The Sight of Blood

With one obvious exception, blood normally remains out of sight. Its appearance may not be ominous but always requires an explanation from someone with more experience than you. Here are some pearls.

Bleeding gums.  Asked for the cause, doctors think of leukemia and other sources of clotting deficiency. It’s true that if your blood clots poorly, this is often the first sign. However, the most common cause of bleeding gums is poor dental hygiene.

Coughing up blood. Anyone who reads the classics knows that this means you have tuberculosis. That’s rare these days. I’ve never seen it. Mostly it’s the result of an ordinary respiratory infection. Coughing up a few flecks of blood is usually not worth pursuing, but don’t make the decision on your own.

Blood in the stool. Accompanied by pain this usually means an anal fissure, a crack in the skin. Blood in the stool is one of the seven warning signs on cancer, but I encounter bowel cancer as often as tuberculosis. The blood I see is from a fissure, hemorrhoids, or colitis.

Vomiting blood is a serious matter and also urgent. I send guests to an emergency room although a few flecks may be the result of stomach irritation. When that happens, I may make a housecall, and sometimes what I see in the toilet is not blood. Again, don’t make the decision on your own.

What types of bleeding are always ominous?... That’s a question too depressing for this blog. Google it.   

Another Stoic

“She thinks her drink was spiked,” explained the caller whose friend was bent over the toilet.

I explained that alcohol is a toxic drug no less than aspirin or penicillin and occasionally provokes an oddball reaction. Common stomach viruses cause most vomiting. Did her friend want me to come?

“I’ll ask.”

I waited for a long time.

“She wants to know if we can buy a medicine.”

I said that there are no good over-the-counter antivomiting drugs, but most vomiting episodes don’t last long.

“I’ll tell her.”

I waited for a long time.

“Will you give her a shot to stop the vomiting?”

I explained that I carry antivomiting shots and antivomiting pills and that they work pretty well. It’s a bad idea for a doctor to make promises.

“Hold the line.”

I waited a long time.

“She wants to know what she can eat.”

“Nothing,” I said. She should suck on a piece of ice until she hasn’t vomited for a few hours.

By now I suspected that the guest was not inclined to spend money. This is common, especially in Americans. 

“Does she want me to come?” I asked.

After the usual wait, I learned that she planned to take my advice and call back if she needed assistance.   

Waiting for the Other Shoe

I buy drugs and give them out gratis. Ten years ago generic Lomotil, the leading diarrhea remedy, jumped from about $20 per thousand to over $200. I switched to Imodium which is probably as good. It’s sold over the counter at Walmart. I buy a lot of drugs at Walmart.

In 2014, I wrote that I tried to reorder doxycycline, an old antibiotic that remains the best treatment for several common infections. My supplier’s web site quoted $1,600 for 500. I knew that was a typo because I’d paid $30 the year before. But it wasn’t. Fortunately, there’s another antibiotic that works well at only four times the old cost. 

Some of you are aware of the furor over the skyrocketing price of Epipen, a device that makes it easy to inject adrenalin during a severe allergy attack. Google it if you’re not. Read the justification from the company’s chief executive. Doesn’t it sound smarmy and dishonest? Don’t you hate her? Epipen is sold throughout the world at the old price, and the company does not complain that it’s losing money.

Congressional Republicans have joined Democrats in denouncing the increase. The furor will fade; the price will remain. Unique among western nations, American government agencies are forbidden from influencing drug prices, and no one to the right of Bernie Sanders is suggesting a change.

Several times a year a similar kerfuffle hits the headlines and runs its course, but I deal with it regularly. A year ago a bottle of my antibiotic ear drops went from about $8.00 to $300. So far antibiotic eye drops haven’t done the same, and experts say one can substitute them, but I’m waiting for the other shoe to drop.

A Special Service

“Someone needs to check my nephew. He’s shaking and really upset. How quick can you be here?”

This was a bad call in many ways. I managed to learn that the child was in good health before a fire alarm roused everyone from bed at 11 p.m. He seemed to be frightened, perhaps more than usual. I had no doubt that he would recover, but that was hard to communicate.

I try not to make housecalls for anxiety attacks because many guests begin recovering while I’m on the freeway and cancel. Keeping the guest on the phone works better. After a half hour of to-and-fro and reassurance they admit they’re not feeling so bad.

This was one time that being reliable got me into trouble. The lady had called the front desk pleading for a doctor. Within seconds she was talking to a doctor. Weird!

She undoubtedly assumed that I was a special service provided by the hotel. Perhaps I was sitting by a phone in the lobby.

In any case, my efforts to keep her talking didn’t work. People are very protective of children. She insisted that a doctor must come. Reluctantly, I agreed. Then I had to mention something I never mention until it’s necessary. When I make a housecall, there’s a fee….. 

She was shocked. “I’m not going to pay that!” she said. “We’ll take him to the hospital!” She slammed down the phone.

This has happened before. I had to speak to her, not only to negotiate the fee but to assuage my fear that she would denounce me to the hotel. But the fire alarm was still in progress. She was not in her room, and it took fifteen minutes before the hotel could track her down. By that time she admitted that the child was feeling better.

Little Red Bumps

 “They’re little bumps all over… Sort of red.”

“Could you be more specific?”

“Little red bumps over my body… spots. Some are raised. They sort of itch…”

Americans, even with a college degree, are painfully inarticulate. Can you describe the face of someone familiar? Novelists do it all the time, but I bet you’d have trouble. Words like nodule, pustule, blister, wheal, plaque, ulcer, scale, and fissure are not obscure medical terms. Educated people know what they mean but can’t seem to use them.

If a caller said “I have dozens of one to three millimeter pustules surrounded by a red base, mostly on my back and chest, not so many on my arms and legs,” my diagnosis is “chicken pox.” But “red bumps” is the best many can do.

I’m happy to make diagnoses over the phone, and guests are eager not to pay for a visit. I have little trouble with respiratory infections and upset stomachs, but skin problems frustrate me.

“I worry about bedbugs. Do you think it’s bedbugs?”

“What do they look like?”

“Little red bumps….. Do you think it might be an allergy?”

“Could you be more specific?”

“Bumps…They’re raised, some of them, and they're red….”

The Upside of Cheap Motels

Cheap motels have many advantages from a hotel doctor’s point of view.

Valets are absent, so I can park inside and safely ignore the threatening signs. Security is absent, so elevators respond to whatever floor I push, and I don’t have to explain myself to the front desk. Americans are absent because they can’t afford the fee. I love America but I also love foreign patients. They’re deferential, and they don’t sue.

On the downside, customer service declines with the price of the room. I often need to call in a prescription or consult with the insurance. When I pick up the hotel phone and punch “9” for an outside line, I may hear a busy signal because many hotels require a deposit before opening the phone. If I identify myself as a doctor, larger hotels open the line, but clerks in cheap hotels refuse unless the guest comes down and pays.

Insurers send me to hotels that don’t call, so I take the opportunity to introduce myself. In mainline hotels, staff remember their manners. They smile, listen intently as I make my pitch, agree that my service sounds wonderful, and thank me effusively for my business card. Then they probably forget about me. It’s rare to pick up business, but I always leave feeling good.  

In cheap motels, clerks don’t disguise their lack of interest. “Nobody gets sick,” they say.   

Lost in Translation Again

“Spik Spanish?”

Not a phrase I like to hear. Ninety percent of Latin American guests speak enough English to get along, and Hispanic hotel staff are usually available. Unfortunately, this visit occurred at a small Super 8, and the single employee on duty was American. Under these circumstances, I shake my head apologetically and proceed in English.

“Tell me what’s going on,” I asked.

As usual when something exotic like an American doctor appears, there was a substantial audience. Usually someone volunteers to interpret. Sure enough, a man stepped forward. He tapped patient’s abdomen and then whirled his finger around his mouth.

“Is she vomiting?” I asked.

Blank looks from everyone, a bad sign. I waited, hoping someone else would contribute, but the man merely repeated his gestures.

I phoned the insurance agency’s 800 number. Its employees are Hispanic and willing to interpret.

“Would you ask what’s bothering her and tell me what she says?” I said after explaining the situation.

I handed over the phone and the lady began a long monologue. When she finally handed back the phone, I listened to the insurance clerk. “She is sick from eating. She give medicine from Argentina, but it does not help. She wants a medicine to help.”

That was too little information. I tried to be specific. “Would you ask what are her symptoms?”

Another long conversation followed by a short, unsatisfactory translation. Eventually I learned enough to thank the clerk, adding that I would examine the patient and then call back for more interpreting.

At the end I gave instructions and medication, and everyone seemed happy. I always leave with the uneasy feeling that the interpreter has left out a great deal. Fortunately the ailments I encounter are usually easy, and the occasional exception is obvious.  

Almost Stiffed

“This is one time the hotel will not be able to charge the bill,” reported the manager one evening when he called about a Middle-Eastern family.

Since I usually collect from the guest, I assured him that that was not a problem.

He connected me to the room where I spoke to someone whose English was not good. The speaker or perhaps someone else had an allergy or maybe a rash that needed a cream. Did I know the proper cream?.... After much to and fro they decided I should come at 11 a.m. the following day.

The guest who answered the door showed me a rash on her neck. It was a simple contact dermatitis. I explained and handed her a tube of cortisone cream. That, of course, was the easy part.

The room was a luxurious suite. The patient was Philippine, so I knew she was a servant. It was disturbing to notice that she was alone. I suspected she did not expect to pay; sure enough, she looked puzzled when I presented my invoice and more puzzled when I explained that the hotel would not pay.

I passed an uncomfortable ten minutes as she noodled with her cell phone, trying to reach her employers. Had they deliberately absented themselves to avoid paying? It might not have been deliberate; sometimes extremely rich people never concern themselves with paying for stuff because it’s always taken care of.

She asked if she could call the hotel. I shrugged, resigned to being stiffed. But it turned out the current manager had no objection to charging the bill.

Worry

A worried mother phoned, asking me to see her two year-old who had a fever of 101.

I’d seen the child two days earlier. He had a 101 fever but was not particularly sick, and my exam was normal. I diagnosed a virus, handed over a bottle of Tylenol, and told the mother he might feel under the weather for two or three or four days.

Patients often call after a few days to tell me the illness hasn’t gone away. Sometimes they report a new symptom that gives me pause, but mostly nothing has changed. That was the case this time, so I reassured the mother. Another housecall wasn’t necessary.

People rarely argue with a doctor, so the mother did not disagree with my reassurance. But worry is contagious. No one is perfect, and there was a tiny chance that something terrible was brewing up.

I could have relieved my mind by sending them to a clinic. The doctor would find nothing and reassure the mother. If something terrible happened later, he was the last doctor she had seen, and I would be off the hook. But I didn’t do that, so I worried.

Unsafe

A young man stood blocking the door.

“I want to see your license,” he said.

I showed him. He examined it suspiciously and didn’t move.

“Get out of the way!” said a voice inside. 

Reluctantly, he let me pass. I approached the patient, apparently the man’s girl friend, who had phoned me because of an earache. As she described her problem, he glowered from the doorway.

“I don’t think you’re a doctor,” he said, interrupting. “Where’s your white coat?”

“Shut up, asshole!” she shouted before turning back to me. “He’s being a jerk. He’s probably a little high. Don’t worry.”  

“You should leave,” he said a few minutes later. Approaching, he delivered a gentle shove to my shoulder. The girl friend cursed and pushed him violently.

“Sorry, but I’m not feeling safe here,” I said. I walked out and went down to the lobby. The woman appeared a minute later, full of apologies, and we finished the consultation.

Insect Bites

A caller was suffering an itchy rash, present for a week. Three companions were also affected. That sounded good. When more than one person has a medical problem, it’s the same problem and not serious.

In the room, all four gathered to show me their skin which revealed the scattered, small pink pustules left by ectoparasites. I use that term to be accurate because not every bug that bites is an “insect.” Spiders, ticks, mites, scorpions, and centipedes aren’t.

Bedbugs (an insect) have become fashionable, but these travelers had been moving frequently from place to place. Where hygiene is reasonable, lice (an insect) limit themselves to hairy areas; I didn’t see any. My diagnosis was scabies, a mite (not an insect) that burrows under the skin. Scabies is hard to catch from clothes or bedding; mostly it requires rubbing against someone else with scabies, and it looked like these young people did a lot of that. 

Deception

A tour leader explained that one of his group wanted a doctor to look at her hand. She had fallen.

Minor injuries are easy, but I don’t want to collect money from someone who needs an x-ray and then send them off to pay more money somewhere else. 

I quizzed him. What happened? Where was the pain? Was there much swelling? He assured me that it was not a big deal. The lady just wanted a doctor to check it.

He was lying. When a member of a tour goes to an emergency room, the leader must go along. Anxious to avoid such a tedious job, tour leaders often hope a doctor will make the problem go away.

The lady had a swollen, painful left wrist. If you fall and instinctively catch yourself on your outstretched hand, you’re likely to break a specific spot at the end of your radius. It’s so common it has a name: the Colles fracture.

I was certain she had a Colles fracture, so off they went.

Gushing Blood

Someone at a Beverly Hills hotel had struck his head on the edge of a table. Blood was gushing, and he wanted a doctor.

Scalp lacerations bleed heavily, but my long experience with bumped heads reveals that the wound is rarely impressive. If victims are willing to apply pressure and wait, they usually agree.

He didn’t want to wait.

This was an upscale hotel, but I am not its doctor who was undoubtedly, this being midnight, fast asleep. Someone had searched the internet and found a housecall service which called me. That meant that I had to give the service forty percent of the fee. My wee-hour charge is not skimpy, but none of this mattered. He wanted a doctor.

I told him I would arrive in half an hour, and the manager expressed surprise when I turned up on time. He led me down a hall, through the kitchen to a large room where the patient was resting on a chair, a wet rag over his forehead. Half a dozen employees stood around.  

Removing the rag revealed that the bleeding had stopped. The wound was a shallow 1½ inch scratch. I delivered the good news and applied a band-aid. Everyone was relieved, and the guest peeled off my fee from a wad of bills.

When an Antibiotic Helps

If you receive an antibiotic for a respiratory infection, it’s probably a placebo because almost all respiratory infections are viruses.

If you receive an antibiotic for a skin infection, there’s a chance you have a bacterial infection that an antibiotic won’t help. A boil or other collection of pus will heal if the pus is drained. If the doctor gives an antibiotic but doesn’t drain the pus, it will also heal. That’s because most infections, boils included, eventually heal.

You’ll get an antibiotic if your doctor diagnoses an ear or sinus infection. It’s a bad idea to ask if this will help because (if he’s honest), he’ll admit that no one knows. In experiment after experiment, when researchers compare patients given and not given antibiotics for ear or sinus infections, the results are never dramatic. Often there’s no difference. Sometimes they help a little. Doctors in some nations don’t treat these with antibiotics.

That’s why urine infections are my favorites. It’s not controversial that antibiotics help. For infections in young women, help comes quickly, usually within a day. These are satisfying encounters for everyone concerned.

Delivering Medical Care is the Easy Part

Park La-Brea Towers is a huge apartment complex in West Hollywood. I’ve been there a dozen times. Inside, the buildings have numbers which follow a cryptic system that I have yet to decipher, and finding them is a chore. Since it’s an old complex with inadequate off-street lots, street parking is permitted.

You don’t want to visit Park La-Brea Towers during the wee-hours. Many streets are gated, and the gates are closed. Everyone is home, and so are their cars.

I went at 2 a.m. last week. I was in luck because someone was leaving as I arrived, so I could slip through the gate before it closed. Since the streets were empty, I was able to drive slowly and peer at the buildings to find the number. Then I searched and searched, but all street parking spots were occupied. I found spaces in the reserved lots, but signs warned of terrible consequences for wrongful parkers. I noticed a car parked directly in front of my building and decided to do the same.

Drawing near, I saw a ticket on its window. I wasn’t willing to take the chance. I couldn’t phone the apartment because the family didn’t have an American cell phone. I phoned the agency and woke up the person who sent me (it’s a boutique agency, so the owner sometimes takes calls). I told her to call the family and tell them to send someone down to watch my car and plead my case if parking enforcement arrived.

Someone duly appeared, and I went upstairs. As usual, delivering medical care was the easy part.

Overdressed for Summer

It’s August. Wearing a suit and tie, I’m reminded of how much I resent hotels that refuse to let me park free. I only learned that the Casa Del Mar didn’t when the clerk declined to validate, and I was stuck for $20. But the Casa Del Mar is on the beach where it’s cool enough to walk a few blocks without suffering.

The Sheraton in Pasadena is in Pasadena where it’s ten degrees warmer than Los Angeles. The average summer day in Los Angeles is tolerable but opening the car door in Pasadena is always a shock. Worse, I travel to the Pasadena Sheraton to see Virgin-Atlantic crew who are British. Foreigners, Arabs excepted, believe that air conditioning is bad for the health. When anyone gets sick, they turn it off, so not only do I arrive at the hotel in a sweat but go about my business in a hot room.

Another Free Service

A caller in Huntington Beach was having a panic attack. He had had them before, and he needed a doctor to come and make sure he wasn’t dying.

This was a bad call in many ways. Waking me at midnight was not one, because I don’t consider that a big deal. Making a housecall for a panic attack is risky because victims often improve while I’m driving and cancel, and Huntington Beach is 45 miles away. There’s not much a doctor on the spot can do with medicine for a panic attack  (“a shot” doesn’t exist).

Finally, the caller didn’t know the fee; I would have to tell him.

In his distress, he had searched the internet and found a national housecall agency. Most such agencies tell callers the fee, so by the time I hear from them, they’ve agreed to pay. But this particular agency specializes in foreign airline crew and tourists with travel insurance where the fee is already arranged. On the rare occasion when an American contacts the agency’s answering service directly, it simply passes the call onto me.

I knew that my fee to Huntington Beach at midnight including a 40 percent cut for the service would never pass. Worse, once I mentioned it the horrified patient would quickly get off the phone.  

That wouldn’t bother an operator, but once someone asks a doctor for help, he or she is obligated to help (ethically obligated; in reality maybe not). So I held off delivering the bad news and kept the conversation going. 

After forty minutes of soothing and reassurance he began running out of gas and admitted that maybe this wasn’t an emergency. He agreed to keep my number and call if he changed his mind.

Taking No Chances

A guest at the Westin wanted a doctor to look at a rash. I quoted the fee, always a tense moment.

“Do you take insurance?”

If the caller is American, the visit is doomed, but this one wasn’t. I asked the name.

“Assistcard.”

I know Assistcard, but it doesn’t allow clients to call the doctor on their own. They must phone Assistcard which confirms their eligibility and then phones me.

Most travelers know this. In the past, when I told the rare exception what to do and then waited for the call from Assistcard, it never came. So I told him I would arrange matters.

Foreign insurers have offices in the US, so their customer service is painfully familiar. I listened to a recorded welcome in Spanish, Portuguese, and English. I punched “3” to choose English. A recorded voice told me to listen carefully to choices on the menu because they had recently changed. I chose and then listened to muzak. 

After several minutes a dispatcher greeted me in Spanish. I proceeded in English which I suspected he spoke and this proved correct. He assured me that he would phone the guest, and arrange approval. He kept his word although an hour passed before he called.

During the wait, the guest’s wife decided that it wouldn’t hurt to have the doctor check her cold. The approval, when it arrived, added a consult with the wife, so it turned out to be a lucrative visit.   

Who's Taking Care of Avianca

Coris, a travel insurer, sent me to the Crowne Plaza to care for a Spanish lady with stuffy ears. She turned out to be a flight attendant for Avianca airlines. Airline crew can’t fly if they suffer a host of minor ailments, so they provide plenty of easy visits.

That evening a call arrived from Traveler’s Aid, a national housecall service, and I returned to the Crowne Plaza. The guest, a Columbian man with a cold, was also an Avianca flight attendant.

That was puzzling. Foreign airlines once called me directly to see their crew. They don’t do that today. They call a more traditional provider organization who then calls me.

But what was Avianca doing? I theorized that it calls Coris, and the Coris dispatcher consults her list for Los Angeles. If she decides to call me, Avianca will pay Coris perhaps double my charge. If she calls Traveler’s Aid, the additional middleman will increase it still more.  

I’ve long since stopped trying to see the logic.

An Easy Visit

A young woman suffered an episode of dizziness earlier that day. By the time I arrived, she had recovered. The examination was normal, and I reassured her. 

Any sudden episode in a young, healthy person (dizziness, chest pain, shortness of breath, even fainting) is probably benign and not worth intensive investigation unless it keeps happening. We take these more seriously in the elderly.

Some guests are sicker than others, but I have a soft spot for guests who are not sick at all. 

Bedbug Calls

“All insect bites look the same,” I explained.

Bedbug calls are tricky. Victims are often unwilling to pay. When, confronted by an angry guest, hotels ask my help and offer to pay the fee, I come but refuse to take their money. The hotel will probably comp the guest’s room, and I don’t want to add to their expense and hassle. Also, since a bedbug call involves management, it’s excellent P.R.

Naturally, I hope that a grateful hotel will remember. This doesn’t always work, but I drove off in a good mood. I love nearby hotels, and the Westwood Comstock, which rarely calls, is three miles away. It’s also very exclusive, and my left-wing politics does not diminish the pleasure of caring for hotel guests with plenty of money.

The patient turned out to be more distressed than angry. Sometime guests show me a rash that is obviously not insect bites. Sometimes I see bites confined to the legs, meaning the guest acquired them while erect, perhaps at the beach. There were many bites on her upper body, so I couldn’t deny the possibility of bedbugs.

I delivered my opinion and handed over a free tube of cortisone cream and my business card. Everyone seemed pleased including the general manager who thanked me for my quick response. Now I must wait.

Departing From Your Routine

Twenty years ago I drove thirty-five miles to Pasadena to see a patient. When I opened the trunk to get my bag, it wasn’t there. I had left it at home. I drove back to retrieve it.

I mention this because last week I made a visit to the Hyatt Regency in Long Beach, thirty-five miles away. I had my bag, but when I consulted my invoice while waiting for the elevator, there was no room number. 

I recalled how it happened. I had never been to that Hyatt Regency, so I had stopped filling out the invoice at home to look up its address on the internet. I found it, copied it down, and forgot to add the room number from my telephone notepad. Departing from your routine is always perilous.

Worse, the patient was a woman. In our sexist society, when a couple checks in, it’s the man whose name goes in the register – and couples sometimes don’t share a last name. That was the case this time as I listened with a sinking heart as the desk clerk assured me that the guest list contained no such person.

The Wrong Way To Do It

“My son has a boil on his leg. Our doctor says he needs an antibiotic.  Could you come to the hotel and give the prescription?”

A boil is collection dead tissue, full of pus and germs. It has no blood supply, so an antibiotic can’t reach it. Antibiotics alone don’t cure boils.

Left alone, boils eventually go away, so victims who use one of the innumerable silly home remedies from the internet will give it credit. Allowing nature to heal is commendable but may require few weeks of misery.

Unnatural healing works instantly. The doctor cuts into the boil, squeezes out the pus, washes the cavity with saline, and then stuffs a strip of sterile cloth into the hole. A few days later, he or she pulls out the strip.

I don’t drain boils in a hotel room, so I had to decide where to send the guest. At an emergency room, the doctor would certainly do the surgery, but an emergency room is a tiresome experience.

A local walk-in clinic would be more civilized. The downside is that the doctor in a walk-in clinic would have a background similar to mine but probably without my vast experience and wisdom.

I sent the boy to a walk-in clinic where the doctor punctured the boil and sent them away with an antibiotic. The puncture might seal and the boil recur (that’s the purpose of packing it with the cloth). Or it might ooze for weeks before resolving. I wish the doctor had done it the right way, but the boil would eventually heal.

Failures in Communication, Part 3

After a forty minute drive, I arrived at 4020 Los Feliz Blvd. No one answered my knock. Thinking the patient might have stepped out, I took a walk around the neighborhood and knocked again and also phoned to no avail. I returned home in a good mood. It was an insurance call, so I’d be paid.

Another call arrived at 5 p.m. I dislike driving during the rush hour, but the patient lived near Beverly Hills only five miles distant. The address was 821 Coldwater Canyon Drive, but I discovered that Coldwater Canyon addresses begin with 900. I continued north, assuming the numbers would drop when Beverly Hills became Los Angeles, but they kept getting higher.

Coldwater Canyon is a not-so-secret alternative to the freeway into the San Fernando Valley, so it’s bumper-to-bumper during the rush hour. Finally, I gave up, pulled into a side street, and phoned the patient. It’s not 821, he said, but 1821. The dispatcher had told me wrong or perhaps I had heard wrong.

That evening an insurer called to ask me to return to the Los Feliz patient. Insurers usually refuse to authorize a second visit to a no-show, but I was happy to go. The dispatcher repeated the address: 1420. Whoops. Whose mistake was that?....

The Easiest Part of Medical Care

The phone rang at midnight for a housecall in Long Beach, 35 miles away. So far, so good. Freeways were clear, and the caller was a reliable travel insurer who agreed to my fee. Good.

The patient was young and suffering a fever. That sounded easy. The patient was a student at California State University, Long Beach. Uh oh.

Navigating a college campus is a nightmare. The address of a university is the administration building where no one lives. College buildings have names or numbers, but they follow their own logic.

The patients are foreign, unfamiliar with the geography, and unhelpful. Finally, campus police may be slow responding to rape and burglary, but they pounce fiercely on an illegally parked car. You don’t want to park inside a college campus without a permit.

Taking no chances, I parked on Bellflower Boulevard outside the entrance and walked far across the campus to the dormitories and International House where I assumed he was staying. As I approached, I saw that the barrier to the lot next to the building was raised, and I could have parked. C’est la vie. As usual, delivering medical care was the easiest part.

Do You Accept My Insurance, Part 2

“I can’t afford that,” wailed the guest, an Australian newlywed at the Biltmore when she learned my fee. She had travel insurance, and I had told her it would undoubtedly pay when she submitted my invoice. But unsophisticated travelers who have never used insurance or asked for a housecall often panic.

I lowered the fee to $250. She consulted her husband who countered with $150.  

Since it was 11 p.m. the drive downtown was easy. When the husband ushered me in, I discovered they were staying in a large, two-room suite. The Biltmore charges well over $300 per night for suites.

But they were young, and I didn’t know their story. I did my duty and pocketed his $150. I was not disturbed and had material for a blog post.

Do You Accept My Insurance?

That’s the most stressful sentence a hotel doctor hears – more than “I’m having chest pain” or “my mother stopped breathing.”

American insurers look with deep suspicion on housecalls, and no hotel doctor wants to bill them. But almost no American has experience handing money directly to a doctor – and a housecall costs a good deal more than an office visit. Many of these guests agree to pay, but I often sense their discomfort. Other doctors are not so picky, but if they sound too reluctant I inform them of local walk-in clinics.

Foreign insurers are different. Many call me directly. Resigned to our rapacious medical system, they expect immense bills. I charge everyone the same, but I’ve been contacted by doctor-entrepreneurs who offer triple my usual fee to make their hotel calls in Los Angeles. They can afford this, they assure me, because they charge several thousand dollars for a housecall. This sounds creepy, but it apparently works because I’ve heard from these doctors more than once. 

Goodbye to the Shangri-La

“I’m not calling for a guest,” explained a desk clerk from the Shangri-La in Santa Monica. “I have a question…. In your arrangement with hotels, do you ever pay anything when we call?”

“That’s illegal,” I said. “I’m happy to give employees free medical care, but it’s against the law for a doctor to pay to get a patient.”

“Is that so? Are you sure?”

“Google it. It’s called a referral fee; it’s unethical and also against the law in California. If you use a doctor who’s breaking one law, what other laws might he break?....”  

“Oh, this is just for our own information. I appreciate your help, doctor. Thanks.”

Goodbye to the Shangri-La, I said to myself after she hung up. I’ve been going there since 1985, but the Shangri-La is not large. Since I give plenty of free phone advice, months may pass before I make an appearance, so most employees have never seen me. I don’t market myself, and most general managers leave the choice of a doctor up to the employee, so I regularly lose hotels when a competitor offers his services with the promise of a referral fee.

Sometimes, often years later, they return. Google “Doctor Jules M. Lusman.” He took a number of hotels away from me, but I regained them.    

Caring For a Physician

Having a doctor as a patient is stressful. They often suggest their diagnosis, and it’s awkward if I disagree. When I make a housecall, American doctors sometimes hint that I shouldn’t charge them.

This patient was an anesthesiologist, a good thing because he almost wasn’t a doctor at all – i.e. he’d long since forgotten how to deal with illnesses. He was foreign, another good thing. And he was Danish: the best sort of foreigner because Scandinavians speak good English. 

He had a headache and a 101 degree fever but no respiratory symptoms. I diagnosed a viral infection, perhaps even Dengue fever because he had flown in from the South Pacific. He did not object to taking pain medicine and waiting, and he recovered after a few days.

More Unsatisfied Guests

The son of two Viceroy guests was suffering a severe sore throat and fever.

I drove off in a good mood because it sounded like an easy visit. This combination often indicates “strep” which an antibiotic cures. Patients like that, so I like it, too.

In fact, sore throat and fever in a grown-up is usually a simple viral infection, my least favorite illness. Strep is overwhelmingly a disease of children and adolescents, but this patient was fourteen, so my hopes were high.

They were dashed when the boy admitted that he had a cough. Strep is strictly a throat infection; coughing is not part of the picture. Sure enough, his throat looked normal.

Rummaging thoughtfully in my bag, I pulled out a packet of acetaminophen (Tylenol), handed it to the parents, and explained that this would help his fever. I extracted a plastic bottle of Lidocaine, a gargle intended to relieve his throat pain. I gave them a cough medicine is similar to the popular Robitussin but in an immense eight-ounce bottle.

I assured them that bed rest would not help, so he should try to enjoy himself. He could eat whatever he wanted. But it was likely that he’d feel under the weather for a few days before recovering.

The parents seemed happy to receive the medicine. They expressed gratitude for my service, and thanked me effusively as I left, but I knew that this was mostly good manners.  They were on vacation. The doctor had come, given some not-very-powerful medicine, and told them the child would continue to be sick. Did the doctor realize how important this trip was to them? Maybe if he had tried harder…. Or if they’d called a better one…. 

Not a Bad Job

Awakened at night, most hotel doctors prefer to give advice, and, if that fails, they discover that the guest requires the paramedics.

I don’t mind wee-hour calls. Traffic is light, parking is easy, and since I have no office, I can sleep late. With TIVO, I can leave whatever television show I’m watching. I don’t mind calls during meals, even restaurant meals, because finishing doesn’t take much time. Calls during a movie are problematic although I’m happy to leave at least half the time. If the call arrives soon after the credits, I ask for a refund, and no one has yet refused. I credit much of my success as a hotel doctor to the rarity of occasions where I’m reluctant to make a visit.

Mostly, I dislike driving during the rush hour. Hotels between Beverly Hills and the ocean are close enough to be tolerable, but traveling downtown or further is tedious. Mostly, guests are willing to wait a few hours provided they are not vomiting or hurting.