Worry, Part 2

I drove to the Magic hotel in Hollywood where a Danish couple’s 18 month-old was vomiting. He looked fine, and looking is essential:  sick children look sick. Nothing abnormal turned up on an exam, so my diagnosis was a common stomach virus. I told the parents it might last a few days and gave the usual dietary advice.

I check on patients before going to bed, but the Danish parents beat me to it. The child had vomited once again, they reported. He was still in no distress, so I told them it was OK to wait.

My assurance was proper, but patients occasionally deliver unpleasant surprises, so I worried a little as I went to bed.

I phoned the Danes the following day to learn that the child hadn’t vomited but was now feverish. This was to be expected, I explained, and I approved their decision to give Tylenol.

The Danish child was still feverish, his parents reported the next day, and now he had diarrhea. I gave dietary advice.

There was no answer the following morning. From the front desk I learned that they had checked out. I had just returned from seeing a young man with abdominal pain at a youth hostel. He was worried about appendicitis; my exam made that unlikely. Since he had no health insurance, I did not want to make my life easier by sending him to an emergency room where a workup including CT scans would run to about $5,000. His symptoms hadn’t improved when I called, but they still didn’t seem like appendicitis. He promised to phone if there was any change. I worried a little as I went to bed.

Worry, Part 1

A guest had stumbled in the shower and thrown out her back. Could I make a visit to decide if she needed hospitalization?

Going to the hospital with back pain is a bad idea; even if you’re in agony, no doctor will admit you without evidence of nerve damage such as paralysis or inability to urinate. He will order x-rays (worthless for acute back pain but an ER tradition), explain that you will recover in a few days, and prescribe pain medication.

My examination showed no nerve damage, so I explained that she would probably improve in a few days. I handed over pain pills, adding that, while it wasn’t essential, I could give an injection that would help for several hours. She agreed, so I gave it. 

 “Not so good,” she replied when I called to ask how she was doing. She had been vomiting since the injection, and each vomit hurt her back. That’s an occasional side-effect. I assured her it would pass, but I worried.

She was marginally better the following morning and the morning after that. She wanted to fly home. Could I provide medical clearance? Visits for “medical clearance” are a lucrative perk of hotel doctoring, but I resisted the temptation, explaining that there’s no medical reason why someone with back pain can’t travel. If she could hobble onto the plane, she should go.

Could I give a “mild” injection so she could move more easily. No such injection exists. I suggested she try the pain medicine.

Later, the lady reported that the medicine made her dizzy. What should she do? I told her it would pass. Rest is not helpful for treating back pain. She should try to make her plane. When I called later she had checked out. I worried that I might hear from her, but I didn’t.

A Creepy Frat Guy

The Andaz Hyatt had given my number, explained the caller. Could I see a member of their cast who was suffering an earache? Unfortunately, he was on location and wouldn’t return until evening.

She was delighted at my suggestion that I come to the film shoot, and I’m as eager as anyone to mingle with movie people. On the downside, I live six miles from the Hyatt; the film was shooting at the far end of the San Fernando Valley, twenty-five miles away, and I’d quoted my fee before learning this. 

The producers had taken over a run-down motel, painted it pink, and restored the coffee shop to its mid-twentieth century interior. I drove past warning “closed to the public” signs and parked among the cabins and scattered 1950s cars.

Several dozen people stood around, none over forty. You should realize that shooting a movie is boring. Filming takes up perhaps two percent of the day. The remainder involves setting up, technical changes, errands, and waiting around. Everyone looks forward to lunch. I attracted attention, being far older and much better dressed.

Earaches are easy. I followed a young man into the empty 1950s diner, made the diagnosis, handed over medicine, and took my leave.

As usual, one aspect of the experience seemed strange. The assistant who had phoned and greeted me on my arrival was a young, attractive woman. Other attractive women were carrying messages, answering phones, setting up the lunch buffet. Almost every actress in costume was beautiful; there were no exceptions for those in street clothes.

Somewhere in Los Angeles there is a creepy frat guy who handles hiring for film sets.

Getting Help, Part 3

If hotel doctoring seems romantic to you, it has the same effect on the medical profession, so a want-ad I placed in the Los Angeles County Medical Journal produced an avalanche of responses.

Many callers had a day job. If they worked at a clinic, they couldn’t help because clinic malpractice insurance never covers work outside the office. Buying their own policy was impossible because none are cheap enough to cover the modest income I could provide. For this reason, residents also couldn’t work for me. Nor could retired doctors who’d dropped their insurance.

Some callers had a practice and their own insurance, but that meant they couldn’t leave during office hours. Most assured me they’d love to make visits afterward – to hotels in their area. Since doctors live in prosperous neighborhoods, but hotels are often downtown or near the airport, this would make my life too complicated.

I never considered myself unique until I tried to find a helper. My ideal would be competent, likeable, available 24 hours a day, and willing to travel anywhere. That describes me but no applicant so far. I enjoy friendly relations with a few other hotel doctors who cover when I leave town, but it’s never ideal to turn your business over to a competitor.

A surprising number of doctors announced they were free during the day and eager to make visits anywhere. All made me suspicious. Why didn’t they have a job? Doctors have no trouble finding work. Quizzing them provided no reassurance. They had just arrived in town; they were unwilling to settle down just yet; they were searching for a congenial position… 

I take for granted any doctor with a day job possesses at least marginal competence, but what about these fellows? Every doctor scratches his head over a few colleagues, wondering how they slipped through medical school and into practice without anyone noticing. So I’m still looking.

Karma Will Find You!

My wife and I were shopping at Trader Joe’s at 5 o’clock. For all its superior features, Trader Joe’s is bagger-deprived, so check-out lines move slowly. They were very long at 5 o’clock.

Searching for the mythical shortest line, we found one that qualified but only because an overflowing cart stood at the end with no one nearby. We considered. Most likely its owner had rushed off for a forgotten item. After a minute when no one appeared, we wondered if someone had abandoned it. The line moved forward, opening a substantial gap in front of the ownerless cart. We decided that sufficient time had elapsed and took our position. Immediately, a woman appeared.

“Excuse me! I was in line,” she said.

“You were gone a long time,” said my wife.

“Not true! I wasn’t away twenty seconds. You’re in my spot.”

 “We’ll stay,” I said, provoked by her mendacious defense.

She seemed about to make a scene, but before anything developed, my wife told me to shut up and moved our cart to the end of the line. As far as we were concerned, that ended the matter. We began discussing the evening’s activities. The lady with the cart couldn’t overhear, but (in retrospect) she probably thought we were muttering about her. After a minute, she whirled angrily.

“This is clearly very important to you! So I’m going to let you have the precious position you yearn for.” She pushed her cart away but not before turning to wave her finger and add: “Bad Karma! But sooner or later it will find you.”

Having the last word in these disputes equals victory, so we were left feeling defeated.

Then miraculously, Karma found us. A clerk opened an empty register, waved us over, and suddenly we were first in line!

Looking for Help

“Your blog is funny, and you’ve got a great thing going with hotels. I wonder if we can work together.”

The caller was a young doctor who explained that he was starting a concierge practice and needed someone to cover when he was away. Naturally, he was available to cover for me.

I’m always looking for help. Hotel doctors keep each other at arm’s length because, while it’s considered unethical to solicit another doctor’s patients, soliciting a hotel is just business, and I don’t want them setting foot in mine.

We met at a local restaurant. He did most of the talking, describing the superb service he provided. As you may know, concierge doctors accept no insurance. In exchange for a large retainer or other cash arrangement, they provide enhanced care: immediate availability, leisurely office visits, 24 hour phone service, and house calls. House calls cost extra, and none of this money covers tests, x-rays, specialists, and hospitalization, so it’s a service aimed at the wealthy.

As it happened I planned to see a Dodger game with my brothers that weekend, July 4. The colleague who covers was attending a wedding and warned that he might have trouble getting away. I decided to give the concierge doctor a chance.

I usually call-forward my number to my colleague, but he knows how to deal with hotel guests, so I didn’t. The phone rang as we were driving to the stadium. A child was suffering a severe cough and fever. The mother wanted a visit as soon as possible. I called the concierge doctor.

“They’re in Hawthorne,” I explained. “It’s far, so I quoted three hundred dollars.”

He sounded shocked “Doctor Oppenheim! It’s a holiday!”

“Right,” I said. “No freeway traffic.”

“Doctors don’t work on holidays. Patients understand that. They know they have to pay extra.”

“And that would be…?”

“My patients pay six hundred dollars.”

“That’s not in the cards. Do you want to make the visit or not?”

“Of course, I do. But I’m celebrating the holiday with my family like everyone else. I have to earn a reasonable fee if I get called away. Patients don’t object.”

“I’ll take care of this another way.” I hung up, furious, and then  phoned the patient’s mother. The child didn’t seem dangerously ill, and she was willing to wait a few hours. That solved the immediate problem but ruined the evening because I worried about a catastrophe occurring while I indulged my frivolous love of baseball. When I phoned after the game, the child was sleeping, and the mother wanted to wait until morning. It turned out he had a routine cold.

I’m still looking for help. 

Stressful and Nonstressful Visits

Driving to a hotel can be stressful. I talk to guests by phone beforehand, eliminating obvious emergencies and unreasonable requests, but plenty of worrisome possibilities remain.

Sick babies make some hotel doctors nervous. I see them but some don’t. If, over the phone, the doctor tells you to take your baby to an emergency room, ask politely if he prefers not to see infants. If he admits this is so, try to find another hotel doctor before going off.

Elderly patients can be challenging. They seem fragile, so a doctor may lean over backwards to treat illnesses that don’t require treatment or refer to a hospital more quickly than he would a younger person. I consider eighty the beginning of fragility; other doctors begin at seventy, but this is clearly wrong because I am over seventy and not fragile at all.

If a patient has a bellyache, I worry. Without tests or x-rays I have to decide if it’s safe to wait. When I decide it’s safe, I’m almost always right, but I send guests to emergency rooms if uncertainty remains. Many endure a long, tedious, expensive experience only to learn that nothing abnormal has turned up. Some consider this good news, but others wonder why, having summoned me and paid my fee, I didn’t save them the trouble.

I’m always uneasy before seeing guests suffering an ordinary respiratory infection because a large percentage – perhaps a quarter – are obviously disappointed if I don’t prescribe an antibiotic. We feel bad when a patient believes we haven’t helped.

On the bright side, I often drive off knowing the diagnosis, knowing I’ll help, and certain the guest will deliver a satisfying dose of gratitude. Relaxing drives include those for simple urine infections, eye infections, ear infections, and rashes. I generally diagnose chicken pox, shingles, hives, and the common cold over the phone. Isolated abdominal pain is tricky, but I feel better if vomiting or diarrhea accompany it because they usually indicate a short-lived stomach virus. Guests who want their blood pressure checked rarely worry me. High blood pressure doesn’t cause symptoms, so those who make this request have other problems, generally anxiety-related.