Rashes Are Easy, Part 2

His client had developed redness over her eyelids. Could I come?

As I wrote last time, rashes are easy, and eyelid rashes mostly turn out to be one of two or three diagnoses. I asked for the room number.

The guest was in a meeting, the caller responded. When I arrived, I should ask the concierge to fetch her.

So I did. The concierge phoned and informed me that the meeting would end shortly. I waited half an hour.

As expected, the eyelid rash was no problem. After accepting a tube of cream, she mentioned that her knee had hurt since her run the previous day. I examined the knee and reassured her. Then we talked about her husband who had a sore shoulder but refused to see a doctor.

Rashes are Easy, Part 1

A woman at a Sunset Strip hotel had seen a doctor for an allergic rash, and now she wasn’t feeling right. Rashes are easy, and her symptoms were probably medication side-effects, so I expected no problem. That seemed to be the case,, and she agreed to stop the medicine.

She handed me her credit card. I took out my cell phone, dialed the credit card company’s computer, and entered a series of numbers at its request. It denied approval. This is often the result of a typing error, so I entered the numbers again. Another denial.

In the distant past, guests would apologize and promise to send a check once they returned home. Some kept the promise, but I soon decided it was better to collect on the spot.

The guest seemed genuinely puzzled. She wondered if the hotel was responsible. At check-in, a hotel often places a hold on a large sum from the guest’s credit card to ensure that it gets paid. She wondered if this exceeded her limit. She phoned the front desk, and this proved true. There followed a long series of calls, referrals, consultations, and arguments before hotel management agreed to remove the hold. It worked. The computer reversed itself and approved.

Googling a Hotel Doctor

If you get sick in a local hotel, you might google “Los Angeles hotel doctor.” My name turns up but only with links to this blog. I don’t have a web site. Nor do my long-established competitors.

However, several young doctors eagerly offer their services. All promise to arrive promptly and deliver superior care. Don’t take their word for it. Rating services such as Yelp are unanimously enthusiastic. Five out of five stars.

In fact, sick guests are more likely to appeal to the hotel than the internet, but these doctors have also been working their charms on bellmen, concierges, and desk clerks.

All this takes money and work, but it’s not going to waste. Veteran hotel doctors possess an exquisite ability to detect an interloper, and these whippersnappers are definitely setting foot in my territory. Listening to my colleagues grumble, I know they are not immune.

As I complain regularly, only a minority of general managers have the good sense to designate an individual, usually me, as the house doctor. I have never solicited hotel employees. It wasn’t necessary when I began because there was no competition. I’m too shy or perhaps too lazy to begin. It would probably be a good idea. 

More Competition

A caller from the Airport Hilton asked how much I charged.

This is often the first question I hear. If I answer immediately, the guest is likely to thank me and hang up. So my first response is that phone calls are free and might be all he or she needs. What’s the problem?....

He wasn’t a guest, the caller replied. Hilton management was checking on what hotel doctors charged. There had been an unpleasant incident…. Hearing that I charged $300 most of the time, $350 for a call that got me out of bed, he responded that this was a big improvement and that he would pass along this information.

When I asked about the other doctor, the caller gave me an 800 number. I called it and learned that I was speaking to Doctors Housecalls. When I asked for the medical director, the person who answered said he was the owner.

When the owner answers the phone, that doesn’t suggest a prosperous business. I introduced myself as a long-standing Los Angeles hotel doctor. He immediately went into PR mode and told me of his burgeoning nationwide service. When I pointed out that I’d only learned of his existence today, he admitted that he was just getting started in the city. He asked me to send my CV.

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.