I Have Syphilis

Those were the first words from a young flight attendant as soon as we had exchanged greetings.

Earlier, he had told his supervisor of a groin rash. I had popped a tube of antifungal cream into my bag and driven off, expecting an uncomplicated visit.

I asked how he knew this, confident that he had searched the internet and received the usual terrifying and incorrect information.

“My boy friend has the same sore. He went to a clinic. They did a test and said he had syphilis and gave him a shot of penicillin.”

I couldn’t argue with that. He would need the same test and injection. Since he was flying back the next day, he could take care of it then.

“I can’t!” he pleaded. “I don’t go to Australia for two weeks.”

His destination was Cairo because he worked for an Egyptian airline. On sexual matters Arabs are less easy-going than Australians, and he was frightened of the consequences if his employer found out.

I encounter this now and then. Even in the US where discrimination is illegal, employees worry. I never encounter syphilis, so I don’t carry injectable penicillin, but I handed over an approved alternative treatment, and he promised to follow up with his doctor in Australia. Later, writing my medical report for the employer, I worked hard to write an accurate if ambiguous description of a bacterial groin infection. 

Doctors Earn a Lot, Part 2

The best justification of our income lies in what we do:  we save lives, relieve suffering, and comfort the afflicted. Most of the time. I look on medicine as a noble, humanitarian calling, perhaps the noblest. Patients acknowledge this. So what’s the problem?

It’s that humanitarians shouldn’t make a lot of money. Few laymen believe clergymen, nurses, social workers, paramedics, teachers, policemen, or firemen are overpaid. They are less certain about doctors, but it doesn’t upset them if they have good insurance and enough money. Those without it rarely speak out or appear in the waiting room.

What are we doing about those who can’t afford us? Some doctors volunteer an afternoon or two. A few genuine humanitarians work full-time with the poor at an unacceptable salary. Most of us do little.

That statement produces an avalanche of disagreement. Poverty is no barrier in their practice, a chorus of doctors insists, but it is. Few doctors would refuse a patient who pleads for charity, but this doesn’t happen often.

Why don’t the needy call? They don’t hesitate to consult clergymen, social workers et al. I believe it’s because we are so powerful and prosperous and (ironically) because no influential group objects to this. In the debate over caring for the uninsured, no one wants doctors to shoulder the burden. Repeated cuts from insurers, Medicare, and Medicaid have had minimal effect on our income. Whatever changes occur in the years ahead, there’s no chance a physician’s income will come to equal that of, say, a teacher.

Doctors enjoy the best of both worlds. We care for the afflicted. For this we are widely admired and well paid. Sacrifices are expected - but only of our time and mental health. It’s hard to feel guilty because almost no one wants us to feel guilty. 

Doctors Earn a Lot, Part 1

The average family doctor earns about $220,000 per year. My peak income came nowhere near, but I’m not complaining. When friends suggest that we earn a great deal, I agree that America pays doctors generously. 

There’s no need to defend myself. Among problems of our health system that upset Americans, the size of our incomes is well down the list. 

Other doctors insist that they’re underpaid, and I wish they’d shut up. Their excuses sound whiny. Every complaining doctor beats two dead horses.

The first is what I call the Oprah Winfrey defense.

“Oprah Winfrey (or Tom Hanks or the chairman of Disney) makes. . .  How many lives do they save?”

Similar excuses include:

“A plumber charges. . .”

And the traditional:

“Lawyers make three hundred dollars an hour, so. . .”

Doctors aren’t the only ones comparing themselves to lawyers, plumbers, and celebrities. Everyone does. Worse, almost everyone who uses this argument earns less than I do. People who feel underpaid for their own honest labor are unlikely to agree that doctors are in the same boat.

Number two, equally feeble, is the trash compactor defense.

       

 “The average American pays more for alcoholic beverages than. . .” 

       

“My last malpractice premium was. . .”

“The consumer price index proves that doctors incomes haven’t. . .”

       

“Ten years ago, Medicare paid ... for a cataract operation.  This year it paid a mere. . .”

The trash compactor is a machine that converts a hundred pounds of trash into a hundred pounds of trash. A physician using this defense doesn’t grow less prosperous.

My blogging book says that readers lose interest when posts are long, so I’ll stop here and finish next time when I explain why we deserve a high income.

The Five Actions of a Hotel Doctor

After the door opens and an exchange of greetings, my first action is to look down at the floor. If I see a pile of shoes, I remove mine. You may think this is a quaint foreign custom, but some Americans have adopted it. When you consider what people and animals deposit outside, it seems terribly unsanitary track it onto anyone’s rugs.

My second action, on entering the room, is to identify the patient. A doctor making a housecall is an exotic event even for Americans, so I often encounter a large, attentive audience.

My third is to brush off apologies as guests rush to clear a space for my bag, clipboard, and buttocks. Apparently no one reads or writes while traveling, so desk and chairs are piled with belongings.

My fourth action is to suggest that someone turn off the television. Time and again, a patient begins talking – and I can’t hear. Guests often seem startled at this request – and occasionally miffed. What’s the problem?.....

It’s surprising how many people around the world turn the TV on before breakfast and leave it on. It’s the background to their daily life.

My fifth, after listening to the patient and before the examination, is to announce that I will wash my hands. This produces more apologies as guests rush to tidy up the bathroom.

I hope this held your attention. You should realize that any competent blogger must write at least once a week, or his audience drifts off. Being a hotel doctor may be a great job, but it’s not always exciting.

It's Just a Stomach Virus

“I’m worried about sunstroke,” said a guest at Maison 140. Her husband was vomiting, and they had returned from a walking tour of Beverly Hills. The temperature was in the 90s.

Sunstroke is life-threatening, and it takes more than a hot afternoon walk in Los Angeles to bring it on. I’ve never made the diagnosis, but hotel guests worry about it.

“I think someone put something into my drink.”

You’d think no one outside of a B movie would say this, but I hear it perhaps once a year. It’s alarming to fall violently ill after a night on the town, and Los Angeles is an exotic locale to many travelers, so anything can happen.

“The sushi tasted funny…”

It’s common sense that food your stomach rejects must be noxious, but if you’ve been paying attention you know that using common sense to explain an illness is proof that you don’t know what’s going on.

Food poisoning is not rare, but the responsible toxins are tasteless. Also, infections such as Salmonella and hepatitis are not the result of spoilage but contamination of perfectly good food with feces.

It’s almost impossible to diagnose food poisoning unless more than one person is sick. Almost everyone blames an upset stomach on the previous meal, but it’s most likely a virus. Google “viral gastroenteritis.”

Being Awakened Twice

 "How quick can you be in Costa Mesa?” asked the dispatcher for Expressdoc, a housecall agency. The call had gotten me out of bed at 11 p.m.

“In about an hour.” 

“Can’t you make it earlier?”

“Costa Mesa is forty miles away. How sick is he?”

“He has back pain. He wants to go to an emergency room, but we said we could send a doctor. Let me see if he’ll wait.”

After fifteen minutes had passed, I phoned the agency.

“I’ve been trying to reach him, but it looks like he’s gone to the hospital. If he comes back, is it OK to call you?”

“No. If he comes back, tell him I’ll be happy to see him in the morning.”

I have no objection to being awakened to make a housecall, but I don’t want to be awakened twice. After breakfast, I phoned the guest. He hadn’t gone to the emergency room, but he was feeling better.

Nearing the End of the Road

I have never denied being America’s most successful hotel doctor. No one has made as many visits – over 18,000 -- or works at it exclusively. All others do it as a sideline.

Yet time is passing. I’m not the only Los Angeles hotel doctor collecting social security. A new generation is muscling in, displaying the energy of youth, fierce marketing skills, and a priceless absence of ethics. All are concierge doctors, building cash-only practices that serve patients willing to pay to have a physician at their beck and call.

Even in Los Angeles, such patients are a limited resource, so concierge doctors have cast an eye on hotels, a major source of cash-payers.

“I guess no one’s been sick,” is the lie I hear when an employee explains why her hotel isn’t calling. I’ve been hearing it lately.

Partly it’s because my field is consolidating. National housecall services are expanding, and almost all use me. This is no news to my competitors, but marketing to these services presents difficulties for a concierge doctor.

One obstacle is their spectacular fees: double, triple, or quadruple mine. This may strike you as terrible business practice, but it’s no problem with hotels. Hotels don’t care what a doctor charges unless guests complain. They rarely do.

In addition, when concierge doctors introduce themselves to a hotel employee, extol their virtues, and offer an amenity for every referral, they have a receptive audience. It’s illegal for a doctor to pay for a referral, but no one is complaining. 

On the bright side, concierge doctors are young and busy. Immediate 24-hour service is their mantra, but providing it is impossible for anyone with a practice and social life. My leisure activities are reading and writing.

The result is that concierge doctors ask my help regularly. They send me to their patients who are increasingly guests at my hotels and those of competitors. When I retire, it won’t be because business is declining.