How to Get the Best of Both Worlds

A lady with a cold phoned for a doctor at 4 p.m. on a Tuesday.

From my home to hers in the Hollywood Hills required a thirteen mile drive through city streets (twice that on the freeway). I go during the rush hour but only for patients a good deal sicker. In her case, I would schedule a visit for 9 or 10 p.m.

Sadly, the lady hadn’t called me but Get Heal, a new service that promises a housecall within an hour and charges a flat $99.

It pays doctors $75 an hour, lower than the going rate, but provides a medical assistant who drives, a delightful perk. Unfortunately, the dispatcher explained, the medical assistant lived near my destination. Would I make the drive myself? Heal would pay extra. If not, Heal would send a cab.

I chose a cab. Fifteen minutes later an Uber car pulled up. We crept through traffic. The medical assistant was there when we arrived. I cared for the patient. We crept back.

Heal earned $99 for my two hours’ work, but I earned $150. The Uber driver earned half that. The driver, dispatcher, and a dozen other employees collected their salaries. Get Heal has an office in Santa Monica and an impressive web site.

Everyone agrees that $99 for a housecall is a money-loser. Perhaps this patient was an outlier, but none of the eight Heal housecalls I’ve made has taken less than an hour door-to-door.

If you need a housecall in Los Angeles, phone Get Heal and ask for Doctor Oppenheim. You’ll get the best of both worlds until one of us goes out of business.

Discovering a Normal Part of your Body

A young woman at the Georgian Hotel felt a cold coming on, so she inspected her throat and discovered a dozen bumps on the far end of her tongue. I reassured her, but she wanted a doctor to see them.

I love housecalls where I know the diagnosis as soon as I hang up the phone. This qualified because the guest had discovered a normal part of her body. When you examine your tongue in the mirror, it seems smooth. People rarely stick it out far enough to reveal a clump of wart-like taste buds deep inside.

I also love telling a fearful patient that he or she has nothing to worry about, so this was a satisfying encounter for both of us.

It may save you some anxiety to memorize the following normal parts of your body.

- Put a finger inside your mouth and feel the gums behind your lower teeth. Moving just to the left and right reveals two hard lumps which may not be the same size. These are part of your mandible, the jawbone.

- With thumb and forefinger, pinch your neck just below the jaw to feel two lumps that mark either end of the hyoid bone that circles the front of your windpipe. You can wiggle them from side to side.

- Run your finger down the middle of your breastbone to an inch beyond the lower end, then push. You’ll feel a hard mass. That’s another bone, the xyphoid process. One guest was certain had a stomach tumor.

- Feel your major lymph node areas (neck, armpit, groin), and remember what you find. Part of the immune system, lymph nodes swell in response to an infection then shrink after it passes - except sometimes a node or two won’t shrink but remains forever as a pea-sized, moveable granule beneath the skin.

What Antibiotics Do To Your Body

When I started out in the 1980s, pharmaceutical companies sold pills labeled “placebo.” They don’t do that today, so a doctor who wants to prescribe one uses a real drug.

Today’s most popular placebos have names like amoxicillin and Z-pak (azithromycin). These help many conditions but not the respiratory infections for which most are prescribed.

Swallowing any antibiotic kills trillions of germs inside your body. If it’s a placebo, those germs are not causing your problem. Other germs immediately move in. Of course, those are germs that can grow in the presence of that antibiotic. If, in the future, they decide to make trouble, another course of that antibiotic might not discourage them. Do you want that?

Experts have been denouncing placebo antibiotics for decades, but their arguments are feeble. They warn about side-effects and allergies, but these are rare. Most antibiotics, useful or not, are safe over the short term.  
  
The long-term consequences are catastrophic. Soaking the environment with unnecessary antibiotics is giving rise to extraordinarily resistant bacteria. Even today about 40,000 Americans die of infections no antibiotic can treat, and this increases every year.

But who cares? It’s a fact that people with a short-term problem don’t take the long view. That might include your doctor.

Another Free Service

Her child’s nose was bleeding, explained the mother. Could I come?

I was tempted. Once in the hotel room, I would ask questions. I would take out my otoscope and peer up the child’s nose. In the end I would reassure the mother and tell her to pinch the nose and wait. The bleeding would probably stop. Persistent nosebleeds are rare and require expert attention. Then I would collect my fee and leave. 

Over the phone, the mother revealed that the child was in good health and suffering a cold.  Respiratory infections occasionally produce a nosebleed. I reassured the mother and told her to pinch the nose and wait. When I phoned later, the bleeding had stopped. 

The End is in Sight

I keep an eye on Craigslist and the internet for new competitors on the housecall scene, and they turn up regularly. Other hotel doctors gnash their teeth, but I send off my C.V.

Being experienced and available 24 hours a day is an appealing quality, so they often respond. Working for competitors is sometimes painful if they send me to one of my hotels. There’s little I can do because I can’t match their marketing techniques (my lawyer warns me not to be more specific).

Mostly I take for granted that this younger, aggressive, social-media savvy, ethically challenged generation will drive us older hotel doctors out of business. Luckily, I’m already collecting from my retirement savings and social security, so I work because I enjoy it.

Getting Help, Part 2

My relations with other Los Angeles housecall doctors are civilized but not close. As a result, when I leave town there’s only one colleague I trust to cover. Mostly this works out. I schedule my trips so they don’t conflict with his.

When I’m in town I’m always available. That includes after bedtime, in the movies and restaurants, and during social events. It includes concerts and live theater, but I sit on the aisle, so I can hurry to the lobby when my phone buzzes. None of this bothers me greatly (my wife is another matter).  

One event causes problems: baseball games. One of my brothers has Dodger season tickets, and we attend a dozen times during the season. We go to a restaurant and then the game: almost the only time we get together; I love it and don’t want to be interrupted. I’m out of commission only about six hours, and occasionally my colleague can’t cover.

I could continue to answer the phone, but crowd noise in the stadium makes conversation difficult. It also reveals that I’m having fun, and patients hate disturbing a doctor during his leisure time. My solution is to change my phone message to announce that I’m unavailable until (whatever time the game ends) and then turn off the phone. Genuine emergencies are very rare in a hotel doctor’s practice, and so far it’s turned out all right. But I’m always looking for help.

Girls Are the Best

 “...allo!!” shouted a little girl from her bed as I walked in, but that was her only English. Her French parents had called because she was running a 101 fever.

She seemed delighted to see me and jumped to sit on the edge for her exam. Smiling happily she waited as I quizzed the parents, opened her mouth widely when asked and made no complaint when I poked my otoscope into her ears.

I found everything normal. She had a virus that might last a few days and required only Tylenol. Staying in bed was not necessary. Everyone seemed pleased, the child most of all; she waved goodbye as I left.

I loved that visit. Readers are familiar with my admirable qualities, but I admit that I am not the sort of jovial physician who enchants young children. Mostly I do fine, but I’ve endured plenty of encounters with apologetic parents and a screaming, struggling toddler.

These are almost all boys. Adult male pugnaciousness has not made the world a comfortable place, and it works equally badly in children. They get the exam regardless, but it’s drawn out and painful. The parents are embarrassed, the doctor relieved when it’s over.

Little girls rarely make a scene. If frightened, they keep quiet. If not, they realize, almost from birth, that charm works wonders. Everyone relaxes and takes care of business. Women should run the world.