Cancelling a Housecall

A guest at the Doubletree wanted a doctor to examine his son’s ear. I was getting in my car five minutes later when the phone rang again.

“I’m really sorry,” said the guest. “The hotel called another doctor, and he’s on his way, so we have to cancel.” That was a shock. The Doubletree is a regular. Was another doctor poaching? This is not a rare occurrence.

I asked the doctor’s name. The guest wasn’t certain. What was his phone number? He didn’t know. I phoned the hotel. The operator assured me that she had given out my number and no one else’s.

To my relief, I realized that the guest had simply changed his mind and wanted to cancel. He assumed that a blunt cancellation would upset me, so he invented an excuse – not realizing that the excuse was more upsetting.

Why I Hate Appointments

“We have two guests with a cough and sore throat, but they’re at a conference. They’d like you to come at three.” This news arrived at nine a.m.

I love seeing two patients at the same time, but I prefer going immediately. Things happen if I wait….

 “No one asked for a doctor,” said the person who answered the door. Shown the names, he recognized them but added that they were at a meeting. He phoned and reported that they had lost track of time but would hurry back. Their conference was at a university five miles away. Their transportation was by city bus. 

I didn’t want to wait, but I have an exalted view of the medical profession. We are humanitarians, a superior breed.

All doctors agree but many feel that if they’re treated with disrespect (by the government, insurance companies, or a discourteous patient), their humanitarian obligations vanish, and they’re free to become jerks (google “concierge doctor”).

After weighing my options and taking no pleasure, I drove to the university, picked them up, drove back to the hotel, and performed my exam.

The Superiority of Alternative Medicine

At the Ramada, I cared for a lady whose eyes were red and itchy. She had no allergies, and I saw no evidence of an infection. I suspected something was irritating them, and she had been using several over-the-counter eye-drops. Drops themselves can irritate eyes, especially with persistent use, so I told her to stop.

No eye drops for an eye problem?.... She looked uneasy at this suggestion, so I left a bottle of antibiotic drops but told her to call in two days if she still felt bad and wanted to use them. This is another occasion why so many patients prefer alternative medical practitioners (herbalists, nutritionists, acupuncturists…). No alternative healer tells a patient: “Don’t do anything. This will go away.” There’s always a treatment.

Security Hell

I’ve been to Park La Brea Towers a dozen times. Navigating its maze of twisting private streets, tall apartments, and rows of bungalows is not exactly a nightmare but always difficult.

It was after midnight, so the drive passed quickly but a barrier blocked my entrance. For security purposes, Park La Brea restricts access during wee hours. I drove until I found a barrier with a kiosk and a security officer. 

Another car was ahead of me. Checking out visitors turned out to be no minor matter, so several minutes passed before the officer handed the driver a pass and waved him in. I pulled forward only to encounter a problem. My patient was visiting, so her name was not on the list of residents, and there was no answer when the officer phoned. Nervous about speaking English, foreign guests often don’t answer.

He explained that regulations did not permit my entry. The sight of my doctor bag, suit, tie, and elderly appearance did not change his mind, but he assured me that his supervisor had been summoned. I parked behind the kiosk and waited. The supervisor never appeared.

My patience exhausted, I phoned the travel insurance office in Miami to warn that I might have to return home. Urging me to wait, the dispatcher contacted the lady on her Brazilian cell phone. Eventually, she contacted the security officer and vouched for me.

Describing the pleasures of wee-hour visits, I always mention easy parking. This applies everywhere except large apartment complexes where everyone and their guests are at home, so all spaces are occupied. After a long search, I parked illegally.

Doing My Duty

“I can’t handle that in a hotel room,” I explained. “She probably needs an ultrasound.”

After consulting his superior, the dispatcher came back on the line to explain that he would like me to evaluate the guest, a flight attendant with abdominal pain and vaginal bleeding, and deliver a recommendation.

If the guest had called directly, I would have sent her to an emergency room or, during the day, to an obstetrician, but this request came from an agency that serves airline crew. It was paying the bill, and I had done my duty by warning that a housecall wasn’t appropriate. I was happy to make the visit. Once I confirmed her symptoms. I would simply call and report, and then send my bill.

A young man opened the door. I entered, expecting to see a girl friend or wife, but he was alone, and he identified himself as the patient. He had a sore throat.

I checked the name and date of birth on my invoice. It was identical. He spoke excellent English, so there was no chance of a misunderstanding.

After dealing with his problem, I phoned the agency. Was there another flight attendant with vaginal bleeding waiting for me? After a long consultation, he assured me that no one knew. It was probably a mistake.

You Don't Need a Better Medicine

“My doctor gave me amoxicillin a week ago, and my sinuses are still blocked. I need a stronger antibiotic,” said a guest.

If a medicine isn’t working the next step is never to find a better medicine but to discover why it isn’t working. Sometimes there’s a problem that medicine won’t help.

Sometimes the patient needs a better exam. Pain on urination usually means a urine infection, and I’ve seen several patients whose urine infection didn’t go away after a course of treatment. They didn’t have a urine infection but herpes. It was obvious when you looked, but the doctor hadn’t looked.

Sometimes the patient needs to wait. After rubbing cream on an insect bite, patients worry when it grows to an itchy patch several inches around. I explain that insect bites generally worsen for two days and then resolve over the following days.

Sometimes the next step is to stop taking medicine. Treating pinkeye with drops usually helps, but patients occasionally return to complain that they’re worse. That’s because the drop has begun to irritate the eye. A few days after stopping, they feel better.

My malpractice lawyer warns me to warn you to read this purely for your own amusement. Only in mathematics can a statement be 100 percent true.

So if a medicine isn’t working, don’t stay away from the doctor on the grounds that I said it was OK.

Japanese Never Travel Alone

The room contained four young Asian men and extra beds, on one of which lay my patient looking miserable with a wet washrag on his forehead.

At my first question, several pulled out Japanese-American phrase books, a bad sign. It’s a fact that all Japanese study English in school, but all Americans study American history, and how much do they learn?...

Answers to my questions were on the order of “please perform a diagnostic evaluation” or “the reading of the thermometer seems excessive.” I had reluctantly decided to call their travel insurer’s 800 number (phone interpreting is tedious) when the tour leader entered. His English was rudimentary, and, being Asian, he was too polite to tell me when he didn’t understand, but I managed to confirm my suspicion that the young man had influenza, not life-threatening but a terrible illness for young people who take for granted they’ll never be ill.