Traffic

Bending over, a guest at the Georgian felt stabbing pain in his back. He could barely move.

Acute back pain usually doesn’t last long, so, over the phone, I assured him that he would be disabled for a day and then gradually improve. I was not anxious to make this visit because it was 4 p.m. I would be driving to Santa Monica and back during the rush hour, a tedious experience. But he wanted a visit.

It was a tedious drive, not improved by the sight of immobile traffic on the opposite side of the freeway. The guest answered the door himself, always a good sign in someone with back pain. I examined him, repeated what I had said over the phone, and handed over pain medication; it was an easy visit.

Returning, I settled into the rear of a nearly motionless stream of cars. I was in no hurry; it was suppertime, but I wasn’t hungry. After ten minutes, my phone rang. A guest at the Crowne Plaza in Beverly Hills asked for a doctor. His wife was vomiting.

I often delay visits, but people who are vomiting hate to wait. This would normally be a quick drive because the Crowne Plaza was only five miles away, and I was headed in that direction. But it was the rush hour. I left the freeway and crept for thirty minutes along Pico Boulevard to the hotel. The visit went well, and the drive home was tolerable.

Going to Disneyland

A child at the Disneyland Hotel had a fever. Disneyland is forty miles away, but the call arrived Sunday morning. Freeway traffic was light; a perfect time for a long drive.

It was nearly noon when I greeted the parents and three other children. Being stuck in a hotel room with a sick child was not part of their plans, so all looked depressed. The child had a fever and cold symptoms but did not seem ill. I explained that children catch half a dozen viral infections every year; they last from a few days to a week or two; one can treat the symptoms, but there is no cure. Rest does not help.

“You mean we can go to Disneyland?” asked the father.

“Saying in bed doesn’t make it go away quicker.”

The family erupted in cheers and followed me out the door.   

A Delightful Bonus

The patient was a Brazilian two-year old who may or may not have had ear pain. Infants love everyone, and older toddlers are usually frightened enough to hold still, but from one to three years of age, children who don’t like doctors are uncontrollable. Taking a temperature in the armpit required the parents to hold her down. I dreaded the ear exam.

There was a knock on the door, and an elderly gentleman entered. This was the child’s grandfather, I learned as we shook hands, and he was a pediatrician. Immediately I held out my otoscope which he accepted with thanks. 

The entire family piled on; the child screamed and fought as the grandfather looked in her ears and forced open her mouth to examine her throat. He spoke little English but made it clear that nothing abnormal had turned up. He delivered an elaborate explanation to the family in Portuguese. I handed over a bottle of Tylenol, and everyone was happy.  

Why Do I Get So Many?...

Everyone thinks he or she has a weak spot. “My kidneys are weak...” “I have a tendency to strep...” “My resistance is low...” In fact, most recurrent complaints are not your fault.

Colds (or other viral infections such as bronchitis, tonsillitis, flu) are contagious diseases. You catch them from another person. They are not caused by chilly weather, wetness, stress, poor nutrition, or a weak immune system.

Backaches happen because our skeleton is defective. Animals walked on four legs for hundreds of millions of years. Humans stood erect a few million years ago, too soon for evolution to correct matters, so back muscles are too weak for the extra work, and our spine is not built to carry so much weight.

Bladder infections plague young women. Many suspect something is wrong, but this is rarely the case. In young adults, these are caused by germs that normally live around the genitalia. Young men suffer much less often because having a penis gives germs much further to travel to reach the bladder. Men catch up after middle-age when their swelling prostate obstructs urine flow.       

Bruises.  Black-and-blue marks occur after an injury. Rarely, they are the sign of a bleeding disorder, but in young women bruises often appear for no reason at all.

 

Flatulence is usually a sign of good health. Humans digest protein and fat easily, so very little reaches the colon. Carbohydrates are another matter; a person who eats a great deal of grain, vegetables, and fruits delivers plenty of undigested carbohydrate to colonic bacteria that feed on it, producing gas.

Age spots become tiresome if you or your doctor don’t take them seriously. They begin around age forty as small brown spots. A quick freeze with liquid nitrogen makes them vanish with no scarring. If ignored, they never go away. They enlarge; some become thick and wart-like; others appear. Eventually there are too many to treat.

Allergies tend to appear in childhood. Most reactions that adults call allergies are something else. If a medicine makes you ill, that’s probably what doctor’s call “drug intolerance,” not an allergy. This is not splitting hairs. A drug allergy can kill you; drug intolerance is merely annoying. Most stuffy noses are not allergies. Neither are most rashes or upset stomachs.

A Difficult Night

People blame an upset stomach on their last meal, but mostly these are viral infections. Although miserable, they rarely last long. Doctors enjoy short-lived illnesses because we get the credit when they go away.

The guest hadn’t vomited for several hours and was already feeling better. As I was congratulating myself on an easy visit, I heard the unmistakable sound of retching from the bathroom. This was her husband, the woman explained, adding that her mother and two year-old were also ill.

When the husband appeared, I took care of him. Unlike his wife, he welcomed an injection in addition to antivomiting pills which I also gave the mother as well as medication for her cramps and diarrhea. The child had diarrhea and little interest in eating but did not look ill. I limited myself to dietary advice and left my phone number.

When I phoned the following day, the husband informed me that the family was fine although everyone had been vomiting all night.

How to Find a Hotel Doctor

Getting sick in a hotel far from home is miserable enough; you shouldn’t have to scramble for help. Here’s the best strategy.

1. Ask a hotel employee.

This often succeeds, but you may see him scratch his head. ‘... St. Mary’s is the nearest emergency room. Take Seventh Avenue about a mile, then...’ 

Ask others. Relations with the ‘house doctor’ are informal. He or she is never a hotel employee, and many on the staff are unaware of such a person. ‘You’re our doctor?  I didn’t know we had a doctor...’ is a comment I hear at hotels I’ve visited for years.

2. Ask the manager.

Every manager knows hotel doctors although you’ll often hear: ‘I’m sorry but we can’t recommend anyone.’ You are encountering one consequence of today’s malpractice crisis. The hotel’s lawyer has assumed (correctly) that a guest who sues the doctor will also sue the hotel that recommended him, so the lawyer has forbidden the staff to name anyone. When a manager clams up, you have four choices.

A. Demand a doctor and keep demanding.

Occasionally I visit an assertive guest who has refused to take no for an answer. I introduce myself to the manager afterwards, but he or she invariably insists that this was an exception, and the hotel can never, never mention my name.

B. Phone another hotel and ask for its doctor.

All luxury hotels (Four Seasons, Ritz-Carlton, Peninsula) have doctors; popular chains (Hilton, Holiday Inn, Hyatt, Ramada) are unpredictable, but the larger the hotel, the more likely you’ll succeed.

C. Phone a national house call service.

All claim to operate nationwide, but they’re a crapshoot if no moonlighter happens to be available. Some names to Google are Expressdoc, Standby MD, Inn-House Doctors, Hoteldocs. Their fee not only pays the doctor but the organization, so it can take your breath away. Ask how much and then ask for the extras because the meter starts running as soon as he walks through the door. I’m pretty sure I’m the only hotel doctor who charges a flat fee.

D. Call your family doctor.

The law requires that a doctor be available to patients. You should reach the doctor or someone covering. If not, complain to your state medical board.

What about insurance? Specific travel insurance pays for almost everything, and it’s cheaper than you think. Traditional health insurance may pay a fraction or apply it to your deductible. HMO’s are variable. All claim to cover emergencies, but they look skeptically on house calls. I hate to give advice no one takes, but  here goes: read your policy.

Medical Myths That Doctor's Believe

Here are myths that most laymen take for granted. A more serious problem is that many doctors also believe them. 

1.  If it hurts, it needs an x-ray.

Excellent for detecting fractures, X-rays are surprisingly unhelpful in other painful conditions.  Almost everyone suffering an excruciating headache, backache, bellyache, or hacking cough wants to know what’s going on inside, and they assume that, like Superman’s X-ray vision, a film reveals this, but it doesn’t.

2.  If your sputum turns green you need an antibiotic.

Your respiratory tract produces a quart of mucus every day.  When irritated, it produces more and the sputum may turn yellow, green, or brown. In an otherwise healthy person, this has no significance.

3. If one medicine isn’t working, you need a better medicine.

Understandable in a layperson but doctors should know better. In medical school, students are drilled in the rule:  if a drug isn’t working, switching is almost never the solution. Find out why the patient isn’t improving. It’s more likely that the diagnosis is wrong.

4.  Spicy food irritates your stomach.  Fats are hard to digest.  Tasteless and colorless (i.e. bland) food is soothing.

All proven false by good studies. 

5. High blood pressure causes headaches or dizziness.

Ordinary high blood pressure causes no symptoms.

6. Bronchitis requires an antibiotic.

Almost anything that causes coughing can be called “bronchitis.”  The most common is a viral infection; antibiotics don’t work.

7. Injections work faster than pills,

Sometimes, sometimes, not.  Doctors can charge for an injection. If they write a prescription, the pharmacist gets the money.