Curing Hiccups

Every few years a hiccuping hotel guest appeals to me.

Hiccups rarely lasts more than a few hours, so a victim gives credit to his last effort and immediately rushes to his computer to proclaim its benefit. Literally hundreds of treatments exist: proof that all are worthless. Google “hiccups cure” to confirm that you must never look for health advice on the internet.

Long ago when an old doctor described a good treatment, I was skeptical. Even today, hotel visits for hiccups make me nervous, so I give a money-back guarantee. Once in the room, I take a tongue depressor and rub the soft palate at the back of the hiccuper’s throat. Sometimes he or she gags, sometimes not, but so far everyone has been happy to pay my fee.  

How to Remove a Sliver Painlessly

Her son had a sliver in his palm, explained a caller from the Airport Marriott. Could I come and remove it? The child was two.

Two is the worst age for a dignified doctor-patient relationship. Infants love everyone, and older children listen to reason. At two, girls are often terrified into silence, but males who don’t like doctors make for a noisy consultation.

Removing a fresh sliver with tweezers is easy, but most victims pluck at it with their fingertips, breaking off the tip, leaving the remainder nestled out of reach under the skin. 

As I unwrapped a scalpel, the parents assured the child that it wouldn’t hurt. Long experience had taught that this was a lie, so his protests became deafening.

In fact, the parents were right. Both worked hard to immobilize the child at first, but when it became clear there was no pain, he calmed. Your epidermis is dead skin, so shaving the very surface with a scalpel should be painless. I shaved enough to expose the splinter. A new safety razor works as well.

A Hotel Doctor's Christmas

I’m the only hotel doctor who loves to work on Christmas. Freeway traffic is light, always a bonus but more so on Christmas because my competitors, including those in Orange County, prefer their holidays undisturbed, so I make some distant visits.

Guests who fall ill are especially grateful to find a doctor. Employees, apologetic when they phone, are impressed when I make an appearance. Visiting a hotel that doesn’t call provides an irresistible opportunity to point out the superior service I deliver.

The only person not delighted by all this is my wife. Long ago, receiving a second call while engaged in the first, I missed the family Christmas dinner. I won’t do that again, but that’s only a matter of juggling a few hours.

You Must See "The Dallas Buyer's Club"

Everyone agrees it’s one 2013’s outstanding films. On Rotten Tomato’s site, a spectacular 42 of 42 reviewers approve. Matthew McConaughey delivers an Oscar-winning performance as a homophobic Texas good-old-boy who learns that he has AIDS in 1985.

Defying his doctor, who announces that he has thirty days to live and that no treatment exists, he pulls himself together, searches for treatments in places beyond the influence of the medical establishment (Mexico, for instance), smuggles them into the USA, and distributes them to AIDS victims despite government persecution.

Although I recommend The Dallas Buyer’s Club, I left halfway through. I couldn’t bear it because it contains every dumb Hollywood cliché about physicians and science.

Every doctor is a jerk except (a) the beautiful young woman doctor who finds Matthew McConaughey cool and (b) the seedy, unshaven doctor whom McConaughey stumbles upon running a Mexican clinic. After announcing that he has lost his US license (undoubtedly for being too compassionate), this doctor explains that his regimen of vitamins and immune boosters will help.

I am not one of those tiresome people who insist that movies stick to facts. History is boring and complicated. American movies must tell a coherent story with an upbeat ending and an admirable hero (Matthew McConaughey has flaws, but they are cute flaws: he is oversexed, a spendthrift, rude, and he lies – but only to bad people).

At that time, a hundred Mexican clinics sold AIDS treatments. None worked. Everyone who took them died. No American audience would accept Matthew McConaughey passing out fake drugs, so the screenwriters tweak the historical facts. In the movie, the drugs work.

I’m puzzled why conservatives denounce Hollywood for turning out liberal propaganda. The Dallas Buyer’s Club is a Tea Party dream. The government is a heartless oppressor. That includes the FDA which the writers confuse with the FBI because they create a menacing agent who threatens to arrest Matthew McConaughey. This FBI… I mean FDA agent never says “Your drugs don’t work!” He says “Your drugs are not FDA approved!” which, since he’s a villain, means they do work.  

Let me know how it turns out.

A Week's Vacation

Returning from a week’s vacation, I took my phone off call-forwarding. Knowing that I keep detailed records, the colleague who covered E-mailed me the information I needed.

Seven hotels phoned; he made four housecalls and took care of three over the phone.

Universal Assistance, a travel insurer, called once. He asked for their credit card number which they gave, and he made the visit.

World Aid, another travel insurer, called twice but refused to give a credit card, so he refused the calls. I fax my invoices to World Aid which usually pays in a month or two. When they don’t, I phone to remind them. Many hotel doctors hate pestering agencies for payment, so they insist on a credit card.

International Assistance called three times, and he declined as soon as they identified themselves. IA still owes him for visits in years past. International Assistance has a poisonous reputation among hotel doctors because it often took six months to pay when it paid at all. Institutions such as clinics and hospitals can deal with this (state-run Medicaid programs are not much better), but individuals soon give up.

Ironically, my patience with IA has been rewarded. After the latest change of ownership a year ago, it got its act together. It now pays reliably every month and provides a great deal of business, but a long time will pass before it lives down its reputation among my colleagues.

Inn-House Doctors called five times, and he made two visits: one to Hollywood and one to the airport area. A national housecall service, Inn-House serves a few hotels and travel insurers but many airline flight crew. In their eternal search for better hotel rates, airlines have been boarding crew further and further from Los Angeles airport which is twenty miles from my colleague’s home. He declined two visits to Long Beach (45 miles) and one to Anaheim (60 miles).

More Humor

"Can you go to Pasadena?” asked a dispatcher from Expressdoc, a housecall service. I could.

“Bloating and nausea,” was the reply when I asked for the patient’s symptoms. Once I arrived at the Pasadena Hilton, I learned that, besides bloating and nausea, the guest was suffering hot and cold flashes, difficulty breathing, dizziness, and blurred vision.

My diagnosis was an anxiety attack. She agreed that this was reasonable. She remembered similar episodes.

“I don’t have more stress than most people, but obviously I’m not handling it well. Why is this happening?”

“Because no one is perfect.”

She laughed, but I believe this. I explained that an anxiety attack is a tiresome body malfunction like a backache or allergy. You suffer, deal with it, and feel better, but it’s likely to recur. Almost everyone believes that stress causes anxiety. When it becomes chronic, victims undergo psychotherapy which sometimes works. I treat it as a simple malfunction; this also works pretty well.

Concierge Doctors

I belong to the American Academy of Family Physicians (AAFP), the leading organization for family doctors with about 100,000 members. My physician brother, more activist than I, belongs to more  liberal physician organizations which are much smaller.

I bought a lifetime membership years ago, so I’m stuck with it, but its heart is in the right place. The AAFP wants members to practice high quality, compassionate medicine and requires that they stay educated and pass a test every seven years. It expresses deep concern with Americans who can’t afford medical care but refrains from urging doctors to greatly inconvenience themselves to remedy this. Most doctors are conservative; the AAFP’s leadership is more politically sophisticated than its members, but, in the end, it reflects their interests.

That brings me to today’s subject. I was perusing the AAFP’s weekly news bulletin. One article cheerfully announced that direct primary care was piquing everyone’s curiosity and that two physician-entrepreneurs would provide the “inside scoop” in a web workshop free to AAFP members.

I was preparing to move on when, with a shock, I realized that direct primary care is a euphemism for concierge medicine. The AAFP was plugging concierge medicine!!! That’s like promoting Mexican cancer clinics!

If you’ve followed this blog you know my low opinion of concierge doctors. They don’t accept insurance. Patients usually pay a monthly or yearly retainer in addition to the usual fees; in exchange, they receive quick access, longer appointments, and, if necessary, housecalls. This money pays for the doctor but nothing else. Tests, X-says, therapy, specialists, and hospitalization cost extra. It’s a luxury service.

When concierge doctors address the public they extol the superior care they deliver to a grateful clientele. Around the lunch table with only doctors present, they extol the pleasures of a cash-only practice. I've never met a concierge doctor I could respect. 

Finishing the article, I hit the “comment” button and forgot my rule about not responding in the heat of emotion. The satisfaction of delivering my opinion which included the adjective “sleazy” evaporated when I read the avalanche of abuse that followed.

Later that day an E-mail from an AAFP official explained that readers were complaining at the lack of respect shown in my response, so it was being deleted. It vanished, but the angry responses remained. You can read them at http://www.aafp.org/news-now/practice-professional-issues/20130508directwebinar.html. If that’s too much of a mouthful, google “inside scoop on running a direct primary care practice” and it will turn up.