda. The Dallas Buyer’s Club is a Tea Party dream. The government is a heartless oppressor. That includes the FDA which the writers confuse with the FBI because they create a menacing agent who threatens to arrest Matthew McConaughey. This FBI… I mean FDA agent never says “Your drugs don’t work!” He says “Your drugs are not FDA approved!” which, since he’s a villain, means they do work.  

Let me know how it turns out.

A Week's Vacation

Returning from a week’s vacation, I took my phone off call-forwarding. Knowing that I keep detailed records, the colleague who covered E-mailed me the information I needed.

Seven hotels phoned; he made four housecalls and took care of three over the phone.

Universal Assistance, a travel insurer, called once. He asked for their credit card number which they gave, and he made the visit.

World Aid, another travel insurer, called twice but refused to give a credit card, so he refused the calls. I fax my invoices to World Aid which usually pays in a month or two. When they don’t, I phone to remind them. Many hotel doctors hate pestering agencies for payment, so they insist on a credit card.

International Assistance called three times, and he declined as soon as they identified themselves. IA still owes him for visits in years past. International Assistance has a poisonous reputation among hotel doctors because it often took six months to pay when it paid at all. Institutions such as clinics and hospitals can deal with this (state-run Medicaid programs are not much better), but individuals soon give up.

Ironically, my patience with IA has been rewarded. After the latest change of ownership a year ago, it got its act together. It now pays reliably every month and provides a great deal of business, but a long time will pass before it lives down its reputation among my colleagues.

Inn-House Doctors called five times, and he made two visits: one to Hollywood and one to the airport area. A national housecall service, Inn-House serves a few hotels and travel insurers but many airline flight crew. In their eternal search for better hotel rates, airlines have been boarding crew further and further from Los Angeles airport which is twenty miles from my colleague’s home. He declined two visits to Long Beach (45 miles) and one to Anaheim (60 miles).

More Humor

"Can you go to Pasadena?” asked a dispatcher from Expressdoc, a housecall service. I could.

“Bloating and nausea,” was the reply when I asked for the patient’s symptoms. Once I arrived at the Pasadena Hilton, I learned that, besides bloating and nausea, the guest was suffering hot and cold flashes, difficulty breathing, dizziness, and blurred vision.

My diagnosis was an anxiety attack. She agreed that this was reasonable. She remembered similar episodes.

“I don’t have more stress than most people, but obviously I’m not handling it well. Why is this happening?”

“Because no one is perfect.”

She laughed, but I believe this. I explained that an anxiety attack is a tiresome body malfunction like a backache or allergy. You suffer, deal with it, and feel better, but it’s likely to recur. Almost everyone believes that stress causes anxiety. When it becomes chronic, victims undergo psychotherapy which sometimes works. I treat it as a simple malfunction; this also works pretty well.

Concierge Doctors

I belong to the American Academy of Family Physicians (AAFP), the leading organization for family doctors with about 100,000 members. My physician brother, more activist than I, belongs to more  liberal physician organizations which are much smaller.

I bought a lifetime membership years ago, so I’m stuck with it, but its heart is in the right place. The AAFP wants members to practice high quality, compassionate medicine and requires that they stay educated and pass a test every seven years. It expresses deep concern with Americans who can’t afford medical care but refrains from urging doctors to greatly inconvenience themselves to remedy this. Most doctors are conservative; the AAFP’s leadership is more politically sophisticated than its members, but, in the end, it reflects their interests.

That brings me to today’s subject. I was perusing the AAFP’s weekly news bulletin. One article cheerfully announced that direct primary care was piquing everyone’s curiosity and that two physician-entrepreneurs would provide the “inside scoop” in a web workshop free to AAFP members.

I was preparing to move on when, with a shock, I realized that direct primary care is a euphemism for concierge medicine. The AAFP was plugging concierge medicine!!! That’s like promoting Mexican cancer clinics!

If you’ve followed this blog you know my low opinion of concierge doctors. They don’t accept insurance. Patients usually pay a monthly or yearly retainer in addition to the usual fees; in exchange, they receive quick access, longer appointments, and, if necessary, housecalls. This money pays for the doctor but nothing else. Tests, X-says, therapy, specialists, and hospitalization cost extra. It’s a luxury service.

When concierge doctors address the public they extol the superior care they deliver to a grateful clientele. Around the lunch table with only doctors present, they extol the pleasures of a cash-only practice. I've never met a concierge doctor I could respect. 

Finishing the article, I hit the “comment” button and forgot my rule about not responding in the heat of emotion. The satisfaction of delivering my opinion which included the adjective “sleazy” evaporated when I read the avalanche of abuse that followed.

Later that day an E-mail from an AAFP official explained that readers were complaining at the lack of respect shown in my response, so it was being deleted. It vanished, but the angry responses remained. You can read them at http://www.aafp.org/news-now/practice-professional-issues/20130508directwebinar.html. If that’s too much of a mouthful, google “inside scoop on running a direct primary care practice” and it will turn up.    

No Easy Way to Hollywood

There is no quick drive to Hollywood. I can take the freeway north through the San Fernando Valley, a twenty mile trip. Or I can take it east through downtown for nineteen miles. A direct route is eight miles, but that’s tedious stop-and-go on city streets. Taking the long way doesn’t mean an easy drive because the freeway is often but unpredictably jammed.

When Loews in Hollywood called at 11 p.m. my heart sank less than usual. It was late enough for most drivers to be in bed.

But not quite late enough. The male fun fair in West Hollywood was in full swing, filling the streets.   

Loews in Santa Monica calls me exclusively, but the Hollywood Loews keeps a list of doctors, thus assuring that none of us will lean over backward to accommodate it by, for example, coming during the rush hour (no hotel doctor lives near Hollywood).

My immediate problem in a nonexclusive hotel is that parking valets may not recognize me, so my mantra:  “I’m the hotel doctor. They let me park here” might not work, and I would have to pay. But it worked this time.

As usual, delivering medical care was the easiest part. A perk of hotel doctoring is that I go home after seeing a single guest. During my best months, I go home a hundred times.

I like my job, but going home always feels better than going to work. I played my audio tape. I looked benignly on the midnight revelers as I crept through West Hollywood. Beverly Hills and Century City were nearly deserted, but traffic lights ensured that I would not make haste.

Ever Hopeful

I made a housecall to the Four Seasons recently. Years ago, I shared the Four Seasons elevator with Robert Duvall. He was reading a script, and I pretended not to notice.

I’ve responded to half a dozen calls from that hotel over thirty years, but this was not one. Assistcard, a travel insurer, had sent me to see an 18 month-old with a cold. I took care of the child and left without introducing myself to the concierge.

The Four Season’s house doctor is the only colleague who has been around longer than I, and he serves half a dozen premier luxury hotels around Beverly Hills. In the distant past I covered for him when he wasn’t available. My records show 45 visits to the Four Seasons and several hundred to his other hotels. I loved those calls.

I retired in 2003 and unretired in 2007. During my absence he found someone else to help out. While he welcomed me back, I’m no longer his main support, but he phones at rare intervals.

When insurance services send me to hotels that don’t call, I remind the staff of my superior qualities. This has proved an excellent source of new clients but, ever hopeful, I don’t solicit this doctor’s hotels.  

Another Year

A wave of heat poured out of the guest’s room as he opened the door.

“Another year has passed,” I reminded myself. May 13 marked Los Angeles’s first heat wave of 2013. The temperature reached 91. Since autumn I’d forgotten that people around the world, Arabs excepted, consider air conditioning unhealthy. They tolerate it as one of the exotic discomforts of travel but not when someone gets sick.

This is not a belief amenable to reason, so I go about my business, sweltering in my suit and tie. I rarely take off my jacket because I keep tools (thermometer, tongue depressor, flashlight, otoscope, syringes, prescription pad) in various pockets. Sometimes medicine is hard.