Customers Come and Customers Go

American doctors complain about paperwork, but it’s no problem with me. I give guests a copy of the record I write in the room. I fax the same to housecall agencies and foreign travel insurers. American insurers look with deep suspicion on housecalls, so I don’t deal with them, and when foreign carriers feel the urge to adopt American techniques (complex codes, lengthy invoices, deductibles, fee schedules), I stop working for them.

This is less of a sacrifice than you’d think because they switch to a national housecall service, most of whom call me. I earn my usual fee, and the service bills the insurer more, often much more. The logic of this is unclear to me.  

Assistcard, an international insurer that has called for twenty years, stopped recently. When I phoned, a representative explained that Assistcard had made arrangements with other Los Angeles doctors who accepted less than I charged. I expressed congratulations, but this seemed unlikely. I charge less than the going rate, other hotel doctors do not work with travel insurers because they pay slowly, and doctors who agree to make housecalls on the side are not likely to drop everything and go. A week after that exchange, Assistcard resumed calling.

Calls from the Biltmore, once a regular, vanished in 2010. Last May the general manager phoned to announce that I was now the hotel’s doctor. I can’t remember the last time a manager did that. Sure enough, the hotel resumed calling. I’m sure an incident in the hotel convinced her that having me as the house doctor would be a good idea. Sadly, I forgot to ask for details.

Bringing the Housecall into the Twenty-First Century, Part 2

My July 2 post concerned Medicast, a service that arrived in Los Angeles with the goal of bringing the housecall into the internet age. Anyone can download the Medicast app. Clicking connects you to a dispatcher who records your credit card information and sends a text message to the doctor on-call who arrives at your “home, office, or hotel” within two hours. You can Google Medicast.

Its fees are less than those of traditional hotel doctors (who don’t advertise) and much less than the entrepreneurial concierge doctors who do.

Always alert to competition, I contacted Medicast whose directors expressed delight at my experience and welcomed me aboard. I attended an orientation where doctors learned to deal with their software. We left carrying an iPad.

Over thirty years, a dozen national housecall services have come to Los Angeles and, mostly, gone. Size is their great obstacle. When I collect a fee, I keep it all. After paying the doctor, a service has other people to pay. Success requires either a high patient volume or high fees.

My maximum volume has been about 2,000 calls per year, and I have never grossed more than $130,000 – a great deal to most of you but peanuts for a doctor. It’s unlikely any organization can match my volume.

One national housecall service has operated since the 1990s. Its site emphasizes the quality of its doctors, and this was certainly true when I was one. It called 26 times between 2000 and 2002 when I stopped working for them. I collected my usual fee. The service charged three times more, but dispatchers often failed to tell guests how much. As a result, when I handed over my invoice they expressed shock. Worse, they blamed me for the fee and did not hesitate to express their displeasure to the hotel. This cause me some difficulty. I'm sorry not to mention its name, but I'm as paranoid about being sued as the average doctor.

Getting back to the present, over the next two months, I received 16 calls from Medicast, the last in mid-July. Last week a director phoned to explain that calls were increasing but not to the extent they expected, so they were adopting a different business plan. Two days later, a courier arrived to reclaim the iPad.

Hotel Visits I Don't Make

I don’t make housecalls for certain symptoms: shortness of breath, chest pain, loss of consciousness, and severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, but possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you’ll sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when he guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind.  

Medical science has no cure for drunkenness, but hope springs eternal, so hotel staff continue to call.

How Can I Break Into Hotel Doctoring?

My first response is always: read my blog. Begun in 2009, it contains everything you need to know about hotel doctoring including how I started.

While it’s entertaining, it might not help. I began in 1983 when there was little competition. I do no marketing except an occasional letter to general managers. I have no web site; this blog, as I chronically complain, has never attracted a customer. I don’t pay hotel employees when they refer a guest (illegal but a long tradition). Yet I do fine. My database, so old it’s a DOS program, contains nearly 18,000 visits. No one will ever match that.

The quickest way to break in is to buy another doctor’s practice. Buying an office practice is bad business because patients drift away, but a doctor selling a hotel practice simply transfers the phone number. As long as the buyer responds to calls, he’ll keep every client because hotels rarely pay close attention to their house doctor.

This is no idle theory because a veteran colleague will soon retire. Another physician has purchased his clientele, a dozen of Los Angeles' and Beverly Hills’ most luxurious hotels. I have heard only good things about the buyer, but he is not an established hotel physician or a friend, so I plan to benefit.

Despite collecting Social Security for ten years, I have no plans to retire, but it’s hard to imagine me working beyond a few more years. I might entertain an offer.

A Tropical Disease

They had just flown in explained a father at 1 a.m. While in Hawaii, their two year-old had suffered mosquito bites followed after a few days by fever, restlessness, and refusal to eat. Checking the internet (my heart sank….) he learned about dengue fever.

I explained that dengue is a viral infection that produces the usual symptoms of a viral infection (fever, body aches, general misery) and has no cure. He agreed but pointed out that deadly complications, although uncommon, did occur, and he wanted the child examined.

Before leaving, I consulted a medical book to refresh my knowledge of dengue fever. I’ve never seen a case. The child did not seem terribly ill. Certainly there was no sign of shock or internal bleeding, the typical complication.

I reassured the parents.

Going Back to College

Every summer, a hundred Brazilian adolescents descend on UCLA’s dormitories to study English. When one gets sick, a counselor phones April Travel Insurance which phones me.

Middle-class teenagers suffer respiratory infections, upset stomachs, and minor injuries, so, once I learned to deal with UCLA’s draconian parking policy, I found these easy visits.

I graduated UCLA fifty years ago, and returning is a strange experience. Crowds outside the dormitories shriek, laugh, and chatter. It sounds like a kindergarten. Were we that noisy? There's nothing strange about the women's fashions, but the men look like dorks. My generation had long hair and tight clothes. Nowadays it’s short hair and baggy clothes. They wear shorts. Don’t they realize how silly they look? We kept books in lockers. Now everyone has a backpack. Especially odd is the number of Asians who make up over a third of the enrollment. They speak perfect English, so they’re clearly American. Where were they when I attended?

In my day, when you entered a university building, you found a door and entered. Today all doors except the main entrance are locked. Students manning the front desk consider names and room numbers privileged information. Using the elevator requires a key which all students carry. This is identical to hotel security and probably no more effective.

On arriving, I phone a counselor who comes down to escort me. The dorm rooms are tinier than I remember, and little studying occurs because the desks are piled with personal items. Delivering medical care is easy, but it’s summer, and foreigners believe that air conditioning is unhealthy, so the rooms are hot.      

Bringing the Housecall into the 21st Century

Housecall agencies spring up regularly. I keep track of them so I saw Medicast’s web site when it came to life a few months ago.

During an interview with two energetic founders, I learned that they plan to bring the housecall into the 21^st century, slashing the cost with volume, marketing, and digital technology. They would launch in June 2014 after a massive marketing campaign. Doctors were rushing to sign up, they added.

I agreed to join them but declined the canvas carry-all they were offering, preferring to keep my traditional doctor’s bag. A handout listed required drugs and supplies which Medicast would sell to its physicians, but they agreed that I could handle my own selection.

They gave me an Ipad Mini. All their doctors receive one. Potential customers download the Medicast app which gives them the choice of signing up for a paying program that provides free housecalls or paying nothing and summoning a doctor when they need one. Clicking the app connects them to a dispatcher who records their credit card information and sends a text message to a doctor on-call. The program then automatically dials the client.

“Hotel guests phone my cell directly, or I phone them,” I said. “Wouldn’t that be quicker?”

“Doctors hate giving out their private numbers,” they explained. “This way you don’t appear on caller-ID, so patients can never bother you.”

A Los Angeles housecall costs $249 during business hours, $349 during nights and weekends. While this is in the ballpark of my fee, Medicast keeps about one third. Medicines and injections cost extra, so a Medicast doctor has the opportunity to earn more – a lot more if he’s creative, and some doctors show a positive genius in this area.

The app includes a tempting feature: a button a doctor can swipe to go “off call.” I don’t mind that hotels and insurance services phone 24 hours a day, but I sometimes can’t resist flipping the button when I go to bed.

Carrying the Ipad everywhere is a minor annoyance, and software bugs still make an appearance. If another doctor answers, the app doesn’t notice, so I’ve phoned patients who’ve already set up a housecall.

Business is brisk. My Ipad chirped nine times in June to announce a call although some may have been software glitches. All were from local residents, so they don’t overlap with my clients, but employees at two hotels have reported visits from a Medicast representative.