Looking for Help

“Your blog is funny, and you’ve got a great thing going with hotels. I wonder if we can work together.”

The caller was a young doctor who explained that he was starting a concierge practice and needed someone to cover when he was away. Naturally, he was available to cover for me.

I’m always looking for help. Hotel doctors keep each other at arm’s length because, while it’s considered unethical to solicit another doctor’s patients, soliciting a hotel is just business, and I don’t want them setting foot in mine.

We met at a local restaurant. He did most of the talking, describing the superb service he provided. As you may know, concierge doctors accept no insurance. In exchange for a large retainer or other cash arrangement, they provide enhanced care: immediate availability, leisurely office visits, 24 hour phone service, and house calls. House calls cost extra, and none of this money covers tests, x-rays, specialists, and hospitalization, so it’s a service aimed at the wealthy.

As it happened I planned to see a Dodger game with my brothers that weekend, July 4. The colleague who covers was attending a wedding and warned that he might have trouble getting away. I decided to give the concierge doctor a chance.

I usually call-forward my number to my colleague, but he knows how to deal with hotel guests, so I didn’t. The phone rang as we were driving to the stadium. A child was suffering a severe cough and fever. The mother wanted a visit as soon as possible. I called the concierge doctor.

“They’re in Hawthorne,” I explained. “It’s far, so I quoted three hundred dollars.”

He sounded shocked “Doctor Oppenheim! It’s a holiday!”

“Right,” I said. “No freeway traffic.”

“Doctors don’t work on holidays. Patients understand that. They know they have to pay extra.”

“And that would be…?”

“My patients pay six hundred dollars.”

“That’s not in the cards. Do you want to make the visit or not?”

“Of course, I do. But I’m celebrating the holiday with my family like everyone else. I have to earn a reasonable fee if I get called away. Patients don’t object.”

“I’ll take care of this another way.” I hung up, furious, and then  phoned the patient’s mother. The child didn’t seem dangerously ill, and she was willing to wait a few hours. That solved the immediate problem but ruined the evening because I worried about a catastrophe occurring while I indulged my frivolous love of baseball. When I phoned after the game, the child was sleeping, and the mother wanted to wait until morning. It turned out he had a routine cold.

I’m still looking for help. 

Stressful and Nonstressful Visits

Driving to a hotel can be stressful. I talk to guests by phone beforehand, eliminating obvious emergencies and unreasonable requests, but plenty of worrisome possibilities remain.

Sick babies make some hotel doctors nervous. I see them but some don’t. If, over the phone, the doctor tells you to take your baby to an emergency room, ask politely if he prefers not to see infants. If he admits this is so, try to find another hotel doctor before going off.

Elderly patients can be challenging. They seem fragile, so a doctor may lean over backwards to treat illnesses that don’t require treatment or refer to a hospital more quickly than he would a younger person. I consider eighty the beginning of fragility; other doctors begin at seventy, but this is clearly wrong because I am over seventy and not fragile at all.

If a patient has a bellyache, I worry. Without tests or x-rays I have to decide if it’s safe to wait. When I decide it’s safe, I’m almost always right, but I send guests to emergency rooms if uncertainty remains. Many endure a long, tedious, expensive experience only to learn that nothing abnormal has turned up. Some consider this good news, but others wonder why, having summoned me and paid my fee, I didn’t save them the trouble.

I’m always uneasy before seeing guests suffering an ordinary respiratory infection because a large percentage – perhaps a quarter – are obviously disappointed if I don’t prescribe an antibiotic. We feel bad when a patient believes we haven’t helped.

On the bright side, I often drive off knowing the diagnosis, knowing I’ll help, and certain the guest will deliver a satisfying dose of gratitude. Relaxing drives include those for simple urine infections, eye infections, ear infections, and rashes. I generally diagnose chicken pox, shingles, hives, and the common cold over the phone. Isolated abdominal pain is tricky, but I feel better if vomiting or diarrhea accompany it because they usually indicate a short-lived stomach virus. Guests who want their blood pressure checked rarely worry me. High blood pressure doesn’t cause symptoms, so those who make this request have other problems, generally anxiety-related.

Phrases Patients Love to Hear, Part 2

4.  “Staying in bed won’t make this go away any faster.”

Many laymen believe illness requires rest. They skip work or school. Mothers go to great (and futile) length to keep children immobile. Travelers waste days in a boring hotel room. This myth is so universal that when I reassure non-English speaking guests, I ask them to repeat what I’ve just said. Almost always, they miss the negative.

5.  “The fever (or vomiting or diarrhea) won’t harm you.”

Temperature by itself - even to 104 - won’t damage a healthy person.  Patients should pay attention, but they needn’t worry that death is near. When patients ask for a genuinely dangerous temperature, I answer “over 105,” but this is less helpful than it sounds because at this level, patients feel very bad. Similarly, healthy laymen fear that a few episodes of vomiting or diarrhea will produce serious malnutrition.

6.  “You’ll feel under the weather for a few days; then you’ll feel better.”

Patients may suffer for a week, but once they see a doctor, they want things to move quickly, so I warn guests that this might not happen. In my experience, if I neglect this, patients become concerned if they’re not feeling better the next day and take advantage of #3.

7.  “It’s not your fault.”

All our efforts at patient education plus the popularity of alternative medical theories have convinced Americans that they are responsible for getting sick. This is occasionally true but mostly not.

Phrases Patients Love to Hear, Part 1

After years of practice, doctors learn to read patients’ minds. I’m proud of my skill, but some doctors do better than others. Here are phrases you love to hear; you should hear them more often.

1.  “You did the right thing.”

Sometimes doctors are so reassuring that patients leave the office unhappy - not at the doctor but themselves.  “I wasn’t sick enough come in,” they think.  “I wasted his time.  I must be a hypochondriac!”  Most often this happens with minor ailments or respiratory infections when we provide reassurance but no prescription. To prevent this, at the end of a visit I might say something like “You did the right thing to come in. Some patients with this symptom have.... but you just have... “

2.  “This isn’t a serious problem, and it never turns into a serious problem.” 
Doctors know that many tiresome problems such as hemorrhoids, bladder infections, migraine, or herpes are not ominous. They never turn into something worse, but many patients don’t know this. A doctor must tell them.

3.  “I want you to call me any time.”

Most patients assume doctors are constantly pestered by neurotics. In fact, almost everyone who calls me has a good reason. Anxious not to disturb the doctor, many sufferers struggle through the night, but that’s a bad idea.  The best time to call is when the urge first appears. To be honest, I don't think you'll ever hear this. 

Lost in Translation Again

As I stepped out of the elevator, a Japanese man was waiting. “Are you the doctor for the hotel?” he asked.

I was pleased. “Yes. Are you going to interpret for me?”

He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the father, and the patient.

The patient had complained of fatigue the previous day. He was otherwise in good health with no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in a child. I suspected an emotional problem, perhaps from the stress of foreign travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.

Luckily these were Japanese, so they listened with unfailing courtesy, through the interpreter, to my reassurance and advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted), nodding approval, and thanking me effusively as I left.

Lack of Patience

“How quickly can you get here?”

“Pretty quick, but I like to talk to the guest first. Would you connect me?”

I didn’t assume this was an emergency; guests who make urgent requests are more often impatient than sick.

“How quickly can you get here?” asked the guest impatiently.

“Pretty quick. What’s going on?”

“It’s my assistant. He’s got the flu.”

“Could you tell me what’s bothering him?”

“I’m not a doctor. That’s why I called you.”

I suppressed a surge of annoyance. “People mean different things when they say ‘the flu.’ Is he vomiting?”

“No.”

“Is he feverish?”

“Yes. I have a dinner reservation at 6:30. Can you make it?”

It was 5:30. Unless guests feel truly miserable (vomiting, pain) they are usually willing to wait, so I like to delay dinnertime calls until rush hour traffic dwindles. But hotel doctoring is a competitive business, and if I disappointed this demanding caller, he might ask the concierge to suggest someone else.

Creeping 1½ miles to the freeway onramp took fifteen minutes, but then traffic moved steadily, and I arrived on time. In hotel doctoring, delivering medical care is the easiest part. The patient suffered a bad cold and didn’t consider it a serious problem. In person, his boss seemed congenial.

On my drive back, the freeway stopped cold. I took an exit three miles from home.  Despite this, traffic crawled so slowly I was expecting a blocked lane ahead, but it was just the rush hour. It took an hour. On the bright side, I had finished half my dinner when the call arrived, so I wasn’t hungry. And in hotel doctoring, when you finish seeing one patient, you go home.

Too Many Cooks

As I was preparing for bed, a call arrived from one of my favorite hotels, the Palomar. It’s large and upscale but mostly I like it because it’s only a short drive. The caller explained that his nine year-old son had been coughing for three days.

“I started him on phenoxymethy penicillin,” he added.

 “Does he have a bad sore throat?” I asked. Penicillin treats strep throat and no other common childhood illness, but the presence of coughing makes strep unlikely.

“No. I thought it might help… My brother is a pediatric consultant in London. He gave me a Ventolin inhaler.”

“Did that help?”

“A little.”  That means 'no,' but it was a good idea. Asthma inhalers often relieve a cough even in patients without asthma.

“I’m a doctor who comes to hotels. Would you like me to see him?” I asked.

“My wife wonders if I should take him to a clinic for a chest x-ray and blood tests.”

“Unless he’s very sick, that’s not necessary.”

“Maybe you should come. Can you give him cortisone?”

“I carry cortisone….”

“So you could give him an injection?”

“I’d have to examine him first.”

After consulting with his wife, he said “We will wait for you.”

I exchanged my pajamas for a suit, filled out my encounter form, and was about to leave when the phone rang. It was the Palomar, and I knew what that meant. Guests don’t like to cancel in person, so a hotel employee delivered the message.

“The gentleman says he’s decided to take the child to an urgent care clinic.”

“There’s none in this area open so late. He’ll have to go to the UCLA emergency room.”

“Thanks for the information. I’ll tell him.”

I reverted to my pajamas and went to bed where I passed an uneventful night. The Palomar guest probably passed it in the emergency room.