Three Discouraging Words

In rudimentary English, a Hilton guest explained that his rash needed attention.

“I’ll be there within the hour,” I said and quoted the fee. He replied with a phrase that makes a hotel doctor’s heart sink.

“I have insurance.”

From an American, this usually means no visit. Collecting from American carriers requires either a trained billing clerk or far more patience than I possess. I refer these guests to a local clinic.

Foreign travel insurers are better. I send a bill, and (unlike American insurers) they send a check for the identical amount. I asked the name of his insurer. It was Assistcard, an agency that’s called since the 90s.

The proper step was to ask the guest to phone Assistcard who would confirm his eligibility, and phone me. This never happens quickly, but it’s rarely a problem because 95 percent of travelers call their insurance first, so I don’t hear about the visit until it’s approved. This guest had mistakenly called me. I told him I would arrange matters.  

After listening to my explanation, the Assistcard dispatcher said she would call the guest, confirm his coverage, and call back. To pass time, I booted up my copy of Sim City. This worked too well; after 45 minutes of wrestling with urban problems I realized the phone had remained silent. Calling, I discovered that my dispatcher had vanished, perhaps to lunch. After putting me on hold, another dispatcher assured me that the wheels were turning. I phoned the guest to make sure he hadn’t wandered off only to learn that no one at Assistcard had called and that his tour was leaving in two hours. I called the dispatcher who explained that the guest was Indonesian. Assistcard was in Argentina, so getting approval from Indonesia might take a while.

Once the guest left for his tour, the visit would evaporate, so I decided to drive down and take my chances. My phone rang while I was on the freeway. The dispatcher informed me that no one could find the guest’s proof of insurance, but it might eventually turn up. Learning I was on the road, he offered to call the guest and suggest he pay me directly and try to claim reimbursement. That rarely works, but it worked this time.

My Distance Record

My distance record is a 94 mile drive to care for a man with a sore throat.

I’ve found it good business not to refuse inconvenient visits. It’s hard arrange a housecall on short notice, so agencies and travel insurers keep a list of doctors for every area. But humans are creatures of habit, and once a dispatcher learns that calling me always gets the housecall, they continue to call. Ignored, other doctors drift away, and I become the only one available. As long as I don’t refuse too often, they don’t bestir themselves to refresh the list.

I quoted a fee that took into account the long drive, pointing out that it would be cheaper to send the patient to a local clinic. This sometimes gets me off the hook, but it didn’t in this case, so I drove to Santa Barbara. That’s where I served my internship long ago in 1972-73, and the hotel turned out to be three blocks from my former apartment. The hotel was not there forty years ago, and the area had become unrecognizable, so I felt no nostalgia. I saw the patient, stretched my legs, and drove home.

Passing the Word

The Kyoto Grand is a large hotel in downtown Los Angeles that hosts many Japanese. Insurers send me every few months, but the hotel never calls.

One of the staff accompanied me to the room to interpret. After the visit, I described my services. He responded that the hotel had a doctor who practiced in nearby Little Tokyo. I pointed out that this doctor was undoubtedly reluctant to make a housecall during office hours and not eager to come at inconvenient times. The employee shrugged, accepted my business card, and promised to keep me in mind.

That same day my phone rang. It was the employee informing me that another guest needed my services. Naturally, I was delighted, and I drove back downtown to care for a guest with an upset stomach.

You might think I am now the doctor for the Kyoto Grand, but this happened long ago, and no calls have arrived since. While the employee may have lost the card, it’s also likely he neglected to tell anyone else about me. A dozen Los Angeles hotels call rarely because only a single employee knows me. Now and then the news gets around, and the hotel becomes a regular, but I have never figured out how to persuade someone to pass the word.

My Norwegians, Part II

At midnight the Norwegian lady from the previous post phoned, begging for a housecall. Something terrible was happening. This was a full-blown panic attack, she informed me. She knew for certain that she was dying. When I assured her that she would not die, she did not deny it but pleaded tearfully for me to come. Victims of panic attacks are not psychotic. They know they’re behaving irrationally, but they can’t resist.

These calls are not rare, and I usually handle them without a visit. Ten minutes of soothing reassurance and the knowledge that I’m immediately available over the phone generally works. Reassurance also works when I visit a guest whose complaint unexpectedly turns out to be a panic attack. Unfortunately, these successes are guests who don’t know they’re having an attack or suffer them rarely. This lady was a hard-core, locked-in panic attack veteran. Her attacks followed a strict pattern, and no reassurance would change matters.

If I came, examined, and found everything normal, she would express gratitude, but even before I finished counting my money, she would be pleading for another exam. Yes (I know you’re asking) there are shots, and I give them, but they don’t work. I hate walking out on a guest who’s begging me to stay, and these attacks may last hours.

This guest’s conviction that she was dying was clearly wrong. Yet every doctor has heard of patients who announce that they’re dying and then proceed to die. No doctor wants to be the source of such an anecdote, so this lady needed at least one exam. As I was agonizing, she broke in to say she would ask the hotel to call an ambulance. Then she hung up. I phoned the front desk to make sure they had done so. Like me the paramedics have encountered plenty of panic attacks; in the unlikely event something bad happened, they were the last medical professionals the guest had seen.     

My Norwegians

Oil gives Norway the world’s highest standard of living because, unlike oil-rich countries in Africa and the middle-east, Norway has an honest government. Besides putting away money for the future, it invests heavily in infrastructure and services such as universal free medical care and college education. Many Americans consider such government programs soul-destroying, but Norwegians tolerate them pretty well.

A  Norwegian tour arrived in the city last year, and I cared for four members. Thanks to a good education, all spoke English.

They were guests at the Hollywood Heights hotel in my least favorite part of Los Angeles. Despite our legendary freeways, none reach from my neighborhood to Hollywood, so I drove nine miles through the city. Planned in the 1960s, the Beverly Hills freeway would have solved my problem, but it vanished from maps when the city insisted it be built underground, an excellent idea.

The first Norwegian suffered a urine infection, common and easy to treat. The second had a hacking cough, present several days, which tormented three roommates almost as much as the patient. I handed over cough medicine. The third had been vomiting. Everyone with an upset stomach blames their last meal, so I listened to a recital of everything he’d eaten. I gave medicine and told him he’d be better in a few hours.

The last had been to Universal Studios and thought she had sunstroke. Sunstroke is life-threatening, but there are lesser sun-related conditions, none of which she had. She did not even have the painful sunburn that northern Europeans acquire almost as soon as they get off the plane. Universal City is in an area hotter than Los Angeles proper, but weather hadn’t been abnormally hot.

Hearing my reassurance, she admitted that her nausea and anxiety may have represented a mild panic attack. She suffered them regularly. This one seemed to be receding…. The story continues in my next post.

Oppenheim's Rule

Less in high school, more in college, and even more in medical school, students agonized before a test, suffering during, and grumbled afterward about how badly they did.

At some point in life, I had an epiphany. It occurred to me that I was smarter than most people. If a test seemed hard to me, it was certainly harder for everyone else. So I would do fine. When I decided to think this way, a great weight lifted from my shoulders, and I stopped worrying about exams.

As a certified family practitioner, I must take a test every six years to keep my certification. With no office practice, I can’t take the shorter test given to colleagues. It takes three hours; later someone visits the office to evaluate their charts. I must take the same day-long written exam given residents fresh out of training.  It includes subjects I’ve long forgotten such as obstetrics and surgery, so I spend a lot of time guessing. But I did fine in exams I took at the age of 39, 45, 51, and 57. By the time I was 63, the questions seemed harder, and I was guessing more often. For weeks afterward I broke my rule and worried. Failure would be humiliating. Also, I’d have to pay $800 to take the test again. But the rule held. I passed.

Wee Hour Gridlock

The phone woke me at 11:30. A lady at a downtown hotel was suffering an allergic reaction. This was not bad news; downtown is not too far, I charge extra for calls that get me out of bed, freeway traffic is light, and I can sleep late. I wrote down the information and dressed.

Traffic was minimal, but as I approached the freeway interchange leading to downtown, a line of traffic cones forced me to the outside lane. The ramp heading north was closed. The highway department schedules inconvenient maintenance for the wee hours, and I occasionally encounter these obstructions. No problem, I thought. I continued on to the next exit and re-entered the freeway to retrace my route. Cones appeared, so the other north ramp was also blocked. By the time I learned this, I was forced onto the freeway heading south. Again I left at the first exit only to discover no on-ramp in the opposite direction.

Fortunately, there was Figueroa, the main street through downtown, so I decided to follow it. That turned out to be everyone’s idea, so I joined a gridlock that crept north.

I apologized for arriving an hour late, and the patient was too polite to express skepticism that heavy traffic at 1 a.m. was responsible.