Things Patients Tell Us That Are Almost Never True, Part 2

“It tasted funny….”

Everyone with an upset stomach blames their last meal, and some are right. But the toxins that make you sick quickly (mostly staphylococcal) and the bacteria that made you sick after a few days (salmonella, shigella, campylobacter) have no taste.

“My pressure is up.”

Calls from guests to “check my pressure” arrive regularly. I can’t remember a visit in which high blood pressure was the problem because high blood pressure doesn’t cause symptoms. I won’t mention the symptoms it doesn’t cause because no one believes me.

Things Patients Tell Us That Are Almost Never True, Part 1

“I need something stronger….”

It’s common sense that if a drug isn’t working, the doctor should prescribe a better drug. In fact, the usual reason a drug doesn’t work is that you have a problem a drug won’t solve. Mostly, when hotel guests make this statement, they’re taking an antibiotic for their bronchitis. A week or two has passed, and they’re still coughing. I have to explain that these illnesses last a week or two no matter what medicine you take. Similarly most “pinkeye” doesn’t respond to drops, and doctors still debate whether antibiotics help middle ear infections.     

“I’m allergic to….”

As I wrote on March 23, almost everyone who believes they’re allergic is wrong. Another large group claims that they’re allergic to a drug that upsets their stomach. In fact, this is not an allergy – meaning that it’s never fatal. This is important because you should never take a drug to which you are (genuinely) allergic. If a drug upsets your stomach but an alternative is more expensive or less effective, you might choose to feel sick for a while.

Always Pack a Flashlight

A guest searching for the bathroom at night stubbed his toe. Pain was excruciating.

Vomiting at 2 a.m. is good housecall. Chest pain at 2 a.m. is usually not a housecall. But some decisions when the phone rings at 2 a.m. are tricky.

Nothing about an injured toe is urgent except for the pain. Even if it’s fractured, the only treatment is to splint the toe by taping it to its neighbor.

Having told this to the guest, I hoped that he wouldn’t insist on a housecall. Once in the room, there is no problem, but I often never get there. After half an hour, while I’m still on the freeway, the guest may realize that the pain is tolerable and that he is on the hook for substantial cash (hotel doctors charge more during wee hours).

As often as not, the guest goes back to bed after asking the hotel operator to phone me and cancel. If I’m lucky, the operator makes the call.

Irritating Things that Movie Doctors Do

Give miracle shots. Whenever a movie character is crazy or really upset, a doctor delivers a shot that calms him. I wish I knew what it contained… Movie doctors are always putting characters to sleep, but no shot does that. An anesthetic delivered intravenously makes you unconscious, but that’s dangerous outside an operating room as Michael Jackson’s doctor learned.

Livesaving pills. I see this less often today, but in older movies a character would suddenly be dying. He wouldn’t have “his pills.” Everyone would look frantically for “his pills.” Someone would find them. He would take one and recover. I can’t think what disease does that.

Movie doctors are always saying “You have six months to live.”  We can predict average life expectancy for a fatal disease by tracking a few hundred victims, but that’s meaningless for an individual who could live a week or years.

“Tests show that you have incurable cancer.” Movie doctors who say this are never portrayed as incompetent, although they are. Delivering bad news is a skill no different from diagnosing a heart murmur. A movie buff will explain that the screenwriter can’t spend the time required for a realistic interchange, and I agree on the problem. But here’s the solution: a better writer. A bad writer uses these dumb shortcuts.

“You need plenty of rest and absolute calm.” This is so Victorian…. Bed rest is wildly unhealthy. Bones dissolve. Blood clots. The bowel falls silent. Today patients are dragged out of bed a day or two after major surgery. Doctors once believed that excitement damaged the heart. Intense emotion might cause a heart attack, so people with heart disease should stay calm. We don’t believe that anymore.

The Yearning for Drops

“I’ve been using them for a week, and the eye is getting worse.”

Hearing this over the phone, I’m usually not concerned. While there’s always the possibility of severe disease, the odds are that the eyedrops themselves have begun to irritate the eye.

Sure enough, that was my diagnosis. If you see a doctor with an eye problem, he’ll prescribe drops whether or not you need them. Many types of “pinkeye” don’t require treatment, but doctors believe (correctly) that patients with eye problems take for granted that they need drops.

Most people will not argue with a doctor, but it was clear (in retrospect) that the guest didn’t like what he heard. I told him to stop the drops and that the eye would feel better in a few days.

He was thinking:  “I have pinkeye, but this doctor says I don’t need drops. Obviously that’s because he doesn’t know what drops I need. I have to find a smarter doctor.”

When I phoned the next day I learned that he had gone off to an ophthalmologist.

This happened a long time ago. Nowadays I tell guests to use a harmless over-the-counter drop until the eye feels better.

More Perils of Common Sense

Fifteen years ago, I broke my leg. After I recovered, the doctor ordered a bone scan that revealed osteoporosis. That’s more frequent in women, but anyone skinny and elderly is at risk.

I began taking a drug for osteoporosis. Every year, I had another bone scan. Sometimes it showed a little improvement, sometimes a little deterioration. After ten years of not much change and a few different drugs, I grew discouraged.

“It looks like this isn’t working,” I said.

The doctor could have been honest (“these drugs usually help, but sometimes they don’t; we’re doing our best”) but instead I heard –

“If you hadn’t taken them, you’d be worse.”

That’s common sense. As I write regularly, if you hear common sense from a doctor it means he doesn’t understand what’s going on. 

It’s no different from the famous ad for a quack remedy: “Cures all but the incurable!”

Real Money

Foreign guests take time counting out my fee because all American bills look alike. Around the world, denominations vary by color, so a quick glance reveals their value. I think America is the only nation with monochromatic money.

When guests mention their difficulty, I explain that we consider colored bills frivolous, like Monopoly money. Real money is green.