A Medicolegal Housecall

Stepping out of the shower, a Doubletree guest stumbled and cut his leg. He had paid little attention, but now, two days later, the wound had grown painful.

That sounded like a good visit until he delivered the bad news: the hotel would pay my fee.

I label these “medicolegal” visits and I don’t collect. When a hotel offers to pay, it’s usually because the guest is making a fuss, and management has already agreed to other expenses such as comping the bill.

I don’t want to be part of the problem, and it’s a chance to remind upper management of my value. During my usual visits I never see a general manager. Most managers are only vaguely aware of my existence, and a few are surprised to learn that the hotel can call a doctor.

The guest’s shallow, one-inch, laceration was healing normally. I doubt he would have called if he had had to pay. I reassured him.

I shook hands with the general manager and assured him that there was no significant problem. I added that, as the hotel’s doctor, I was always available, and he should feel free to consult me under any circumstance. I waved off his offer to pay. He expressed gratitude.

Don’t assume that this guarantees a hotel’s loyalty. It’s been years since Loews in Hollywood and the Adventure hotel called. My last visits to both were medicolegal freebies.

A Better Medicine

A 2 year-old was ill with vomiting, diarrhea, fever, and a rash. That sounded bad.

I know a pediatrician who makes housecalls, and I considered sending him. But the news came from the guest’s travel insurer, and their pronouncements are often exaggerated. I decided to go.

The guest greeted me at the door with a cheerful toddler at his side. That, to my relief, was the patient. He still had diarrhea, and a spotty rash was present but fading.

Suffering a respiratory infection, the child had seen the family doctor and received the traditional antibiotic. Instead of amoxicillin (the world’s most popular antibiotic for people who don’t need an antibiotic), he had prescribed Augmentin, excellent when necessary but a legendary stomach upsetter.

The parents took for granted that the solution was a better medicine and something for his rash and diarrhea. But this was one of those situations where stopping everything works best. 

Disaster Averted

“We have a situation with a guest…” explained the manager of the Georgian.

I love doing favors for hotel management, but this sort of announcement is not promising. Medical science cannot calm drunk, stoned, or disruptive guests, but hope springs eternal among hotel staff.

This turned out to be not so bad. A guest was taking an injectable medicine for rheumatoid arthritis. It required refrigeration, and the hotel had agreed to store it. Unfortunately, for unclear reasons, someone had left it on top of the refrigerator all night. What should he tell the guest? Could I call a pharmacy to replace it?

The medicine was Humira, a high-tech, genetically engineered monoclonal antibody. The internet pharmaceutical supplier that I patronize would sell me two doses for $7,000.

I did a Google search to find the manufacturer’s medication guide. While Humira should be kept in cold storage, leaving it at room temperature for a few days is OK. You can bet the manager was grateful for this news.

Easy Money

A Brazilian traveler had left her medication at home. Could I drive to Hermosa Beach and write some prescriptions? The caller was the guest’s travel insurer.

When hotel guests call directly, I tell them to go to a pharmacy and explain what they need. I would approve over the phone. It’s free; everyone is happy.

Before I could offer to do the same, the dispatcher informed me that, as a new service, the insurance would pay for visits to replace prescriptions. I could not turn down easy money.

It turned out not to be so easy. Helpfully, the traveler’s family doctor had faxed his prescriptions, but the writing was illegible and in Portuguese. There followed half an hour of phone calls to pharmacies and to Brazil and Google searches before I found the American equivalent of three of the four. The fourth never turned up, but it was probably an herbal remedy.

 

Trusting the Guest to Take Care of Things

A guest at the Crowne Plaza was feeling under the weather.

The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.

After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him to check and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.

I called an hour later, but the bellman didn’t remember the guest’s name.

Sickness Makes You Sick

“Normally I wouldn’t bother with this cough, but when I started to bring up green mucus I knew I had to do something…..”    

Hotel guests tell me this regularly, and it’s wrong. Everyone’s respiratory tract makes a quart of mucus a day. When the respiratory tract is irritated, it makes more, and the mucus may turn yellow or green. In an otherwise healthy person, this has no ominous significance.

No one stares at their throat when they feel fine, and a sore throat always looks suspicious. Everyone knows that white spots on your tonsils are a sign of Strep that requires urgent attention. In fact, plenty of ordinary viral infections make tonsils look bad.

 “The fever came back,” guests tell me as if this were a serious development. But Tylenol or aspirin only work for a few hours, and then you must take more. When patients tell me that they worry about a fever, my advice is “then don’t take your temperature.” They treat this as a joke, but the truth is that fever is just another symptom.

 All bets are off if you suffer a chronic illness or serious immune deficiency or are extremely old or extremely young, but this is not the case with almost everyone I see. When people in good health get sick, they feel sick.

 

 

Luckless Americans

 Ailing US airline crew are out of luck. They must travel to a clinic in a strange city, present their insurance card, and hope for the best.

 Foreign airlines do better, sending a doctor to care for crew when they lay over. In Los Angeles that’s often me. Being young, crews suffer common ailments. Even better, company rules forbid work if they have a cold, a digestive upset, or a minor injury.

 On my own, I often handle minor ailments over the phone, but airlines demand a doctor on the spot to confirm the ailment and name a date when the employee may fly again. I enjoy those visits. These patients are never demanding; their priority is getting home. They hate being stuck in a hotel room. Airlines permit them to return as passengers, and I’m liberal about allowing them, so those visits usually end happily for both of us.