Noise is Everywhere

“Could you please turn down the television?”

“Huh…?”

I repeated the question – not because the guest didn’t hear but because the request seemed to strike him as peculiar. He turned down the volume but not a great deal.

This happens routinely. Families from around the world check into a single hotel room, turn on the TV, and go about their business. Some watch, others ignore it. All would consider it rude to talk while I interview a patient but most make no move to the yammering television unless I mention it.

Going Blind

Late one evening, a guest called to say his son had gone blind. That was beyond my expertise, I explained, but the guest insisted on a housecall.

Sure enough, the son, age 18, seemed blind although my exam was otherwise normal. He seemed only mildly upset. A stroke affecting a tiny area of the optic nerve can cause blindness with no other symptoms, but this would be extremely odd. It could be psychosomatic, but it’s risky to jump to this conclusion, and the family insisted that nothing stressful was happening.

I sent them to an emergency room. The doctor found nothing abnormal and summoned an ophthalmologist who concluded that the blindness was psychosomatic. You’re probably wondering if he was right, but this is a real story. They checked out, and I never learned what happened. 

Temptation

“Could you check out my ankle? I don’t want to go to an emergency room.”

These are tempting calls. I could make the housecall, solemnly examine the painful, swollen ankle, express sympathy, wrap it in an Ace bandage (universally agreed to be not much use), and tell the guest to see a doctor if he’s not dramatically better in a day or two. Happy to avoid rushing to an emergency room, the guest would consider his money was well spent.

Of course, I could have told him this over the phone. If walking on an injured ankle is painful, it requires medical attention. But unless pain is unbearable or the skin is mangled, it’s not an emergency.  

Furthermore, the medical attention should be delivered by a doctor who knows ankles such as an orthopedist. Going to an emergency room is a bad idea. You’ll get an x-ray, a bill for around a thousand dollars, and advice to see a doctor if you’re not better in a day or two.

A Better Medicine

“My doctor gives me Bactrim to take whenever I get another infection, and I need more.”

Antibiotic requests are good news to some hotel doctors who know that, provided they go along, the guest will happily hand over the fee. An easy visit.

When I see these patients and do my best and don’t prescribe an antibiotic if they don’t need one (usually the case), most are grateful, but a minority aren’t. It’s not a small minority, and I hate driving off to what might be an unpleasant encounter.

Hearing this request I go into “no-housecall” mode, perhaps mentioning that the illness is self-limited and doesn’t require medical attention or directing the guest to an urgent-care clinic. I don’t want to see them.

But I gave this lady her Bactrim.

There is a single exception to the rule that healthy patients are wrong when they decide that they need an antibiotic: the common, uncomplicated urinary tract infection. In fact, it’s OK to prescribe over the phone. Scientific studies show that this works as well as an office visit.

Better to Be Right Than Wrong

A guest told me she had a stomach virus, so I drove off in a relaxed mood. This is the second most common complaint that a hotel doctor sees and easy to deal with.

But it wasn’t easy. The guest was huddled on the bed, looking very ill. I could barely touch her abdomen. I wondered if she had acute pancreatitis or a gallstone.

The paramedics arrived and took her off.

When I called that evening, the husband answered. I learned that by the time the emergency room doctor saw her, she wasn’t feeling so bad. After several hours and many tests, he sent her out with a prescription and the diagnosis of a stomach virus. She was now better.

Naturally, I expressed pleasure at her recovery. He thanked me for my concern, but I admit to a touch of chagrin. A doctor must send a patient to an emergency long before he’s 100 percent certain there’s an emergency. Otherwise, he’d decide not to send some who needed to go: a much worse scenario. Still, it feels better to be right than wrong.  

Fear

Leafing through mail revealed a letter from a law office. I broke into a sweat and then calmed myself. Malpractice suit announcements rarely arrive in ordinary US mail. Sure enough it was simple request for records. Someone was having trouble with an insurance company. I get these once or twice a year, and they never fail to upset me.

Whether they win or lose, sued doctors rarely pay a penny, but it’s a horrible experience which they all dread. Doctors worry if something is not going right – say a patient who should get well is not getting well or seems dissatisfied. We all want to do better, but never absent from a doctor’s thoughts is that he doesn’t want to be sued.

You may wonder about the odds that this will happen. The answer: a hundred percent. Five percent of American family doctors are sued each year. The highest risk specialties are neurosurgery and cardiac surgery: 19 per cent sued each year.

To make sure your doctor has never been sued, find one who has just entered practice. If you want to investigate, most states make it easy. You can look me up at the California Medical Board site by entering my name. Feel free to do so. I’m clean.

But state boards are not terribly efficient, and many have time limits – say ten years – after which they drop the information.

Every bad thing that’s happened to a doctor is in the National Practitioners Data Bank in Washington. Hospitals and clinics query it when they’re checking out a doctor. When they don’t, you often read the results on the front page. 

The NPDB is off limits to the general public. Activists yearn to change this, but every professional organization would fall upon any legislator who agreed.

Lost in Translation, Part 5

“My husband…  not good…”

“Tell me what’s happening.”

“….chest…. Not good.”

The desk clerk helped by repeating my words in a loud voice.

“She doesn’t speak much English,” he pointed out.

She wasn’t Hispanic, so there was no hotel employee to interpret. If she had travel insurance, someone at the agency office would help, but it was hopeless to ask about it.

“Would you like me to come to the hotel?”

“WOULD YOU LIKE THE DOCTOR TO COME TO THE HOTEL!!” 

She would. I then listened as the clerk informed everyone within shouting distance of my fee.

The scene in the room resembled absurdist theater. One guest made funny noises (?coughing). Another tapped various parts of the patient’s body. A third read from an English phrase-book (…“can you prescribe an appropriate medication…?”)

Everyone listened intently when I asked a question and then exchanged glances to see if anyone understood. Finally, all nodded agreement.

I’m exaggerating. Guests have simple problems, and there’s usually enough comprehension to get along. So far everything has worked out.