Ignoring the Lab

A young woman complained that urinating was painful, and she was running frequently to the bathroom.

That sounded like the common bladder infection, my favorite disease. It’s one of the infections that antibiotics treat, and patients usually feel better within a day. Everyone is pleased.

After arriving in the room, I asked for a urine sample and took a dipstick from a bottle I carry. It can detect sugar and blood and protein and half a dozen other substances in urine, but in this case I was looking for white blood cells (a sign of infection) and leukocyte esterase, a chemical that bacteria produce. Both tests were negative. What was going on? Her story and all the evidence pointed to a bladder infection.

Every medical student learns to treat the patient, not the test. The test showed that she didn’t have a bladder infection, but I disagreed, and I turned out to be right.

Doesn't This Seem Dumb?

In the old days doctors took for granted that anyone who practiced alternative medicine (herbalists, naturopaths, homeopaths, Ayurveda, holistic healing) was a quack, but times have changed. The establishment (even the AMA) urges us to show respect. All popular media doctors (Oz, Weil, Pinsky, Chopra) emphasize that conventional medicine, while useful, ignores life-saving natural, traditional, spiritual, mind-body, and otherwise unorthodox treatments. 

Here’s something that puzzles me. Alternative medicine is respectable, but no one gives a damn about alternative surgery.

If a cool guy breaks his leg or cuts his face or suddenly can’t pee or gets a piece of dirt in his eye or sees blood pouring out his anus, he never ramps up his yoga or seeks a healing herb.

He heads straight for a conventional doctor like me. We take out our tools and fix him.

Doesn’t this give the impression that orthodox medicine works for urgent problems and those visible to the naked eye? Alternative medicine is OK if your problem is not urgent and not visible.

An Upscale Client

The phone rang as I sat down to breakfast at 6 a.m. The caller was Le Montage, a super-luxury hotel in Beverly Hills. The hotel is only a few miles away. Traffic was light. Street parking was easy. It was a good visit.

This was the eighth guest I’d seen at Le Montage in a year and a half.

But there was something odd. All calls arrived during the wee hours. Perhaps five percent of a hotel doctor’s business comes at these times. What was going on?... It’s a rule that once staff realizes that phoning Doctor Oppenheim always gets Doctor Oppenheim, they see the light, but this hadn’t worked at Le Montage.

I know who serves that hotel, and if the regular, daytime staff continues to call him, it’s undoubtedly because he’s a skilled, compassionate physician. 

Obscure Colleges

The lady who answered the door had no idea who I was.

“Carlos! Did you call a doctor?” she shouted over her shoulder.

He had. Carlos was a 19 year-old student from Chile renting a room in Hollywood. His hay fever was acting up.

Foreign students often have health insurance from their native country administered by agencies that call me, so I make many trips to UCLA and USC. Carlos was not attending either.

His room contained an amplifier, guitars, and an electronic piano synthesizer. He was studying composition but not at a university. It turns out Los Angeles contains music colleges that attract international students. These seem to operate like traditional schools; I often write doctor notes to justify missed classes.

Now that I think about it, Los Angeles contains plenty of obscure but internationally known educational institutions. Acting and film production come to mind, but they mostly enroll Americans so I rarely hear from them. I’ve cared for a dozen students studying jewelry and others in fashion design, architecture, cooking, graphic design, and business.  

"I Need a Shot"

Mostly, these callers are wrong, but now and then I hear from a guest undergoing legitimate treatment – usually for infertility – who needs a regular injection. They have the vial in their possession.

Invariably, they told their doctor that they must leave town, and the doctor messed up. He didn’t teach them how to self-inject or (if they recoiled at this) warn that finding someone to give an injection in a strange city guarantees frustration, wasted time, and massive expense.

Hotel doctors are in it for the money. Most guests are not terribly sick, and delivering an injection is only a little easier than the usual visit, so there’s no great reason to give a discount.

A walk-in clinic is less convenient and cheaper but probably futile. The doctor (a G.P. like me) is likely to examine the vial of medicine and say to himself:

1.     This is a medicine I don’t prescribe.

2.     I’m supposed to give it on the patient’s say-so.

3.     If she sues me, (1) and (2) will not help my defense.

If you think a letter from your doctor will change his mind, read my blog post “A Letter from His Doctor.” (April 20, 2016).

Nurses earn less than doctors, but nurses do not give medicine without a doctor’s order. A guest must convince a doctor to order the shot (good luck with that). Then a nursing service will send one of its nurses to give the injection. This will cost more than a hotel doctor’s visit.

If the medicine seems reasonable and being a nice fellow, I give injections free if the guest comes to my house. Don’t depend on that anywhere else. 

Work That Pays Very Well

How many of you would take a job that paid 200 dollars an hour for driving your car? (for my international readers that’s 200 euros, 1400 yuan, or 12,000 rubles).

All of you, right?... But no doctors.

$200 an hour is what I earn for a distant housecall. It may take three hours to drive fifty miles to Newport Beach, care for a patient, and return.

I’ve made hundreds, but the colleague who covers for me refuses them, and no other housecall or hotel doctor in Los Angeles will drive far.

I’m not exaggerating when I write that I’m paid for driving. 95 percent of my patients suffer minor illnesses – respiratory infections, rashes, upset stomachs – that I’ve seen a thousand times. So it’s a matter of (1) a long, boring drive, (2) doing some easy stuff, and (3) another long, boring drive.   

Doctors get into trouble when they assume no one is sick, so I try to pay attention. And five percent of patients describe symptoms that might be serious. I worry on those drives, but usually everything works out.

When a Doctor Sees a Doctor, Part 2

Doctors enjoy chatting about diseases but not their own. We’re as frightened as you, and we want a doctor who sympathizes and makes it go away.

Some doctors don’t understand this. They assume that, being in the business, we don’t require any touchy-feely stuff and that it’s OK to talk shop.

Twenty years ago my dermatologist biopsied a bump near my ear. When he revealed it showed a basal cell carcinoma, he had me look through the office microscope at the biopsy slide, and I saw my cancer cells. Ik!....

Five years ago, my internist heard a heart murmur and sent me to a cardiologist. After determining that I had a damaged mitral valve, he led me into an adjacent room to show the ultrasound. Since I was a doctor, he took for granted that I wanted to know the technical details, but I absolutely did not want to see a film of my poor, diseased heart in action. As he happily pointed out the leaky valve I tried not to look.

We returned to his office where he extolled the skills of a cardiac surgeon at the nearby university hospital who had great success repairing heart valves. While it wasn’t urgent, he was certain I’d enjoy talking to him.

I found another cardiologist whom I like much better. I might need surgery in the future, he explained. He’ll let me know. I see him for an ultrasound every six months. Otherwise I try not to think about it.