The Law

A Finnish man with a fever was staying in a Hollywood Hotel. Treating flu symptoms is rarely satisfying, but I was pleased to learn that he was taking nothing for the fever. I handed over some Tylenol, and when I called back that evening he felt better. 

The following day was July 4. Hotel doctors look forward to holidays because freeway traffic is lighter. Sadly, no calls arrived. None arrived the day following or the day after that.

Deep down, no one believes in the law of averages. If you flip a coin heads ten times in a row, that’s not a fluke but as likely as any other combination. And the odds that the next flip will be heads remains fifty/fifty. It’s guaranteed that someone will win the lottery, but the winner always credits God. After several days with a silent phone, I conjure up images of a rival sweeping up my hotels with irresistible charm or fifty-dollar bills. But calls resumed

Against Medical Advice

A friend has had his gall bladder removed. He’s recovered, and you’ve agreed to drive him home. He is dressed and ready when you arrive. Hospital rules require the surgeon to examine him and approve the discharge, but after two hours the surgeon has not appeared. When asked, the nurse says he has been delayed. Asked an hour later, the nurse admits that no one knows where he is. They must wait.

An hour later, the exasperated friend announces that he will leave. You can’t do that says the nurse. If you do, you must sign this. She produces an impressive document that relieves the hospital of responsibility and lists terrible things that might happen when the signer leaves Against Medical Advice.

“Another thing,” adds the nurse. “If the doctor doesn’t sign the discharge, your insurance won’t pay.” Naturally, your friend decides to stay.

This happens all the time, but it’s nonsense.

First, you don’t have to sign an Against Medical Advice form. You can just leave.

Second, according to surveys, almost all doctors and nurses believe that medical insurance doesn’t pay if a patient leaves AMA, but it’s not true. Insurance pays.

Surveys also show that patients who leave AMA have a much higher rate of complication and readmission. Generally, it’s not a good idea. But, except for certain psychiatric cases, hospitals have no legal right to keep you.

A Risky Housecall

A lady at the Holiday Inn in North Hollywood reported that her husband was suffering diarrhea. She added that he had fainted during the last several episodes. I had never heard that before. Doubting that I could solve the problem, I told her we needed to call the paramedics. Sure enough, they took him to the hospital for a day of rehydration.

Warning! Make Sure You're Admitted!

This is strictly for American readers, but others will get a taste of the grotesqueries of our medical system.

Let’s say you’ve been vomiting for a few days and drag yourself to an emergency room. The doctor says you need IV fluids, so an aide wheels you to a room where you spend the night and most of the next day and then return home, feeling better.

Or you have chest pain. The ER doctor doubts that it’s a heart attack, but he wants to keep you for observation. After two days connected to a heart monitor and getting blood tests, you’re discharged, feeling better.

In both cases you’ll get a bill for at least $5,000, and YOUR HOSPITAL INSURANCE WON’T PAY!! 

Hospital insurance only pays if you’re admitted to the hospital, but remaining in a holding area for a few days or being kept “for observation” is not admission. You’re still an outpatient, so you’d better have good outpatient insurance.

If you’re over 65 and have Medicare Part A (which is free) but have decided to skip Part B (which costs $109 a month) you have no outpatient coverage. Part A only pays for the hospital. If you’re under 65 and have the usual Blue Cross or Blue Shield, you’re largely covered for hospital charges. Depending on the policy you’re willing to pay for, outpatient coverage varies. A lot. 

The solution, when the ER doctor announces that you need to stay for a while, is to ask: “am I admitted or not?”

Of course, you’re probably miserably sick or frightened (if not, maybe you shouldn’t be in an emergency room), so asking about insurance is not a priority. Woe unto you if you don’t.

The End of Narcotics

I once carried narcotics but gave it up. It’s too much hassle.

For garden-variety pain, codeine, Vicodin et al are sometimes but not always superior to over-the-counter pain medicines. I liked them because hotel guests have usually tried ibuprofen, Advil, Motrin, naproxen, etc. During the visit, I can hand over a few days of narcotics, and the guest knows he’s getting something different.

Nowadays, when I determine during the phone call that the guest only needs a pain medicine, I have nothing to offer, so I end up not making the visit. Many guests don’t want to pay the housecall fee in exchange for a prescription.

In an effort to fight the raging opioid epidemic, states have passed laws to keep track of narcotics. Pharmacists now send a report to the state for every narcotic prescription they fill. That’s easy because pharmacists already record everything on their computer, so they merely hit an extra button to send the report. 

If I hand out a few narcotics, I must sit down at my computer when I return home, find the reporting form, and fill it out. Some of the questions seemed cryptic, so I worried that I wasn’t doing it correctly. It seemed safer to stop handing them out.

An Odd Anecdote

Long ago when I was a medical student, a woman came to our gynecology clinic to have an IUD removed.

Five years earlier, when abortions were still illegal, she had had an abortion. For some reason, the woman believed that IUDs were also illegal. The abortionist said that he would insert an IUD for an extra $180, and she agreed.

When the resident looked inside, he didn’t see a string hanging out of her cervix. All IUDs have this string, so they can be easily removed. He ordered an X-ray. It showed a bobby pin.

The resident removed it in the operating room, rusty but intact. It had served her well for five years.

Gratitude is All I Get

The Adventure is a large motel near the airport that caters to foreign tourists on a budget. It’s full of colorful, young Europeans and Asians. The owner-manager phoned to inform me that his girl friend was sick. Could I see her? He would pay.

That was the third time he had asked me to see the girl friend who had a tendency to get sick. I like calls from general managers because it gives me a chance to do public relations.

After my first visit, I waved off his money but suggested that I’d like to be the Adventure’s doctor. He expressed gratitude and promised to tell his employees that I was the man.

Six months later, after the second visit, I refused his money and reminded him of his promise. He expressed gratitude and swore he would give my name to everyone.

Doing favors for general managers has won me new hotels, but it’s remarkable how often it hasn’t. Most of the time, gratitude is all I get. On my third call from the Adventure’s manager, I accepted his money.