It Never Hurts to Check

Universal Assistance asked me to visit a sick Costa Rican in Downy, a suburb of Los Angeles about thirty miles distant.

She gave the hotel address: 9640 Bell Avenue.

“Is that B – e – l – l?” I asked, spelling it out because English is never the native language of travel insurance dispatchers.

“Yes,” she said.

On Google maps (“29.4 miles; 39 minutes”), that address turned up in an adjacent city five miles away but not Downy itself. My first instinct was to accept it. As a visitor, the Costa Rican was unfamiliar with local geography. But several unhappy experiences persuaded me that it never hurts to check. 

“Not ‘Bell,’ said the desk clerk when I phoned. “It’s B – u – e – l – l.  Buell.”  Google found it in Downy.

"I Can't Afford That!

I hear this now and then when a guest learns my fee, more often in the form of a hint (“I’ll talk to my husband and call you back…”).

My routine when hotels call is to listen to a patient’s symptoms, deliver an opinion and advice, and discuss options (only half my callers require a housecall). Once a guest agrees to a visit, I reveal the cost.

Hearing a reluctance to pay, I mention local walk-in clinics. Their basic charge is less than mine, although that difference disappears if the doctor does anything (i.e. orders a test, gives a shot, writes a prescription, applies a dressing).

I feel uncomfortable suggesting leaving the hotel room if it’s a struggle – for example if someone is vomiting or dizzy. This guest had been dizzy all day. In these cases, I insist on coming, telling them they can pay whatever they feel is fair. Many guests end up paying the usual, but I’ve taken as little as $5.00.

Since she had already protested the fee, my expectations were low. They dropped to zero when I approached the hotel and saw paramedics loading her into an ambulance.

The guest’s symptoms were not life-threatening, but paramedics lean over backwards to take patients to the hospital, having been burned in the past when they didn’t. 

I wondered if she had called them because of worries about my fee. She may not have realized that paramedics will send a whopper of a bill.

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.