A Medicolegal Housecall

Stepping out of the shower, a Doubletree guest stumbled and nicked his leg. He had paid little attention, but now, two days later, the wound had grown painful.

That sounded like a good visit until he delivered the bad news: the hotel would pay my fee.

I label these “medicolegal” visits and I don’t collect. When a hotel offers to pay, it’s usually because the guest is making a fuss, and management has already agreed to other expenses such as comping the bill.

I don’t want to be part of the problem, and it’s a chance to remind upper management of my value. During the usual visit I never see a general manager. Most are only vaguely aware of my existence, and a few are surprised to learn that the hotel can call a doctor.

The guest’s shallow, one-inch, laceration was healing normally. I doubt he would have called if he had had to pay.

I shook hands with the general manager and assured him that there was no significant problem. I added that, as the hotel’s doctor, I was always available, and he should feel free to consult me under these circumstances. I waved off his offer to pay. He expressed gratitude.

Don’t assume that this guarantees a hotel’s loyalty. It’s been years since Loews in Hollywood and the Adventure hotel called. My last visits to both were medicolegal freebies.

Another Wee-Hour Call

It was midnight when the phone woke me. An Emirate flight attendant at the Hilton in Costa Mesa needed a doctor.

That Hilton is in Orange County, a 46 mile drive. The agency that serves airline crew has an Orange County doctor but calls me when she doesn’t respond.

After I’d dressed and filled out the necessary forms, the phone rang again. The Orange County doctor had checked in and wanted to make the visit. Was that OK?... 
 
I’d received a similar call last month when I was already on the freeway. At that time, when the agency announced that my visit was cancelled, I made a fuss, so it promised not to do that again.

Did I want to spend two hours driving plus twenty minutes delivering medical care in the middle of the night? I boast that, not having an office, I can sleep late, but I enjoy getting up early to write. In any case, my body automatically wakes at the same time.

Returning to my cozy bed seemed extremely attractive; I gave my consent.

As soon as I hung up, I remembered that the agency pays generously for long drives in the wee hours. That thought gave me a touch of insomnia, so I still passed a sleepy morning.

Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.

Sometimes This is a Thankless Job

A one year-old at the Ramada was fussy and congested, but my exam was normal. She had a cold, I explained. It was not serious but might last a few days. Staying in bed wouldn’t make it go away quicker. The parents should encourage the child to drink, but it was OK if she didn’t eat. They were already giving Tylenol for the fever, and that was fine. They should try to enjoy themselves.

“So she doesn’t need anything,” said the father. I assured him she didn’t.

I gave them my phone number and promised to keep in touch. They thanked me effusively as I left, but I was not fooled.

Understand their point of view. They were in a strange city on an expensive vacation, and their child was sick. Naturally, all fun was cancelled and the doctor summoned fix things.

Had I written a prescription, I would be doing what a proper doctor does. They would have given the medicine and waited. Not giving “anything” meant that I considered the illness trivial. That was clearly wrong.

Mind you, obeying long and sad experience, I had carefully explained that the child might feel under the weather for several days. They had listened and nodded, but their yearning took priority.

I intended to call in 24 hours, but the following morning their travel insurer phoned to say the parents were requesting another visit. I explained that that wasn’t necessary. I would call.

“She’s the same. The fever hasn’t gone away,” said the mother.

I repeated that this was to be expected and that she should wait. She agreed and thanked me for calling.

No one answered when I phoned the next day. The insurance agency dispatcher explained that the mother had called earlier to demand another visit, so he had sent her to an urgent care clinic.

The child had barely swallowed the first spoonful of Amoxicillin when she began to improve. By evening she was fine, and the parents were congratulating themselves. Who knows what might have happened if they hadn’t found a competent doctor? 

The Conundrum of Ear Pain

I hate forbidding guests from flying because of the ticket-change fee. The era when a doctor’s note impressed the airline is long gone. It still works for travel insurers, a good reason to buy a policy.

My problem arises most often with ear pain.

Cabin pressure at cruising altitude drops only about 25 percent from sea level, but that’s significant. If you bring a bag of potato chips you’ll notice that it swells like a balloon. Air in any closed space does the same. If you have gas, you’ll have more gas. If air in your middle ear can’t escape, the ear will feel stuffy and then painful. If pressure increases still more, it may blow a hole in the eardrum. This relieves the pain, and most small perforations heal in a few weeks, but we don’t like to encourage them.

The best preventative is a chemical nasal spray (Afrin, Dristan). As you sit in the plane before takeoff, spray generously, wait five minutes for it to work, and spray again. This should send the spray far up to reach the eustachian tube opening, the only connection between your middle ear and the outside world. Do the same before the plane begins its descent, an hour before landing.

Flying doesn’t cause ear infections, so if you felt fine before boarding, it’s OK to wait if your ear hurts after landing. Pain should improve after a few days. If you see a doctor, he’ll forbid you to fly.

Tooting My Horn

Would I see a lady at the Airport Hilton with an eye problem?

I asked the dispatcher from Amerilink, a travel insurance agency, for details, but she couldn’t provide them.

It turned out that the lady had no complaints. Apologizing, she explained that she had neglected to pack her glaucoma drops. Would I write a prescription? I was happy to comply. Amerilink would pay my usual fee.

These delightful visits are not rare. Travelers with insurance who forget a medicine often lie because they suspect, correctly, that the carrier will not pay for the truth.

When a hotel calls directly, I always speak to the guest. If he or she has forgotten a legitimate medication, I phone a pharmacy to replace it, gratis. I don’t have the gall to collect a fee for delivering a prescription.

Readers of this blog know what a humble physician I am, but this is one time I will boast. Many competing hotel doctors charge for any service they perform over the phone, including simple advice. If a guest calls the 800 number of one of the half-dozen national housecall services that advertise widely, he or she will have choice of (1) a paying visit, (2) going to an emergency room, or (3) nothing.

The Most Deeply Compassionate Physician

I’m an early riser, so the 5:30 a.m. phone call last week found me at my computer writing this blog. The caller was Le Montage, a luxury hotel in Beverly Hills.

It was a perfect time. Wilshire Boulevard was deserted. The hotel was three miles away. I could park on the street. Guests during the small hours are particularly grateful. I was home in time for breakfast.

My last visit to Le Montage occurred several months ago. The call arrived at 3 a.m.

That I am Los Angeles’ leading hotel doctor is beyond doubt, but I have never dominated the elite establishments (Bel Air, Four Seasons, Beverly Wilshire, L’Hermitage, Peninsula, Beverly Hills Hotel). These already had doctors when I began in 1983.

After a few decades, some took notice, and I often covered for their doctors, but nowadays when these hotels call, it’s generally during the wee hours.

I suspect this is because a new generation came on the scene a few years ago including several young aggressive doctors building a concierge practice. Concierge doctors offer an exclusive personal service, but they accept only cash. They have no interest in Hiltons, Ramadas, Holiday Inns et al whose middle-class guests might object to the fees, but luxury hotels are a different matter. They solicited with considerable success.

“Do you think they're paying off the concierges and bellman?” asked a veteran colleague when the subject came up.

"They wouldn't stoop to that," I responded. It's illegal. I’ve met several of these doctors, and they seem personable. Check their web sites (google “Los Angeles house call doctor”). All describe themselves as skilled and deeply compassionate. Read their testimonials or the Yelp comments. Unanimous praise.

When these physicians introduce themselves to bellmen and concierges, they undoubtedly emphasize their skill and deep compassion. Who would not be impressed?

As midnight approaches, bellmen and concierges go home. The skeleton night staff has never encountered these exceptional physicians, so when a guest falls ill, they call Doctor Oppenheim.