The Most Deeply Compassionate Physician

I’m an early riser, so the 5:30 a.m. phone call last week found me at my computer writing this blog. The caller was Le Montage, a luxury hotel in Beverly Hills.

It was a perfect time. Wilshire Boulevard was deserted. The hotel was three miles away. I could park on the street. Guests during the small hours are particularly grateful. I was home in time for breakfast.

My last visit to Le Montage occurred several months ago. The call arrived at 3 a.m.

That I am Los Angeles’ leading hotel doctor is beyond doubt, but I have never dominated the elite establishments (Bel Air, Four Seasons, Beverly Wilshire, L’Hermitage, Peninsula, Beverly Hills Hotel). These already had doctors when I began in 1983.

After a few decades, some took notice, and I often covered for their doctors, but nowadays when these hotels call, it’s generally during the wee hours.

I suspect this is because a new generation came on the scene a few years ago including several young aggressive doctors building a concierge practice. Concierge doctors offer an exclusive personal service, but they accept only cash. They have no interest in Hiltons, Ramadas, Holiday Inns et al whose middle-class guests might object to the fees, but luxury hotels are a different matter. They solicited with considerable success.

“Do you think they're paying off the concierges and bellman?” asked a veteran colleague when the subject came up.

"They wouldn't stoop to that," I responded. It's illegal. I’ve met several of these doctors, and they seem personable. Check their web sites (google “Los Angeles house call doctor”). All describe themselves as skilled and deeply compassionate. Read their testimonials or the Yelp comments. Unanimous praise.

When these physicians introduce themselves to bellmen and concierges, they undoubtedly emphasize their skill and deep compassion. Who would not be impressed?

As midnight approaches, bellmen and concierges go home. The skeleton night staff has never encountered these exceptional physicians, so when a guest falls ill, they call Doctor Oppenheim. 

A Case of Domestic Violence

A lady’s arm injury seemed straightforward until she explained that her husband had twisted it during an altercation the previous night.

“It was a case of domestic violence,” she said in exactly those words.

That was disturbing news. California law requires that a doctor who suspects a patient is a victim of domestic violence must inform the police. When I told her, she merely shrugged. The husband looked depressed.

I returned to my car, took out my Iphone, and asked Siri to find the nearest police station. She complied. Although the nearest, it wasn’t the correct police station for that area. I was directed to another where an officer told me a car would be sent.

The Hotel Business in 2014

My records show 685 calls during 2014, slightly fewer than 2013. This represents my first decline since 2001 (the months after 9/11 were bad for tourism).

In my defense I took more time off because we bought and remodeled a house in Lexington, Kentucky where I plan to retire in the future. The distant future.

While this is comforting, the painful truth is that hotel doctoring has grown brutally competitive.

If you google “Los Angeles house call doctor” half a dozen names appear but not mine. Furthermore, these newcomers are amazing: Christlike in their empathy, compassionate, brilliant. For proof, read comments on Yelp or Healthgrades: five out of five stars every time, unanimous praise.

These doctors market aggressively. They have web sites. They visit hotels, speaking to concierges, bellmen, and desk clerks, undoubtedly emphasizing their compassion and brilliance.

Most hotel managers ignore this area, so when a guest asks for a doctor, the choice is up to the employee. While I’m the best choice, most doctors are adequate although you must google “Jules Lusman.” He arrived, acquired a flourishing hotel practice, and left the country in 2003 in a flurry of publicity and minus his license.

Every Los Angeles hotel has called me. About twenty call exclusively, but even their employees are not immune to the charm of these newcomers.

Luckily, calls directly from hotels make up less than half my business. I’m the doctor for half a dozen travel insurers with offices around the world. I also work for national housecall services which solicit the general public as well as hotels. I care for airline crew when they lay over. When Frenchmen living or passing through Los Angeles get sick, they call a French lady who calls me.

These businesses pay attention to the bottom line: quality of service and fees. They have less interest in charm or the amenities that appeal to hotel employees. I don’t foresee a problem with them.

A Hotel Doctor's Thanksgiving

I had finished breakfast at 7 a.m. on Thursday when the phone rang. A Quantas pilot at the Hilton in Anaheim was suffering a respiratory infection. This was a great call in many ways.

That Hilton is forty miles away, but I don’t mind long drives provided traffic moves smoothly. Holiday mornings are a good time, and I could take the Santa Ana freeway which is two miles shorter than my usual route. I avoid the Santa Ana because it’s often jammed and in poor repair except for a tiresome five-mile stretch of construction. But it was fine at 7 a.m. on Thanksgiving.

Leaving the freeway, I drove past Disneyland where sidewalks overflowed with crowds streaming toward the entrance.

Unlike most patients with a respiratory infection, airline crew give priority to getting home, not to getting medicine. They hate being stuck in a hotel room, so I try to accommodate them.   

The drive home was easy. Unlike other clients, the airline agency requires a special form which I must fill out and fax to get paid. Happily, I checked boxes for “distance,” “after hours,” and “sat/sun/holiday,” all of which get me extra money. I have no objection to any of the three and actually prefer the last two because traffic is light. I’m perfect for this job.

It's Not an Ear Infection!

When I peered into the guest’s ear, the drum looked normal, so there was no middle-ear infection. When I pulled his earlobe, it hurt but not a great deal. In an external infection (swimmer’s ear), pulling is very painful.

Many adults with ear pain don’t have an infection (children are a different matter). I pressed a finger to his temple in front of the ear and asked him to open his mouth. That hurt badly. He had pain in the temperomandibular (jaw) joint.

The jaw joint is no different from the knee, ankle, or shoulder joint. You can injure it, or it can hurt for no obvious reason. This is common, but I can’t remember the last time someone complained of jaw pain. They tell me it’s an earache.

Flying with a middle-ear infection is a bad idea but no problem with jaw pain, so the diagnosis is good news, but guests are skeptical. Ear pain means an ear infection, and pain medicine lacks the cache of an antibiotic. Guests often make it clear that they’re not getting their money’s worth.

Housecalls Are Not Cheap

A lady fell, catching herself on outstretched palms. That often breaks the tip of the radius where it meets the wrist, and she felt pain in that precise area. She needed an X-ray and an office visit.

A man accidentally bent his forefinger far backwards lifting a heavy box. He suffered excruciating pain over the knuckle. I suspected a fracture or torn tendon. He needed the same follow-up.

Both patients lived in Santa Ana, a fifty mile drive. The director of the housecall service who phoned admitted that these were not typical clients, but someone wanted the visits and was paying generously.

The next day, the director informed me that a mobile X-ray van had gone to both apartments. The patients’ employer wanted to know my plans. That’s when I realized that I shouldn’t have made those visits. These patients had been injured at work, and the employer had decided a housecall was the cheapest way to handle them. That was his first mistake. The major advantage of a housecall is convenience; it’s cheap only for trivial problems.

Far worse was his failure to know that job-related injuries must be handled through Workers Compensation, a system most doctors, me included, take care to avoid. It is a bureaucratic nightmare, wildly expensive and corrupt. Your state legislators, Republican and Democrat, know this but keep quiet. Workers Compensation is the state government equivalent of Israel: no elected official in Washington dares criticize Israel.

I told the housecall service that I was out of the picture and that the employer should read the law, and find a doctor who deals with Workers Compensation.    

Customers Come and Customers Go

American doctors complain about paperwork, but it’s no problem with me. I give guests a copy of the record I write in the room. I fax the same to housecall agencies and foreign travel insurers. American insurers look with deep suspicion on housecalls, so I don’t deal with them, and when foreign carriers feel the urge to adopt American techniques (complex codes, lengthy invoices, deductibles, fee schedules), I stop working for them.

This is less of a sacrifice than you’d think because they switch to a national housecall service, most of whom call me. I earn my usual fee, and the service bills the insurer more, often much more. The logic of this is unclear to me.  

Assistcard, an international insurer that has called for twenty years, stopped recently. When I phoned, a representative explained that Assistcard had made arrangements with other Los Angeles doctors who accepted less than I charged. I expressed congratulations, but this seemed unlikely. I charge less than the going rate, other hotel doctors do not work with travel insurers because they pay slowly, and doctors who agree to make housecalls on the side are not likely to drop everything and go. A week after that exchange, Assistcard resumed calling.

Calls from the Biltmore, once a regular, vanished in 2010. Last May the general manager phoned to announce that I was now the hotel’s doctor. I can’t remember the last time a manager did that. Sure enough, the hotel resumed calling. I’m sure an incident in the hotel convinced her that having me as the house doctor would be a good idea. Sadly, I forgot to ask for details.

Bringing the Housecall into the Twenty-First Century, Part 2

My July 2 post concerned Medicast, a service that arrived in Los Angeles with the goal of bringing the housecall into the internet age. Anyone can download the Medicast app. Clicking connects you to a dispatcher who records your credit card information and sends a text message to the doctor on-call who arrives at your “home, office, or hotel” within two hours. You can Google Medicast.

Its fees are less than those of traditional hotel doctors (who don’t advertise) and much less than the entrepreneurial concierge doctors who do.

Always alert to competition, I contacted Medicast whose directors expressed delight at my experience and welcomed me aboard. I attended an orientation where doctors learned to deal with their software. We left carrying an iPad.

Over thirty years, a dozen national housecall services have come to Los Angeles and, mostly, gone. Size is their great obstacle. When I collect a fee, I keep it all. After paying the doctor, a service has other people to pay. Success requires either a high patient volume or high fees.

My maximum volume has been about 2,000 calls per year, and I have never grossed more than $130,000 – a great deal to most of you but peanuts for a doctor. It’s unlikely any organization can match my volume.

One national housecall service has operated since the 1990s. Its site emphasizes the quality of its doctors, and this was certainly true when I was one. It called 26 times between 2000 and 2002 when I stopped working for them. I collected my usual fee. The service charged three times more, but dispatchers often failed to tell guests how much. As a result, when I handed over my invoice they expressed shock. Worse, they blamed me for the fee and did not hesitate to express their displeasure to the hotel. This cause me some difficulty. I'm sorry not to mention its name, but I'm as paranoid about being sued as the average doctor.

Getting back to the present, over the next two months, I received 16 calls from Medicast, the last in mid-July. Last week a director phoned to explain that calls were increasing but not to the extent they expected, so they were adopting a different business plan. Two days later, a courier arrived to reclaim the iPad.

Hotel Visits I Don't Make

I don’t make housecalls for certain symptoms: shortness of breath, chest pain, loss of consciousness, and severe abdominal pain.

Treating asthma, the leading cause of breathlessness in the young, takes hours. Giving a shot and then leaving before the guest improves is risky.

Breathless in older people usually means heart or lung disease. No doctor in his right mind treats this with a prescription, but possessing a mind is not a legal requirement for practicing medicine.

No one ignores an elderly person who faints, but this doesn’t happen often. The young seem to faint regularly. They collapse, wake up, and call me, frightened. I’m happy to make a housecall, check blood pressure, do an exam, and ask questions. By this time he or she has recovered, and I’ve never discovered something alarming in otherwise healthy young people. “Everyone is entitled to one faint,” a wise old doctor told me. If it keeps happening, a doctor should investigate.

Chest pain is a serious sign, but serious chest pain is not subtle. Niggling discomfort does not qualify. Textbooks warn that heart attacks can occur with no symptoms although these are usually in people with other problems, especially diabetes. Since a doctor cannot diagnose a heart attack by listening with a stethoscope, a housecall isn’t helpful. If you phone because you’re worried, it’s unlikely the doctor will tell you not to worry because if he’s wrong, you’ll sue him.

As I’ve written before, when a guest suffers abdominal pain, I feel reassured when there’s diarrhea or vomiting. That usually indicates a stomach virus, miserable but short-lived, and I get the credit when he guest recovers. Pain alone can also be a stomach virus but plenty of serious conditions (gallstones, kidney stones, blood clots) come to mind.  

Medical science has no cure for drunkenness, but hope springs eternal, so hotel staff continue to call.

How Can I Break Into Hotel Doctoring?

My first response is always: read my blog. Begun in 2009, it contains everything you need to know about hotel doctoring including how I started.

While it’s entertaining, it might not help. I began in 1983 when there was little competition. I do no marketing except an occasional letter to general managers. I have no web site; this blog, as I chronically complain, has never attracted a customer. I don’t pay hotel employees when they refer a guest (illegal but a long tradition). Yet I do fine. My database, so old it’s a DOS program, contains nearly 18,000 visits. No one will ever match that.

The quickest way to break in is to buy another doctor’s practice. Buying an office practice is bad business because patients drift away, but a doctor selling a hotel practice simply transfers the phone number. As long as the buyer responds to calls, he’ll keep every client because hotels rarely pay close attention to their house doctor.

This is no idle theory because a veteran colleague will soon retire. Another physician has purchased his clientele, a dozen of Los Angeles' and Beverly Hills’ most luxurious hotels. I have heard only good things about the buyer, but he is not an established hotel physician or a friend, so I plan to benefit.

Despite collecting Social Security for ten years, I have no plans to retire, but it’s hard to imagine me working beyond a few more years. I might entertain an offer.

A Tropical Disease

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

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

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

I reassured the parents.

Going Back to College

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

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

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

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

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

Bringing the Housecall into the 21st Century

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

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

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

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

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

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

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

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

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

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

When Doctors Wish They'd Chosen a Different Profession

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

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

I Don't Do Adderall

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

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

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

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

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

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

No Housecalls Today

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

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

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

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

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

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

Paramedics

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

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

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

Siri Would Catch That

Could I visit a Quantas crew member at the Marriott in Costa Mesa, asked the answering service at one a.m. Costa Mesa is fifty miles away, but the local doctor had just been there and didn’t want to go back.

I don’t work for nothing or keep office hours, so I have no objection to long drives during the wee hours. Unfortunately, the San Diego freeway, the major route to Orange County, closes at 11 p.m. for major construction at the San Gabriel interchange. You might think that this requires a modest detour, but closing the San Diego freeway, even at 2 a.m., produces an immense backup as it contracts to one lane leading to the exit. That’s followed by a long, slow drive through city streets.

Several aggravating experiences have persuaded me to take an alternate route through downtown and the Santa Ana freeway, a bumpy truck route and ten miles longer. After driving fifteen miles, I was dismayed to discover that the Santa Ana Freeway was also temporarily closed, a fact not revealed on my computer's Google Maps.

I followed the orange cones onto Washington Boulevard, a major street that intercepts the freeway further on. It was a deserted industrial area with little traffic, but I grew increasingly uneasy as the miles flew by with no freeway in sight. Pulling over, I consulted my ancient Thomas guide which revealed that I had turned the wrong way on Washington Boulevard and driven five miles back toward downtown.

“Siri would have caught that,” my wife pointed out later. Siri, of course, is Apple’s computer voice that recites your route on the I-phone GPS. She has proved valuable on vacations despite the occasional glitch. If you wander off course, Siri immediately recalculates it and tells you how to get back.

Thirty years of making housecalls has convinced me that I know everything about driving Los Angeles streets, a confidence not shaken by the rare occasion when I get lost. There’s an I-phone in my future.

Lost In Translation

“Bom dia” said the woman who opened the door.

“Bom dia,” I responded. That’s the limit of my conversational Portuguese. My heart sank as I looked around the room which contained a toddler but no adult male. Among foreign couples, the husband is much more likely to speak English.

The mother pointed at her child, made coughing noises, tapped his chest, and produced a thermometer which she waved significantly. Once she understood that I needed more information, she took up her cell phone. 

After some effort because her husband was apparently in a meeting she delivered a long recitation before handing me the phone.

“He have cough. He have the flu. He need something. She wants you to examine him.”

In response to my question, the father insisted that this was everything she had said, but I knew he was summarizing. This is a chronic problem with amateur interpreters. I asked more questions and received short versions of her long answers. The child looked happy and not at all sick, and my examination was normal. He had a cold. He’d coughed for four days and might cough for a few more, I explained. She was already giving him Tylenol, and no other medicine is safe for a two year-old. Luckily, he didn’t need medicine or bed rest or a special diet. It wasn’t even necessary to stay in the room.

If I had handed over medicine, every mother from Fiji to Mongolia to Nigeria would understand that I was behaving like a doctor. But I wasn’t. What was going on?

I’ve encountered this hundreds of times, so I work very, very hard to communicate that the child has a minor illness (husband’s translation: “Doctor says child is OK…”), that no treatment will help (husband’s translation: “Doctor does not want to give medicine…”) and that being stuck in a hotel room is boring, so she should try to enjoy herself (husband’s translation: “Doctor says go out; child is OK…”).

Tap, tap, tap…. The mother beat a tattoo on he child’s chest in a wordless appeal. Everyone knows that a sick child must be confined and given medicine. Why was I implying that he wasn’t sick?

I knew what she was thinking. I repeated my reassurance, and the husband translated. When, at the end, I asked if she understood she knew the correct answer: yes. She remembered her manners as I left and thanked me effusively.

I left feeling as discouraged as the woman. She was in a strange country, trapped in a hotel room with a sick child. Despite her best efforts, the foreign doctor didn’t understand that her son was sick.

A Brush With Disaster

A Beverly Garland guest phoned as I worked out at my gym one morning. I’m happy to cut this short to make a housecall, but the guest wanted me to come at one o’clock. I don’t like appointments, but this seemed an easy visit, and it was convenient because I could go after lunch.

After showering, I was walking to my car when a disturbing thought occurred. Exercise is boring, so I read the New Yorker while on the treadmill. When I finish an issue, I leave it in the locker room for anyone else. With a shock, I realized that I had scribbled the guest’s name and room number on that New Yorker which I later finished and absent-mindedly left behind. I rushed back, but the magazine had vanished. I prowled the gym, searching for anyone reading a New Yorker. No luck. I phoned the Beverly Garland to ask if anyone remembered referring a guest. No one remembered.

Now and then a competitor’s hotel calls when its doctor fails to show up, but I boast that this never happens at my hotels. I always tell a guest when I’ll arrive and make sure that I arrive on time. Now I had visions of the guest fuming as hours passed and eventually denouncing me to the staff.   

I racked my brain. The guest sounded Australian and had a Slavic-sounding name. Dutifully, the desk clerk checked her computer and found nothing. I asked if I could come and examine it myself; she agreed.

Guests who make appointments occasionally change their minds, so I always phone to make sure they’re in the room. With great good sense, I had told the guest I would check at noon. To my immense relief, when 12:30 passed with no call, he phoned.

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.    

No Easy Way to Hollywood

There is no quick drive to Hollywood. I can take the freeway north through the San Fernando Valley, a twenty mile trip. Or I can take it east through downtown for nineteen miles. A direct route is eight miles, but that’s tedious stop-and-go on city streets. Taking the long way doesn’t mean an easy drive because the freeway is often but unpredictably jammed.

When Loews in Hollywood called at 11 p.m. my heart sank less than usual. It was late enough for most drivers to be in bed.

But not quite late enough. The male fun fair in West Hollywood was in full swing, filling the streets.   

Loews in Santa Monica calls me exclusively, but the Hollywood Loews keeps a list of doctors, thus assuring that none of us will lean over backward to accommodate it by, for example, coming during the rush hour (no hotel doctor lives near Hollywood).

My immediate problem in a nonexclusive hotel is that parking valets may not recognize me, so my mantra:  “I’m the hotel doctor. They let me park here” might not work, and I would have to pay. But it worked this time.

As usual, delivering medical care was the easiest part. A perk of hotel doctoring is that I go home after seeing a single guest. During my best months, I go home a hundred times.

I like my job, but going home always feels better than going to work. I played my audio tape. I looked benignly on the midnight revelers as I crept through West Hollywood. Beverly Hills and Century City were nearly deserted, but traffic lights ensured that I would not make haste.

Ever Hopeful

I made a housecall to the Four Seasons recently. Years ago, I shared the Four Seasons elevator with Robert Duvall. He was reading a script, and I pretended not to notice.

I’ve responded to half a dozen calls from that hotel over thirty years, but this was not one. Assistcard, a travel insurer, had sent me to see an 18 month-old with a cold. I took care of the child and left without introducing myself to the concierge.

The Four Season’s house doctor is the only colleague who has been around longer than I, and he serves half a dozen premier luxury hotels around Beverly Hills. In the distant past I covered for him when he wasn’t available. My records show 45 visits to the Four Seasons and several hundred to his other hotels. I loved those calls.

I retired in 2003 and unretired in 2007. During my absence he found someone else to help out. While he welcomed me back, I’m no longer his main support, but he phones at rare intervals.

When insurance services send me to hotels that don’t call, I remind the staff of my superior qualities. This has proved an excellent source of new clients but, ever hopeful, I don’t solicit this doctor’s hotels.  

Another Year

A wave of heat poured out of the guest’s room as he opened the door.

“Another year has passed,” I reminded myself. May 13 marked Los Angeles’s first heat wave of 2013. The temperature reached 91. Since autumn I’d forgotten that people around the world, Arabs excepted, consider air conditioning unhealthy. They tolerate it as one of the exotic discomforts of travel but not when someone gets sick.

This is not a belief amenable to reason, so I go about my business, sweltering in my suit and tie. I rarely take off my jacket because I keep tools (thermometer, tongue depressor, flashlight, otoscope, syringes, prescription pad) in various pockets. Sometimes medicine is hard.

D as in "Dog"

A travel insurer sent me to Koreatown, an older area of Los Angeles, home to a mixture of Koreans and Hispanics. It’s a colorful neighborhood, and like all colorful neighborhoods, parking is a chore. I found a spot several blocks away from the apartment.

Travel insurance patients are subletting or visiting friends, so searching the directory near the locked entrance never reveals their name. Phoning her number, I heard a voicemail message. That was not bad news because insurance services pay for no-shows, but I had to make an effort. I phoned the agency to explain. The dispatcher urged me to wait while she tried to contact the client. I waited. After five minutes, a resident entered the building; I followed and knocked on apartment 1D. The lady who answered denied that anyone needed a doctor.

After another ten minutes, I decided I’d done my duty and returned to my car. My phone rang as I arrived.

The client was taking a shower, said the dispatcher. She was now ready to receive me. I recounted my experience at apartment 1D, but 1B turned out to be the correct number. In my defense, during the original call I confirmed that the patient was in 1D as in “dog.” But English was not the first language for both guest and dispatcher.

A Light at the End of the Tunnel

I’ve been warning that this blog may vanish on January 15 when my E-mail provider, Physicians On-Line, goes out of business. Google could make it easy for bloggers to change their primary E-mail, but it turns out to be nearly impossible. However, Google does allow us to invite another person to join the blog and share all contributing and editing privileges.

So I sent an invitation to myself which I accepted. Google apparently has no objection to two Mike Oppenheim’s hosting a blog, identical in all areas except E-mail. I keep my fingers crossed that one will remain after the 15th.