Insect Bites

A caller was suffering an itchy rash, present for a week. Three companions were also affected. That sounded good. When more than one person has a medical problem, it’s the same problem and not serious.

In the room, all four gathered to show me their skin which revealed the scattered, small pink pustules left by ectoparasites. I use that term to be accurate because not every bug that bites is an “insect.” Spiders, ticks, mites, scorpions, and centipedes aren’t.

Bedbugs (an insect) have become fashionable, but these travelers had been moving frequently from place to place. Where hygiene is reasonable, lice (an insect) limit themselves to hairy areas; I didn’t see any. My diagnosis was scabies, a mite (not an insect) that burrows under the skin. Scabies is hard to catch from clothes or bedding; mostly it requires rubbing against someone else with scabies, and it looked like these young people did a lot of that. 

Deception

A tour leader explained that one of his group wanted a doctor to look at her hand. She had fallen.

Minor injuries are easy, but I don’t want to collect money from someone who needs an x-ray and then send them off to pay more money somewhere else. 

I quizzed him. What happened? Where was the pain? Was there much swelling? He assured me that it was not a big deal. The lady just wanted a doctor to check it.

He was lying. When a member of a tour goes to an emergency room, the leader must go along. Anxious to avoid such a tedious job, tour leaders often hope a doctor will make the problem go away.

The lady had a swollen, painful left wrist. If you fall and instinctively catch yourself on your outstretched hand, you’re likely to break a specific spot at the end of your radius. It’s so common it has a name: the Colles fracture.

I was certain she had a Colles fracture, so off they went.

Gushing Blood

Someone at a Beverly Hills hotel had struck his head on the edge of a table. Blood was gushing, and he wanted a doctor.

Scalp lacerations bleed heavily, but my long experience with bumped heads reveals that the wound is rarely impressive. If victims are willing to apply pressure and wait, they usually agree.

He didn’t want to wait.

This was an upscale hotel, but I am not its doctor who was undoubtedly, this being midnight, fast asleep. Someone had searched the internet and found a housecall service which called me. That meant that I had to give the service forty percent of the fee. My wee-hour charge is not skimpy, but none of this mattered. He wanted a doctor.

I told him I would arrive in half an hour, and the manager expressed surprise when I turned up on time. He led me down a hall, through the kitchen to a large room where the patient was resting on a chair, a wet rag over his forehead. Half a dozen employees stood around.  

Removing the rag revealed that the bleeding had stopped. The wound was a shallow 1½ inch scratch. I delivered the good news and applied a band-aid. Everyone was relieved, and the guest peeled off my fee from a wad of bills.

When an Antibiotic Helps

If you receive an antibiotic for a respiratory infection, it’s probably a placebo because almost all respiratory infections are viruses.

If you receive an antibiotic for a skin infection, there’s a chance you have a bacterial infection that an antibiotic won’t help. A boil or other collection of pus will heal if the pus is drained. If the doctor gives an antibiotic but doesn’t drain the pus, it will also heal. That’s because most infections, boils included, eventually heal.

You’ll get an antibiotic if your doctor diagnoses an ear or sinus infection. It’s a bad idea to ask if this will help because (if he’s honest), he’ll admit that no one knows. In experiment after experiment, when researchers compare patients given and not given antibiotics for ear or sinus infections, the results are never dramatic. Often there’s no difference. Sometimes they help a little. Doctors in some nations don’t treat these with antibiotics.

That’s why urine infections are my favorites. It’s not controversial that antibiotics help. For infections in young women, help comes quickly, usually within a day. These are satisfying encounters for everyone concerned.

Delivering Medical Care is the Easy Part

Park La-Brea Towers is a huge apartment complex in West Hollywood. I’ve been there a dozen times. Inside, the buildings have numbers which follow a cryptic system that I have yet to decipher, and finding them is a chore. Since it’s an old complex with inadequate off-street lots, street parking is permitted.

You don’t want to visit Park La-Brea Towers during the wee-hours. Many streets are gated, and the gates are closed. Everyone is home, and so are their cars.

I went at 2 a.m. last week. I was in luck because someone was leaving as I arrived, so I could slip through the gate before it closed. Since the streets were empty, I was able to drive slowly and peer at the buildings to find the number. Then I searched and searched, but all street parking spots were occupied. I found spaces in the reserved lots, but signs warned of terrible consequences for wrongful parkers. I noticed a car parked directly in front of my building and decided to do the same.

Drawing near, I saw a ticket on its window. I wasn’t willing to take the chance. I couldn’t phone the apartment because the family didn’t have an American cell phone. I phoned the agency and woke up the person who sent me (it’s a boutique agency, so the owner sometimes takes calls). I told her to call the family and tell them to send someone down to watch my car and plead my case if parking enforcement arrived.

Someone duly appeared, and I went upstairs. As usual, delivering medical care was the easy part.

Overdressed for Summer

It’s August. Wearing a suit and tie, I’m reminded of how much I resent hotels that refuse to let me park free. I only learned that the Casa Del Mar didn’t when the clerk declined to validate, and I was stuck for $20. But the Casa Del Mar is on the beach where it’s cool enough to walk a few blocks without suffering.

The Sheraton in Pasadena is in Pasadena where it’s ten degrees warmer than Los Angeles. The average summer day in Los Angeles is tolerable but opening the car door in Pasadena is always a shock. Worse, I travel to the Pasadena Sheraton to see Virgin-Atlantic crew who are British. Foreigners, Arabs excepted, believe that air conditioning is bad for the health. When anyone gets sick, they turn it off, so not only do I arrive at the hotel in a sweat but go about my business in a hot room.

Another Free Service

A caller in Huntington Beach was having a panic attack. He had had them before, and he needed a doctor to come and make sure he wasn’t dying.

This was a bad call in many ways. Waking me at midnight was not one, because I don’t consider that a big deal. Making a housecall for a panic attack is risky because victims often improve while I’m driving and cancel, and Huntington Beach is 45 miles away. There’s not much a doctor on the spot can do with medicine for a panic attack  (“a shot” doesn’t exist).

Finally, the caller didn’t know the fee; I would have to tell him.

In his distress, he had searched the internet and found a national housecall agency. Most such agencies tell callers the fee, so by the time I hear from them, they’ve agreed to pay. But this particular agency specializes in foreign airline crew and tourists with travel insurance where the fee is already arranged. On the rare occasion when an American contacts the agency’s answering service directly, it simply passes the call onto me.

I knew that my fee to Huntington Beach at midnight including a 40 percent cut for the service would never pass. Worse, once I mentioned it the horrified patient would quickly get off the phone.  

That wouldn’t bother an operator, but once someone asks a doctor for help, he or she is obligated to help (ethically obligated; in reality maybe not). So I held off delivering the bad news and kept the conversation going. 

After forty minutes of soothing and reassurance he began running out of gas and admitted that maybe this wasn’t an emergency. He agreed to keep my number and call if he changed his mind.

Taking No Chances

A guest at the Westin wanted a doctor to look at a rash. I quoted the fee, always a tense moment.

“Do you take insurance?”

If the caller is American, the visit is doomed, but this one wasn’t. I asked the name.

“Assistcard.”

I know Assistcard, but it doesn’t allow clients to call the doctor on their own. They must phone Assistcard which confirms their eligibility and then phones me.

Most travelers know this. In the past, when I told the rare exception what to do and then waited for the call from Assistcard, it never came. So I told him I would arrange matters.

Foreign insurers have offices in the US, so their customer service is painfully familiar. I listened to a recorded welcome in Spanish, Portuguese, and English. I punched “3” to choose English. A recorded voice told me to listen carefully to choices on the menu because they had recently changed. I chose and then listened to muzak. 

After several minutes a dispatcher greeted me in Spanish. I proceeded in English which I suspected he spoke and this proved correct. He assured me that he would phone the guest, and arrange approval. He kept his word although an hour passed before he called.

During the wait, the guest’s wife decided that it wouldn’t hurt to have the doctor check her cold. The approval, when it arrived, added a consult with the wife, so it turned out to be a lucrative visit.   

Who's Taking Care of Avianca

Coris, a travel insurer, sent me to the Crowne Plaza to care for a Spanish lady with stuffy ears. She turned out to be a flight attendant for Avianca airlines. Airline crew can’t fly if they suffer a host of minor ailments, so they provide plenty of easy visits.

That evening a call arrived from Traveler’s Aid, a national housecall service, and I returned to the Crowne Plaza. The guest, a Columbian man with a cold, was also an Avianca flight attendant.

That was puzzling. Foreign airlines once called me directly to see their crew. They don’t do that today. They call a more traditional provider organization who then calls me.

But what was Avianca doing? I theorized that it calls Coris, and the Coris dispatcher consults her list for Los Angeles. If she decides to call me, Avianca will pay Coris perhaps double my charge. If she calls Traveler’s Aid, the additional middleman will increase it still more.  

I’ve long since stopped trying to see the logic.

An Easy Visit

A young woman suffered an episode of dizziness earlier that day. By the time I arrived, she had recovered. The examination was normal, and I reassured her. 

Any sudden episode in a young, healthy person (dizziness, chest pain, shortness of breath, even fainting) is probably benign and not worth intensive investigation unless it keeps happening. We take these more seriously in the elderly.

Some guests are sicker than others, but I have a soft spot for guests who are not sick at all. 

Bedbug Calls

“All insect bites look the same,” I explained.

Bedbug calls are tricky. Victims are often unwilling to pay. When, confronted by an angry guest, hotels ask my help and offer to pay the fee, I come but refuse to take their money. The hotel will probably comp the guest’s room, and I don’t want to add to their expense and hassle. Also, since a bedbug call involves management, it’s excellent P.R.

Naturally, I hope that a grateful hotel will remember. This doesn’t always work, but I drove off in a good mood. I love nearby hotels, and the Westwood Comstock, which rarely calls, is three miles away. It’s also very exclusive, and my left-wing politics does not diminish the pleasure of caring for hotel guests with plenty of money.

The patient turned out to be more distressed than angry. Sometime guests show me a rash that is obviously not insect bites. Sometimes I see bites confined to the legs, meaning the guest acquired them while erect, perhaps at the beach. There were many bites on her upper body, so I couldn’t deny the possibility of bedbugs.

I delivered my opinion and handed over a free tube of cortisone cream and my business card. Everyone seemed pleased including the general manager who thanked me for my quick response. Now I must wait.

Departing From Your Routine

Twenty years ago I drove thirty-five miles to Pasadena to see a patient. When I opened the trunk to get my bag, it wasn’t there. I had left it at home. I drove back to retrieve it.

I mention this because last week I made a visit to the Hyatt Regency in Long Beach, thirty-five miles away. I had my bag, but when I consulted my invoice while waiting for the elevator, there was no room number. 

I recalled how it happened. I had never been to that Hyatt Regency, so I had stopped filling out the invoice at home to look up its address on the internet. I found it, copied it down, and forgot to add the room number from my telephone notepad. Departing from your routine is always perilous.

Worse, the patient was a woman. In our sexist society, when a couple checks in, it’s the man whose name goes in the register – and couples sometimes don’t share a last name. That was the case this time as I listened with a sinking heart as the desk clerk assured me that the guest list contained no such person.

The Wrong Way To Do It

“My son has a boil on his leg. Our doctor says he needs an antibiotic.  Could you come to the hotel and give the prescription?”

A boil is collection dead tissue, full of pus and germs. It has no blood supply, so an antibiotic can’t reach it. Antibiotics alone don’t cure boils.

Left alone, boils eventually go away, so victims who use one of the innumerable silly home remedies from the internet will give it credit. Allowing nature to heal is commendable but may require few weeks of misery.

Unnatural healing works instantly. The doctor cuts into the boil, squeezes out the pus, washes the cavity with saline, and then stuffs a strip of sterile cloth into the hole. A few days later, he or she pulls out the strip.

I don’t drain boils in a hotel room, so I had to decide where to send the guest. At an emergency room, the doctor would certainly do the surgery, but an emergency room is a tiresome experience.

A local walk-in clinic would be more civilized. The downside is that the doctor in a walk-in clinic would have a background similar to mine but probably without my vast experience and wisdom.

I sent the boy to a walk-in clinic where the doctor punctured the boil and sent them away with an antibiotic. The puncture might seal and the boil recur (that’s the purpose of packing it with the cloth). Or it might ooze for weeks before resolving. I wish the doctor had done it the right way, but the boil would eventually heal.

Failures in Communication, Part 3

After a forty minute drive, I arrived at 4020 Los Feliz Blvd. No one answered my knock. Thinking the patient might have stepped out, I took a walk around the neighborhood and knocked again and also phoned to no avail. I returned home in a good mood. It was an insurance call, so I’d be paid.

Another call arrived at 5 p.m. I dislike driving during the rush hour, but the patient lived near Beverly Hills only five miles distant. The address was 821 Coldwater Canyon Drive, but I discovered that Coldwater Canyon addresses begin with 900. I continued north, assuming the numbers would drop when Beverly Hills became Los Angeles, but they kept getting higher.

Coldwater Canyon is a not-so-secret alternative to the freeway into the San Fernando Valley, so it’s bumper-to-bumper during the rush hour. Finally, I gave up, pulled into a side street, and phoned the patient. It’s not 821, he said, but 1821. The dispatcher had told me wrong or perhaps I had heard wrong.

That evening an insurer called to ask me to return to the Los Feliz patient. Insurers usually refuse to authorize a second visit to a no-show, but I was happy to go. The dispatcher repeated the address: 1420. Whoops. Whose mistake was that?....

The Easiest Part of Medical Care

The phone rang at midnight for a housecall in Long Beach, 35 miles away. So far, so good. Freeways were clear, and the caller was a reliable travel insurer who agreed to my fee. Good.

The patient was young and suffering a fever. That sounded easy. The patient was a student at California State University, Long Beach. Uh oh.

Navigating a college campus is a nightmare. The address of a university is the administration building where no one lives. College buildings have names or numbers, but they follow their own logic.

The patients are foreign, unfamiliar with the geography, and unhelpful. Finally, campus police may be slow responding to rape and burglary, but they pounce fiercely on an illegally parked car. You don’t want to park inside a college campus without a permit.

Taking no chances, I parked on Bellflower Boulevard outside the entrance and walked far across the campus to the dormitories and International House where I assumed he was staying. As I approached, I saw that the barrier to the lot next to the building was raised, and I could have parked. C’est la vie. As usual, delivering medical care was the easiest part.

Do You Accept My Insurance, Part 2

“I can’t afford that,” wailed the guest, an Australian newlywed at the Biltmore when she learned my fee. She had travel insurance, and I had told her it would undoubtedly pay when she submitted my invoice. But unsophisticated travelers who have never used insurance or asked for a housecall often panic.

I lowered the fee to $250. She consulted her husband who countered with $150.  

Since it was 11 p.m. the drive downtown was easy. When the husband ushered me in, I discovered they were staying in a large, two-room suite. The Biltmore charges well over $300 per night for suites.

But they were young, and I didn’t know their story. I did my duty and pocketed his $150. I was not disturbed and had material for a blog post.

Do You Accept My Insurance?

That’s the most stressful sentence a hotel doctor hears – more than “I’m having chest pain” or “my mother stopped breathing.”

American insurers look with deep suspicion on housecalls, and no hotel doctor wants to bill them. But almost no American has experience handing money directly to a doctor – and a housecall costs a good deal more than an office visit. Many of these guests agree to pay, but I often sense their discomfort. Other doctors are not so picky, but if they sound too reluctant I inform them of local walk-in clinics.

Foreign insurers are different. Many call me directly. Resigned to our rapacious medical system, they expect immense bills. I charge everyone the same, but I’ve been contacted by doctor-entrepreneurs who offer triple my usual fee to make their hotel calls in Los Angeles. They can afford this, they assure me, because they charge several thousand dollars for a housecall. This sounds creepy, but it apparently works because I’ve heard from these doctors more than once. 

Goodbye to the Shangri-La

“I’m not calling for a guest,” explained a desk clerk from the Shangri-La in Santa Monica. “I have a question…. In your arrangement with hotels, do you ever pay anything when we call?”

“That’s illegal,” I said. “I’m happy to give employees free medical care, but it’s against the law for a doctor to pay to get a patient.”

“Is that so? Are you sure?”

“Google it. It’s called a referral fee; it’s unethical and also against the law in California. If you use a doctor who’s breaking one law, what other laws might he break?....”  

“Oh, this is just for our own information. I appreciate your help, doctor. Thanks.”

Goodbye to the Shangri-La, I said to myself after she hung up. I’ve been going there since 1985, but the Shangri-La is not large. Since I give plenty of free phone advice, months may pass before I make an appearance, so most employees have never seen me. I don’t market myself, and most general managers leave the choice of a doctor up to the employee, so I regularly lose hotels when a competitor offers his services with the promise of a referral fee.

Sometimes, often years later, they return. Google “Doctor Jules M. Lusman.” He took a number of hotels away from me, but I regained them.    

Caring For a Physician

Having a doctor as a patient is stressful. They often suggest their diagnosis, and it’s awkward if I disagree. When I make a housecall, American doctors sometimes hint that I shouldn’t charge them.

This patient was an anesthesiologist, a good thing because he almost wasn’t a doctor at all – i.e. he’d long since forgotten how to deal with illnesses. He was foreign, another good thing. And he was Danish: the best sort of foreigner because Scandinavians speak good English. 

He had a headache and a 101 degree fever but no respiratory symptoms. I diagnosed a viral infection, perhaps even Dengue fever because he had flown in from the South Pacific. He did not object to taking pain medicine and waiting, and he recovered after a few days.

More Unsatisfied Guests

The son of two Viceroy guests was suffering a severe sore throat and fever.

I drove off in a good mood because it sounded like an easy visit. This combination often indicates “strep” which an antibiotic cures. Patients like that, so I like it, too.

In fact, sore throat and fever in a grown-up is usually a simple viral infection, my least favorite illness. Strep is overwhelmingly a disease of children and adolescents, but this patient was fourteen, so my hopes were high.

They were dashed when the boy admitted that he had a cough. Strep is strictly a throat infection; coughing is not part of the picture. Sure enough, his throat looked normal.

Rummaging thoughtfully in my bag, I pulled out a packet of acetaminophen (Tylenol), handed it to the parents, and explained that this would help his fever. I extracted a plastic bottle of Lidocaine, a gargle intended to relieve his throat pain. I gave them a cough medicine is similar to the popular Robitussin but in an immense eight-ounce bottle.

I assured them that bed rest would not help, so he should try to enjoy himself. He could eat whatever he wanted. But it was likely that he’d feel under the weather for a few days before recovering.

The parents seemed happy to receive the medicine. They expressed gratitude for my service, and thanked me effusively as I left, but I knew that this was mostly good manners.  They were on vacation. The doctor had come, given some not-very-powerful medicine, and told them the child would continue to be sick. Did the doctor realize how important this trip was to them? Maybe if he had tried harder…. Or if they’d called a better one…. 

Not a Bad Job

Awakened at night, most hotel doctors prefer to give advice, and, if that fails, they discover that the guest requires the paramedics.

I don’t mind wee-hour calls. Traffic is light, parking is easy, and since I have no office, I can sleep late. With TIVO, I can leave whatever television show I’m watching. I don’t mind calls during meals, even restaurant meals, because finishing doesn’t take much time. Calls during a movie are problematic although I’m happy to leave at least half the time. If the call arrives soon after the credits, I ask for a refund, and no one has yet refused. I credit much of my success as a hotel doctor to the rarity of occasions where I’m reluctant to make a visit.

Mostly, I dislike driving during the rush hour. Hotels between Beverly Hills and the ocean are close enough to be tolerable, but traveling downtown or further is tedious. Mostly, guests are willing to wait a few hours provided they are not vomiting or hurting.

Two For the Price of Two

An insurance service informed me that two sick children awaited in Orange. It’s a rule that if one child is sick, there’s a small chance it’s serious; for two children, never. They almost always have a simple virus.

The major difficulty was the distance, nearly fifty miles, and the fact that my wife was preparing dinner. To my delight she offered to delay it and accompany me on the visit, something she rarely does. We had a pleasant hour’s drive to Orange where I cared for two children with a simple virus, and we ate dinner at the hotel.

Lost in Translation, Part 3

“I am constipated.”

“’Constipation’ means different things to different people. What exactly bothers you?”

Silence…. When a caller doesn’t answer, it usually means he doesn’t understand.

“Do you have pain?”

Silence.  I knew the word for pain in French is ‘douleur.’

“Pain….douleur?”

“Yes.”

“So you have pain in the abdomen.”

“Yes,” he answered without conviction. He made it clear he wanted a visit, so I quoted my fee (“yes”) and made the trip.

Half of my hotel guests are foreign, but usually one person in the group speaks enough English to get along. Men do better than women. Guests from Asia cause the most trouble. South Americans are the easiest because every hotel has Hispanic workers. I can’t remember the last time I drew a blank from a European male.

“When was your last bowel movement?”

Incomprehension. The wife handed me an Ipad with a translation app. I typed “bowel movement” and the screen obligingly displayed “movement de l’intestine.” Even I knew that this meant “movement of the intestine” in French. He looked blank.

He had no fever, and my examination of his abdomen was normal. His urinalysis was unremarkable. He wasn’t old enough to be at risk for the many abdominal catastrophes that affect the elderly. I concluded that it wasn’t an urgent problem. He seemed to understand that he should go to the hospital if he weren’t better in a few hours. The hotel promised to keep an eye on him. Everything worked out.

A Stoic Patient

This patient lived on the edge of Beverly Hills, far up Topanga Canyon Road. Turning into a side street, I stopped at a guard house. It was not impressive – a tiny shack next to a commercial port-a-potty, but a genuine uniformed guard asked my business. According to Google, the street beyond held only a dozen houses, but they were big. Really big.

Following the lady who greeted me at the door, I walked and walked, passing through room after room with polished wooden floors, high ceilings, exquisite furnishings, bookshelves and paintings lining the walls. Movie stars and Arab princes live in such places. Visit Hearst’s Castle to share the experience.

But sick people are just sick. A lady was suffering excruciating right eye pain. She hadn’t injured it. My diagnosis was acute glaucoma, an emergency.

You may know about glaucoma, a disease where fluid drainage from the eye is blocked, increasing pressure, eventually causing blindness. Experts advise you to have a yearly check, but this is for common, chronic glaucoma where pressure rises slowly, so doctors can make an early diagnosis and treat it with eye drops. It’s painless. Acute glaucoma, where drainage stops abruptly, is rare and very painful.

This was not news to the patient who explained that many family members were blind from the disease. She agreed to go to UCLA’s emergency room but asked for something to help her vomiting; severe pain often causes vomiting. I gave an injection and took my leave.

Phoning the next day, I was flabbergasted to learn she had stayed home. She didn’t want to travel because of the vomiting, she explained. By evening it had diminished, but so had the pain. She decided to wait. She had an appointment at the ophthalmologist for the afternoon.

Twilight of the Hotel Doctor

Uber is driving taxi companies out of business. Air Bnb is putting stress on hotels. A stream of retail chains are declaring bankruptcy in the face of online competition. No one doubts that this trend will continue. Online services are cheaper if sometimes inferior. Uber drivers earn less than traditional cabbies – not a notably prosperous profession. But customers aren’t complaining. They like cheap.

It’s absolutely certain that housecall doctors like me are doomed. We’re expensive and often – at least in my case – the quality of our service is too good.

Los Angeles residents already have a choice of two phone apps. Tap either one, enter your credit card information, and a doctor will arrive within hours. The fee will be less than mine – and I charge less than the typical hotel doctor.

One consequence of a low fee is that they pay doctors less than the going rate. As a result, they attract residents in training or just beginning practice, but these seem adequate.

As you know I work for everyone, and I worked for both. I didn’t care for the low pay, but I’d still be working if it weren’t that I had no control over the patients I saw.

When hotel guests phone, I always talk to them. If the problem is minor, I give advice and suggest that a housecall isn’t necessary. If it requires a simple service such as a prescription, I take care of it over the phone. If it requires a test, x-ray, or emergency room visit, I can usually determine that.

If the guest has unrealistic expectations, I can avoid an unsatisfying encounter. I can warn a hoarse singer that she probably won’t be better by evening.

Many callers request treatments that they don’t need. You might think of narcotics, but mostly it’s an antibiotic for their respiratory illness. I only prescribe an antibiotic if it will help which puts me at odds with most of the medical profession, so many patients will be disappointed and a few upset if I don’t treat their “bronchitis” or “sinus infection” as their doctors do. When this seems likely I direct them to a local clinic where they’ll get their antibiotic or (if they stumble on a competent doctor) express their disappointment to someone else.

When hotels phone, I make a housecall less than half the time. Guests love the free service. Even better, when I drive off, I know that I’ll be able to help, and – no less important – the guest will feel helped.

Working for these Uber services, I had to make every visit they assigned. All I learned was a symptom (“cough” “allergy”). The result is that I walked into situations where a housecall was not appropriate (“granny hasn’t seen a doctor in thirty years; would you check her out?...”). Many had problems I could have handled over the phone; others required more than a housecall could provide. And there were the usual unreasonable requests.

My faithful readers know that hotel visits don’t always work out. I’d estimate that five percent are less than satisfactory. Working for housecall services, the percentage was much higher. I didn’t like the stress of wondering what I would encounter.

But I see the writing on the wall. Hotels that emphasize superior service (i.e. expensive ones) will continue to refer guests to a specific doctor. Otherwise, ironically, the old days will return. When I began in 1983, motels and chains (Holiday Inn, Ramada, Hilton, Best Western…) had no interest in a hotel doctor. At least in Los Angeles, I was the first to approach them. By the 1990s, they were calling me and an increasing number of competitors, but managers of these hotels still pay little attention, so employees are on their own when guests ask for help.

Although my faithful clients continue to call, I’ve noticed a decline from the great mass of hotels that never called regularly. But I already collect Social Security, and I’ll be fine when I retire.

Easy Money, Part 2

“I need an eye doctor,” said the caller. “A big red spot came out this morning!”

The guest added that the eye felt fine. The spot didn’t affect his vision but looked terrible.

I’ve encountered several dozen subconjunctival hemorrhages, a fancy name for a bloody patch on the eyeball. Googling turns up a dozen causes from injuries to coughing, leukemia, high blood pressure, and clotting disorders. In reality, if there are no symptoms and the person is in good health, the blood appears for no reason and disappears in a few weeks. That’s happened in every case I’ve seen, including my own.

The guest was staying at the Mondrian, a luxury hotel. He was in room 500 which I knew was a suite. If he’d been at a cheap motel, I might have been more reassuring, but I confined myself to suggesting he might have a subconjunctival hemorrhage and that this was probably not as serious has he thought. He wanted a visit.

It was, of course, entirely satisfying. I examined the eye, paused thoughtfully, and then assured him that it was a subconjunctival hemorrhage and that he had nothing to worry about. He was thrilled. I collected my fee. Everyone was happy.

When the General Manager Consults the Lawyer

The concierge expressed relief when I answered. A lady’s 11 year-old son was seriously ill, but the mother had refused to take him to an emergency room. She had been pestering the hotel staff all day.

“What’s the problem?” I asked. “You only had to phone me.”

I’d made over 300 visits to that hotel since the 1990s. But even as I spoke, I remembered that it hadn’t called in six months. As I feared, the concierge explained that a new general manager had decreed that, for liability reasons, sick guests would be directed to the local emergency room unless calling 911 was appropriate. Doctor referrals were forbidden.

At any given time, about twenty percent of Los Angeles hotels have this policy, but it’s never the same twenty percent. Hotels adopt and then discard this rule because it causes public relations problems. Most guests don’t require 911 and don’t want to go to an emergency room, so they stay in the hotel, sick and resentful. A few persistent guests make so much trouble that, as in this case, a desperate employee disobeys her boss. I’ve made a dozen such visits.

Calling me would have saved everyone trouble. The child had a fever and a bad cough, a routine viral infection. It was an easy visit.

Afterward, as I was commiserating with the concierge, my phone rang with an example of how things are done right. A man at the Langham in Pasadena wanted a doctor to check out his cold. I told him I’d arrive in 45 minutes.

A Rule of Medicine That Didn't Apply

I give out medicines gratis. Mostly, they’re cheap, but exceptions exist. For unclear reasons my supplier charges $17 for antibiotic ear drops but $1.50 for antibiotic eye drops. Experts agree that it’s OK to use antibiotic eye drops in the ear, so that’s what I do.

I felt pleased handing over a bottle to a lady with swimmer’s ear. Ear infections are easy visits, and guests appreciate that they do not have to hunt for a pharmacy.

My heart sank when the guest’s insurer called the following day. She wanted another visit. I phoned the guest who admitted that her ear was no worse, but now she had a fever, headache, and sore throat. That was disturbing. Had I missed something?

I returned to the hotel. She had a 102 temperature with swollen tonsils and swollen neck glands. Since she was barely out of her teens, Strep throat was a reasonable diagnosis.

It’s a rule of medicine that a doctor who makes two separate diagnoses is not thinking clearly. Patients have one thing, but this woman definitely had swimmer’s ear and Strep throat. 

Relentless Time

Melrose Avenue is hip and upscale as it passes through West Hollywood. Further east, toward downtown, businesses tend toward pawnbrokers, bodegas, and Kentucky Fried Chicken. At least that’s how I remembered it.

If you live long enough, everything familiar vanishes, and I parked among a chic collection of freshly painted boutiques, restaurants, and fashionable clothing shops. Plus a beautiful new hotel that I’d never heard of.    

It was the Hollywood Historic Hotel, converted from a 1920s apartment a few years ago, I learned from the desk clerk. He insisted that I was the first doctor that had appeared, and he seemed happy accept my card.

Even better, there was no answer when I knocked. Since I’d come at the request of a travel insurer, I’d be paid. I tell the insurer that if the guest wants to drive to my home, I’ll take care of him at no charge. No one has taken me up on it.

Goose Chases

I knocked at room 777 of the Hyatt Regency, downtown. The guest who answered denied calling a doctor.

Did I get the room number wrong? It’s happened, but this seemed unlikely. Did I get the hotel wrong? There is only one Hyatt Regency in Los Angeles but many Hyatts. The only one that calls regularly is at the airport. I phoned. Sure enough, room 777 at the Airport Hyatt wanted a doctor.

“You’re at the Hyatt,” I said. “Why did you say you were at the Hyatt Regency?”

“Aren’t they the same?”

They aren’t. I drove the fifteen miles to the airport and took care of him.

A Medicolegal Visit

A guest was eating lunch in the hotel restaurant when the chair collapsed. Unfortunately, her hand was resting underneath. The desk clerk asked if I could come immediately.

During my early years, I would hurry over, take care of the problem, and present my bill only to have the guest insist that the hotel was responsible. Management sometimes disagreed, so I learned to settle matters over the phone.

“I need to know who’s paying,” I said.

The clerk she put me on hold, returning to announce that the hotel would take care of it. This would be my 146^th  medicolegal visit, my name for a housecall when the hotel offers to pay. Most involve minor injuries that occur on the premises. There were also thirteen upset stomachs, purportedly from hotel food, and nine insect bites, always bedbugs according to the guest.

I arrived to greet a young Englishwoman, her hand in a bowl of ice. Two fingers were exquisitely painful. She needed an x-ray. I found a local orthopedic group on the internet and phoned.

“An initial visit is $500,” said the receptionist. “She needs to pay when she comes in.”

“Wow!” said the guest when I passed this on. This was probably not a comment on the size of the fee (which the hotel would cover) but the traditional European amazement-cum-horror at American doctors’ preoccupation with money.

Both fingers were fractured. Fortunately, her visit was ending, and she flew home the next day.