Another Shot Request

The guest had the medicine and syringes; all I had to do was draw it up give the injection. The drug was a blood thinner she needed after hip surgery, so it was a legitimate request (some guests, usually from third world nations, arrive with weird stuff).

Giving a shot is easy, but most guests don’t want to pay my fee. Long ago, I explained that a hotel doctor spends ninety percent of his time driving and parking, so delivering a shot takes as long as other routine visits. This never convinced anyone, so I offer a discount.    

It’s a mystery to me why doctors prescribe injections and then – hearing that the patient is traveling – advise them to find a doctor or nurse to administer it. A nurse won’t give an injection without a doctor’s order, and most doctors will refuse.

In our suit-happy society, why would a doctor give medicine to someone he’s never seen strictly on the patient’s say-so? As a result, I hear from plenty of guests steaming from frustrating encounters at local clinics. They remain convinced that giving a shot shouldn’t cost much, so these are not visits that produce much gratitude.   

Don't Do Anything!

The guest was feverish, and his abdomen felt tender and rigid, a sign of peritonitis. He needed to go to an emergency room. I phoned his travel insurance to let them know.

This particular agency was a slow payer, usually a sign that it would be hard to deal with. Sure enough, after hearing the news, the dispatcher informed me that the patient must first go to the Airport Medical Center, an urgent care clinic. It’s not part of a hospital, and the doctor on duty has the same training as I.

Getting a second opinion before sending a client to an emergency room saves the agency money, but it wouldn’t in this case because my patient needed to go. There was always a chance the AMC doctor would send him home, so I phoned the clinic to make sure he thought twice.

No sensible doctor tells another doctor what to do, so I chose my words carefully. I was sending a man with bad abdominal pain and peritoneal signs, I explained. I felt he needed to go to an emergency room and be admitted, but his insurance insisted on an urgent care clinic. He thanked me for the information. “We don’t have too many facilities here,” he added. “But we’ll do what we can.”

“Don’t do anything. Send him to the hospital,” would have been tactless, so I didn’t say it.

Once a doctor decides a patient needs emergency care, allowing a test to change his mind is a bad idea. For example, an abnormal blood count points to an infection. Good. But what if the blood count comes back normal? The answer: send him anyway. Doctors shouldn’t order a test that won’t change the treatment, but we do it all the time.

So the man spent a few miserable hours while the doctor ordered tests that doctors order when a patient has a fever and bellyache: blood work and an abdominal x-ray. I have no idea of the results, but I checked to make sure he’d gone to the hospital, and he had.

I Get Letters

In my dreams, agents write, suggesting a book, perhaps entitled “Hotel Doctor to the Stars.” So far these haven’t arrived, but physicians occasionally E-mail me. They want to know how to become a hotel doctor.

I advise them to (1) let local hotels know they’re available and (2) wait. It helps if (3) there’s no competition. That worked for me although I began in 1983 and it wasn’t until 1992 when my yearly visits passed 1,000, and I quit other jobs to become a fulltime hotel doctor. By then others were entering the field, so newer doctors will wait longer.

My only advertising is a dignified letter to general managers three or four times a year. Aggressive competitors who extol their services to desk clerks and concierges often take over my regular hotels, at least temporarily, but it didn’t work when I tried it. At better hotels, employees are nice to everyone, so they listened intently, eagerly accepted my business card, and promised to keep me in mind. The first few times, I left feeling pleased with myself, but calls never followed. At cheap hotels and motels, staff seemed mystified at the concept of calling a hotel doctor. No one ever got sick, they insisted.

It’s possible I was missing the key inducement: money. Paying a bellman, desk clerk, or concierge “referral fee” has a long tradition in hotel doctoring. It’s illegal, and all my competitors condemn the practice, but I suspect it happens.

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.