A Tropical Disease

They had just flown in explained a father at 1 a.m. While in Hawaii, their two year-old had suffered mosquito bites followed after a few days by fever, restlessness, and refusal to eat. Checking the internet (my heart sank….) he learned about dengue fever.

I explained that dengue is a viral infection that produces the usual symptoms of a viral infection (fever, body aches, general misery) and has no cure. He agreed but pointed out that deadly complications, although uncommon, did occur, and he wanted the child examined.

Before leaving, I consulted a medical book to refresh my knowledge of dengue fever. I’ve never seen a case. The child did not seem terribly ill. Certainly there was no sign of shock or internal bleeding, the typical complication.

I reassured the parents.

Going Back to College

Every summer, a hundred Brazilian adolescents descend on UCLA’s dormitories to study English. When one gets sick, a counselor phones April Travel Insurance which phones me.

Middle-class teenagers suffer respiratory infections, upset stomachs, and minor injuries, so, once I learned to deal with UCLA’s draconian parking policy, I found these easy visits.

I graduated UCLA fifty years ago, and returning is a strange experience. Crowds outside the dormitories shriek, laugh, and chatter. It sounds like a kindergarten. Were we that noisy? There's nothing strange about the women's fashions, but the men look like dorks. My generation had long hair and tight clothes. Nowadays it’s short hair and baggy clothes. They wear shorts. Don’t they realize how silly they look? We kept books in lockers. Now everyone has a backpack. Especially odd is the number of Asians who make up over a third of the enrollment. They speak perfect English, so they’re clearly American. Where were they when I attended?

In my day, when you entered a university building, you found a door and entered. Today all doors except the main entrance are locked. Students manning the front desk consider names and room numbers privileged information. Using the elevator requires a key which all students carry. This is identical to hotel security and probably no more effective.

On arriving, I phone a counselor who comes down to escort me. The dorm rooms are tinier than I remember, and little studying occurs because the desks are piled with personal items. Delivering medical care is easy, but it’s summer, and foreigners believe that air conditioning is unhealthy, so the rooms are hot.      

Bringing the Housecall into the 21st Century

Housecall agencies spring up regularly. I keep track of them so I saw Medicast’s web site when it came to life a few months ago.

During an interview with two energetic founders, I learned that they plan to bring the housecall into the 21^st century, slashing the cost with volume, marketing, and digital technology. They would launch in June 2014 after a massive marketing campaign. Doctors were rushing to sign up, they added.

I agreed to join them but declined the canvas carry-all they were offering, preferring to keep my traditional doctor’s bag. A handout listed required drugs and supplies which Medicast would sell to its physicians, but they agreed that I could handle my own selection.

They gave me an Ipad Mini. All their doctors receive one. Potential customers download the Medicast app which gives them the choice of signing up for a paying program that provides free housecalls or paying nothing and summoning a doctor when they need one. Clicking the app connects them to a dispatcher who records their credit card information and sends a text message to a doctor on-call. The program then automatically dials the client.

“Hotel guests phone my cell directly, or I phone them,” I said. “Wouldn’t that be quicker?”

“Doctors hate giving out their private numbers,” they explained. “This way you don’t appear on caller-ID, so patients can never bother you.”

A Los Angeles housecall costs $249 during business hours, $349 during nights and weekends. While this is in the ballpark of my fee, Medicast keeps about one third. Medicines and injections cost extra, so a Medicast doctor has the opportunity to earn more – a lot more if he’s creative, and some doctors show a positive genius in this area.

The app includes a tempting feature: a button a doctor can swipe to go “off call.” I don’t mind that hotels and insurance services phone 24 hours a day, but I sometimes can’t resist flipping the button when I go to bed.

Carrying the Ipad everywhere is a minor annoyance, and software bugs still make an appearance. If another doctor answers, the app doesn’t notice, so I’ve phoned patients who’ve already set up a housecall.

Business is brisk. My Ipad chirped nine times in June to announce a call although some may have been software glitches. All were from local residents, so they don’t overlap with my clients, but employees at two hotels have reported visits from a Medicast representative.        

When Doctors Wish They'd Chosen a Different Profession

Up to age one, infants look on everyone as a friend, so they’re a delight to care for. Afterward, they become aware that some people are strangers, and it’s not a happy discovery. Frightened girls tend to keep quiet, but boys often protest the moment a doctor enters and don’t stop until he leaves.

During one occasion, I removed stitches from the chin of an energetic three year-old. His family doctor had tried, then decided to wait a few days during which time the parents traveled to Los Angeles. Now the skin around the sutures was inflamed, so they had to come out. Normally suture removal is painless, but the child began shrieking at my approach. Both parents struggled to immobilize him, but you can’t prevent someone from moving his chin if that is his intention. Everyone on that hotel floor knew something terrible was happening. It took five minutes to snip four sutures, leaving everyone exhausted.

I Don't Do Adderall

“A guest at the Century Plaza wants his Adderall refilled. Can you go?” asked someone from the office of a local concierge doctor.

“I can go, but I don’t do Adderall,” I said.

“No problem.” She would find another doctor. Prescription refills are easy house calls.

You’ve heard of childhood attention-deficit disorder. Recently psychiatrists have discovered that it also affects adults. Treatment is the same. That includes drugs related to amphetamines; the most popular for adults is Adderall. As a hotel doctor my only experience with attention-deficit disorder comes from guests who need more Adderall.

None sounded like drug-seekers. All were happy to pay my fee for a visit during which I would check them out. Since there is no way that I can examine a guest and determine if he or she suffers adult attention-deficit disorder, I told them I’d have to speak to his or her doctor. None ever called.

It’s been decades since I made a similar decision on narcotics. Guests occasionally forget their heart pills, but soon after becoming a hotel doctor, I grew puzzled at how many needed more Vicodin or Oxycontin. Some sounded suspicious from the start, but many were clearly in great pain. Their distress tore at my heart, and they often produced a sheaf of X-rays and letters from a doctor. With no reliable way to tell the fakes from the genuine, I gave up on narcotics.

No Housecalls Today

A guest dropped an ice bucket on her toe. Pain was excruciating, and blood poured out. Holding the toe under the tap didn’t help.

Over the phone, I explained that running water won’t stop bleeding. She should apply pressure over the wound and add ice to dull the pain. When I called an hour later, she was having dinner in the hotel restaurant.

A man had developed a slight cough, in his opinion a prelude to full-blown bronchitis. He wanted something to knock it out. I explained that, in a healthy person, viruses cause almost all coughs. I could come, but I couldn’t promise an antibiotic. The man said he would get a second opinion.

A teenager bumped his head on a bedpost and developed a lump the size of an egg. The parents asked that I check him for brain injury. That requires a CT scan, I explained. He would certainly get one if he went to an emergency room, but the injury didn’t seem serious enough for that. It was OK to wait. He did fine.

A guest had missed his flight because of an upset stomach. He was well now but needed a doctor’s note to avoid an expensive ticket-exchange fee. These requests arrive now and then, and they put me in a difficult position. I can’t write “The guest was unable to travel because of an upset stomach” because I don’t know if that’s true (sometimes the patient admits that it isn’t). So I offer to write the truth: “The guest states that he suffered an upset stomach and could not travel.” I sweeten the pot by offering to fax it to the hotel at no charge.

Guests usually accept. To date, no one has complained, so the note may work.

Paramedics

My personal encounter with paramedics occurred the day I fell (ironically during my morning exercise walk) and broke my hip. I might have lain there for some time because pedestrians in my middle-class neighborhood ignore the occasional bearded old man lounging on the sidewalk. Luckily, I had taken a detour through an alley behind a restaurant where two Hispanic workers noticed, came to my aid, and called 911.

I was not in great pain as long as the leg remained immobile. Any movement hurt terribly. When the paramedics approached with their gurney, I was frightened, but they scooped me up, drove to a hospital, and shifted me to another gurney with hardly a twinge. Never mind their medical skills; that showed talent.

While I admire paramedics, they have little use for me in my capacity as a hotel doctor. Paramedics almost never encounter a physician on their calls, and they don’t like finding one. Most likely, they worry he might pull rank. As a result, when paramedics arrive at my hotels, I sit quietly, never speaking unless spoken to. In turn, the paramedics go about their business, pretending I’m not there.