The Same Thing

“My wife had strep last week. Now I have the same thing.”

I receive one “same thing” phone call per week. Naturally, guests hope I’ll agree.

This is not the traditional warning against self-diagnosis, because the guests are usually right. If necessary, I’m happy to phone a pharmacy with the appropriate prescription.

Everyone with an upset stomach suspects food poisoning. If your dinner companions are also sick, it’s a possibility, but if you’re the only one, you probably suffer the common stomach virus which makes you miserable for a day or two. Most guests with vomiting or diarrhea don’t want to travel to a pharmacy. For those willing, I sometimes provide symptomatic remedies. Sadly, in the US no common intestinal infection is curable with antibiotics.

Other illnesses are tricky, but a young woman who’s had several bladder infections knows when she has another. This is perhaps the only infection where it’s acceptable to prescribe an antibiotic over the phone.

Inevitably, respiratory infections produce the most “same thing” calls. These are stressful calls because many guests proceed to tell me what they need, and they’re wrong.

As I repeat with boring regularity, many doctors, perhaps a majority, prescribe useless antibiotics for viral respiratory infections. That includes yours. That doesn’t mean you have a bad doctor; prescribing useless antibiotics is so common that competent doctors do it.

When, after hearing the symptoms, I explain that this doesn’t describe anything that antibiotics cure, guests assume there will be no antibiotic unless I make a housecall and collect a fat fee. In fact, I do everything possible to avoid a housecall because not giving an antibiotic guarantees an unhappy patient. If I yield to his entreaties, I hate myself.

A Doctor's Routine

“Under your tongue… under your tongue… close your mouth… don’t bite!”

Seeing a thermometer, the guest had unbuttoned his shirt and lifted his arm. Over much of the world, doctors take a temperature in the armpit. It’s often a struggle to make them understand.

Once the thermometer is in place, I announce that I will wash my hands. This produces minor panic, and someone rushes to the bathroom to tidy up. After returning and announcing the temperature, I sometimes take the blood pressure. It’s not useful for most ailments, but patients, especially the elderly, often expect it.

After the examination, I announce the diagnosis and hand over an appropriate medicine. Then I give advice. You probably think it differs from patient to patient, but this is only partly true. I give several bits of advice regularly. These include:

“Rest doesn’t make this go away any quicker.”

Despite the universal belief, this is true for almost every illness, and it’s miserable to be confined to a hotel room during a vacation. I encourage sick guests to get out.

“You’ll feel bad for a few days, and then you’ll feel better.”

Once a doctor performs his magic, patients often expect immediate results. I receive plenty of calls the next day from guests wondering why they’re still sick.

“If you call, I answer in person.”

I demonstrate by holding up my cell phone. Of course, your doctor also encourages you to call, but have you tried? You reach voicemail or, if you’re lucky, a receptionist, and then you leave a message and wait. I want to spare patients this hassle. But I also don’t want them to call the hotel to let them know they’re not feeling better.

Jumping to Conclusions

Midafternoon is a slow time, so I take a history class at UCLA, and I’m rarely disturbed. But my phone buzzed.

“This is International Assistance about the patient you saw today. She has begun to vomit and wants another visit.”

That morning I had given ibuprofen to a woman with a headache. She was in Hollywood, a tedious eight mile drive through city streets with the rush hour beginning. After twenty minutes of stop-and-go, a sense of unease grew. Ibuprofen shouldn’t cause such a violent reaction. Then I remembered that the Hollywood patient was not from International Assistance but World Assistance.

International Assistance had called the previous night at 1 a.m. and sent me to the Airport Hilton for a guest suffering a backache. I’d given an injection and left strong pain pills for later. I checked caller ID on my cell phone and, sure enough, I’d jumped to the wrong conclusion.

The Hilton was in the opposite direction. It took another twenty minutes to reach the freeway and join the rush hour creep. 

I Don't Like Coughing

“I’ve been hacking up stuff for a couple days, and it’s turning green.”

“It sounds like the virus that’s going around,” I said. “It’ll last three or four or five or six more days. Medical science doesn’t do anything dramatic.”

“At home I’d tough it out. But I have meetings all week, and I need something to knock it out. When can you get here?”

If you read this blog you know my heart sinks when I hear “I need something to knock it out….” It guarantees an unsatisfying visit. Either the guest will feel resentful if he doesn’t get an antibiotic, or I’ll give an antibiotic (if it seems like he’ll blow his top, and sometimes I’m too slow), and I’ll leave hating myself.

Now, readers, you’re probably thinking: “Yes, isn’t it disgraceful that doctors give useless antibiotics so often that patients expect them. But sometimes you need an antibiotic. How can you tell?...”  The answer is so surprising that you and your doctor may not believe it. In an otherwise healthy person (infants and the elderly excepted) the only common disease with a cough that antibiotics cure is pneumonia. Everything else is a virus. ..in my opinion (my lawyer insisted I add that).

I Like Vomiting

A businessman at the Standard had been throwing up since the wee hours. I assured him I’d arrive within the hour. It was nine a.m., so the usual half-hour drive downtown might last longer.

Before leaving, from my medication closet I extracted a syringe, a packet of antinausea pills, and an antivomiting suppository and dropped them into my pocket. This enabled me to avoid restocking my bag after returning home. Sometimes I forget.

The drive was tolerable. The guest was miserable, but he hadn’t vomited in two hours, so I suspected he was over the worst. I left feeling good. I like vomiting.

People chuckle to hear this, but in an otherwise healthy person, most episodes don’t last long, rarely more than a day. My medicines help symptoms but don’t speed recovery. When guests feel better, often by the time the medicine wears off, they believe I've cured them. He felt better by evening.

A Stressful Life

I’m running low on ondansetron, the best antinausea pill.

Unfortunately, I’m not low on many other supplies. I buy through an internet pharmaceutical company that charges a fat handling fee for orders under $200. Eight bottles of ondansetron, 240 pills, will cost $25. I could use more tongue depressors, but 500 at $5.24 is not much help. I dispense large quantities of  cough medicine and lidocaine gargle for sore throats, but those cost only a few dollars a piece. My bottle of 500 Amoxicillin capsules ($28) is half empty; stocking up would help but medicines have expiration dates, so one must be careful.

A few years ago, after thirty years of use, my blood pressure cuff broke, but I had a spare. Should I buy another? Will I be practicing when I’m 108?....

One of my boasts is that, unlike other hotel doctors, the fee I announce is the fee I collect. I don’t charge extra for anything. It turns out that pills, injectables, and supplies for common ailments are so cheap that I struggle to assemble an order exceeding $200. Life is tough.

Dealing With Buenos Aires

“Can you make a visit to Palo Alto?”

“That’s four hundred miles away!”

“How much would you charge?”

“I’m in Los Angeles. Do you understand?”

“Yes. How much would you charge?”

In fact, she didn’t understand. To save money, many travel insurers have closed their US offices, so this call originated from the patient’s home country. Inevitably, dispatchers in Buenos Aires don’t speak English as well as their former colleagues in Miami. I carefully explained that the distance made a visit impossible.

Unlike American travel insurers who require clients to pay up front and submit a claim, South American insurers send a doctor and pay me directly. I’ve made over two thousand visits for them. They’re among my favorites because patients who don’t pay directly are less demanding. Also, these insurers send me to hotels that don’t call or, even better, to my competitor’s hotels. A downside is that, if I don’t listen carefully, they send me to the wrong address. In Spanish “v” and “b” have identical sounds; so do “y” and “ll.”  

Then there was the time an insurer called at midnight.

“Can you make a visit to Culver City tomorrow?”

“Yes… But why did you call so late?”

“Because it says on your profile that you are available 24 hours.”