Failures in Communication, Part 3

After a forty minute drive, I arrived at 4020 Los Feliz Blvd. No one answered my knock. Thinking the patient might have stepped out, I took a walk around the neighborhood and knocked again and also phoned to no avail. I returned home in a good mood. It was an insurance call, so I’d be paid.

Another call arrived at 5 p.m. I dislike driving during the rush hour, but the patient lived near Beverly Hills only five miles distant. The address was 821 Coldwater Canyon Drive, but I discovered that Coldwater Canyon addresses begin with 900. I continued north, assuming the numbers would drop when Beverly Hills became Los Angeles, but they kept getting higher.

Coldwater Canyon is a not-so-secret alternative to the freeway into the San Fernando Valley, so it’s bumper-to-bumper during the rush hour. Finally, I gave up, pulled into a side street, and phoned the patient. It’s not 821, he said, but 1821. The dispatcher had told me wrong or perhaps I had heard wrong.

That evening an insurer called to ask me to return to the Los Feliz patient. Insurers usually refuse to authorize a second visit to a no-show, but I was happy to go. The dispatcher repeated the address: 1420. Whoops. Whose mistake was that?....

The Easiest Part of Medical Care

The phone rang at midnight for a housecall in Long Beach, 35 miles away. So far, so good. Freeways were clear, and the caller was a reliable travel insurer who agreed to my fee. Good.

The patient was young and suffering a fever. That sounded easy. The patient was a student at California State University, Long Beach. Uh oh.

Navigating a college campus is a nightmare. The address of a university is the administration building where no one lives. College buildings have names or numbers, but they follow their own logic.

The patients are foreign, unfamiliar with the geography, and unhelpful. Finally, campus police may be slow responding to rape and burglary, but they pounce fiercely on an illegally parked car. You don’t want to park inside a college campus without a permit.

Taking no chances, I parked on Bellflower Boulevard outside the entrance and walked far across the campus to the dormitories and International House where I assumed he was staying. As I approached, I saw that the barrier to the lot next to the building was raised, and I could have parked. C’est la vie. As usual, delivering medical care was the easiest part.

Do You Accept My Insurance, Part 2

“I can’t afford that,” wailed the guest, an Australian newlywed at the Biltmore when she learned my fee. She had travel insurance, and I had told her it would undoubtedly pay when she submitted my invoice. But unsophisticated travelers who have never used insurance or asked for a housecall often panic.

I lowered the fee to $250. She consulted her husband who countered with $150.  

Since it was 11 p.m. the drive downtown was easy. When the husband ushered me in, I discovered they were staying in a large, two-room suite. The Biltmore charges well over $300 per night for suites.

But they were young, and I didn’t know their story. I did my duty and pocketed his $150. I was not disturbed and had material for a blog post.

Do You Accept My Insurance?

That’s the most stressful sentence a hotel doctor hears – more than “I’m having chest pain” or “my mother stopped breathing.”

American insurers look with deep suspicion on housecalls, and no hotel doctor wants to bill them. But almost no American has experience handing money directly to a doctor – and a housecall costs a good deal more than an office visit. Many of these guests agree to pay, but I often sense their discomfort. Other doctors are not so picky, but if they sound too reluctant I inform them of local walk-in clinics.

Foreign insurers are different. Many call me directly. Resigned to our rapacious medical system, they expect immense bills. I charge everyone the same, but I’ve been contacted by doctor-entrepreneurs who offer triple my usual fee to make their hotel calls in Los Angeles. They can afford this, they assure me, because they charge several thousand dollars for a housecall. This sounds creepy, but it apparently works because I’ve heard from these doctors more than once. 

Goodbye to the Shangri-La

“I’m not calling for a guest,” explained a desk clerk from the Shangri-La in Santa Monica. “I have a question…. In your arrangement with hotels, do you ever pay anything when we call?”

“That’s illegal,” I said. “I’m happy to give employees free medical care, but it’s against the law for a doctor to pay to get a patient.”

“Is that so? Are you sure?”

“Google it. It’s called a referral fee; it’s unethical and also against the law in California. If you use a doctor who’s breaking one law, what other laws might he break?....”  

“Oh, this is just for our own information. I appreciate your help, doctor. Thanks.”

Goodbye to the Shangri-La, I said to myself after she hung up. I’ve been going there since 1985, but the Shangri-La is not large. Since I give plenty of free phone advice, months may pass before I make an appearance, so most employees have never seen me. I don’t market myself, and most general managers leave the choice of a doctor up to the employee, so I regularly lose hotels when a competitor offers his services with the promise of a referral fee.

Sometimes, often years later, they return. Google “Doctor Jules M. Lusman.” He took a number of hotels away from me, but I regained them.    

Caring For a Physician

Having a doctor as a patient is stressful. They often suggest their diagnosis, and it’s awkward if I disagree. When I make a housecall, American doctors sometimes hint that I shouldn’t charge them.

This patient was an anesthesiologist, a good thing because he almost wasn’t a doctor at all – i.e. he’d long since forgotten how to deal with illnesses. He was foreign, another good thing. And he was Danish: the best sort of foreigner because Scandinavians speak good English. 

He had a headache and a 101 degree fever but no respiratory symptoms. I diagnosed a viral infection, perhaps even Dengue fever because he had flown in from the South Pacific. He did not object to taking pain medicine and waiting, and he recovered after a few days.

More Unsatisfied Guests

The son of two Viceroy guests was suffering a severe sore throat and fever.

I drove off in a good mood because it sounded like an easy visit. This combination often indicates “strep” which an antibiotic cures. Patients like that, so I like it, too.

In fact, sore throat and fever in a grown-up is usually a simple viral infection, my least favorite illness. Strep is overwhelmingly a disease of children and adolescents, but this patient was fourteen, so my hopes were high.

They were dashed when the boy admitted that he had a cough. Strep is strictly a throat infection; coughing is not part of the picture. Sure enough, his throat looked normal.

Rummaging thoughtfully in my bag, I pulled out a packet of acetaminophen (Tylenol), handed it to the parents, and explained that this would help his fever. I extracted a plastic bottle of Lidocaine, a gargle intended to relieve his throat pain. I gave them a cough medicine is similar to the popular Robitussin but in an immense eight-ounce bottle.

I assured them that bed rest would not help, so he should try to enjoy himself. He could eat whatever he wanted. But it was likely that he’d feel under the weather for a few days before recovering.

The parents seemed happy to receive the medicine. They expressed gratitude for my service, and thanked me effusively as I left, but I knew that this was mostly good manners.  They were on vacation. The doctor had come, given some not-very-powerful medicine, and told them the child would continue to be sick. Did the doctor realize how important this trip was to them? Maybe if he had tried harder…. Or if they’d called a better one….