Things Guests Say Again and Again

“Can you come up right away?”

It’s surprising how many guests believe I am sitting in an office downstairs. In fact, I’m at home or going about my daily business when the phone rings. I keep a suit jacket, tie, black bag, and paperwork in the car, a mild inconvenience because I must park in shade on sunny days to prevent the heat from melting my pills.

“I’ll call you back.”

Middle-class Americans are mostly insured. Talking to a doctor willing to make a housecall is already disorienting; hearing that they’ll have to hand over money comes as an additional jolt, so they often reconsider (“I’ll talk to my husband and call you back…..”). No one who says this ever calls.

“Sorry about the mess”

Entering a room, I look for a place to set down my clipboard and bag, so I hear this as someone hastily removes the pile of articles covering the desk. After putting a thermometer in the guest’s mouth, I announce that I will wash my hands, so I hear it again as someone rushes ahead to clear a space around the sink. 

“Do you accept insurance?”

My answer is yes – if the guest is foreign. Billing US carriers is so complicated that offices employ trained billing clerks. I work alone.

Impresssing the General Manager

Years ago Prentice-Hall published The Man’s Health Book, and UPS delivered my ten free copies. Usually I gave those to family and friends who didn’t read them, so I wondered if I could put them to better use. 

I decided to visit general managers of my biggest hotels, introduce myself, and impress them by handing over my new book.  

At each, I approached the secretary in the executive office, identified myself as the hotel doctor, and asked for a minute of her boss’s time. I delivered my spiel, surrendered the book, and accepted their thanks. Some GMs expressed pleasure at finally meeting me, adding flattering words about my service. Others listened politely and thanked me for the book, but it was obvious they had no idea who I was.

I encountered a third reaction at the Los Angeles Downtown Hilton. The secretary had barely replaced her phone when the GM shot out of his office. I began my spiel but he interrupted.

“What do you mean you’re our hotel doctor?” he exclaimed. “This hotel doesn’t have a doctor!”

“I’ve been coming for years….,” I said. My database showed 119 visits which implied over 200 phone calls. The staff knew me; the valets never refused to hold my car (essential downtown).

“This hotel doesn’t have a doctor!” he repeated. “What do you mean calling yourself our doctor?”

“When a hotel calls so often…”

“We don’t have a doctor. You’re not to call yourself our doctor!”

Flustered, I held out my book. He snatched it and disappeared back into his office. I could have made better use of that copy. A few days later the mail brought a certified letter from an attorney informing me that I was hereafter forbidden to refer to myself as the Los Angeles Hilton’s doctor.

I stopped handing out books. Seven years passed before the hotel, then the Wilshire-Grand, resumed calling.

Why Don't They Call?

In my experience, a hotel generates approximately one request for a doctor per month for every hundred rooms. My record, in case you’re wondering, is 208 calls in 1995 from the old Century Plaza which had 1076 rooms.

The Airport Hilton has over 1,200 rooms, but I average a dozen calls a year. When I asked the security officer why the hotel called so infrequently he gave the usual wrong answer (“no one’s been sick”). When I asked who they called besides me, he peered down at his desk where, under a sheet of glass lay business cards advertising taxis, masseurs, florists, limousine services, clinics, pharmacies, et al. I saw my card and none from three rival hotel doctors who prefer the area in and around Beverly Hills where luxury hotels concentrate. They occasionally drive the extra ten miles to the airport, but I doubted they were responsible for my shortfall.

My eyes fell on a card from a national housecall service. Several exist, and I made half a dozen visits for this agency but stopped because guests blamed me for the bill.

“Do you know how much these people charge?” I asked. “Eight hundred dollars!” The security officer expressed polite dismay. Guests rarely complain about a doctor’s fee, so he didn’t care.

That’s the problem. Luxury hotels make sure a doctor is available, but many managers at the mid-level give it a low priority, so employees make their own choices when a guest asks for help.

Now and then, mysteriously, the light dawns, and a hotel begins to call regularly. Decades may pass before this happens, and I’m still waiting for the Airport Hilton. 

Drugs are Cheap

A least they’re cheap for common problems your doctor encounters in the office which are the same as I see in hotels. Here are examples from my favorite internet supplier as of 2018.

Some drugs cost almost nothing, less than a penny a pill. A thousand hydrochlorothiazide (the most popular diuretic and blood pressure pill) costs $6.34. Valium 5mg is over a penny: $12.20 for a thousand. I can buy a thousand Benadryl, an antihistamine, for $11.28.

An excellent prescription pain remedy, Tramadol, costs $1.69 for a hundred; $15.11 for a thousand.

Long ago states began requiring doctors to file a report each time they hand out narcotic pain pills, so I gave it up. Despite the impressive street price of the most popular drug of abuse, Oxycontin, a bottle of a hundred costs $8.77.

Cortisone cream: $0.99 per tube.

Antibiotic eye drops for conjunctivitis: $2.25

Antibiotic ear drops for swimmer’s ear used to be about twice as expensive, but they’ve shot up to over $20. Luckily, it’s considered OK to use antibiotic eye drops for ear infections, so that’s what I do. 

The three day Bactrim antibiotic treatment for urinary infection (six tablets) is about 35 cents. A hundred costs $5.40.

Ten day treatment for strep throat, twenty amoxicillin 500mg: $1.30.

Ten day treatment for pneumonia, twenty doxycycline, is about $1.70.

A big attraction of injections is that a doctor can charge for them. If he writes a prescription, the pharmacy gets the money. Don’t assume common injectables are expensive. To begin, a disposable syringe costs twenty cents.

For allergies and itching, a vial containing thirty doses of injectable cortisone (Decadron 4mg) costs $11.06. That’s about 40 cents a shot.

For pain, a shot of morphine costs about $2.30 if the doctor buys single-dose vials, but that’s an expensive form. Multiple dose vials cost less than half as much per dose if he or she can find them.

Within the past five years, ondansetron has replaced Compazine and Phenergan as the leading treatment of vomiting. One shot costs 15 cents. A vial of ten doses is $1.54

Plain old Valium injectable has skyrocketed. This happens when some companies stop making a drug and the others realize they have little competition. Five years ago I paid $5.04 for a vial of ten shots; it’s now $51.00.

A Dirty Trick

In 1993 I opened a letter from the California Medical Board announcing a complaint against me.

The days when state boards went easy on doctors were past. In response to persistent criticism, California had joined others in raising license fees, hiring investigators, and issuing press releases boasting of doctors it has disciplined. Every month I receive a bulletin listing names of those punished with license revocation, suspension, or some humiliating probation. These doctors seemed sad cases: incompetent, alcoholic, dishonest without being clever. Was I about to join them?

Although Los Angeles is the largest city in California, my hearing took place in Diamond Bar, thirty miles east, and it was a gloomy drive. The investigator ushered me into a room where I sat at a long table, bare except for the evidence. He told me the name of my accuser who turned out to be a competing hotel doctor.

The investigator held up a tiny pill box labeled with my handwriting. The name on the box belonged to a guest I’d seen months earlier. My rival had visited her, noticed the box, and realized it offered an irresistible opportunity.

I carry dozens of medications in little boxes. Handing them out, I once wrote the name of the drug and the instructions. This violated California State Pharmacy laws, the investigator informed me. Whenever anyone (not only a pharmacist) gives out a prescription drug, its container must include the patient’s name, the date, the drug’s name, dose, quantity, expiration date, and instructions plus the doctor’s name and contact information. For violating these laws, he added, the board would levy a fine and issue a written reprimand. This was not, however, an offense that endangered my license.

The reprimand announcing my three hundred dollar fine duly arrived. For months I scanned the bulletin, dreading to read my name, but the offense apparently didn’t qualify. It also never appeared on the California Medical Board’s web site when I checked for transgressions (you can look up me or any California doctor at http://www.medbd.ca.gov/Lookup.htm. Other states have a similar arrangement.

Obeying the pharmacy law required a great deal of writing on that tiny box, but I went along. As for repaying that doctor for the dirty trick, my only recourse was to continue setting foot in his hotels. Hotel doctors hate that.

A Doctor for Cheap Lodging, Part 2

I had seen a guest at the Banana Bungalows, a budget motel near the Hollywood freeway converted into a hostel. It was my first visit, so I wanted to introduce myself. I caught the eye of the desk clerk, a youth with a shaved head, tank top, and jeans.

The quality of front desk personnel varies directly with the quality of the hotel. Since hostels are a nonprofit enterprise, their employees fall below the bottom of the scale. 

“Could I speak to the front desk manager?”

“I guess that’s me.”

“I’m Doctor Oppenheim. I took care of the man in bungalow ten. Did you call me?”

The clerk shook his head no.

“Maybe one of your colleagues?”

“I’m the only one on duty.” It’s a mystery how often I find no one willing to admit referring a guest. I began my sales pitch.

“Who do you call when a guest wants a doctor?”

“Nobody gets sick. We send them to an ER.”

“You must call someone. Someone called me…. I’m a fulltime hotel doctor. All the hotels use me.….”

At chain hotels, staff maintain eye contact and a smile as I speak. I often sense their lack of interest, but at least they remember their manners. The Banana Bungalow’s clerk kept nodding to encourage me to get to the point. He flicked an impatient glance at a guest standing nearby.

“I’m always available.”

“We don’t really need a doctor.”

“Here’s a number anyone can call 24 hours a day. Could you post it?”

“No problem.” The clerk snatched my card and then turned to the waiting guest.

A Doctor for Cheap Lodging, Part 1

The Banana Bungalows consists of cabins strung out along narrow alleys off the Hollywood Freeway. I parked near the largest.

A desk clerk directed me to a cabin a hundred yards up a hill. Its Spartan interior slept eight in four bunk beds, all unmade. Papers, food cartons, luggage, and clothes littered the floor, and there was no furniture, not even a table where I could write. The air smelled of French fries and unwashed bodies:  a typical youth hostel.

Sitting on a vacant bed, I introduced myself. One glance under the man’s shirt confirmed the diagnosis. Chicken pox can be serious in an adult, but this was a mild case. He wanted to go home. I told him not to get on the plane until all his pocks were scabbed over. That might take a week, and I suspected he wouldn’t wait.

Walking down the hill, I puzzled over the appeal of youth hostels. They charge thirty-five dollars a night, a bargain, but cheap motels begin at fifty dollars and offer privacy as well as an unshared bathroom. Perhaps young travelers like to clump together.

Something to Knock It Out, Part 3

Her vacation had been a disaster so far. Worse, when she tried to buy amoxicillin to knock out her bronchitis, the pharmacist told her she needed a prescription. This was obviously a scam to line the pockets of American doctors, the guest added. She didn’t need my services except to provide the amoxicillin, so I should not take up her time.

This monologue occurred in Spanish. I don’t speak Spanish, but I’ve seen thousands of Latin American travelers, so I got the drift.

This lady appeared upset as soon as she opened the door. Apparently accustomed to this behavior, her husband and a child sat in a corner, trying to look inconspicuous. Following my rule (see the post from March 16) I had no plans to refuse the amoxicillin, but first I had to deliver good medical care. I phoned the travel insurance office, and the dispatcher agreed to interpret.

I asked the usual questions; she answered at great length.

The dispatcher translated but summarized her interruptions with: “she’s mad about something.”

The guest rolled her eyes when I put a thermometer into her mouth and seemed impatient during my exam.

When I concluded that she would recover in a few days with or without an antibiotic but that I would give her amoxicillin, she slammed down the phone and waved off my prescription.

“If you don’t think I need an antibiotic then I don’t want an antibiotic. According to you I should continue to suffer. Thank you very much!….”  I’m not certain those were her exact words, but they were close.

I laid the prescription on the bed. The door closed behind me with a deafening slam.

Something to Knock It Out, Part 2

Influenza had afflicted a guest for five days with fever, body aches, and general misery. He had meetings, he said, and needed something to knock it out.

While antibiotics don’t affect influenza, antiviral drugs such as Tamiflu shorten the illness by a day or two. Sadly, they only work if taken within the first 48 hours; afterwards they are useless although doctors continue to prescribe them.  I gave him some useful medicine and told him that flu rarely lasts longer than five or six days, so he would feel better soon.

After I left, the patient went to a local clinic and received the traditional antibiotic which solidified his conviction that I did not know my business. A day after beginning the antibiotic he felt better which proved it. Confronting the hotel manager, he demanded his money back. Guests often believe that the hotel doctor works for the hotel.

The general manager phoned to pass on the request.

Something to Knock It Out, Part 1

An FBI agent was suffering a bad cough. He informed me that this happened every year, and his doctor knocked it out with an antibiotic.

My philosophy on prescribing a useless antibiotic is that I don’t unless the patient threatens to make a scene.

This FBI man seemed out of an old movie: dressed in suit and tie, composed and unemotional. He made eye contact, listened intently, answered succinctly, submitted to my exam, and did not interrupt as I spoke.

I explained that he had a virus that was incurable but would go away in a few days. As I delivered advice and handed over cough medicine and tablets for his fever, I could see him absorbing the news that I wasn’t prescribing the antibiotic.

He was not a person to quarrel with a figure of authority. He said nothing, but I could sense his inner turmoil….

Deciding the ice was getting very thin, I added: “You said your doctor gives you an antibiotic. This illness doesn’t require one, but I’ll write a prescription in case you want to call him and discuss it.”

He accepted it without comment. He also handed back the medical form that I had asked him to sign. In the hall, glancing at the paper, I saw that he had covered it with obscenities.

24 Hour Duty

As a hotel doctor, I’m on duty 24 hours a day. This sounds oppressive until you realize that even a busy week – say twenty visits – requires about thirty hours of actual work. A downside is that calls can arrive at precisely the wrong time.

This one came one hour and twenty minutes before a dinner reservation with friends.

I calculated furiously and decided I could make it. My destination, the Mondrian, was on the Sunset Strip, six miles away. It was Sunday, so traffic was tolerable, but street parking on the Strip is difficult. The Mondrian is not one of my regulars, so parking attendants would probably not accommodate me. The hotel possesses only a skimpy open space around the entrance, so the valet might drive my car deep into the garage where it might take ten minutes to retrieve. Worse, there was a chance they would charge.

Making a snap decision, I drove past, but no street parking materialized. I turned down a side street but no luck, so I returned to the hotel, handed over my keys, and announced (incorrectly) that I was the hotel’s doctor.

I arrived at the room and introduced myself only to hear the discouraging words: “Spik Spanish?”…

I shook my head regretfully and proceeded in English. This usually works because most Latin American males speak enough English to get along (women don’t do so well). Sadly, he proceeded to perform the Zero-English pantomime: pointing to his throat, pointing to his head, making coughing noises.

No problem. Peering outside the door, I appealed to a group of maids on their cleaning rounds, but they were recent arrivals and spoke no English. Luckily, a bellman pushing a food cart was bilingual.

Delivering medical care was, as always, the easiest part. To my delight, the valets had held my car, and I arrived at the restaurant not excessively late.

No Income Today

A lady at the Westin wanted a housecall for her cough and fever. This seemed reasonable until I learned that she was under treatment for multiple myeloma, a serious blood disease. It affects the immune system, so any sign of infection is a red flag.

I explained that she needed more than I could provide in a hotel room and gave directions to the nearest emergency room.

                                                 *          *          *

Two hours later I spoke to a guest at the Airport Holiday Inn who was experiencing stabbing chest pains. Chest pain is worrisome, but significant chest pain lingers. Fleeting pain in an otherwise healthy person is almost never a serious sign. I looked forward to the visit when, after my exam, I would deliver reassuring news. That anticipation disappeared when the guest mentioned that he had suffered several blood clots in his lung and was taking blood thinners. He added that these chest pains were different.

Different or not, it was a bad idea to assume that these were trivial. I sent him to a facility that could perform tests.

                                                *          *          *

A travel insurance agency asked me to see a hotel guest in Encinitas.

“That’s near San Diego,” I pointed out. “It’s a hundred miles.”

I’ve traveled that far in the past and charged accordingly, but I didn’t want to quote a fee and risk having it accepted because I wasn’t in a mood for the grueling drive. A local clinic would be cheaper, I informed the dispatcher. 

                                                *          *          *

“I’m a physician in the U.K., and my wife has conjunctivitis in both eyes. I went to the chemist for antibiotic drops, but apparently I have to see an American doctor.”

“It’s unusual to have bacterial conjunctivitis in both eyes,” I said. “If you’re certain, ask the pharmacist to phone, and I’ll approve the prescription.”

Later the pharmacist phoned. When it comes to their own illness or that of their family, doctors are no more accurate than laymen, but they have no interest in my opinion. 

A Mystery

Universal Assistance asked me to see a young woman with abdominal pain at the Airport Hyatt. According to the dispatcher, she had no other symptoms.

Arriving in the room, I learned things the insurance dispatcher hadn’t mentioned. The woman was three months pregnant and had noticed vaginal bleeding. It’s surprising how often doctors know the diagnosis as soon they set foot in the room, but it looks bad to blurt it out, so I asked questions, performed an exam, and then delivered my conclusions. She was having a miscarriage and had to go to an emergency room. 

The following afternoon, the lady’s husband called. They were back in the hotel. The emergency room doctor had diagnosed a miscarriage. Then he had discharged her. But she was still bleeding. Was that normal?...

Bleeding stops when a miscarriage is complete; if it continues, a doctor performs a D&C to scrape away remaining tissue. I have no explanation of why the doctor sent her out still bleeding. I told the husband that, sadly, he would have to take her back. The second time she received her D&C.  

Is It Annoying?

 "My other son is coming down with something. Do you mind taking a quick look?”

If you wonder if it annoys doctors to see an extra patient at the last minute, it does. They grumble regularly on physician internet forums which, like forums in general, are full of petty complaints.

In an office, that second patient generates a second bill, but I rarely charge double in a hotel. Driving takes up 80 percent of my housecall time, so an extra consultation doesn’t add much. I’m also aware of one rule of medicine that may come as a surprise.

Rule:  If one member of a family is ill, it might be serious. When two members are ill, it’s never serious.

A guest with chest pain, vertigo, or difficulty breathing is probably the only one in the room suffering. When two people are sick, it’s a respiratory infection: cough, congestion, fever, sore throat… These are not serious.

No medical rule is one hundred percent accurate, but I’d rate this near 99. In an otherwise healthy person, the only common, serious respiratory infection is bacterial pneumonia. Since pneumonia is not generally contagious, I’ve never seen two cases in the same room.