Lost in Translation Again

As I stepped out of the elevator, a Japanese man was waiting. “Are you the doctor for the hotel?” he asked.

I was pleased. “Yes. Are you going to interpret for me?”

He stepped back in alarm and waved his English-Japanese phrase book. Hiding my disappointment, I followed him to the room. When he began flipping through the booklet, I shook my head and pointed to the phone before dialing the guest’s Japanese insurance service for an interpreter. There followed a lengthy encounter as the phone passed back and forth between me, the father, and the patient.

The patient had complained of fatigue the previous day. He was otherwise in good health with no other symptoms, and I found nothing abnormal on examination. Sudden fatigue is an ominous sign in the elderly but rarely in a child. I suspected an emotional problem, perhaps from the stress of foreign travel. This is hard to explain across both language and culture, made even harder because I didn’t give a medicine. Giving medicine is a universal language; that’s why doctors prescribe even when it isn’t necessary.

Luckily these were Japanese, so they listened with unfailing courtesy, through the interpreter, to my reassurance and advice (get a good night’s sleep, continue with their itinerary, call if the problem persisted), nodding approval, and thanking me effusively as I left.

Lack of Patience

“How quickly can you get here?”

“Pretty quick, but I like to talk to the guest first. Would you connect me?”

I didn’t assume this was an emergency; guests who make urgent requests are more often impatient than sick.

“How quickly can you get here?” asked the guest impatiently.

“Pretty quick. What’s going on?”

“It’s my assistant. He’s got the flu.”

“Could you tell me what’s bothering him?”

“I’m not a doctor. That’s why I called you.”

I suppressed a surge of annoyance. “People mean different things when they say ‘the flu.’ Is he vomiting?”

“No.”

“Is he feverish?”

“Yes. I have a dinner reservation at 6:30. Can you make it?”

It was 5:30. Unless guests feel truly miserable (vomiting, pain) they are usually willing to wait, so I like to delay dinnertime calls until rush hour traffic dwindles. But hotel doctoring is a competitive business, and if I disappointed this demanding caller, he might ask the concierge to suggest someone else.

Creeping 1½ miles to the freeway onramp took fifteen minutes, but then traffic moved steadily, and I arrived on time. In hotel doctoring, delivering medical care is the easiest part. The patient suffered a bad cold and didn’t consider it a serious problem. In person, his boss seemed congenial.

On my drive back, the freeway stopped cold. I took an exit three miles from home.  Despite this, traffic crawled so slowly I was expecting a blocked lane ahead, but it was just the rush hour. It took an hour. On the bright side, I had finished half my dinner when the call arrived, so I wasn’t hungry. And in hotel doctoring, when you finish seeing one patient, you go home.

Too Many Cooks

As I was preparing for bed, a call arrived from one of my favorite hotels, the Palomar. It’s large and upscale but mostly I like it because it’s only a short drive. The caller explained that his nine year-old son had been coughing for three days.

“I started him on phenoxymethy penicillin,” he added.

 “Does he have a bad sore throat?” I asked. Penicillin treats strep throat and no other common childhood illness, but the presence of coughing makes strep unlikely.

“No. I thought it might help… My brother is a pediatric consultant in London. He gave me a Ventolin inhaler.”

“Did that help?”

“A little.”  That means 'no,' but it was a good idea. Asthma inhalers often relieve a cough even in patients without asthma.

“I’m a doctor who comes to hotels. Would you like me to see him?” I asked.

“My wife wonders if I should take him to a clinic for a chest x-ray and blood tests.”

“Unless he’s very sick, that’s not necessary.”

“Maybe you should come. Can you give him cortisone?”

“I carry cortisone….”

“So you could give him an injection?”

“I’d have to examine him first.”

After consulting with his wife, he said “We will wait for you.”

I exchanged my pajamas for a suit, filled out my encounter form, and was about to leave when the phone rang. It was the Palomar, and I knew what that meant. Guests don’t like to cancel in person, so a hotel employee delivered the message.

“The gentleman says he’s decided to take the child to an urgent care clinic.”

“There’s none in this area open so late. He’ll have to go to the UCLA emergency room.”

“Thanks for the information. I’ll tell him.”

I reverted to my pajamas and went to bed where I passed an uneventful night. The Palomar guest probably passed it in the emergency room.

The Wonders of GPS

My wife and I wanted to visit the Riverside photography museum, seventy miles away.

During this time there was a 50-50 chance of a hotel call, but only half require a visit. Our luck didn’t hold, and my phone rang after forty miles; someone was vomiting, not a visit I can stall. When I asked directions to the address from my iPhone, it claimed no such location existed. Since this was an insurance call, the patient was not an English-speaker. She had phoned the insurance office in Miami whose dispatcher (also not a native English speaker) phoned me. Addresses often become garbled.

I called the patient’s number and heard a busy signal, always a bad sign on today’s phones. I was forced to call the insurance number, spending a few minutes on hold before reaching a different dispatcher who spent several minutes researching before turning up the correct address.

Then the iPhone GPS worked its magic, laying out a very specific route to an obscure area near Long Beach thirty miles away. While I took care of the patient, she looked up a nearby restaurant on an iPhone App. We ate lunch and returned home.

Two days later we repeated the drive, this time successfully. Most photography museums are art galleries, but Riverside’s is part of the University of California, so it delivers large dose of history with displays of old cameras and old photographs. Driving home with the rush hour approaching, I kept an eye on the iPhone GPS, marveling at its accuracy at predicting freeway jams.

Suitophobia, Part 2

The only American doctors who don’t worry about malpractice suits are fresh out of training. They believe that practicing good medicine will keep them safe. Once they are sued, they join the worriers.

Fifteen percent of surgeons are sued every year. It’s twenty percent for high-risk subspecialties like neurosurgery and cardiac surgery. Family doctors like me do better -- only five percent per year. This means that every doctor is sued sooner or later. Mostly we win, and almost no one pays a penny even if we lose, but it’s a miserable experience. I work hard to find material for this blog, but you’ll never read about my suit.

One reason doctors are sued for malpractice is malpractice, but plenty of other reasons exist.

Hollywood generally presents doctors in a good light, but in the dozen or so movies about medical malpractice, the doctor character is always evil. Hollywood generally presents lawyers in a bad light, but in those same movies about malpractice, the victim's lawyer is always the hero. 

I once wrote a courtroom drama about a surgeon who was committing malpractice – doing hysterectomies strictly for the money. But he had a pleasant personality, so patients liked him (in the movies these doctors are always sleazy); he was a skillful surgeon, so there were no pitiful victims to testify, and he had a smart lawyer, so he won. I thought the story was deliciously ironic, but the number of editors who agree is holding steady at zero.

Why I Discourage Appointments

“The guest will be in the room at six o’clock and would like to see you then,” announced the concierge at two o’clock.

Tactfully, I suggested that she not make appointments without consulting me. The Torrance Marriott is eighteen miles away, and I didn't want to drive across town during the rush hour to see someone who wasn’t sick enough to leave work. I phoned to tell the guest that I could come immediately or at nine p.m. She chose nine.

Arriving ten minutes early, I knocked, and no one responded. Reached by cell phone, the guest reminded me that the visit was scheduled for nine. She was dining nearby, she added, and would hurry back. Twenty minutes passed before she arrived, but during that time another hotel phoned with a visit on my way home, so it looked like a good evening.

The guest arrived, apologized, and described her problem, a minor eye irritation. After I finished she mentioned that her husband felt under the weather. This is usually pleasant news because this couple had travel insurance. My routine is to ask the patient to phone the insurance to obtain approval, so I could care for him and be paid. But obtaining authorization takes time. It was late, and I was anxious to see the next patient who seemed genuinely ill, so I treated the husband’s cold gratis and hurried off.  

Suitophobia

“I’m Doctor Oppenheim….”

“Welcome to the Intercontinental, Doctor Oppenheim. Are you checking in?”

Damn. Another employee who doesn’t recognize me. This happens in hotels that have called for decades. Who knows what she’ll tell a guest who asks for help?

I don’t market myself, but years ago I decided to hand a copy of my latest book to general managers of my regular hotels and explain, modestly, that writing allowed me free time to serve their guests. They listened politely, made flattering comments, and went back to work. It was clear many had no idea who I was. My tenth visit, to the downtown Hilton, was my last. 

“What do you mean ‘serve our guests?’” snapped the GM. “We don’t have a hotel doctor. We don’t want a hotel doctor. You’re going to get a letter from our lawyer!” He snatched my book and marched off. I was a familiar figure to Hilton staff, having made over 100 visits, but I never made another.

That was my first encounter with the epidemic of suitophobia that rages among hotel managers, compelling them to forbid staff from helping sick guests except by getting them off the premises. At any given time, about ten percent are affected. Most recover after a few years, but in the meantime both guests and hotel doctors suffer. I made over 600 visits to the J.W. Marriott in Century City before calls abruptly stopped. I learned the reason from concierges who swore me to secrecy when they snuck me in to see a particularly demanding guest.