Almost Stiffed

“This is one time the hotel will not be able to charge the bill,” reported the manager one evening when he called about a Middle-Eastern family.

Since I usually collect from the guest, I assured him that that was not a problem.

He connected me to the room where I spoke to someone whose English was not good. The speaker or perhaps someone else had an allergy or maybe a rash that needed a cream. Did I know the proper cream?.... After much to and fro they decided I should come at 11 a.m. the following day.

The guest who answered the door showed me a rash on her neck. It was a simple contact dermatitis. I explained and handed her a tube of cortisone cream. That, of course, was the easy part.

The room was a luxurious suite. The patient was Philippine, so I knew she was a servant. It was disturbing to notice that she was alone. I suspected she did not expect to pay; sure enough, she looked puzzled when I presented my invoice and more puzzled when I explained that the hotel would not pay.

I passed an uncomfortable ten minutes as she noodled with her cell phone, trying to reach her employers. Had they deliberately absented themselves to avoid paying? It might not have been deliberate; sometimes extremely rich people never concern themselves with paying for stuff because it’s always taken care of.

She asked if she could call the hotel. I shrugged, resigned to being stiffed. But it turned out the current manager had no objection to charging the bill.

Worry

A worried mother phoned, asking me to see her two year-old who had a fever of 101.

I’d seen the child two days earlier. He had a 101 fever but was not particularly sick, and my exam was normal. I diagnosed a virus, handed over a bottle of Tylenol, and told the mother he might feel under the weather for two or three or four days.

Patients often call after a few days to tell me the illness hasn’t gone away. Sometimes they report a new symptom that gives me pause, but mostly nothing has changed. That was the case this time, so I reassured the mother. Another housecall wasn’t necessary.

People rarely argue with a doctor, so the mother did not disagree with my reassurance. But worry is contagious. No one is perfect, and there was a tiny chance that something terrible was brewing up.

I could have relieved my mind by sending them to a clinic. The doctor would find nothing and reassure the mother. If something terrible happened later, he was the last doctor she had seen, and I would be off the hook. But I didn’t do that, so I worried.

Unsafe

A young man stood blocking the door.

“I want to see your license,” he said.

I showed him. He examined it suspiciously and didn’t move.

“Get out of the way!” said a voice inside. 

Reluctantly, he let me pass. I approached the patient, apparently the man’s girl friend, who had phoned me because of an earache. As she described her problem, he glowered from the doorway.

“I don’t think you’re a doctor,” he said, interrupting. “Where’s your white coat?”

“Shut up, asshole!” she shouted before turning back to me. “He’s being a jerk. He’s probably a little high. Don’t worry.”  

“You should leave,” he said a few minutes later. Approaching, he delivered a gentle shove to my shoulder. The girl friend cursed and pushed him violently.

“Sorry, but I’m not feeling safe here,” I said. I walked out and went down to the lobby. The woman appeared a minute later, full of apologies, and we finished the consultation.

Insect Bites

A caller was suffering an itchy rash, present for a week. Three companions were also affected. That sounded good. When more than one person has a medical problem, it’s the same problem and not serious.

In the room, all four gathered to show me their skin which revealed the scattered, small pink pustules left by ectoparasites. I use that term to be accurate because not every bug that bites is an “insect.” Spiders, ticks, mites, scorpions, and centipedes aren’t.

Bedbugs (an insect) have become fashionable, but these travelers had been moving frequently from place to place. Where hygiene is reasonable, lice (an insect) limit themselves to hairy areas; I didn’t see any. My diagnosis was scabies, a mite (not an insect) that burrows under the skin. Scabies is hard to catch from clothes or bedding; mostly it requires rubbing against someone else with scabies, and it looked like these young people did a lot of that. 

Deception

A tour leader explained that one of his group wanted a doctor to look at her hand. She had fallen.

Minor injuries are easy, but I don’t want to collect money from someone who needs an x-ray and then send them off to pay more money somewhere else. 

I quizzed him. What happened? Where was the pain? Was there much swelling? He assured me that it was not a big deal. The lady just wanted a doctor to check it.

He was lying. When a member of a tour goes to an emergency room, the leader must go along. Anxious to avoid such a tedious job, tour leaders often hope a doctor will make the problem go away.

The lady had a swollen, painful left wrist. If you fall and instinctively catch yourself on your outstretched hand, you’re likely to break a specific spot at the end of your radius. It’s so common it has a name: the Colles fracture.

I was certain she had a Colles fracture, so off they went.

Gushing Blood

Someone at a Beverly Hills hotel had struck his head on the edge of a table. Blood was gushing, and he wanted a doctor.

Scalp lacerations bleed heavily, but my long experience with bumped heads reveals that the wound is rarely impressive. If victims are willing to apply pressure and wait, they usually agree.

He didn’t want to wait.

This was an upscale hotel, but I am not its doctor who was undoubtedly, this being midnight, fast asleep. Someone had searched the internet and found a housecall service which called me. That meant that I had to give the service forty percent of the fee. My wee-hour charge is not skimpy, but none of this mattered. He wanted a doctor.

I told him I would arrive in half an hour, and the manager expressed surprise when I turned up on time. He led me down a hall, through the kitchen to a large room where the patient was resting on a chair, a wet rag over his forehead. Half a dozen employees stood around.  

Removing the rag revealed that the bleeding had stopped. The wound was a shallow 1½ inch scratch. I delivered the good news and applied a band-aid. Everyone was relieved, and the guest peeled off my fee from a wad of bills.

When an Antibiotic Helps

If you receive an antibiotic for a respiratory infection, it’s probably a placebo because almost all respiratory infections are viruses.

If you receive an antibiotic for a skin infection, there’s a chance you have a bacterial infection that an antibiotic won’t help. A boil or other collection of pus will heal if the pus is drained. If the doctor gives an antibiotic but doesn’t drain the pus, it will also heal. That’s because most infections, boils included, eventually heal.

You’ll get an antibiotic if your doctor diagnoses an ear or sinus infection. It’s a bad idea to ask if this will help because (if he’s honest), he’ll admit that no one knows. In experiment after experiment, when researchers compare patients given and not given antibiotics for ear or sinus infections, the results are never dramatic. Often there’s no difference. Sometimes they help a little. Doctors in some nations don’t treat these with antibiotics.

That’s why urine infections are my favorites. It’s not controversial that antibiotics help. For infections in young women, help comes quickly, usually within a day. These are satisfying encounters for everyone concerned.