Bad Credit Cards

A member of an Argentine soccer team fell while roller staking, wrenching his ankle.  A doctor from their travel insurer in Buenos Aires determined that he needed an orthopedist but that this could wait until office hours the following day. However, the doctor wanted someone to examine him that evening, so my phone rang.

The team was staying in Long Beach, 35 miles away, but the rush-hour had passed, and the agency did not object to the extra fee. This was International Assistance. I’ve made 896 of its visits, but after an ownership change, it became extremely slow to pay. Losing patience, I insisted it give me a credit card number, so I could pay myself. This is always a critical request, because some agencies refuse and disappear from my radar. But International Assistance agreed.

As soon as I hung up, I remembered that IA’s current credit card had expired in August. When I called back, the dispatcher put me on hold to consult her superior. After a few minutes, she returned with a new number.

I phoned the credit card company and entered my identification and the credit card number only to hear the computer declare: “Do not honor! Do not honor!” I phoned IA again, awaited the consultation, and received another card. “Do not honor!” intoned the computer a second time.

“Invalid credit card number” I heard on my third attempt. This turned out to be my mistake; in my increasing frustration, I made an error entering her third number. After correcting it, I heard the satisfying: “Approved” following by a confirmation number. Insurance agencies often give me bad credit cards. I suspect their business is as competitive as mine, so many are in perilous financial condition.

My patient was reclining on a couch, an ice pack on his ankle, his teammates gathered around. The ankle was massively swollen, and he was in pain. Waiting would not have caused permanent harm, but people with painful injuries deserve quick attention.

Fortunately, IA is an agency that takes my advice even when it costs money, so his companions took him to an emergency room to deal with fractures of both leg bones. 

Adventures in Parking

In parts of Los Angeles, especially downtown and the Sunset Strip, street parking is impossible. I dislike turning my car over to an attendant because it can take fifteen minutes to retrieve it from the parking garage. Also, although it’s irrational, I’m willing to pay $15 for a movie or book but not for twenty minutes of parking. I try to leave my car near the entrance, a small area where only VIPs are permitted. When the attendant doesn’t recognize me (“Welcome to the Biltmore; are you checking in?...”), I do not accept the voucher he holds out, explaining “I’m the hotel doctor visiting a sick guest. They let me park.” This sometimes works, but if he insists, I take it. Sometimes the hotel will validate, but it’s unpredictable.

Searching for a spot on the street, I follow the position of the sun as closely as a sailor because I must park in shade. I keep extra supplies in the car, and an hour in blazing sun will melt my pills and ruin batteries. I don’t mind walking a few blocks if I find free street parking (and I know all the secret places), but since I wear a suit and tie, hot weather discourages this. Rain does the same because carrying an umbrella is awkward in addition to my doctor bag and clipboard.

One advantage of wee-hour calls is that parking restrictions vanish and valets grow somnolent or disappear entirely. I’ve never felt in danger, but downtown parking remains problematic because homeless men invariably rush up and offer to watch my car.

My most upsetting parking experience occurred during a visit to the Ramada in Culver City at 4 a.m. I left my car at the deserted entrance, cared for the guest, and returned to find a parking ticket on my windshield. The hotel’s driveway was private property, so ticketing a car requires phoning the police. Looking around the lobby I noticed a security officer looking innocently away. There was nothing to be done.

Why I Am a Patriot

Hot summer days remind me of why I love America. We appreciate air conditioning. Citizens of most other nations consider it unhealthy. They tolerate it as an exotic American quirk, but as soon as someone in the party falls ill, the air conditioning goes off.

Wearing a suit and tie, I conduct my business in suffocatingly hot hotel rooms. When I extol the benefits of machine-cooled air to foreigners, they listen politely with an expression identical to that of Americans hearing me explain that antibiotics will not cure their bronchitis.

Satisfying and Unsatisfying Problems

A guest interrupted my questioning to dash into the bathroom, and I heard the sounds of gagging as she vomited.

While waiting, I took a vial of ondansetron from my bag and began filling a syringe. After a few minutes I heard the toilet flush.

“Why don’t I give the vomiting injection now?” I said when she reappeared. “You’ll probably want one.” She agreed with enthusiasm.

I finished my exam, made a diagnosis – the common stomach virus – and delivered advice and a packet of pills. I also went to the ice machine down the corridor and filled her ice bucket, so that she could suck on the chips for the next few hours. She was very grateful and equally grateful the following morning when I phoned to learn she had recovered. Most stomach viruses don’t last long, a day or so.

Vomiting and diarrhea are usually satisfying problems for a doctor. Most skin problems are easy. I rarely have a problem with earaches, backaches, minor injuries, common eye inflammations, even most urinary and gynecological complaints. A hotel doctor’s patients are healthier than average, but serious problems occur. It turns out that these are not necessarily “hard.” When I encounter someone with chest pain, eye pain, sudden weakness, difficulty breathing, or an injury that may be serious I know what to do. At the end patients receive the care they should receive, and we both know it. That’s a satisfying feeling.

What is the most unsatisfying problem a doctor faces? Rare diseases? Puzzling symptoms? Neurotics? Drug addiction? None of these. Most doctors would agree that it’s the common viral upper respiratory infection. About twenty percent of everyone who consults a doctor suffers. Hotel guests are no exception. No one tries to educate me about heart attacks, but everyone is an expert on these. Patients tell me how they acquired theirs (“I got caught in the rain”), or why (“I’m not eating right; my resistance is low”), the proper treatment (“my doctor gives me a Z-pak”), and what will happen if I disagree (“It’ll go to my chest”). These explanations are always wrong.

You catch a virus from another person. The illness lasts from a few days to a few weeks. If you see a doctor, he or she will prescribe an antibiotic at least half the time. The antibiotic is useless. Doctors know this but prescribe them anyway.

No patient agrees. “I have a good doctor,” they reply. “He would never do that.”

My response is that prescribing useless antibiotics is not necessarily a sign of incompetence. It’s so common that good doctors do it. One expert calls this avalanche of unnecessary antibiotics one of our greatest environmental pollutants. It’s producing a growing race of “superbugs:” germs resistant to all antibiotics.

Here’s a professional secret. When doctors chat among themselves, we often bring up the subject. Challenged by colleagues like me, prescribers never claim that antibiotics cure these infections. They know they’re a placebo, but they respond with a powerful argument. “When I’m finished, I want patients to be happy, and they are happy. One hundred percent. What’s your experience?”

It’s not as good. When I deliver sympathy, advice, and perhaps a cough remedy to patients with a respiratory infection, most seem genuinely grateful, but a solid minority drop hints (“Isn’t there something to knock this out….?” “My regular doctor gives me…..” “I have a meeting tomorrow, and I can’t be sick…”).

Doctors love helping patients. That’s why we went into medicine. Equally important, we want you to feel “helped,” and we are super-sensitive to your gratitude. Almost everyone is too polite to argue with a doctor, but we can detect the tiniest trace of disappointment as you leave. It hurts us. Every doctor knows that he can eliminate this pain and produce heartfelt gratitude by prescribing an antibiotic. This is terribly tempting, and after a few dozen or few hundred or few thousand disappointed patients, most doctors give in.

Avoiding the Rush Hour

A guest with a respiratory infection was staying in a Whittier hotel, thirty miles away. The call arrived at 5:00. Driving sixty miles in rush hour traffic is an experience I prefer to avoid if the problem isn’t urgent. I told the insurance dispatcher I would arrive between 8 and 9.

Usually I explain that “I won’t get out of the office till 7.” That’s an excuse patients usually accept. This time I slipped up and merely explained that I didn’t want to get caught in the rush hour. This is less acceptable and, sure enough, the patient cancelled in favor of going to an emergency room. I felt bad, but that turned out to save me from a difficult evening.

At 6 o’clock, a guest in West Hollywood announced that he was having a gout attack. The rush hour was in full swing, but West Hollywood is only five miles away. Before I walked out the door, the phone rang again, and I agreed to see a Swede suffering flu symptoms at the Sheraton in Santa Monica. The Sheraton is ten miles from West Hollywood and not a convenient drive, but I hoped traffic would have diminished.

Gout is an easy visit, and I carry the treatment, so the visit ended happily for everyone. After a passable drive, I arrived at the Sheraton where I answered a call from the Hong Kong office of Cathay-Pacific Airlines. I care for their crew in Los Angeles, and they are a joy to work with. Being young, they suffer simple ailments; all are Asian but speak good English; best of all, every request comes with a credit card number, so I don’t have to send a bill. A mild downside is that every visit also comes with a sheaf of documents evaluating the employee’s fitness to work.

After caring for the Swede’s flu, I drove ten miles to the Airport Hilton to treat a flight attendant’s sore leg and fill out paperwork. I arrived home at 10:30, weary but pleased at the night’s work. No sooner had I taken my phone off call-forwarding than it rang with news that an elderly lady at a Sunset Strip hotel was ill. Not everyone who wants a doctor needs a doctor, and I often convince guests that a visit isn’t necessary. I yearned to do that in this case, but she was vomiting, not a symptom patients can tolerate.

In the room, I was prepared to diagnose a routine stomach virus until I pulled back the covers and saw her swollen abdomen.

“Is this how your stomach usually looks?” I asked.

She denied it. She also had more pain than I expected, and I heard loud intestinal noises through my stethoscope. It seemed like a bowel obstruction, I explained. She needed to go to the hospital. Immediately she reconsidered my question, remembering that she was constipated, a condition that often made her abdomen swell.

Hearing they must go to the hospital, guests often work hard to change my mind, but I persisted. She went off in an ambulance, and I left hoping I’d made the right decision (doctors worry about these things). I phoned the next day to learn she had been admitted to Cedars-Sinai where she remained several days.

Loyalty

As long as they do good work, doctors assume patients will remain loyal, but hotel doctors learn not to be so trusting. Helping sick guests produces no income for the hotel. Ninety percent are not terribly ill; if rebuffed they rarely make a fuss, so the manager never hears about them. Paramedics deal with emergencies. Years may pass before a GM encounters an imbroglio that only a doctor on the spot can defuse; I’ve recounted a few. Although the best marketing tool, they never happen when I need them.

So how does a doctor keep a hotel’s loyalty? You might think that practicing good medicine is the best P.R. That’s not necessarily so because, ironically, people take for granted that doctors are good. In fact, most are competent, and that includes my competitors. Patients are usually grateful after seeing me, and over thirty years I’ve acquired plenty of flattering letters, but when patients feel the urge to tell the world about a doctor, they are generally less happy. When a GM hears from a guest, it’s almost always a complaint.

Assuring bellmen and concierges of $20 for every referral is a long tradition. It’s illegal, and my last competitor who definitely took advantage lost his license in 2003, but hotel staff continue to drop hints.

Other doctors tour hotels to extol their virtues to the staff, but I don’t. Three or four times a year I write to a hundred GMs but stop once a hotel starts calling. I dislike merchants who keep telling me how much they love my business, so I assume this feeling is general. Perhaps fifty hotels call during a typical year, but I doubt if five GMs know me by sight.

In 1994, I bumped into the doctor who serves a dozen crème de la crème luxury hotels around Beverly Hills. As we talked shop, he mentioned that he knew most of his general managers since he encountered them at social engagements. That’s a marketing tool I can’t match. It turns out that, when a hotel opens, he chats up the manager, and matters are settled. I send my usual letter of introduction, but I never acquire a new hotel in his territory.

During that conversation, he grumbled that a colleague who covered for him recently had left a business card at every hotel. I sympathized, adding that I’d be happy to cover, and I promised not to solicit afterward. Since my leisure time activities are reading and writing, I rarely decline his calls, so we’re both pleased with the arrangement. I still have no answer to the question at the beginning, but at least someone else is responsible for keeping the loyalty of many hotels I visit.

"Welcome to the Biltmore. Are You Checking In?"

That is not my favorite greeting, because it means the valet doesn’t recognize me. My response is always: “I’m the hotel doctor. I’ll be here twenty minutes. They hold my car.”

That’s my mantra to parking attendants, delivered a thousand times and followed by a moment of tension. Will he smile, accept my key, and park my car nearby? Or will he hand over a voucher, jump behind the wheel, and drive off into the bowels of the parking structure?

I have no problem tipping attendants, but I hate paying ten to twenty dollars to park. Accepting the voucher makes that a possibility, so I repeat the mantra, hoping he will reconsider or appeal to his boss who might know me or decide an elderly doctor with his bag deserves VIP status.

Once I accept, my next step, after caring for a guest, is to ask the desk clerk or concierge to validate. Sometimes they comply, but now and then…

“Sorry. The hotel doesn’t handle parking. It’s a separate company.” Hotels often outsource parking, but luxury hotels always accommodate me. Chains are unpredictable, even those where I go regularly. But once I hear this, I pay because I have a rule against arguing with hotel staff. Validation sometimes requires only that the employee scribble “comp – hotel doctor” on the voucher. Once, when refused, I scribbled it myself, and it worked, but I don’t do it. The chance of getting caught is very low, but the consequences are so humiliating that it’s not worth the risk.

After thirty years, I know the nearest street parking for every hotel; if it isn’t hot or raining, I’m willing to walk a few blocks. Downtown is a problem because, even during wee hours, homeless men hurry up, offering to watch my car. In the immense wasteland near the airport and hip entertainment sections of the Sunset Strip and Hollywood, street parking is often impossible. As with so many amenities, Beverly Hills is a pleasant exception.

I loved the temporary handicapped pass I used for six months after breaking my leg in 2003. Its benefits are no secret to the able-bodied; it turns out that eleven percent of Los Angeles drivers have one including not a few running the treadmills at my gym.

Human Nature, Part 2

Cynicism is a cheap substitute for sophistication, but I find it as tempting as most people... The lady just phoned, full of apologies, and we're working on ways to get the money. It hasn't arrived, but I assume it will.

Human Nature

An elderly Mexican psychoanalyst was attending a psychoanalytic convention, but a cold was making her so miserable that she wanted to return home early.

This seemed an excellent call in many ways. It arrived during the evening rush hour, but the Royal Palace was only two miles away. It was my first visit to that hotel, always a delight, and I planned to introduce myself to the management. Finally, the lady’s stuffy ears dominated her concerns, so she probably wouldn’t demand useless antibiotics which Latin American doctors prescribe for colds as often as we do.

Everything proceeded smoothly. I finished my traditional lecture on preventing ear pain when flying (generous use of nasal sprays); she expressed gratitude and laid down an American Express card.

American Express charges a larger service fee than other credit cards, so some companies that handle transactions don’t cover them. That includes mine, but I wasn’t concerned. So far everyone has had cash or another credit card, but on learning that I only accept Visa or Master Card, she expressed dismay. She only used American Express, she explained. Her plane left the next morning, and all she had was cab fare.

While I considered my next move, she snatched the phone, dialed the front desk, and poured out her distress. The doctor they recommended wouldn’t take her credit card; she had no money, and she needed help. I cringed at this terrible P.R. She wasn’t complaining about me, but it’s never good for a hotel to hear a guest having problems with the doctor. Luxury hotels will advance money and add it to the bill, but the Royal Palace, while comfortable, was not in that class. The desk clerk suggested she find an ATM.

Long ago, I drove a guest in search of an ATM, and I’ll never do it again. Begging my forgiveness, she swore that when she returned to Mexico City she would phone with the number of an acceptable credit card. I had no other suggestion, so I brushed off her apologies, and we parted on good terms.

That was several weeks ago; I don’t expect to hear from her.

My practice where almost no one see me a second time and everyone lives far away is a supreme test of integrity, and it’s discouraging how few measure up. Guests have already agreed on the fee before I arrive, so it’s rare that I leave unpaid. When this happens, guests are invariably upset and embarrassed. Once home and aware that there will be no unpleasant consequences if they don’t pay, only about twenty percent come across.

A No-lunch Day

The Langham called 11 a.m., a perfect time. I was finishing at the gym; I could shower, make the visit, and return home for lunch.

The gym is near the 405 freeway, a few miles from my home. It’s not my usual route for the 25 mile drive to Pasadena, being slightly further, but I decided to experiment. A mile after I set out, traffic stopped cold as far as the eye could see.

That’s when I remembered we are adding a single northbound lane to the 405 through Sepulveda Pass. There’s no room, so workers must rebuild every overpass, carve out and reinforce cliffs, and heap up dirt to widen the roadway. This six-mile addition will cost a billion dollars. I cannot think how much mass transportation a billion dollars would buy if there were any political support.

After fifteen minutes of creeping, I reached an exit and took old Sepulveda Boulevard past the construction. While driving, I answered a call from an insurance service and agreed to see a Brazilian boy with a fever in Huntington Beach. Huntington Beach is in Orange County, forty-five miles from my house. It could have been worse; it’s the same distance from Pasadena.

The Langham guest was a Washington Post reporter with a respiratory infection. He was covering a local convention, so the paper was paying for his room at the very posh Langham, but it wasn’t paying his medical expenses, so he had phoned several times before deciding on a visit. I delivered advice and medication before proceeding on my way.

The knowledge that I’ll miss a meal stimulates my appetite, so I suck on hard candy from a supply I carry. I never grab a bite at a hotel because I love eating and prefer to remain hungry and take care of obligations, so I can relax and enjoy it.

After shaking my hand, the Brazilian father reminded me that I had visited him a month earlier. Over most of the US, travel insurers send clients to clinics or emergency rooms. Having a doctor appear at their door is more pleasant, so Los Angeles travelers lose their inhibitions about asking for help, and I see many repeat customers. After examining his son, I explained this it wasn’t necessary to give him a cold shower for his 101 temperature. He would feel bad for a few days and then recover; I handed out four packets of Tylenol.

It was after 3 when I pulled into my garage and answered a call from the Westin at the airport. This was one of those what-might-have-been calls because I’d passed the freeway exit only blocks from the Westin half an hour earlier. I retraced the route to care for a lady with a painful eye, returning in time for supper.

The American Way

“This is AXA insurance about the patient you saw last month, Mrs. Diaz. We are asking you to accept a lower payment. In exchange, we list you as a preferred provider.” The offer was for less than half what I billed. I declined. AXA would eventually pay my regular rate although a few months would pass.

AXA sells travel insurance to Latin Americans. Its US agency and a dozen others phone me to make housecalls. Afterward, I fax my invoice, and (here American doctors will recoil in amazement) the carrier sends a check for the full amount. I’ve made thousands of such visits.

Working alone, I can’t accept American medical insurance with its complex requirements and unreliable reimbursement. The universal American claim form (called the HICF 1500) is cryptic and ambiguous, requiring mysterious codes and far, far more writing than the form I use. Thus, mine has a single space for today’s date; a HICF form requires today’s date in four or five places. Under “place of service” there is no box to check for “housecall.”

Not accepting American insurance is no problem for me, but I’m a special case. As soon as the average doctor opens an office, every American carrier makes an offer he can’t refuse. If he agrees to become a “preferred provider” and accept a reduced fee, the insurer will send patients. If not….

While foreigners look with horror on our medical care system, foreign insurance carriers have long admired their American counterpart’s techniques for saving money. Inevitably, the temptation has grown irresistible. I’ve long since stopped explaining that, including travel, a housecall may take ten times as long as a clinic visit. These callers are not negotiating; they want a “yes” or “no” answer. They lump all doctor visits together, so housecalls get no special treatment.

American doctors have not taken this lying down. One advantage of the Byzantine American billing system is that a resourceful doctor can tack on charges for tests, injections, medication, dressings, complexity-of-visit, length-of-visit, etc. so that he ends up collecting what he thinks he deserves. After decades of dueling with insurers, the typical American medical bill has become a purely fictional creation.

I quote my fee on the initial phone call. It’s larger if the call gets me out of bed or requires a long drive but never changes once I set off. I’ve made 700 housecalls for AXA over twenty-five years but only four during 2011. This is less tragic than it seems.

Confronted by my refusal to become a preferred provider, AXA and a few other travel insurers transfer their business to one of the national housecall services with names like Expressdoc, Hoteldocs, Travel-Med, AM-PM Doc. All boast that they can send a doctor on a housecall in any US city. Since none employ doctors, when a request arrives, their dispatchers consult a list of moonlighters and begin phoning. Tracking down a doctor willing to make a housecall can be a tedious business except in Los Angeles where calling me always succeeds. I’ve made thousands of visits for these services.

I quote my usual fee. To make a profit these services must bill AXA et al several hundred dollars more. If this seems illogical, you should realize that every insurance carrier knows that the “preferred provider” policy saves money, so no one questions it.

Returning from ten days out of town, I took my phone off call-forwarding, unpacked, and prepared to drive to Trader Joe’s for groceries. Before I left, the phone rang with a housecall at the Torrance Marriott, twenty miles distant. The good news was that it was Saturday evening, so freeway traffic was light, and the patient was seventeen, an age when illnesses are rarely complicated. The bad news was that he was Japanese, a people admirable in every respect except for their reluctance to learn English.

As I stepped out of the elevator, a middle-aged Japanese man rose from a chair. “Are you the doctor for the hotel?” he said.

I was delighted. “Yes. Are you going to interpret for me?”

He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the parents, and the patient. The young man had suddenly complained of fatigue the previous day. He was otherwise in good health; he had no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in an adolescent. I suspected an emotional problem, perhaps from the stress of travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.

Luckily these were Japanese, so they listened to my advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted) with unfailing courtesy, nodding approval, and thanking me effusively as I left.

Can I Submit This to My Insurance?

The phone rang at 9:30 a.m., the perfect time. I was finishing breakfast. My routine is to work an hour on the computer and then go to the gym, but I’m happy to do a housecall instead. If two housecalls arrive, I skip the gym, an even greater pleasure.

The hotel was the Holiday Inn at the airport. The patient, a young Australian woman, had arrived after a tiresome flight during which she was forced to run back and forth to the bathroom. Urine infections are among my favorite diseases. They’re miserable but respond quickly to the antibiotics I carry. Patients are always grateful. This looked like a good visit. I quoted my fee.

“Oh… I didn’t realize it would be so much.”

This happens now and then. I remember guests at the Beverly Hills Hotel where room rates start at $300 who didn’t want to pay half that. In any case, once I mention the fee, I try not to refuse someone who thinks it’s too high. So I asked if $100 was OK. It was.

It was a satisfying visit. I tested her urine, announced she had an infection, and handed over a packet of pills. She was grateful. As I left, she indicated my receipt.

“Can I submit this to my insurance?”

“You have travel insurance?”

“I think so. They made us buy something for this trip.”

It was too late to ask why, if she had insurance, she had objected to my fee. But this happens regularly. In every advanced country outside the US, except Russia, China, and South Africa, if you need a doctor, you don’t first decide if you can afford it, so foreign tourists often pay little attention to their insurance.

“Can you make a housecall in Larkspur?”

I’d never heard of it. Google Maps revealed that it’s four hundred miles away, north of San Francisco. The dispatcher seemed disappointed at the news.

Half a dozen travel insurance agencies serving clients from Latin America have US offices in Miami, and it’s natural that they’re unfamiliar with California geography. Looking up cities is easy, but it’s even easier to call me. I'm sure you've phoned your family doctor, wading through voicemail, answering services, receptionists, and leaving messages. Hours may pass, but eventually the doctor calls except when he doesn’t.

Pity these poor dispatchers. Once a sick client phones, the dispatcher retrieves a list of doctors from that city and begins calling. Even after she finds one willing to make a housecall, her task is not finished because everyone knows doctors are terribly busy. I can confirm from my own experience that a colleague who agrees to help might not give this a high priority. Early in my career my requests were invariably followed, a few hours later, by a call from the hotel informing me that the guest was still waiting. Now I extract a promise that he will go quickly and then phone later to make sure he does.

I’ve never had an office. My number reaches my cell phone; I always answer in person, and I try not to decline visits within reasonable driving distance. Without being asked, I always tell the caller when I’ll arrive.

This turns out to be good for business. Tracking down a doctor remains a tedious process in other cities but requires a single call in Los Angeles, so dispatchers find it easiest to call me. Some phone whenever a California client calls, so I often deliver the bad news that they must begin working down the list for San Francisco, Sacramento, or San Diego.

Various Way in Which I Didn't Get Paid -- Part 4

I didn’t charge eight guests because theirs was the first call from that hotel, and I wanted to make sure they had a good experience. I stopped when I realized that most hotels that call for the first time never call again. The important call is the second.

Assistcard, which insures travelers from Latin America, owes me for six visits from the 1980s. Other doctors had warned me of its reputation as a slow payer, but I was eager and young. After several years, innumerable calls to its billing department, and with my business prospering, I began refusing its requests. A few checks owed to me drifted in over the following year but not all.

After ten years, an Assistcard employee called to announce that the company was under new management and to promise to pay more reliably. Since then I’ve collected on every visit but often after months of reminders. I finally decided to cut back on pestering but add $100 to my fee. Assistcard knows this, but nothing has changed. Most of its bills are vastly higher than mine because they come from hospitals and emergency rooms, so delaying payment helps their bottom line so much that making an exception for me is probably too much trouble.

Various Way in Which I Didn't Get Paid -- Part 3

Four times I arrived to discover another doctor in the room. The hotel had summoned another doctor. After waiting a few hours, the guest complained, so the hotel summoned me without mentioning the other call.

Eighteen guests gave me a bad check. Almost all were single males, and these occurred before I accepted credit cards. While everyone I managed to contact expressed surprise and promised to correct matters, this was not always a lie. In six other cases, guests sent a second, good check.

I mailed a refund to three guests on Medicare. Early in my career, I simply informed elderly American guests that I was not a Medicare doctor. Most assured me that was no problem, but it turned out many believed I meant only that I didn’t bill Medicare myself. When Medicare rejected their bill, they were outraged. Since then I explain in more detail that they can collect nothing from Medicare or any Medicare supplement insurance. Some agree to a visit; others accept my directions to an urgent care clinic.

I also reimbursed a guest who was unhappy to hear that an antibiotic would not help his flu. He went to an urgent care clinic later that day, received the traditional antibiotic, and felt better as soon as he swallowed the first pill. The hotel manager who passed on his complaint expressed sympathy, but I felt it best to make a refund.

Various Way in Which I Didn't Get Paid -- Part 2

Over the past thirty years, twenty-four guests cancelled. I don’t count those that arrive before I leave the house, so all occurred while I was on my way. To this I must add eighteen no-shows: guests who weren’t in the room when I knocked. This always annoys me because I tell guests when I’ll arrive. In my younger, passive-aggressive days, I would phone later. Guests would swear they had told the hotel and express outrage that the employee had failed to pass on the message. After hearing the same excuse every time, I stopped calling.

Fifty database files appeared under “No Pay,” meaning I wanted to collect but couldn’t. A minority were blunt refusals from guests who never intended to pay; a dozen were clearly mentally ill. Four guests had called the paramedics before I arrived, and they were already on the scene.

“No way!... Take it up with the manager” caused trouble until I saw the light. Hotels often pay if guests are injured on the premises, find bugs in the room, or believe they’re poisoned by hotel food. Unfortunately, sometimes the hotel refuses, and it’s a bad idea to argue. After leaving unpaid several times, I learned to stay alert during the initial phone call for situations when guests blame the hotel. If so, I tell them to discuss matters with management before I leave the house.

Various Way in Which I Didn't Get Paid -- Part 1

In my database of over 16,000 visits, entering zero for my fee and searching turns up 789 files, but this includes 529 when colleagues covered. That leaves over 200 where I collected nothing.

On nearly 100 occasions, this was my decision. 50 patients were hotel employees whom I don’t charge even if they’re willing to pay. Most can’t afford the fee, and I’m happy at the thought that they’ll tell their co-workers about the experience.

In 19 cases, I arrived and realized immediately that the guest needed a referral, either to a specialist or an emergency room. I try to detect these during the phone call before the visit, because I feel guilty accepting a fee and then sending the guest off to pay a second fee. In four additional cases, I had decided to call the paramedics, and I remained in the room until they arrived. Naturally, these were distressing events. Everyone was preoccupied, and I felt inhibited about mentioning my fee. In other cases, the guest or his companions remembered, but these were the times they didn’t.

Poor people rarely stay in hotels, but a few cheap motels and youth hostels have my number, and college-age travelers often arrive in the US without health insurance. As a result, I sometime trim my fee and occasionally charge nothing if they come to my home. I’ve done that a few dozen times.

One guest was dead when I arrived. I didn't collect from his wife.

Why I Love Arabs

Examining a Danish hotel guest last month, I became uncomfortably aware of sweat dripping down my back. I hadn’t experienced this since the previous autumn.

Summer doesn’t arrive in Los Angeles until mid-June, and it was an average day with temperatures in the 80s. The hotel lobby and corridors felt comfortable, but a wave of hot air greeted me as the guest opened his door.

Entering, I recalled why I like Arabs so much. They appreciate air conditioning as much as Americans. Citizens of all other nations believe it spreads disease. They tolerate it as one of the perils of foreign travel, but when someone falls ill, the air conditioning stays off. Hip young hotel doctors dress in shirtsleeves, but hipness is a distant memory for me, so I wear a suit and tie. During a long summer visit, it’s debatable if I or the patient is suffering more.

I always explain that the machine that cools air in an air conditioner is identical to that in your refrigerator, and no one worries about disease from refrigerator air. This convinces no one, college graduates included.

The room stood at the end of the hall, the largest suite on the floor. Through the half-open door I smelled alcohol and cigarette smoke, never a good sign. At my knock a voice urged me to enter. The room was empty, but this was the sitting room. A doorway led to the bedroom containing a small figure in a huge bed, covers drawn up to his chin. Balding and past forty, his disheveled hair was the single unkempt feature, and a goatee the only evidence of his foreignness. He was Prince Abdul-Aziz from Saudi Arabia. Arabian princes are more common than you’d think.

“I have pain,” he announced.

“Where is the pain, Mr. Aziz?”

“Kidney. I have kidney stones in my kidney.” He threw the covers to one side and pointed to his right flank. “My doctor prescribes Dihydrolex.”

“That’s not a drug I’m familiar with.”

“It is from London. I live in London.”

“Do you need a prescription?”

“Yes, but also a shot.”

I examined the prince’s abdomen and tested his urine for blood. Both exams were normal but this can happen with a stone. I thumped his back in the kidney area, and he groaned.

“I’ll give you a Toradol injection, but if the pain comes back, you’ll have to go where they can do some tests.”

“Many thanks.”

Any doubt about the prince’s drug consumption vanished when my needle jerked to a halt half an inch beneath the skin. Fibrosis from hundreds of injections had given his gluteus the consistency of a block of wood. I forced the syringe down a further inch and delivered the injection. Anticipating the pleasures ahead, the prince whirled to thank me, clasping my hand in gratitude.

“Remember what I said if the pain returns…” I repeated. “Should I ask the hotel to pay and put it on your bill?”

“No, no no. I pay!” Keeping a grip on my hand, he yanked open the drawer of the bedside table which turned out to be stuffed with hundred dollar bills. He snatched a handful and held them out.

Grateful the prince had forgotten his request for a prescription, I thanked him and hurried off. Later I counted fourteen bills. I gave them to my wife who bought a small Chinese rug for our living room.

The following day a rival hotel doctor phoned. “The Nikko wants me to see a guest,” he said. “Apparently you saw him yesterday, but you don’t want to see him again. Naturally I’m curious to know why.”

“I’m pretty sure he’s a drug abuser.”

“They said he was difficult. Is there any reason for me to see him?”

“He’s a big tipper.”

A guest at a Beverly Hills hotel was sitting in the hotel restaurant when her chair collapsed. Unfortunately, her hand was resting underneath. The desk clerk asked if I could come immediately.

During my early years, I often hurried over, took care of the problem, and presented my bill only to have the guest insist that the hotel was responsible. Management sometimes disagreed, leaving me unpaid, so I quickly learned to settle matters over the phone.

“Who’s responsible for the bill?” I asked. “If it’s the guest, I have to talk to her.”

The clerk hadn’t thought of this, so she put me on hold, returning to announce that the hotel would take care of it. This would be my 139th medicolegal visit, my name for a housecall when the hotel pays. The majority involve minor injuries that occur on the premises. There were also thirteen upset stomachs, purportedly from hotel food, and nine insect bites, always bedbugs according to the guest.

I arrived at the restaurant to greet a pleasant young Englishwoman, her hand in a bowl of ice. My examination revealed a torn and bloody middle fingernail but no laceration that required suturing. I explained that her nail might fall off but that another would grow. Unfortunately her ring finger, while not bloody, was exquisitely painful. She needed an x-ray.

If there were a fracture, an emergency room or perhaps even a family doctor would refer her to an orthopedist, so I decided to send her directly. If someone needs a referral, I want to make sure that they go, so I make the appointment myself. I didn’t know anyone locally, so I found an orthopedic group on the internet and phoned. When the receptionist asked about insurance, I said she would be a cash patient, a rare phenomenon even in Beverly Hills.

“An initial visit is $500,” the receptionist said. “She should have it when she comes in.”

“Wow!” said the patient when I passed this on. This was probably not a comment on the size of the fee (which the hotel would pay) but the traditional European amazement-cum-horror at American doctors’ preoccupation with money.

Both fingertips were fractured, she announced over the phone the next day before asking how long the pain would last. I sympathized; fingers are sensitive. She should apply ice and take ibuprofen and see her doctor in a few days. She planned to fly home.

Universal Assistance, a travel insurer asked me to visit an Argentinean teenager who was behaving oddly. When I arrived, her father explained that his daughter was under treatment for leukemia but was doing well. They were visiting relatives when, a few hours before, she had stopped speaking to them.

Except that she was bald from chemotherapy, the daughter looked fine. She was sitting up in bed, arms folded, looking glum. When her parents appealed to her to talk to me, she obviously heard but merely shook her head and remained silent. She did not resist when I examined her, and nothing abnormal turned up. I was faced with a sullen teenager who didn’t appear sick. This was another occasion when, for no obvious reason, things didn’t seem right. I told the parents she needed to go to an emergency room and then phoned Universal Assistance who would handle matters. The family obeyed. The daughter died soon after being admitted.

The Christmas Rush

The last week of the year is my busiest. Competitors with whom I’m on speaking terms deny this, and I’ve long stopped theorizing why this is so. But calls begin pouring in at Christmas.

His teenage son had a terrible cough and sore throat, explained a caller from the Shangri-La, an upscale beach hotel. Maybe he needed an antibiotic.

The son had the usual virus. The father and mother were unfailingly polite as I delivered my explanation, handed over a bottle of cough medicine, and took my leave, but it was clear they would have been preferred an antibiotic. I urge patients to resist suggesting a treatment to a new doctor. If it’s unnecessary, the doctor may prescribe it anyway to make you happy. If he doesn’t prescribe it, and your thank-you at the end isn’t heartfelt (we are supersensitive to gratitude) he will feel he disappointed you.

Two hours later I drove to another Santa Monica hotel to see another teenager, this one with a sore throat. The father had seen white spots on her tonsils. Laymen believe “white spots on tonsils” is a sign of “strep,” but ordinary viral infections can make tonsils look bad. Some day I’ll write an article on ominous-signs-that-usually-aren’t (white spots on tonsils, cough with green mucus, yellow mucus, thick mucus, no mucus, fever more than … degrees, fever more than … days, green diarrhea, yellow diarrhea, funny smelling diarrhea, funny smelling urine….). Hearing this, patients invariably ask “then how do I know I’m sick?” My answer is: “because you’re sick.” Sickness makes you sick. If you don’t feel very sick, you’re probably not sick. Decide to see a doctor because you feel bad, not because a symptom.

It turned out that I treated her for strep. Good studies reveal that exudates on tonsils plus three other symptoms (fever, swollen neck glands, absence of cough) make the chance for strep fairly likely, and she had all four, so I handed over ten days of penicillin and received everyone’s heartfelt gratitude. Another pearl: if you’re not allergic to penicillin, and a doctor prescribes a different antibiotic for your sore throat (amoxicillin is acceptable), that’s excellent evidence you’re getting a placebo. After 70 years, penicillin is still the treatment of choice for strep; newer antibiotics work as well, but none work better, and all cost far more.

"Do You Go To Ontario?"

“Do you go to Ontario?” asked the dispatcher for Expressdoc, an agency that sends doctors on housecalls. Travel insurers who don’t call me directly use Expressdoc. It’s a mystery why because it costs them extra, but I charge the same no matter who calls, so I don’t mind. Ontario is in San Bernardino County, fifty miles distant, but this is small potatoes. My record is ninety miles to Carpinteria. Freeway traffic, not distance, determines if I drive. I delay distant, late afternoon visits until the evening. Morning drives are acceptable; the hours between ten and noon are golden because traffic slows after the morning rush; it builds again after twelve, and there is no afternoon decline. The Ontario call arrived at 12:20, so I was not optimistic about the return. But it worked out fine. I took the Pomona freeway, bypassing downtown, and the hour’s drive passed with no significant slowing. I listened to Slaughterhouse Five on my CD; highly recommended.

The patient was a Brazilian lady visiting her son; her upset stomach presented no problem. Accompanying me to the elevator, the son he told me he was reevaluating his decision to remain in the US because the political atmosphere had grown so shrill and confrontational. I agreed. Did you ever think there’d come a time when South Americans considered their governments more stable than ours?

Another Easy Visit

Airport security confiscated a tourist’s glaucoma eye drops, so he called his insurance who called me. The drops come in a tiny 2½ cc bottle, so the seizure seemed puzzling. On the other hand, nearly ten years ago they took my tweezers, a beautiful needle-nosed instrument perfect for removing slivers. It cost $20. Later, I checked the Transportation Security Authority web site and learned that tweezers are specifically permitted. Naturally, I’m still fuming.

The visit was easy. Usually, I phone a refill to a pharmacy when a traveler needs a legitimate prescription, but December has been slow; no calls have arrived in a few days, so I’ve felt uneasy. Ironically, medical experts unanimously frown on giving prescriptions without an examination. They never explain how an examination in a hotel room can prove that a patient has, for example, glaucoma, osteoporosis, emphysema, acid reflux, or epilepsy. If he takes high blood pressure medication, and I find a normal pressure, must I refuse the refill?

Things I Don't Charge For

Quantas and other airlines recently canceled flights after an engine exploded, stranding a large number of passengers in hotel rooms. Within days I began receiving calls from guests running out of their heart or diabetes medication. They had brought only enough for their trip or the bottles were packed in luggage which the airlines refused to release. Aware of terrifying stories about America’s medical system, they were counting their money, hoping to have enough for the necessary king’s ransom. They were pleased to hear that I don’t charge for replacing legitimate prescriptions.

Most American drugs are available in other countries, but often in different formulations and with different names. Rather than try to figure things out, I tell guests to go to a drug store where the pharmacist will research the matter and phone. I’ll approve whatever he determines. Guests regularly forget to pack medication or find their trip unexpectedly extended, so I do this routinely. My record for replacing prescriptions occurred after 9/11 when all flights stopped, and hotels were packed. Some travelers also fell ill, so my paying business jumped for a few weeks. Then everyone returned home, and tourism plunged for almost a year. That was a bad time for hotel doctors, too.

I deliver plenty of free services. I don’t charge for anything I do over the phone. I don’t charge hotel staff. I’m happy when they consult; it’s a sign they know about me and, after the consultation, they might tell colleagues about the experience. As I’ve mentioned before, no hotel employs a house doctor. Even at my regulars, I don’t occupy an official position, so many employees have never heard of me. “Are you our doctor? I didn’t know we had a doctor” is something I hear even at hotels that have called for decades. This is not good because when guests ask for help, they usually accept the first answer.

Since I am the world’s most successful hotel doctor, you might assume I command respect in my profession. There is some truth in this, but it’s not unanimous. Delivering free care upsets many doctors. Those I know personally don’t mind, but I also belong to internet physician forums whose members feel differently. Although the forums exclude nonphysicians, any clever person can figure out how to join, but I advise against it because you don’t want to hear what doctors say when they believe you’re not listening. I enjoy their medical discussions but avoid threads on business and politics. As in most forums, contributors with strong opinions dominate. I find it unsettling that the longest, angriest discussions concern money. The most energetic participants tend to work in private practice where their income depends on patients or insurance. They detest not getting paid; they suspect most poor people are deadbeats; they hate insurance, the government, President Obama, and healthcare reform.

Recently I contributed a funny story. You may have read it earlier on this blog. An Israeli man at a Beverly Hills hotel needed a doctor’s signature on his request for a disabled parking pass but didn’t want to pay my fee. Since it was a trivial task, I told him I’d sign it gratis if he came to my home. After hanging up, I began to worry. Obtaining disabled parking permits is a scandal in California; eleven percent of drivers have one. If I didn’t believe this man was disabled, I planned to refuse to sign thereby risking an unpleasant scene. I passed an uncomfortable half hour until I heard the sound of someone approaching. Opening the door, I saw a man, one arm around a young woman (his daughter) hopping up the steps to my house. He had one leg. That was a relief.

I posted the story and awaited expressions of amusement. Almost immediately a doctor wrote angrily that I had prostituted my profession, undoubtedly to curry favor with the hotel. Doctors provide a service for which they deserve a fee, he added. Any Beverly Hills hotel guest could afford it; that I blithely gave him a free ride showed that, in my degraded state, I didn’t realize how this damaged hardworking physicians with bills to pay. Other responders agreed, and then, as happens on forums, they wandered off-topic and exchanged of anecdotes about being stiffed: by obnoxious patients, welfare patients, dissatisfied patients, insurance carriers, Medicaid, Medicare, the government. Doctors on doctor forums spend a good deal of time fuming over not getting paid.

A Relatively Easy Housecall

Before driving home, I answered a message from the Embassy Suites at the airport. The previous evening, a Canadair stewardess had phoned, confined to bed with a backache. Many foreign airlines call me to see sick crew members; I bill their central office. American air crew with their American insurance are out of luck. Billing an American insurance carrier – and for a housecall! – guarantees torment and aggravation, and I’ve long since given it up. Billing a foreign airline is no simple matter (“my manager says send your bill to the main office” never works), but once we’ve agreed on a formal arrangement, matters work smoothly. Sadly, I have no arrangement with Canadair. I explained this to the flight attendant, and she agreed to consult her supervisor. When I answered my message, I was delighted to hear her explain that Canadair had faxed an approval for my visit and its credit card number. Her backache had improved, and all she needed was a doctor’s note approving travel home as a passenger. I expected an easy visit.

After a short consultation and the note, I presented myself to the front desk where I discovered my optimism was premature. The number on the Canadair fax belonged to an American Express card. American Express charges more, so many credit card services, including mine, don’t cover them. I explained this to the desk clerk who summoned her manager who apologized, phoned Canadair, and learned that the airline did not have a Visa or Master card, a situation I’ve never encountered. No problem, the manager assured me. The hotel would mail me a check and bill Canadair. This seemed a bad idea because hotels don’t normally do that, and long experience has taught that expecting a hotel to do something it doesn’t normally do leads to frustration. But my rule is to never hassle a hotel, so I smiled and agreed. An hour later, the manager phoned to say that, rather than mail a check, the hotel would pay cash on my next visit. Naturally, I agreed.

Two days later, picking up my wife at the airport, I stopped by the Embassy Suites. I wouldn’t be writing this if matters went smoothly, but the desk clerks looked mystified when I explained my purpose. They phoned the manager who was tied up in an important meeting. I waited half an hour, but when my wife called. I departed after leaving a polite message on his cell phone. He was off duty when I returned the next day, and the desk clerks remained puzzled. There is no great lesson here, and I’ll eventually collect, although I suspect I’ll have to phone Canadair a few times, fax a few forms to Canada, and wait a few months.
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Caring for Airline Crew

Every night in every big city, several hundred commercial airline flight crew lay over. Lacking transportation, they have trouble finding medical care. Airlines in Los Angeles soon learned about me, and I’ve made 618 visits, mostly to flight attendants, and sent my bill to the airline. Flight crew are young and healthy with uncomplicated illnesses, so visits tend to be easy. On the other hand, airlines switch hotels when they obtain a better rate. Since I’m reluctant to give up business, I find myself traveling farther than I like.

As in other aspects of health care, foreign nations have a better system. When American crew need a doctor, they can go wherever they want and use their insurance. The combination of no transportation and huge deductibles mean they usually go nowhere. Since many call the front desk to ask if there is a doctor, I dealt with their pitiful calls. American pilots occasionally bit the bullet, but flight attendants couldn’t afford me unless I cut my fees. I give free advice and, if necessary, direct them to the nearest 24-hour clinic.

Then I have to decide if they’ll go. Once anyone calls me, I become his or her doctor. I think this is the law, but it’s certainly how some doctors feel, and it’s the reason lawyers (American lawyers) warn us never to give phone advice. If a patient disobeys my instructions, I’m still responsible, and I hate hanging up and worrying, so I occasionally make a housecall to an American flight attendant. My fee for a charity visit was $30 or $40. Afterward, I always feel virtuous, so there are compensations. Foreigners never required charity.

I’ve been the doctor for a dozen foreign airlines including Alitalia, El-Al, Virgin-Atlantic, Aer Lingus, Japan Airlines, and Cathay Pacific. Two provided a fascinating contrast. Conveniently (for this discussion) they laid over a few hundred yards apart: Virgin-Atlantic at the Torrance Hilton, Cathay Pacific across the street at the Torrance Marriott. These were seventeen miles from my house, over a half-hour drive when traffic moved smoothly.

If a guest at the Park Hyatt, a mile away, wants a housecall, I go, but I’m liberal at giving free advice over the phone. I don’t claim immunity from human nature, so my willingness to handle an illness over the phone grows with the driving time. A check of my computer reveals a visit on 56 percent of calls from the Park Hyatt. When the Warner Center Marriott in distant Woodland Hills phones, I make the trip 29 percent of the time. I also lean over backwards to avoid a visit if the guest might find the fee painful: 63 percent to the upscale Bel Air Summit versus 43 to the Airport Holiday Inn.

Foreign airline crew do not pay, but I have no objection to giving phone advice to guests in faraway Torrance. That’s when the English proved again why they’re the world’s best patients. If I explained that their illness didn’t require a visit, they understood. If I didn’t give a prescription, they didn’t point out the oversight.

Matters were different with Cathay-Pacific. Based in Taiwan, its flight attendants came mostly from Southeast Asia: Thailand, Malaysia, Singapore, Indonesia, the Philippines as well as Taiwan. These cultures have a different view of a doctor’s powers.

Although most Americans would deny it, they believe doctors – invariably doctors they like – possess healing powers that go beyond scientific medicine. It’s my impression southeast Asians take this more literally, and they also believe employing such powers require a doctor’s presence. When Cathay-Pacific crew called they rarely welcomed advice.

Hotel guests generally love to learn they suffer an ailment too minor to require a doctor, so I dispense a great deal of instructions on self-care. The common cold makes up fifteen percent of all human illnesses including those of Cathay-Pacific flight attendants, but my expertise seemed lost on them. I deliver an excellent explanation of stuffy nose treatment. Since foreigners need names of American over-the-counter medicine, I always asked them to get a pencil. Time and again, the phone remained silent for several seconds before I heard: “When you come?...”

Everyone who flies worries about ear damage when they have a cold, so I discussed it. Everything you’ve heard is either worthless or positively harmful. Never pinch your nose and blow. Over-the-counter decongestants aren’t strong enough. Everyone who flies with a cold should buy a nasal spray such as Afrin or Neo-synephrine. While you’re sitting in the plane before it takes off, spray each nostril thoroughly. Wait ten minutes for the spray to work, then repeat. That carries the spray far back into your nasopharynx to the exit of the eustachian tube, the only connection between your middle ear and the outside world. Even if your nose is clear, swelling of mucus membranes can block this opening. If the flight lasts more than a few hours, repeat this as the plane begins its descent, an hour before landing.

Too polite to interrupt, Cathay-Pacific crew waited until I finished before speaking words that made my heart sink.

“You come?... When you come?”

My database confirms what I always believed: that I made visits on about half my callers. Cathay-Pacific held first place among my clients with 82 percent.
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Michael Jackson's Doctor

According to the Los Angeles Times, police are looking for Michael Jackson’s doctor. That brings back memories. In 2001, I received a call from a concierge at the Beverly Hills Hotel asking if I could see a celebrity. When a concierge speaks of a "celebrity" instead of giving the name, it means she suspects there might be a problem. So I asked if it were Michael Jackson. She admitted it was. I told her that I had some experience with him, and during my last visit we had agreed that he wouldn't call any more. I told her I planned to hold him to that agreement. She was entirely sympathetic, but that was the last call I received from the Beverly Hills Hotel.

How I Became America's Only Fulltime Hotel Doctor

Every few years I open my Los Angeles Times to learn the paper has, once again, discovered the housecall. Americans yearn for it, I read, and a clever doctor is about to satisfy that need.

The reporter interviews an entrepreneurial physician (different every time) who describes the sufferings of hotel guests forced to stumble through unfamiliar streets searching for an emergency room or the hardship of the housebound elderly. He and his physician recruits will scurry about the city delivering care to a grateful clientele. Despite charging a fraction of an emergency room’s fee, they plan to make a great deal of money.

We take for granted the news is accurate, so it’s a shock to read about something we’ve experienced personally – and realize the reporter has gotten it all wrong. None of these articles mention me. Yet I am not only the busiest hotel doctor in Los Angeles, I’ve made more visits than my competitors combined; over 15,000.

I know how these articles come to be written. Given his assignment, the reporter consults the avalanche of public relations material that pours into every newspaper. Finding a release about a doctor who makes housecalls (there’s always one) he phones its subject, does the interview, and writes. Sometimes reporting is easy.

Had he worked harder, querying local hotels and travel agencies, he would have learned about me; he might not have heard his subject’s name at all. After every Times article, I write the reporter to announce my existence and point out his errors (the fees quoted are purely imaginary; housecall doctors do not visit the uninsured), adding that I can provide more interesting stories as well as information that is actually accurate. No reporter responds, and in a few years another article features the same fanciful material from the mouth of a different doctor who is never me.

I began making hotel visits around 1980, but I was not an overnight success. 1990 had passed by the time I acquired enough clients to quit my other jobs. I was the only fulltime hotel doctor in the country, and there will never be another. This achievement owes something to my kindly bedside manner, nothing to business acumen, but most to the absence of competition. Until I arrived on the scene, hotel doctors confined themselves to luxury establishments such as the Bel Air or Beverly Hills Hotel. While it’s fun to visit rich and famous people in exclusive hotels, these doctors did it as a sideline, so all gave priority to their office practice. They also enjoyed a normal social life. Since calls invariably arrived when they were doing something else, old-time hotel doctors charged breathtaking fees to compensate for the aggravation.

I never had my own practice, and reading is my major leisure activity. I also enjoy writing about health; by the 1970s magazines were buying my articles, so stopping whatever I was doing to make a housecall was no inconvenience. Even that bane of a doctor’s life, the middle-of-the night call, didn’t bother me. With no office patients waiting, I could sleep late. Traffic was light. Parking was easy. Guests were grateful.

Mostly, however, they weren’t rich because I was soliciting the great mass of mid-level hotels. That was no problem; my needs were modest. I had bought a small house in West Los Angeles before the 1970s explosion in real estate prices; my mortgage cost $418 a month, which I could earn in two eight-hour shifts in an urgent-care clinic. My wife and I drove Honda Civics.

You might think the combination of lower fees and quick response ensured my success, but I faced a problem that still exists: hotel management doesn’t care. Providing a doctor produces no revenue for the hotel; in any case Americans don’t demand one. Calling 911 takes care of guests who seem seriously ill. The remainder rarely complain if told to go to an emergency room.

My marketing also lacked urgency. I was too shy to tour hotel lobbies, dispensing my card and the promise of a tip. Being a writer, I wrote: dignified letters on deluxe stationery offering my service twenty-four hours a day to about 150 general managers. I wrote every few months, addressing every manager by name (this meant I had to phone every hotel beforehand), working hard to rephrase and personalize each letter. It was boring work, but I had plenty of free time.

Mostly, the letters vanished into a void, but now and then they caught a manager’s attention. By the end of the eighties a dozen hotels called regularly. Then something happened. Maybe a critical mass of hotel employees grew familiar with me, or general managers decided a house doctor was a good idea. Within a few years, calls quadrupled to over two thousand a year. I stopped taking clinic jobs to pay my bills.

I was a fulltime hotel doctor. Like most life changes, it did not so much solve my problems as exchange them for others. Local doctors began to notice this mass of potential patients, none of whom were poor. Entrepreneurs across the nation decided they could make themselves known to big city hotels, send moonlighters to care for guests, and prosper by keeping part of the fee. Competition arrived. My income rose, but so did my stress level.

Why Doctor Oppenheim Isn't Rich

Being a fulltime hotel doctor isn’t fulltime work, so I have plenty to leisure during which I’ve become a successful writer. I’ve written five popular health books plus several hundred magazine articles – 35 for Woman’s Day, for example, more than any other doctor. So why haven’t you heard of me? More important, why aren’t I rich? Part of the answer is that I’m not a media personality. Doctors who write make big money only if they appear on TV and radio regularly. I did this a few times long ago and hated it.

But I still hope. I wrote a novel about a hotel doctor. Fiction is a hard sell, and it’s still making the rounds. Everyone who learns I work in Los Angeles insists my memoirs would be a gold mine. So I wrote memoirs. Every time I contact an agent, he or she is thrilled.

“That sounds like a great book. I bet you’ve seen plenty of celebrities.”
“So I have.”
“I bet you have great stories about them.”
“I do.”
“Tell me one.”
“I’m a doctor. I can’t do that.”

That ends the conversation. Agencies are still considering “Hotel Doctor to the Stars,” but my inability to include celebrity scandal seems to be a deal killer.

A Freebie

“This is Franklin De Forest. We’re staying at the Hilton. I wonder if you could help us.” There was a pause although the caller hadn’t asked a question. His voice quavered, so I knew he was elderly. American guests over sixty-five were awkward because Medicare paid a pittance for housecalls and forbade doctors from collecting the difference from the patient. I tried to avoid Medicare housecalls. Knowing the reason, many guests offered to paying the fee directly, promising not to send the bill on the Medicare. I think this is also illegal.

I heard muffled sounds, and then a female voice came on the line. Elderly men invariably handed the phone to their wives. “We just flew in from Chicago, and we leave for Tahiti in three hours. I feel so stupid... We went off without our medicine. Is there any way you could see us and write some prescriptions?”

Tourists regularly forgot their pills or lost them or packed them in luggage that disappeared. Authorities discourage doctors from prescribing without a thorough evaluation. Housecall agencies virtuously explained this, then sent a doctor who wrote prescriptions for heart pills, cholesterol pills, diabetes pills et al, then collected a few hundred dollars. I could not bring myself to charge for writing prescriptions.

“If they’re medications you take regularly, I’ll phone a pharmacy, and tell them to give you some more.”
“That’s so nice. My husband takes Lanoxin.”
“And what dose?”
“What dose, Frank…? He says the usual.”
“Point two five milligrams?”
“Point two five milligrams, Frank…? He says that’s probably right.”
“How many do you want?”
“Just enough till we get back.” The woman paused either to calculate or simply because she felt I was psychic. I repeated the question. “Say fifteen. He also needs Glyburide for his diabetes.”
“What’s the milligrams?”
“What milligrams, Frank…? He’s not sure, but it’s a little green pill.”

The man required three prescriptions, his wife four. Their recollections of dose and dosing schedule were vague. I determined several by consulting the Physician’s Desk Reference, but details of the wife’s “for my stomach” pill remained a puzzle, so I chose one that seemed harmless. I compromised on two other uncertainties by prescribing the lowest dose. The elderly take so many medicines there’s a good chance many are unnecessary. The call took fifteen minutes.

“We’re so grateful for your help, doctor. How can we pay?”
“No charge. But I’d like you to tell the manager how nice I was. This is a competitive business.”
The woman laughed. “I’ll do it first thing.”

Asked about payment after providing phone help, I always refused, then suggested the guest praise me to the hotel staff, and the guest always treated it as a joke. It was a joke, mostly, but I hoped a few would obey.

Treating Drunks

Medical science has no cure for drunkenness, but hotels regularly phone for help. I always ask if the guest wants a doctor. The answer is never yes and always followed by assurance that the hotel would pay my fee. A doctor is not supposed to care for someone who doesn’t want a doctor, but when a hotel appeals for help I do not like to refuse. Suggesting calling the police never works because (like calling paramedics) their arrival ruffles the businesslike atmosphere hotels prefer. Also, arrested guests rarely turn into repeat customers.


Confronting drunks, I enjoy certain advantages. I’m old. conservatively dressed in a suit and tie, and obviously a physician. These qualities inhibit abuse, but they work best in people who think rationally. Drunks are not impervious to my charisma, but they’re unpredictable. Obstreperous drunks nurse a grievance against someone: the staff, a lover, or life in general. Providing an attentive audience helps, so I try to get them talking. Success gives me a sense of accomplishment after the fact but no pleasure at the time. Drunks are boring.


To illustrate, an executive staying at a downtown hotel learned he had been fired. After drinking too much, he phoned his boss to discuss the matter only to learn the boss was also in Los Angeles. Efforts to get a room number from the front desk failed, probably because his boss was in a different hotel. Drunks do not discourage easily; his increasingly loud appearances at the front desk made the staff nervous, so they consulted me.


Drunks obsess about their grievances because no one wants to listen, so they cheer up when someone expresses interest. He followed me to a quiet corner of the lobby, and I composed myself to look attentive as he explained that his dismissal was inexplicable and possibly an error because his last performance review had been entirely positive. Having a copy in his possession, he read the review to me. I agreed it was flattering. He reread it aloud and then asked why a company would dismiss someone it clearly valued. I agreed this sounded unreasonable. Then I made the usual mistake of those speaking to the deranged and asked a logical question: what might have happened since the review to upset his superiors.


Consulting the review, he decided to read it to me again. Suddenly there was silence. The lobby was deserted. A housekeeper was operating a vacuum cleaner at the far end; the drunk gentleman lay back in his chair, snoring. I had fallen asleep, too. Feeling pleased at a tedious job well-done, I proceeded to the front desk for gratitude and payment. Unfortunately, at that time the Marriott was not a regular client where everyone knew me. During the change of shift, the day manager had mentioned calling a doctor to deal with a drunk but failed to add that the hotel had agreed to pay, so the night manager told me to take up the matter during the day.

A Spanish lady wanted her ears checked because she had an ear infection last week and flies tomorrow. So I drove eight miles to Hollywood and examined her ears. They were fine. I collected my money and returned. Sometimes hotel doctoring is easy.

Advice

Note: I originally wrote this for hotel general managers, but any reader will learn a great deal.

Having a house doctor may be the best service you provide that doesn’t cost the hotel anything. Except… how do you know guests are getting good service? How much control can you exert over a doctor? The answer is: a great deal. You would never dream of setting your family doctor’s fees, choosing his office hours, or insisting he respond immediately when you call. Not only can you influence all these factors, you should. If you’re reluctant, here are some questions whose answers might unsettle you.

1. Is your doctor charging $600 a visit? It happens, and guests pay. But they don’t like it.

2. Is he liberal with phone advice, and how much does he charge? The answers may not be yes and zero, but they should.

3. How does he respond at 2 a.m.? Is he a bit testy? Does he send everyone to an ER or suggest they wait till morning? Does he tell your staff to summon paramedics even if there’s no emergency? You don’t want that.

4. Does the doctor, as he leaves, slip $20 to a bellman or concierge? That’s illegal but a tradition among hotel doctors. Your employees will never mention this, but you may not want them to choose your guests’ doctor according to the size of his kickback.

THE NATURE OF HOTEL DOCTORING

When I began during the 1980s, only luxury hotels had a “house doctor,” usually a local practitioner who did it as a sideline. Nowadays, in a large city even the lowliest motel receives blandishments from a dozen individuals plus several agencies that send moonlighting doctors if they can find one. “Hotel” doctors often acquire hotels by dropping by to extol their virtues to front desk personnel, perhaps with the promise of a tip. I got my start in Los Angeles writing letters to general managers, but this was 1983 when no doctor served chain hotels (Hiltons, Holiday Inns, Ramadas, Sheratons). Despite this, responses were slow; it was 1992 before I became a full-time hotel doctor, and there will never be another.

During the 1990s, half a dozen housecall services sprang up. Working from a central office with an 800 number, they accepted calls from around the US and then phoned a local doctor to make the visit. At that time, their base fee was about $200. The doctor received half but could keep whatever extra he charged for drugs and injections. Finding someone willing to make a housecall on the spur of the moment turned out to be difficult. Agencies quickly learned about me, so I made hundreds of visits for organizations with names like Hoteldocs, Expressdoc, Travel Med, and Medical Express. An agency that clears $100 per visit requires an immense volume to make a profit, so most have vanished. I once made visits for AMPM Housecalls which charged $350 per visit around 2001-2. AMPM Housecalls remains in business.

Since GMs hear about only the most disruptive problems, they underestimate how often guests want medical attention. A hotel generates one to three requests for a doctor per month for every hundred rooms. As an example, my records over recent years show that the Ritz-Carlton in Los Angeles (304 rooms) called me 77, 84, 83, 77, 100, and 66 times.

Guests who ask for a doctor want a doctor. They don’t want directions to the nearest emergency room or a list of clinics. In my long experience, about ten percent of Los Angeles hotels refuse to name a doctor because of liability fears. The hotel lawyer has explained that when a guest sues the doctor, he’ll also sue the hotel that recommended him. That’s right, but it doesn’t matter! Having a good hotel doctor doesn’t cause liability problems, it prevents them.

Here’s the scenario. A guest feels ill, consults the staff, receives a list of clinics, returns to his room to think matters over, and dies. Under this circumstance, lawyers will fall over themselves in their eagerness to sue the hotel. After all, the guest asked for help and didn’t get it. When I visit guests who need urgent care (it’s not always obvious), I take them to my car, drive (gratis) to a clinic or ER and usher them inside. This is not only good medicine, it’s self-defense. I’m responsible for that guest, but once he settles into another facility, I’m off the hook. Your staff could offer the same service, but they lack a doctor’s authority. When I decide a guest needs to go somewhere, I don’t take no for an answer.

THE RELATIONSHIP

In the old days, hotel staff summoned a doctor in the same way they summoned a prostitute. A bellman made a phone call, and the lady arrived. Departing, she stopped by the bell desk to leave a portion of her fee. This custom has not vanished. In my regular hotels, I was always aware of a few employees who called competitors because they wanted the tip.

Even in the old days, a European hotel’s doctor was not an employee, but these things were managed better overseas where general managers chose the doctor. This is clearly not the case in the US because I recall only half a dozen interviews in thirty years. Of course, hotels that chose me sight-unseen never had cause to regret it, but this was not invariably the case. Google Jules Lusman.

An encounter with a doctor sticks in a guest’s mind, so you should do your best to ensure it’s a positive experience. This means an interview and a check of credentials. To find candidates, phone other hotels to ask who they use. Any experienced concierge or bellman can provide names if approached tactfully. Asking your family doctor might help, but most doctors hate doing housecalls, and you wouldn’t want someone with a busy practice. Internet searches are skimpy (“housecall doctor” works better than “hotel doctor”). Your mail may turn up publicity from housecall agencies, but these are a crapshoot because they employ an ever-changing cast of moonlighters.

Determining a doctor’s competence is essentially impossible (fortunately most are OK), but you want to make sure there are no skeletons in his closet. Don’t spend money on internet companies that claim to uncover a doctor’s background. Simply do a search for “(your state) medical board complaints” to find a site where you can enter the doctor’s name and learn if he has come to the board’s attention. In California, this turns up http://www.medbd.ca.gov/Lookup.htm where you can check me out.

Then you or a trusted colleague should ask him to drop in. The interview shouldn’t take long; your guests will form an opinion based on a quick first impression, so why shouldn’t you? It’s a good idea to keep in mind the following.

WHAT GUESTS WANT WHEN THEY WANT A DOCTOR

1. When guests call the doctor, they should reach the doctor.

I’m amazed that physicians still use numbers that reach answering services, beepers, and receptionists. Mine reaches my cell phone. Guests love that I answer in person. Other doctors express horror that anyone can call my “home number.” I point out that hotel doctoring is a luxury service and expensive. Guests should get what they pay for. Since it’s also highly competitive, a GM should have no trouble persuading a doctor to respond quickly. It’s something you can check on by dialing the number now and then.

3. Phone advice should be free.

Lawyers agree unanimously that doctors should never, never give advice over the phone. Some obey, but you don’t want one to serve your hotel. More than half of guests who call me don’t require a visit, so this is no minor matter. Here you’re out of luck if you use a commercial housecall service, because the guest will speak to a dispatcher whose sole duty is scheduling a visit.

Every few months a guest will unpack and realize his or her heart medication or birth control pills are at home. They will be in despair, because they assume getting a replacement will be a tiresome, expensive process. They love hearing that the house doctor will simply phone a local pharmacy. I do that regularly, and I don’t charge.

4. When the doctor agrees to come, he should come.

Since competition moved in, my greatest source of new clients is doctors who take hours to show up. Patients will fume quietly in a waiting room, but hotel guests are quick to complain. Staff then call the doctor’s number, reaching the answering service who promises to page him. After a while they call me. In thirty years, no one has called to wonder where I am because I always tell a guest when I’ll arrive and call again to apologize if I’m delayed. This is such common courtesy that you should be deeply suspicious of any doctor who gets complaints. If asked about housecalls during the wee hours, all candidates will proclaim their eagerness, but your staff should keep a record of guests who ask for help late at night. You’ll soon learn if the doctor doesn’t like to get out of bed.

5. He should not charge an arm and a leg.

I charge $200-$250 during most of the day plus $50 for calls that get me out of bed. Guests at cheap hotels pay less. My only extra is for distant hotels which varies according to the distance and how reluctant I am to make the drive. I don’t charge for supplies or medication, and that includes injections. These turn out to be surprisingly cheap; I rarely give out anything that costs me over $10, and most guests get everything they need. My housecall fee is less than the going rate which is probably around $300 plus medication. Don’t assume this is because of my deep humanitarian instincts; it’s a rate that I feel comfortable quoting, and I’ll certainly raise it as time goes by. But it does cause resentment even among rival hotel doctors with whom I’m on speaking terms. They probably think I’m trying to steal hotels, but, if pressed, they’ll admit that hotel management doesn’t care what the doctor charges and most probably don’t know his fee. As long as patients aren’t complaining, management doesn’t don’t care. I’ve never acquired a hotel because my fee is lower.

Don’t be reluctant to tell the doctor how to run his business. An office practice may have several thousand patients. At my busiest I had forty regular clients and twice that many who called irregularly, so a single hotel represented a major source of income. No sensible doctor will ignore your suggestions. Here’s one that worked. Long ago, I charged $100 for a visit, but expenses were rising, so I decided it was time for an increase. Shortly after, I visited the JW Marriott in Century City, a regular. All upscale hotels and many chains will pay my fee, adding it to the guest’s bill (a good idea; guests like it, and it enables you to keep track). When I handed my invoice to the concierge, she examined it, hesitated, then said: “I see you’ve gone up to $120… Doctor Lusman stopped by a few weeks ago. He said he’d see guests for $100.” What could I do? Thereafter, guests at the JW Marriott continued to pay $100. Guests everywhere else paid more. Wasn’t that easy?

At midnight in the hotel restaurant, a guest asked the waiter to light her cigarette. When he complied, her finger burst into flame. She had recently applied acrylic nails, and the cement is flammable. The guest was drunk and abusive, and she refused to go to an emergency room… I’ll save that story for an essay in which I recount times I’ve saved a hotel’s bacon. This won’t happen often, but you’ll thank your lucky stars when it does.

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