The Reward of Virtue

I did something admirable last week while reviewing my credit card statement. 

I keep receipts until the charge shows up on my monthly bill and then discard them. I noticed that a $137 restaurant bill from October still hadn’t appeared. Had the waiter mislaid it?....  What to do…. No one would object if I kept waiting. But when I ordered the meal, I was obligated to pay for it.

After some agonizing, I e-mailed the restaurant to remind them. Then, since no one was around to praise me, I praised myself.  

As I turned that honorable action over in my mind, a memory took shape. Didn’t the restaurant mistakenly decline my credit card? And didn’t my wife pay with her credit card for which I reimbursed her?

I examined the receipt.  Sure enough, it revealed the last four numbers of her credit card, not mine. So I had paid the bill! I sent another e-mail to the restaurant, cancelling the earlier one. Honesty had cost me nothing. Who says virtue is its own reward?

Screwing the Guest

A February 13 Craigslist ad is recruiting hotel doctors.

If you read this blog, you know that I keep track of new arrivals and offer to work for them. They often take me up on it because it’s not easy to find a doctor on the spur of the moment. 

A few hours after my response, the phone rang. The caller introduced himself, adding that he knew me, admired me, and was certain that I was a perfect hire.

He operated a concierge hotel doctor service in big cities, he explained. Clients were busy businessmen who absolutely could not interrupt work to be sick. His doctors made sure this happened through aggressive treatment and powerful drugs, perhaps more powerful than a doctor would use in an office. He asked what injectables I carried and suggested others. His doctors sutured lacerations, drained boils, administered IV fluids and breathing treatments, incised hemorrhoids – whatever a guest need to keep going.

The charge was $3250.

“They pay that?” I asked.

“Just about everyone,” he responded. “Because there’s NO OUT-OF-POCKET EXPENSE!” (I write in caps because his voice grew loud). “We deal mostly with foreign businessmen. They have travel insurance that pays whatever we bill, so I promise they’ll have NO OUT-OF-POCKET EXPENSE, and no one has complained.”

This was probably true. Aware of the rapacious American medical system, foreign insurers may be inured to spectacular bills.

When I asked about American guests, he segued seamlessly into another monologue. American insurers are less generous, but his service was vastly superior, effective, convenient, and cheaper than the five or ten thousand dollars charged at an emergency room. Hearing this, many paid and express gratitude afterward.

Unlike the previous harangue, this was not true, but I encounter it on web sites and publicity from competing hotel doctors. It puts me in a bad mood.

“So you’re not screwing the guests, you’re screwing the insurance companies.”

“Why shouldn’t I? They screw us!” he exclaimed, adding that many of his doctors are forced to work for him to make ends meet because of piddling insurance reimbursement. Surgeons who once made $1500 for repairing a hernia are now getting $1000.  

This did not improve my mood although I share his low opinion of American health insurers. Foreign insurers give me little trouble, but I’m not billing them $3250. 

“You’re selling yourself short,” he exclaimed after learning what I charge. I responded that I have no complaints about my income.

“You do realize you’re running a business,” he added on hearing that I don’t charge for phone calls. That’s probably true, but I’ve noticed that every doctor who announces that medicine is a business is an asshole.

He is not the first entrepreneur to discover that sick hotel guests, trapped in a strange city, are an easy mark and that foreign insurers are even easier. You can read about another on my September 3 post. 

A Perfect Housecall

On Sunday I wrote for a few hours and then ate breakfast. My routine is to go to the gym afterward, but as I was leaving the phone rang. A travel insurer asked me to see a guest in Anaheim, near Disneyland, forty miles away. 

That was good news; not only did I have a visit but I could skip the gym. I don’t mind long drives provided the freeways move smoothly which is the case on Sunday morning, and the insurer agreed to pay extra for the distance.

Sure enough, the drive went quickly. The patient was a five year-old with an itchy rash on his legs, obviously atopic dermatitis. I informed the parents, explained how to care for his skin, and handed over a tube of hydrocortisone cream from my bag. They were pleased. I didn't hurry, but I doubt I spent ten minutes in the room. Sometimes this is an easy job.

A Wee-Hour Call

Two nights ago the phone rang at 3 a.m. An insurance agency wanted me to see a client with a sore throat at the Torrance Residence Inn. At 8:30 the following morning.

“Why did the agency call now?” I asked.

“I don’t know. They hung up.”

The operator gave me the patient’s information. The Torrance Residence Inn is fifteen miles away. I do not like long drives during the rush hour, so this was already a problem visit. If I went back to bed, I’d probably lay awake and fume.

Patients who phone for my services during the wee hours usually feel bad, so I took a chance and called the hotel. The guest was awake and feeling very bad. When I told her I could be there in 45 minutes, she was amenable. I threw on my clothes. The drive was easy. I gave her the necessary medicines. Everyone was satisfied.      

The Pinnacle of Success

Walking toward the entrance of the Viceroy, a luxury Santa Monica hotel, I noticed half a dozen parking valets gathered around their supervisor who was giving instructions. As I passed, he paused and pointed: “Look at him. That’s our hotel doctor. You let him park wherever he wants.”

This happened in July of 2003, but I still remember the pleasure it gave me. When the parking valets grant you a free pass, there are no more worlds to conquer.

My Best Customer

I’m the doctor for scores of Los Angeles hotels, but even the largest (the Bonaventure) rarely generates five visits per month.

National housecall agencies and international travel insurers provide more business. My leading client is Inn House Doctor, a national agency run by an entrepreneur based near Boston. You can google it.

He solicits hotels, including mine, but they are not an important source of business. Since Inn House collects a cut of the fee, guests who call hear a large quote.

Many travel insurers use Inn House Doctor for their clients in America. It would make more sense for them to call me directly, but I earn my usual fee, so I don’t care. I prefer Inn House when guests live far away, because insurers often refuse to pay a larger fee. Inn House understands.

Its biggest clients are foreign airlines who need doctors for sick crew. In the past some airlines called me, but I’m happy to work for Inn House because it handles many more.

I don’t solicit distant hotels, but airlines, always searching for the best deal, may house crew fifty miles from the airport. I make half a dozen very long trips every month, but airline crew make excellent patients – not demanding and rarely very sick.

Free Medical Care

When guests ask my fee, I tell them and then steer the conversation to their problem. Half the time, they don’t need a visit. If so, they’re grateful for the advice, especially after learning that I don’t charge for phone calls. It’s good public relations, but I also don’t like to make a housecall and collect money for a trivial service.

If you google “house call doctor” plenty of eager individuals and national housecall services turn up but not me. None deliver free care, so the caller has the choice of a paying visit or nothing. A doctor (sometimes me if you call a national service) may come, hand over a prescription for a medicine you accidentally left at home, and then collect several hundred dollars.

My Fifteen Minutes of Fame

Every five years or so, the Los Angeles Times discovers the housecall and publishes an enthusiastic article that doesn’t mention me, the nation’s leading housecall doctor.

Another appeared two days ago. As always, I wrote the reporter to point out his error. To my surprise, he phoned yesterday, interviewed me for half an hour, and wrote another article in today’s Times. You can find it at:

http://www.latimes.com/business/hiltzik/la-fi-mh-is-the-house-call-really-dead-20160202-column.html

A Dog-Eat-Dog Business, Part 12

On September 3 I wrote about a new housecall service that charged up to $2000. On September 7 I described one that charged $99. Clearly these are extreme. 

So what about $250? That’s painful but, in a pinch, suffering a stomach virus or bad case of flu, many of you might pay. 

What are the alternatives? Several concierge doctors pop up on a Google search, but they may charge triple this. Veteran Los Angeles hotel doctors visit private houses if asked; they charge around double. Call Heal, the $99 service, if it’s still in business. One side-effect of a low fee is that it pays doctors less than the going rate, so many are residents in training. This does not mean they don’t know their business; in fact, being residents, they take every illness very, very seriously. Of course, you could always ask for Doctor Oppenheim. 

The founder of the $250 service, SOS Doctor Housecall, contacted me first because I already work for her. She is the French lady who sends doctors to Frenchmen in Los Angeles. I mention her in posts from February 28, 2011, September 2, 2014, and January 4, 2015. 

She is putting together her app and hopes to launch soon. If she’s successful, my colleagues will feel the strain, but I’ll be making visits for her.

Be Careful What You Ask For

He had been coughing for several days, a guest explained, adding that he probably needed a Z-pak. When a patient suggests he needs an antibiotic, a doctor feels one of two emotions.

(1) Pleasure because this guarantees an easy visit. Give the antibiotic, and the patient will make it clear that the doctor has done what a good doctor does. I doubt most of you realize the importance of your gratitude. No matter how you try to conceal it, if you’re disappointed, we feel depressed.

(2) Depression. In an otherwise healthy person, the only common illness with a cough that antibiotics cure is bacterial pneumonia which is not common. All others are viral infections. These affect fifteen percent of everyone who consults a doctor, so they are no trivial matter.

Over the phone, I quizzed him about his symptoms and then explained that he was suffering a self-limited illness requiring only over-the-counter remedies. When he insisted that he needed a doctor, I directed him to a nearby urgent care clinic where he would get his antibiotic.

How Doctor Oppenheim Met His Wife

In 1975 I and a friend were fresh out of internship. He had a job at a Los Angeles clinic that remained open during the weekend. Few patients came, so I often visited, and we sat talking. The only other employee, a nurse – really a young woman who wore a white coat and acted as receptionist -- joined us. After a few visits I got up the nerve to ask her on a date.

She was committed, she explained. But she worked at the Woman’s Building, a flourishing feminist arts center. She offered to give me some phone numbers.

I declined. I was too shy to call women I didn’t know.

“Then what’s the solution?” she asked.

“Maybe they could call me.” I meant this as a joke and forgot about it until a week later when a woman phoned. I did my duty by asking her to dinner, and it proved an excellent decision.

There is more to it. It turns out that she and the nurse were candidates for a college art teaching position in Oakland. Both flew up for an interview. My future wife later learned that the nurse had already sewn up the job, so there was no point in the interview. During the plane ride, she had given me an enthusiastic recommendation, perhaps as a consolation prize. 

When we discussed how our lives and the nurse’s had progressed over the years, we agreed that my wife had gotten the better deal. 

Good News. Or Maybe Not.

2 a.m. calls rarely thrill me, but this was from the Beverly West, a boutique hotel that never calls. Happily, I threw on my suit and drove off. Traffic was light. Parking was easy.

Afterward I introduced myself to the desk clerk.

“I remember you from the Beverly Garland,” he said. “I’ve only been here two months.”

It’s flattering that employees continue to call when they change hotels, but it also meant that the Beverly West was probably not switching doctors.

“So you got my number from the Beverly Garland?”

He shook his head. “You’re on the computer. I picked you because the name was familiar.”

That was good news. Sort of. I’m probably on every hotel’s computer.

As the wee-hour desk clerk, he had little contact with veteran employees, but they would soon clue him in. After caring for a guest, the Beverly West’s regular doctor gives a “referral fee” to the employee that called. This is illegal but a hotel doctor tradition as well as a superb marketing tool.  

Not Again!!!

“I have the European plague. I need a doctor.”

“Excuse me?...”

“I have the European plague. I need a doctor for the American plague.”

“I’m not sure what you mean. What’s the American plague?”

“My child is in the bathroom with the European plague. Can you bring the doctor for the American?”

What was he talking about?.... The exchange continued for some time until the light dawned. This was the fourth occasion this has happened in over thirty years and 30,000 phone calls. The guest had phoned the front desk because his electrical devices used European outlets which are different from ours. He needed an “adaptor.” The clerk, not listening carefully, had heard “a doctor” and forwarded his call to me.

But I was also not listening carefully. It’s human nature to hear what you expect to hear, so I assumed that the caller had a medical problem.

I had heard “European plague” when he had said “European plug.” He had not said “my child is in the bathroom” but “my shaver is in the bathroom….”

Christmas Season

In the Pasadena Sheraton last Sunday, my phone rang for a visit in Irvine. Pasadena is twenty miles from home, Irvine fifty miles. I would miss supper by several hours, but the month before Christmas is slow, so I was pleased at another visit.

I often drive to Irvine but not from Pasadena, so I consulted Siri from my I-Phone. She directed me toward the nearest freeway but told me to turn off as I reached it. That didn’t seem right, but disobeying Siri is usually a bad idea. A drive through city streets to the Long Beach Freeway saved several miles but probably not much time.

I settled down for the trip before realizing with a shock that she was directing me toward the Santa Ana freeway. No one takes the Santa Ana freeway. It’s always jammed. Sure enough, as soon as I drove on, traffic slowed to a crawl.

I arrived after 1½ hours to face another irritation. The address, 2120 Waterbury, wasn’t a street address but suite 2120 at the Waterbury Apartments. Siri found the complex but getting to 2120 among the buildings was my job.

It was night. The guest was a traveler and unfamiliar with the area. There was no parking except in locked underground garages, so I couldn’t wander far from my car. Also (and I’m not making this up) it was raining. In the end, she came out and searched the streets until we encountered each other. The visit, as usual, was the easy part.

Leaving, I drove to the San Diego freeway, the sensible, if not the shortest, route from my house to Irvine. To my dismay, traffic was crawling. Weekends are usually OK, but I should have remembered that this was the Sunday before Christmas.

How to Get the Best of Both Worlds

A lady with a cold phoned for a doctor at 4 p.m. on a Tuesday.

From my home to hers in the Hollywood Hills required a thirteen mile drive through city streets (twice that on the freeway). I go during the rush hour but only for patients a good deal sicker. In her case, I would schedule a visit for 9 or 10 p.m.

Sadly, the lady hadn’t called me but Get Heal, a new service that promises a housecall within an hour and charges a flat $99.

It pays doctors $75 an hour, lower than the going rate, but provides a medical assistant who drives, a delightful perk. Unfortunately, the dispatcher explained, the medical assistant lived near my destination. Would I make the drive myself? Heal would pay extra. If not, Heal would send a cab.

I chose a cab. Fifteen minutes later an Uber car pulled up. We crept through traffic. The medical assistant was there when we arrived. I cared for the patient. We crept back.

Heal earned $99 for my two hours’ work, but I earned $150. The Uber driver earned half that. The driver, dispatcher, and a dozen other employees collected their salaries. Get Heal has an office in Santa Monica and an impressive web site.

Everyone agrees that $99 for a housecall is a money-loser. Perhaps this patient was an outlier, but none of the eight Heal housecalls I’ve made has taken less than an hour door-to-door.

If you need a housecall in Los Angeles, phone Get Heal and ask for Doctor Oppenheim. You’ll get the best of both worlds until one of us goes out of business.

Discovering a Normal Part of your Body

A young woman at the Georgian Hotel felt a cold coming on, so she inspected her throat and discovered a dozen bumps on the far end of her tongue. I reassured her, but she wanted a doctor to see them.

I love housecalls where I know the diagnosis as soon as I hang up the phone. This qualified because the guest had discovered a normal part of her body. When you examine your tongue in the mirror, it seems smooth. People rarely stick it out far enough to reveal a clump of wart-like taste buds deep inside.

I also love telling a fearful patient that he or she has nothing to worry about, so this was a satisfying encounter for both of us.

It may save you some anxiety to memorize the following normal parts of your body.

- Put a finger inside your mouth and feel the gums behind your lower teeth. Moving just to the left and right reveals two hard lumps which may not be the same size. These are part of your mandible, the jawbone.

- With thumb and forefinger, pinch your neck just below the jaw to feel two lumps that mark either end of the hyoid bone that circles the front of your windpipe. You can wiggle them from side to side.

- Run your finger down the middle of your breastbone to an inch beyond the lower end, then push. You’ll feel a hard mass. That’s another bone, the xyphoid process. One guest was certain had a stomach tumor.

- Feel your major lymph node areas (neck, armpit, groin), and remember what you find. Part of the immune system, lymph nodes swell in response to an infection then shrink after it passes - except sometimes a node or two won’t shrink but remains forever as a pea-sized, moveable granule beneath the skin.

What Antibiotics Do To Your Body

When I started out in the 1980s, pharmaceutical companies sold pills labeled “placebo.” They don’t do that today, so a doctor who wants to prescribe one uses a real drug.

Today’s most popular placebos have names like amoxicillin and Z-pak (azithromycin). These help many conditions but not the respiratory infections for which most are prescribed.

Swallowing any antibiotic kills trillions of germs inside your body. If it’s a placebo, those germs are not causing your problem. Other germs immediately move in. Of course, those are germs that can grow in the presence of that antibiotic. If, in the future, they decide to make trouble, another course of that antibiotic might not discourage them. Do you want that?

Experts have been denouncing placebo antibiotics for decades, but their arguments are feeble. They warn about side-effects and allergies, but these are rare. Most antibiotics, useful or not, are safe over the short term.  
  
The long-term consequences are catastrophic. Soaking the environment with unnecessary antibiotics is giving rise to extraordinarily resistant bacteria. Even today about 40,000 Americans die of infections no antibiotic can treat, and this increases every year.

But who cares? It’s a fact that people with a short-term problem don’t take the long view. That might include your doctor.

Another Free Service

Her child’s nose was bleeding, explained the mother. Could I come?

I was tempted. Once in the hotel room, I would ask questions. I would take out my otoscope and peer up the child’s nose. In the end I would reassure the mother and tell her to pinch the nose and wait. The bleeding would probably stop. Persistent nosebleeds are rare and require expert attention. Then I would collect my fee and leave. 

Over the phone, the mother revealed that the child was in good health and suffering a cold.  Respiratory infections occasionally produce a nosebleed. I reassured the mother and told her to pinch the nose and wait. When I phoned later, the bleeding had stopped. 

The End is in Sight

I keep an eye on Craigslist and the internet for new competitors on the housecall scene, and they turn up regularly. Other hotel doctors gnash their teeth, but I send off my C.V.

Being experienced and available 24 hours a day is an appealing quality, so they often respond. Working for competitors is sometimes painful if they send me to one of my hotels. There’s little I can do because I can’t match their marketing techniques (my lawyer warns me not to be more specific).

Mostly I take for granted that this younger, aggressive, social-media savvy, ethically challenged generation will drive us older hotel doctors out of business. Luckily, I’m already collecting from my retirement savings and social security, so I work because I enjoy it.

Getting Help, Part 2

My relations with other Los Angeles housecall doctors are civilized but not close. As a result, when I leave town there’s only one colleague I trust to cover. Mostly this works out. I schedule my trips so they don’t conflict with his.

When I’m in town I’m always available. That includes after bedtime, in the movies and restaurants, and during social events. It includes concerts and live theater, but I sit on the aisle, so I can hurry to the lobby when my phone buzzes. None of this bothers me greatly (my wife is another matter).  

One event causes problems: baseball games. One of my brothers has Dodger season tickets, and we attend a dozen times during the season. We go to a restaurant and then the game: almost the only time we get together; I love it and don’t want to be interrupted. I’m out of commission only about six hours, and occasionally my colleague can’t cover.

I could continue to answer the phone, but crowd noise in the stadium makes conversation difficult. It also reveals that I’m having fun, and patients hate disturbing a doctor during his leisure time. My solution is to change my phone message to announce that I’m unavailable until (whatever time the game ends) and then turn off the phone. Genuine emergencies are very rare in a hotel doctor’s practice, and so far it’s turned out all right. But I’m always looking for help.

Girls Are the Best

 “...allo!!” shouted a little girl from her bed as I walked in, but that was her only English. Her French parents had called because she was running a 101 fever.

She seemed delighted to see me and jumped to sit on the edge for her exam. Smiling happily she waited as I quizzed the parents, opened her mouth widely when asked and made no complaint when I poked my otoscope into her ears.

I found everything normal. She had a virus that might last a few days and required only Tylenol. Staying in bed was not necessary. Everyone seemed pleased, the child most of all; she waved goodbye as I left.

I loved that visit. Readers are familiar with my admirable qualities, but I admit that I am not the sort of jovial physician who enchants young children. Mostly I do fine, but I’ve endured plenty of encounters with apologetic parents and a screaming, struggling toddler.

These are almost all boys. Adult male pugnaciousness has not made the world a comfortable place, and it works equally badly in children. They get the exam regardless, but it’s drawn out and painful. The parents are embarrassed, the doctor relieved when it’s over.

Little girls rarely make a scene. If frightened, they keep quiet. If not, they realize, almost from birth, that charm works wonders. Everyone relaxes and takes care of business. Women should run the world.   

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.

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. 
  

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.

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.

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.

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? 

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.

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.

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.