Good News. Or Maybe Not.

2 a.m. calls rarely thrill me, but this was from the Beverly West, a boutique hotel that never calls. Happily, I threw on my suit and drove off. Traffic was light. Parking was easy.

Afterward I introduced myself to the desk clerk.

“I remember you from the Beverly Garland,” he said. “I’ve only been here two months.”

It’s flattering that employees continue to call when they change hotels, but it also meant that the Beverly West was probably not switching doctors.

“So you got my number from the Beverly Garland?”

He shook his head. “You’re on the computer. I picked you because the name was familiar.”

That was good news. Sort of. I’m probably on every hotel’s computer.

As the wee-hour desk clerk, he had little contact with veteran employees, but they would soon clue him in. After caring for a guest, the Beverly West’s regular doctor gives a “referral fee” to the employee that called. This is illegal but a hotel doctor tradition as well as a superb marketing tool.  

Not Again!!!

“I have the European plague. I need a doctor.”

“Excuse me?...”

“I have the European plague. I need a doctor for the American plague.”

“I’m not sure what you mean. What’s the American plague?”

“My child is in the bathroom with the European plague. Can you bring the doctor for the American?”

What was he talking about?.... The exchange continued for some time until the light dawned. This was the fourth occasion this has happened in over thirty years and 30,000 phone calls. The guest had phoned the front desk because his electrical devices used European outlets which are different from ours. He needed an “adaptor.” The clerk, not listening carefully, had heard “a doctor” and forwarded his call to me.

But I was also not listening carefully. It’s human nature to hear what you expect to hear, so I assumed that the caller had a medical problem.

I had heard “European plague” when he had said “European plug.” He had not said “my child is in the bathroom” but “my shaver is in the bathroom….”

Christmas Season

In the Pasadena Sheraton last Sunday, my phone rang for a visit in Irvine. Pasadena is twenty miles from home, Irvine fifty miles. I would miss supper by several hours, but the month before Christmas is slow, so I was pleased at another visit.

I often drive to Irvine but not from Pasadena, so I consulted Siri from my I-Phone. She directed me toward the nearest freeway but told me to turn off as I reached it. That didn’t seem right, but disobeying Siri is usually a bad idea. A drive through city streets to the Long Beach Freeway saved several miles but probably not much time.

I settled down for the trip before realizing with a shock that she was directing me toward the Santa Ana freeway. No one takes the Santa Ana freeway. It’s always jammed. Sure enough, as soon as I drove on, traffic slowed to a crawl.

I arrived after 1½ hours to face another irritation. The address, 2120 Waterbury, wasn’t a street address but suite 2120 at the Waterbury Apartments. Siri found the complex but getting to 2120 among the buildings was my job.

It was night. The guest was a traveler and unfamiliar with the area. There was no parking except in locked underground garages, so I couldn’t wander far from my car. Also (and I’m not making this up) it was raining. In the end, she came out and searched the streets until we encountered each other. The visit, as usual, was the easy part.

Leaving, I drove to the San Diego freeway, the sensible, if not the shortest, route from my house to Irvine. To my dismay, traffic was crawling. Weekends are usually OK, but I should have remembered that this was the Sunday before Christmas.

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.