Making the Doctor Feel Bad

If a prescription gave you diarrhea or made you vomit, you would complain. But until well into the twentieth century, people looked on a good “purge” as an excellent way to expel toxins. Physicians took pride in their cathartics, and when patients discussed a doctor’s skill, they gave high marks for the violence of his purges.

People who consult a doctor expect him to behave in certain ways. 21^st century Americans frown upon purges, but this is not a mark of superiority because we seem to expect medicine. It should be one only a doctor can prescribe; over-the-counter drugs don’t count. Pills are good; an injection works better.

Most of you will deny expecting medicine whenever you see a doctor. You want help. If you’ll get well without medicine, you won’t be upset… I often encounter such patients, but the other sort turns up regularly. I’m slower to prescribe than most, so I have many opportunities to see disappointment in patients’ eyes when they realize I don’t plan to “give them something.” This makes me feel bad.

Doctors genuinely want to help you, and it depresses us when we can’t. We also feel bad when we’ve done our best, and you don’t feel “helped.” So we often add a prescription or order a test to convince you that we’re doing what a proper doctor should do.

Following Instructions

I drove up into the hills late at night and parked on a narrow street. Following instructions from the caller, I walked up a driveway. It rose steeply and seemed to go on and on. There were no lights, but luckily I carry a flashlight for examining throats. After a hundred yards, I came to a small house with no lighted windows. No one answered my knock. There were two cars in the garage, so I assumed someone was home. I pounded on the door inside the garage. The lights came on, and a nervous woman’s face appeared at a window.

“I’m the doctor,” I said. “Is this 232 North Beverly Glen?”

It wasn’t. That was the house on the street. My instructions to “park on the street and walk up the driveway” weren’t wrong, but the caller failed to add that his front door was only a few yards up. 

How to Find a Good Doctor

Readers of these posts occasionally ask me to be their doctor. Since I’m long past retirement age and make housecalls exclusively, I can’t be anyone’s family doctor.

These requests bring up a serious problem:  how do you find a good doctor? Searching the internet turns up an avalanche of physicians yearning to care for you.

All seem humane, state of the art, eager to serve. Why isn’t the choice easy? The answer, of course, is that these are advertisements: fawning and phony.

It’s impossible for doctors to advertise without appearing shifty. They invariably point out their expertise, but you take that for granted. They extol their compassion. That sounds creepy, but they can’t resist. 

I’m not after your business. I give medical advice but only if it contradicts what you hear elsewhere or seems amusing.

I enjoy describing life as a hotel doctor and delivering opinions on the world, mostly as it relates to medicine. I write what I want although my wife exerts a modest influence (almost always by saying “you can’t post that...”).

I’m often the hero of my stories, but they’re mostly day-to-day events, some of which I wish hadn’t happened. The result is that I come across as a real human being. Why shouldn’t I? I’m a good writer. Most doctors can’t write; neither can their advertising agencies.

Terrific doctors aren’t rare. Their patients know who they are, so the best way to find one is to poll people you know. Asking doctors is OK, because they’re unlikely to name anyone bad, but they tend to prefer their friends. The only terrific doctors I know are those I’ve seen in action – most often caring for me. Ask around.

Amazing Facts on Nutrition, Part 2

Here are questions I often hear often.

“How can I make sure my diet is nourishing?”

Answer:  “Eat a variety of food. By consuming a good mixture of vegetables, fruits, grains, proteins, and dairy products, you’ll get everything you need.”

“How will I know if I’m missing something?  For example, how can I get enough riboflavin?  What foods have riboflavin?”

Answer:  “I don’t know.”

“You’re a doctor, and you don’t know the foods with riboflavin?”

Answer:  “I could look it up. It’s not important. Eating a variety is important.”

“I haven’t had much energy lately. Is it because I’m not eating right?”

Answer:  “Probably not.”

What should you do first if you're anemic?

Answer:  Find out where you’re bleeding. The most common anemia is the result of blood loss.

Amazing Facts on Nutrition

Although a third of the world would be better off on the typical American diet, it’s not ideal, but the defects are not what you believe.

What should you worry about?

Protein?  Not a problem.  Most adults consume more than they need. There’s no advantage to a high protein diet but not much harm either. Your body will use as much as it needs and turn the rest into fat.

Carbohydrates?  Americans should eat more. They’re high in roughage.  Americans need more roughage.

Fats?  Fat is OK. Vegetable fat is probably better than animal fat for lowering your cholesterol. Dieters should be careful about choosing low fat foods. They’re not necessarily low in calories; in fact, manufacturers add sugar to make them taste better.  

Sugar?  Americans consider sugar sinful. Like sin, it’s probably not good for you. Sugar certainly contributes to obesity and tooth decay but doesn’t cause serious diseases such as diabetes or heart attacks.

Preservatives?  They may do more good than harm. In poor countries a leading killer of children is diarrhea, often from spoiled food. This was also true in the U.S. during the nineteenth century. Refrigeration and canning makes this less of a problem today, but considering how careless we are storing and preparing food, preservatives still prevent disease. 

Should I Make a Housecall?

Only half my callers require one.

As I repeat, I’m happy to phone a pharmacy when guests forget legitimate medication: blood pressure pills, heart pills, contraceptives, etc. I don’t do this for guests who tell me “I had the same thing last year, and my doctor prescribed……” 

Exceptions exist. If a caller has had gout I believe him. It’s acceptable to treat a young woman with a typical bladder infection over the phone. If you’re wondering about symptoms of a “typical” bladder infection, I’m not telling. You have to tell me. Most “my doctor prescribes...” calls concern upper respiratory infections where the guest has received the traditional placebo antibiotic and believes he needs another.

Guests with stuffy ears don’t object if told they need a housecall, but I resist the temptation because ordinary congestion causes bilateral ear discomfort without pain. Over the phone, I advise aggressive use of nasal spray before takeoff and before the plane descends.

Injuries can be tricky. A doctor’s exam rarely diagnoses a fracture, but most common injuries are not urgent, even when a fracture is present. If guests are willing to wait until business hours, I can send them to an orthopedist’s office, more civilized than an emergency room. For back pain, a housecall is better. If you go where there’s an x-ray, you’ll get one, and experts agree that back x-rays are almost never helpful.

Much of my decision on making a housecall depends on the law of averages. Chest pain in a fifty year-old is usually not serious, but it’s unwise to assume this. It’s less unwise in a twenty year-old. A sore throat in a child or adolescent might be strep which medical science can cure. After age fifty it’s almost unheard of. I’ve never seen a case.

Laborl Day

Everyone left town for the holiday including the local concierge doctors and at least one colleague, but plenty of travelers arrived, so I was busy.

A Virgin-Australia flight attendant was vomiting at the Warner Center Marriott twenty miles to the northwest. That midnight an Emirate Airline crewlady suffered the same symptom at the Hilton in Costa Mesa fifty miles southeast. My heart sank when I remembered that the freeway to Costa Mesa in Orange County closes from 11 p.m. to 5 a.m. for major construction, and the long detour is always jammed despite the wee hour. My heart leaped when, checking traffic, I learned that the shutdown was suspended for the holiday.  

The parade of upset stomachs continued at a home near the beach in Venice. This is a funky area that brings back memories because my wife lived there when I met her during the Ford administration. It’s packed with small houses and shops built before World War I, so no one has a garage. Everyone parks on the street, and on a holiday afternoon the beaches and shops are crowded. The rule on parking (like the rule on difficult spinal taps) is: keep trying. After fifteen minutes I found a spot less than half a mile away.