A Costly Mistake

Since 1984, twelve hotel guests cleaned their ear with a Q-tip, extracted it, noticed that the cotton had vanished, and called for a doctor.

These were stressful visits because I worried that the cotton might be too far inside to reach, and I don’t like poking with needle-nosed tweezers. Mostly, I was lucky, but one visit didn’t work out as planned.

“I don’t see anything,” I said after looking in the ear. The guest insisted that I must be in error. I looked again. Nothing that didn’t belong.

While he thought this over, I looked in the bathroom. On the floor near the sink lay a tiny ball of cotton.

He tried to laugh this off, but I could see his pain. I’d made the visit at the request of a housecall service that had already collected on his credit card, so there was no way I could give him a discount. It was an expensive mistake.

Another Arab Prince

It seemed a routine visit for an upset stomach until I knocked at what turned out to be the penthouse suite of a Beverly Hills hotel. The man who answered identified himself as “the prince’s personal assistant.” I followed him into another large room where the prince, an elderly Saudi, lay in bed. It was five in the morning.

The assistant indicated the patient – not the prince but a young woman sitting nearby, looking wan. I took her into another room to deliver my care. She was an American in her twenties, and I wondered why she was in the prince’s room at this hour. Perhaps she was a prostitute, but she seemed nice.  

When I returned to the bedroom, the prince thanked me for coming, adding that he had a personal problem. He suffered crippling back pain and had run out of medication. Could I help? As we talked, I noticed the assistant waggling his finger in a gesture indicating that I should not pursue the matter. I took the hint.

Accompanying me to the elevator, the assistant explained that everyone preferred that the prince’s doctor handle the prince’s drugs. Then he pulled out a sheaf of bills and paid me far too much. I don’t decline tips from the very rich.

Most Arabs that I see are ordinary people, but over thirty years the occasional prince turns up. They pay generously and provide material for this blog .

Losing Two Out of Three

A guest at the Hollywood Heights with an upset stomach requested my services. I had barely hung up when an Englishman at the Shangri-La wanted a doctor for a respiratory infection. These hotels were not convenient – the Hollywood Heights is ten miles east, the Shangri-La in Santa Monica five miles west. But two visits make for a good day, so I drove off in a pleasant mood.

As I approached Hollywood, the phone rang. My heart sank when I learned the caller was the Sheraton in Pasadena, twenty miles away – thirty from Santa Monica.  
  

Having visits pile up, especially those with long drives, oppresses me, so this was one I’d prefer to skip.

This guest’s husband, who was driving to the hotel from the airport, was suffering a cough and sore throat and wanted a doctor when he arrived. Launching my no-visit effort, I explained that viral infections cause these symptoms in almost all cases, so a doctor can do little except relieve symptoms. I suggested that she discuss this with her husband when he arrived. She agreed. With that weight off my shoulders, I continued on to the Hollywood Heights.

After finishing, I reversed my course and headed for Santa Monica. As I neared the hotel my phone rang. “A friend of mine found a bottle of amoxicillin,” said the Shangri-La guest. “I think I’ll give it a try and save you the trip.”

Having lost that visit, I immediately called the Pasadena Sheraton. The husband had arrived, and they had decided to wait.

The Kiss of Death

Malpractice insurers look with suspicion on doctors who operate pain clinics or diet clinics or who perform botox injections or liposuction. My brother saved $12,000 on his premium when he gave up obstetrics – and that was thirty years ago. Doctors pay a fat surcharge if they engage in controversial practices, perform legitimate if risky procedures, or have personal difficulties such as numerous malpractice suits.

None of this applied to me. From a malpractice carrier’s viewpoint, I was easy money. I saw perhaps one fifth as many patients as an office doctor. Being travelers, they were younger and healthier than average. Even better, most were foreigners who don’t sue.

Except writing for a large check every year, I ignored this area until a letter arrived in 2003 from my malpractice carrier. It was a routine survey with questions about the nature of my practice: hours of operation, employees, office locations, number of patients, hospital affiliations, procedures.

I made certain they understood that I was a full-time housecall doctor who cared for a small number of healthy, nonlitigious patients.

A few weeks later I opened a certified letter cancelling my insurance. It was a terrible shock. When I applied to other carriers, all turned me down. I contacted an insurance agent who was very helpful and obtained a policy from a company in Illinois that specializes in difficult cases. It cost three times what I had been paying.

Each year when she applied to the regular malpractice carriers, they declined. They won’t insure a housecall doctor, she explained.

How did this affect my competitors? It didn’t. They cared for hotels as a sideline, usually from an office practice. If asked, none would deny that they make housecalls, but no carrier forbids them, and they’re so uncommon that applications for malpractice insurance don’t ask about them.

Boasting that I was America’s only fulltime housecall doctor produced flattering feedback but got me the kiss of death from my malpractice carrier. Perhaps they remember celebrities from Michael Jackson to Elvis Presley whose lurid final moments involved a doctor who made home visits.

Dodging a Bullet

The army does not hand out generous transportation allowances, so it housed this officer’s family in a single room of a Days Inn. Arriving, I squeezed past stacks of luggage and between three rollaway beds where the children slept.

I suspected the officer’s wife had pneumonia. Although rarely serious in a young patient, she looked sicker than usual: feverish and short of breath. 

Doctors make most decisions based on evidence or gut feeling, but sometimes a third factor intervenes: inconvenience. For example, as a patient it’s risky to be the final appointment before lunch or at the end of the day. There’s a small chance the desire to get out of the office will influence the doctor. Rarely, this leads to a decision that comes back to haunt him. I’ve been around long enough to think twice before making a decision that saves aggravation.

Leaving after giving an antibiotic for pneumonia was a reasonable option, but, reluctantly, I announced that the wife needed to go to an emergency room.

Aggravation followed. The father did not normally care for the children, so I sat patiently for half an hour as he woke them, struggled with their clothes, made several phone calls to reschedule his flight, and then shifted a dozen boxes between his wife’s bed and the door. After this was well under way, I left to fetch my car, parked two blocks away. Fitting six people into a tiny Honda took additional effort.

It was a relief to usher them into the waiting room, explain matters to the clerk, and say my goodbyes. It was a greater relief to learn, when I called the hospital later, that the wife lay in the intensive care unit and on a respirator, fighting a catastrophic pulmonary infection.

Can I Submit This to My Insurance?

The guest’s symptoms suggested a urine infection, one of my favorite diseases. They’re miserable but respond quickly to antibiotics. This looked like a good visit. I quoted my fee.

“Oh… I didn’t realize it would be so much.”

This happens. I remember guests from the Four Seasons where room rates start at $600 who didn’t want to pay half that. In any case, once I mention the fee, I consider it tacky to refuse someone who complains. I quoted a lower fee. That was OK.

It was a good visit. I tested her urine, announced she had an infection, and handed over her medicine. She was grateful. As I left, she indicated my invoice.

“Can I submit this to my insurance?”

“You have travel insurance?”

“I think so. They made us buy something for this trip.”

It was too late to ask why, if she had insurance, she had objected to my fee. But this also happens. In every developed country except Russia and China, if you need a doctor you don’t first decide if you can afford it, so foreign tourists often pay little attention to insurance.

Really Good Luck

I was leaving the Universal City Hilton when the elevator stopped. The door opened, and a young man rushed in, blood dripping down his face.

“I have to get to a hospital. How do I get to a hospital?” he cried.

I told him to calm down and peered at his bloody scalp, but the light was too dim to make out anything. “I hit my head on the edge of a table,” he added. “I have to get to an emergency room!”

We left the elevator at the ground floor, and I looked more closely but couldn’t see anything alarming. Introducing myself as a doctor, I led him to the men’s room, and cleaned away the blood. There was no laceration, just a long scratch along his scalp that was oozing blood. I patted it dry, applied a dressing, and assured him that it was not serious and didn’t require a trip to an ER. He felt better.