Another Freebie

A guest at the Georgian hotel in Santa Monica wanted a housecall, said the desk clerk. She had a urine infection.

That was good news. The Georgian was not far, and urine infections are easy.

“The guest has gone to dinner,” the clerk added. “She’d like you to come at 9 o’clock.”

I hate it when hotels make an appointment without consulting me. I want to talk to guests before a visit. They need to know how much I charge and that they’ll have to pay directly. Learning this, some guests reconsider. A few guests assume the doctor is in the hotel, so it’s no big deal if they’re late or decide to skip the consultation entirely. Finally, it’s stressful to kill time at home, hoping another call doesn’t arrive to complicate matters.

Sure enough, at 8:30, as I was about to leave, the phone rang. A guest at the Airport Hilton was vomiting. Vomiters don’t like to wait. There was no way to contact the Georgian guest to suggest a delay, but I decided I could make the visit and reach the Hilton in an hour. I hurried off.

Freeway traffic stopped cold at my exit. Santa Monica was holding an arts festival. The streets were jammed.  Normally, I would park and walk the six blocks to the hotel, but this would make me outrageously late for the poor vomiter at the Hilton.

Guests usually agree to wait when I explain the problem. The Georgian guest was back in her room.

“I just flew in from London. There’s no way I can stay awake,” she said on hearing that I’d like to return later that evening.

In the end, I phoned a prescription for a urine infection into a nearby pharmacy and then drove to the airport.

Major and Minor Tranquilizers

Guests often ask for something to calm them, and I try to comply by stocking Valium.

Tranquilizers relieve anxiety but not the pain of a terrible event such as a family death. Unhappy victims regularly ask for something to “put me to sleep,” but only general anesthesia does that. Even sleeping pills merely produce drowsiness; if you’re miserable, sleep comes hard.

I give a Valium injection if asked, but I have a low opinion of its tranquilizing properties. Valium pills work better because the more you take, the drowsier you get. The effect of the maximum Valium injection does not impress me. I prefer Thorazine.

Valium and its relatives are minor tranquilizers; the Thorazine family belongs to the major tranquilizers. “Major” and “minor” have nothing to do with strength; they refer to the seriousness of problem they treat. Thorazine helps schizophrenia, a major mental illness. The first of a numerous class of drugs called phenothiazines, its US approval in 1954 marked a huge advance because it calmed schizophrenics enough so most could leave mental hospitals and live on the street, thus saving tax money.

People who deny that schizophrenia is a brain disease claim Thorazine works because it makes patients somnolent. In fact, many newer phenothiazines aren’t sedating but work as well. Thorazine and its family turn off the positive symptoms of schizophrenia:  hallucinations, delusions, bizarre behavior. Movie schizophrenics seem to enjoy themselves, but hearing a voice inside your head frightens most people even if it’s God.

Despite their dramatic effects, phenothiazines don’t cure schizophrenia because they don’t eliminate the negative symptoms such as apathy, social withdrawal, and self-neglect. Being around a well-behaved schizophrenic remains an uncomfortable experience. Something is missing.

Isn't Science Wonderful - Continued

As I wrote last time, doctors treat strep throat with an antibiotic. Does it work?

That seems a no-brainer because antibiotics definitely kill strep bacteria. But the answer turns out to be….maybe. In scientific studies, giving antibiotics to patients with strep throat is not dramatically effective. Some doctors suspect they don’t work. This contrasts vividly with treating strep infections in other areas such as the skin where it’s often obviously lifesaving.

“Wait a minute!!” assert experts including my professors in medical school. It’s true that strep throat goes away in three to five days even if not treated, but doctors must treat in order to prevent rheumatic fever, a disease that can produce devastating heart disease. Scientists don’t understand why, but a small percentage of strep victims go on to develop rheumatic fever. Antibiotics lower the risk.

Are they right? Again science delivers the answer: maybe. Evidence for preventing rheumatic fever in America comes from a study conducted sixty-five years ago when rheumatic fever was common. It’s rare now. I’ve never seen a case. Everyone agrees it wasn’t a terrific study.

Some doctors believe that rheumatic fever is so rare in the US that giving an antibiotic is more likely to cause harm (yes, antibiotics can cause harm) than benefit.

While it’s fun to make controversial statements in this blog, with patients I stick to the standard of practice. This means I sometimes give treatments whose scientific basis is weak. If you prefer therapy that’s guaranteed, you must stop seeing scientific practitioners like me and seek out alternative or complementary healers. Google “alternative medicine.”  You’ll notice that their treatments always work.

Isn't Science Wonderful!

“He has pus on his tonsils, so it’s probably strep,” said a guest, calling about her teenage son. I hear this phrase regularly. It causes me some stress because I know that later I might find myself delivering a why-antibiotics-won’t-help explanation to a sullen audience. 

One popular (i.e. wrong) medical belief is that pus on tonsils is a sign of strep throat. In fact, this is true only about ten percent of the time. Viral infections produce identical exudates.

Arriving in the room, I discovered that the boy had pus on his tonsils but also a fever, swollen, painful glands in his neck, and no cough. Good scientific studies show that the presence of these four signs: pus on tonsils, fever, swollen neck glands, and NO cough raise the odds of strep to over fifty percent, so prescribing an antibiotic is appropriate. I prescribed an antibiotic. The family made it clear they were in the presence of a doctor who knew his business.

Isn’t science wonderful? It is. But it’s wonderful in ways that are often not satisfying. More in my next post.

Easy Visits, More or Less

My phone rang as I walked into the gym. A guest at the Sunset Plaza wanted a doctor to “check out” her 9 year-old daughter who’d awoken with a fever and vomited once. This was a good call. Multiple vomits can be worrisome, but one is OK. I jumped at the chance to skip my morning exercise.

Sunset Plaza parking is indoors and free, a bonus on a hot day and on the Sunset Strip where street parking is impossible. The daughter was recovering, so I reassured the parents, a pleasure for everyone.

As I returned to my car, the phone rang again. This was a perfect time for a second call. Lunch was two hours away. Late morning traffic is the day’s thinnest. I could thrill the guest by announcing a speedy arrival.

The caller was a national housecall service. The patient was a Quantas flight attendant at the Hilton. While there is a Hilton at Los Angeles airport, this one was in Costa Mesa, 45 miles away. This was not so good, but there were compensations.

As I’ve written, in the old days airlines called me directly, and I billed them directly. No airline does that now. They call a national housecall service which, of course, calls me. I’m happy to work for the service because, being a better marketer, it’s acquired far more airlines, so I receive more calls. It also pays much more. This is possible because it charges airlines triple my former fee. You may wonder why airlines are willing to pay so much more, but I don’t. I’ve long since stopped believing that bad decisions by people who seem intelligent have a good explanation.  

Another Perk of Hotel Doctoring

A travel insurer sent me to visit a woman complaining of asthma. When I arrived, she admitted that she had a little wheezing. She didn’t seem ill, and my exam was negative. She added casually that she had left home without her asthma inhaler, so I wrote a prescription for another.

When guests phone me directly because they’ve forgotten a medicine, I call a pharmacy to replace it at no charge. Guests who phone their travel insurance are often reluctant to admit their mistake, so they claim they’re ill. These are easy visits.

I Resist Temptation

A businessman at the Hilton-Garden Inn asked a pharmacist to recommend a cream for his insect bites. To his alarm, the pharmacist informed him that what looked like insect bites might be Lyme disease and that he should consult a physician.

This provided another delicious temptation in the life of a hotel doctor. I could make a housecall, assure the man he did not have Lyme disease, and collect my fee. He would feel vastly relieved and grateful. Everyone would be happy.

The businessman described half a dozen itchy pimples around his ankles. Even over the phone, it was obvious that they were insect bites. I reassured him, and he was relieved and grateful, but no money changed hands.