Monday, September 7, 2015
A Dog-Eat-Dog Business, Part 10
My last post reported a housecall service that charged an unbelievable fee. By an odd coincidence within a week I came across another new service with an even more unbelievable fee: $99.
A high-tech startup similar to Airbnb, Uber, and Lyft, Heal is clearly the wave of the future. You download its app. If illness strikes, you click on it, enter information, and (according to the web site) a doctor arrives within an hour. Business was brisk, its medical director assured me.
With a “medical assistant,” driving, Heal’s doctors care for acute illnesses, performing complex procedures that I don’t do such as suturing, injecting joints, and even complete physical exams.
Paying the doctor, driver, staff, and investors at $99 per housecall seems impossible, especially since the web site emphasizes that there are no extra charges. On the other hand, taxi companies complain bitterly about Uber, and hotels denounce Airbnb, yet both are prospering. Financial acumen is not my strong point, so it’s possible that Heal will drive me and my more expensive colleagues out of business.
If so, I might to work for them. Pay is low for a doctor but acceptable to me. Having a driver would relieve a major stress, and I might enjoy not being on-call 24 hours a day. This blog would vanish, but you could read Heal’s. It lacks my whimsy, being mostly earnest medical advice and public relatoins, but $99 will not include entertaining literary diversions.
Let me know if it works for you.
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Wednesday, August 26, 2015
Lost in Translation, Part 2
5:30 a.m. Saturday is an ideal time for a call. I had finished writing and was sitting down to breakfast. I told the dispatcher I would be at the hotel in an hour.
The freeway was clear. Parking, even downtown, would be easy. My phone rang as I drove. It was the guest’s travel insurer warning that there was no answer when he phoned to tell her when I’d arrive. When guests call directly and then vanish, I don’t get paid, but this is not the case with travel insurers, so I drove on. It was unlikely she had left the hotel.
At this hour, I check at the desk to make sure I don’t knock at the wrong door. The clerk confirmed the room, called, and reported that someone had answered and then hung up.
It was good news that she was present, not so good that she had immediately hung up. That’s a sign that a guest’s English is not good.
A young Japanese woman greeted me at the door, ushered me inside, consulted her Ipad, then announced in triumph: “......stomach!!....”
One advantage of travel insurance is that dispatchers will interpret. Despite my admonition, they prefer to edit, abridge, and summarize rather than simply translate; their English is often rudimentary, and passing the phone back and forth makes for a long, tedious visit.
On the plus side, hotel guests usually have uncomplicated problems. It worked out fine.
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Friday, August 14, 2015
A Medicolegal Housecall
Stepping out of the shower, a Doubletree guest stumbled and nicked his leg. He had paid little attention, but now, two days later, the wound had grown painful.
That sounded like a good visit until he delivered the bad news: the hotel would pay my fee.
I label these “medicolegal” visits and I don’t collect. When a hotel offers to pay, it’s usually because the guest is making a fuss, and management has already agreed to other expenses such as comping the bill.
I don’t want to be part of the problem, and it’s a chance to remind upper management of my value. During the usual visit I never see a general manager. Most are only vaguely aware of my existence, and a few are surprised to learn that the hotel can call a doctor.
The guest’s shallow, one-inch, laceration was healing normally. I doubt he would have called if he had had to pay.
I shook hands with the general manager and assured him that there was no significant problem. I added that, as the hotel’s doctor, I was always available, and he should feel free to consult me under these circumstances. I waved off his offer to pay. He expressed gratitude.
Don’t assume that this guarantees a hotel’s loyalty. It’s been years since Loews in Hollywood and the Adventure hotel called. My last visits to both were medicolegal freebies.
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Wednesday, July 29, 2015
Another Wee-Hour Call
It was midnight when the phone woke me. An Emirate flight attendant at the Hilton in Costa Mesa needed a doctor.
That Hilton is in Orange County, a 46 mile drive. The agency that serves airline crew has an Orange County doctor but calls me when she doesn’t respond.
After I’d dressed and filled out the necessary forms, the phone rang again. The Orange County doctor had checked in and wanted to make the visit. Was that OK?...
I’d received a similar call last month when I was already on the freeway. At that time, when the agency announced that my visit was cancelled, I made a fuss, so it promised not to do that again.
Did I want to spend two hours driving plus twenty minutes delivering medical care in the middle of the night? I boast that, not having an office, I can sleep late, but I enjoy getting up early to write. In any case, my body automatically wakes at the same time.
Returning to my cozy bed seemed extremely attractive; I gave my consent.
As soon as I hung up, I remembered that the agency pays generously for long drives in the wee hours. That thought gave me a touch of insomnia, so I still passed a sleepy morning.
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Saturday, July 25, 2015
Trusting the Guest to Take Care of Things
A guest at the Crowne Plaza was feeling under the weather.
The guest spoke poor English but, through the bellman, asked if I took his insurance: April Assistance. I did, adding that, unless he wanted to pay me directly, he must call April and ask for a doctor. Then April calls me.
After giving April’s 800 number to the bellman who passed it on to the guest, I hung up and immediately regretted it. I should have asked for the guest’s insurance I.D. and then sent him to his room. Then I should have phoned April to tell them a client wanted a housecall. They would have phoned him and then approved. I’ve done this in the past; when I’m lazy and trust the guest to take care of things, I often never hear back.
I called an hour later, but the bellman didn’t remember the guest’s name.
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Sunday, July 5, 2015
Sometimes This is a Thankless Job
A one year-old at the Ramada was
fussy and congested, but my exam was normal. She had a cold, I explained. It
was not serious but might last a few days. Staying in bed wouldn’t make it go
away quicker. The parents should encourage the child to drink, but it was OK if
she didn’t eat. They were already giving Tylenol for the fever, and that was
fine. They should try to enjoy themselves.
“So she doesn’t need anything,”
said the father. I assured him she didn’t.
I gave them my phone number and
promised to keep in touch. They thanked me effusively as I left, but I was not
fooled.
Understand their point of view.
They were in a strange city on an expensive vacation, and their child was sick.
Naturally, all fun was cancelled and the doctor summoned fix things.
Had I written a prescription, I
would be doing what a proper doctor does. They would have given the medicine
and waited. Not giving “anything” meant that I considered the illness trivial. That
was clearly wrong.
Mind you, obeying long and sad
experience, I had carefully explained that the child might feel under the
weather for several days. They had listened and nodded, but their
yearning took priority.
I intended to call in 24 hours,
but the following morning their travel insurer phoned to say the parents were
requesting another visit. I explained that that wasn’t necessary. I would call.
“She’s the same. The fever
hasn’t gone away,” said the mother.
I repeated that this was to be
expected and that she should wait. She agreed and thanked me for calling.
No one answered when I phoned
the next day. The insurance agency dispatcher explained that the mother had
called earlier to demand another visit, so he had sent her to an urgent
care clinic.
The child had barely swallowed
the first spoonful of Amoxicillin when she began to improve. By evening she was fine, and the parents were congratulating themselves. Who knows
what might have happened if they hadn’t found a competent doctor?
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Thursday, May 14, 2015
The Conundrum of Ear Pain
I
hate forbidding guests from flying because of the ticket-change fee. The era
when a doctor’s note impressed the airline is long gone. It still works for
travel insurers, a good reason to buy a policy.
My
problem arises most often with ear pain.
Cabin
pressure at cruising altitude drops only about 25 percent from sea level, but
that’s significant. If you bring a bag of potato chips you’ll notice that it
swells like a balloon. Air in any closed space does the same. If you have gas,
you’ll have more gas. If air in your middle ear can’t escape, the ear will feel
stuffy and then painful. If pressure increases still more, it may blow a hole
in the eardrum. This relieves the pain, and most small perforations heal in a
few weeks, but we don’t like to encourage them.
The best
preventative is a chemical nasal spray (Afrin, Dristan). As you sit in the
plane before takeoff, spray generously, wait five minutes for it to work, and
spray again. This should send the spray far up to reach the eustachian tube
opening, the only connection between your middle ear and the outside world. Do
the same before the plane begins its descent, an hour before landing.
Flying
doesn’t cause ear infections, so if you felt fine before boarding, it’s OK to
wait if your ear hurts after landing. Pain should improve after a few days. If
you see a doctor, he’ll forbid you to fly.
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Sunday, May 10, 2015
Tooting My Horn
Would
I see a lady at the Airport Hilton with an eye problem?
I
asked the dispatcher from Amerilink, a travel insurance agency, for details,
but she couldn’t provide them.
It
turned out that the lady had no complaints. Apologizing, she explained that she
had neglected to pack her glaucoma drops. Would I write a prescription? I was
happy to comply. Amerilink would pay my usual fee.
These
delightful visits are not rare. Travelers with insurance who forget a medicine
often lie because they suspect, correctly, that the carrier will not pay for
the truth.
When
a hotel calls directly, I always speak to the guest. If he or she has forgotten
a legitimate medication, I phone a pharmacy to replace it, gratis. I don’t have
the gall to collect a fee for delivering a prescription.
Readers
of this blog know what a humble physician I am, but this is one time I will
boast. Many competing hotel doctors charge for any service they perform over
the phone, including simple advice. If a guest calls the 800 number of one of
the half-dozen national housecall services that advertise widely, he or she
will have choice of (1) a paying visit, (2) going to an emergency room, or (3)
nothing.
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Saturday, May 2, 2015
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.
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Monday, January 12, 2015
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.
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Sunday, January 4, 2015
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.
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Saturday, November 29, 2014
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.
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Saturday, November 1, 2014
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.
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Wednesday, October 8, 2014
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.
Saturday, October 4, 2014
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.
Tuesday, September 30, 2014
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.
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Friday, September 26, 2014
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.
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Thursday, September 18, 2014
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.
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Sunday, August 17, 2014
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.
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Thursday, July 10, 2014
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.
Labels:
Brazil,
dormitory,
hotel doctor,
house call,
housecall,
Los Angeles,
travel insurance,
UCLA
Wednesday, July 2, 2014
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 21st 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.
Labels:
hotel doctor,
house call,
housecall,
Los Angeles,
Medicast
Saturday, May 31, 2014
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.
Labels:
hotel doctor,
house call,
housecall,
Los Angeles,
suture removal
Wednesday, May 14, 2014
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.
Tuesday, April 29, 2014
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.
Labels:
concierge,
hotel doctor,
house call,
housecall,
Los Angeles,
physician
Thursday, April 17, 2014
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.
Labels:
Doctor,
hotel,
house call,
housecall,
Los Angeles,
paramedics,
physician
Wednesday, March 12, 2014
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.
Labels:
Apple,
house call,
housecall,
I-Phone,
Los Angeles hotel doctor,
physician,
Siri
Tuesday, January 28, 2014
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.
Tuesday, January 21, 2014
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.
Labels:
boring,
Doctor,
exercise,
gym,
hotel,
house call,
housecall,
Los Angeles,
New Yorker,
physician
Thursday, January 16, 2014
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.
Sunday, January 12, 2014
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.
Labels:
Doctor,
hotel,
house call,
housecall,
Los Angeles,
physician,
removal,
sliver
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