Saturday, November 22, 2014

We Love to Help You


A patient once kissed my feet after I removed a speck of dirt from his eye. Removing splinters and earwax also produces excellent feedback.

At the other extreme, if I deliver the best medical care for a respiratory infection or sore throat, I’m likely to feel discouraged when the patient delivers a tepid thanks as he leaves. After all, he isn’t feeling better, and I haven’t done anything to cure him. Doctors addicted to gratitude give useless treatments (in this case, an antibiotic) to make sure the patient leaves feeling “helped.”

Doctor love helping patients. That’s why most of us went to medical school. If we’re doing our job, you leave feeling that the visit has been worthwhile. Cures produce intense gratitude, but doctors cure only a minority of the ailments they see, and doctors who pretend otherwise harm their patients.

Monday, November 17, 2014

My Favorite Infections


Urine infections are number one. Handing over a packet of antibiotics, I can assure a woman who has been running to the bathroom every half hour that she’ll feel better by the next morning. In men, urine infections are usually prostate infections; these resolve more slowly, but they resolve.

Eye infections (“pinkeye,” conjunctivitis) respond quickly to antibiotic drops; those that antibiotics won’t help (viral conjunctivitis which may be more common) also go away quickly. Since doctors prescribe drops for almost every red, irritated eye, we find these satisfying to treat.

Bacterial intestinal infections respond to antibiotics but most occur in poor parts of the world. They’re rare in the US where vomiting and diarrhea usually mean a “stomach virus.” Fortunately for everyone, these are generally short-lived, and I carry medicines that help.   

Amazingly, experts debate whether antibiotics help a middle ear infection. Doctors in many nations don’t prescribe them, but Americans do, so patients give us credit when they get better. We like that.

Even more amazing, experts don’t debate whether antibiotics help respiratory infections. All agree that they don’t, mostly. If you’re otherwise healthy and suffer a cough (a cold that hangs on, mucus that turns green, bronchitis), we can cure you – if it’s pneumonia. Otherwise, it’s a virus that lasts a few days to a week or two no matter what we do…. Yes, antibiotics don’t help “bronchitis.” Google it you don’t believe me.

Thursday, November 13, 2014

41 No-Shows


When there was no response after my third knock, I experienced a familiar sinking feeling. Under the category “no show,” my database reveals 41 entries. 

I phoned the room, but there was no answer. At the front desk, the clerks assured me that I had the correct number, and that they had no idea where the guest might be. A security officer opened the room and confirmed that no one was inside.

For mysterious reasons, guests occasionally wait downstairs. I wandered through the lobby and restaurants. With my beard, suit, and black bag, I look exactly like a doctor, and now and then my quarry jumps up and identifies themselves. Not this time.

“When do you plan to arrive?” asked a desk clerk who phoned an hour later, adding that my guest had been waiting in the lobby. When I spoke to the guest, he insisted that he’d “told the hotel” where he could be found. Guests respond badly to a suggestion that they pay for two visits, so I simply went back.

Sunday, November 9, 2014

This Has to Go Into My Blog!


A dispatcher from the agency that handles airline crew mentioned a sore throat, but the guest admitted to an “unprotected sexual contact” two nights earlier. The sore throat appeared soon after, and he was worried. Very worried.

No problem. Unprotected sex with a stranger is a bad idea, but the odds of disaster are low. I settled back to learn what happened, planning to deliver advice which would be mostly reassuring.

He seemed distracted. Asked for details of the contact, he didn’t remember. The phone rang. During the conversation, he pointed out that the caller (apparently his supervisor) had told him to go to a clinic, but someone had arrived who claimed to be a doctor. Could he explain?

That sounded odd. When he hung up, I suggested he call the agency to confirm my identity. He did so and then handed me the phone. The dispatcher apologized and admitted that the guest had been calling since the previous day and seemed disturbed. He hoped I could help.

Confirming my identity did not improve matters. When someone knocked at the door, he told them to go away. Ignoring me, he dialed the hotel phone. Reaching voicemail he explained that he had a clinic appointment but someone had sent a doctor. He needed an explanation. Hanging up, he dialed his cell phone, reaching a friend for a short chat during which he mentioned that there was a stranger in the room.

I suggested that if he wanted to go to a clinic, I could arrange it. Waving this off, he dialed another number. It wasn’t clear who or why he was phoning, but he continued for fifteen minutes. Someone knocked, and he told them to go away. When I expressed a wish to leave, he was standing at the door. For the first time I felt nervous. I repeated my request several times in a soothing voice. He opened the door a crack. I squeezed out, and he slammed it behind me.

In the lobby, I phoned the agency to explain that the guest needed a psychiatric evaluation. Minutes later, as I sat filling out forms, a noisy flotilla of fire trucks, police cars, and paramedic van pulled up.

I followed half a dozen men up to the room. Several crewmates were on the scene, trying to persuade the guest to open the door. They would have succeeded if given time, but the officers wanted to wrap things up.

If I were paranoid, I would not want to hear strange men pounding on my door demanding that I open so they could help me.

They broke in and hauled him off. Acute psychotic breaks rarely last long, and he was back in the room the next day, much better according to the dispatcher. He needed another visit to clear him to fly.    

Wednesday, November 5, 2014

Does Everyone Live Like This?!


The Beverly Garland is a sixteen mile freeway drive. The guest had phoned at 8 a.m. on Wednesday. I avoid distant housecalls during the rush hour; guests rarely object to waiting.

But I had finished breakfast. I had no plans for several hours, and a second housecall would make for a harassing morning. Why not get the visit out of the way?

I checked my traffic app. North on the 405 was not too bad; East on the 101 was solid red. Maybe it would ease by the time I reached it.

Driving north on the 405, and I shared my fellow drivers’ relief that we were not on the immobile southbound side. Half a mile before the connector to the 101, the right lane stopped cold. 

It took another 45 minutes to reach the hotel. I hate being late, but I had warned the guest, giving myself plenty of time. I was bored. I played the radio. I paid close attention to driving, moving at a steady few miles per hour instead of braking and accelerating constantly. Doing that requires allowing the car in front to move ahead some distance. Cars from the adjacent lane occasionally pulled into that space, infuriating the driver behind me. I hoped he wasn’t armed.

Getting stuck in the rush hour was my decision, but millions of people have no choice. They do it ten times a week. How can they live like that?.....

Saturday, November 1, 2014

It's Not an Ear Infection!


When I peered into the guest’s ear, the drum looked normal, so there was no middle-ear infection. When I pulled his earlobe, it hurt but not a great deal. In an external infection (swimmer’s ear), pulling is very painful.

Many adults with ear pain don’t have an infection (children are a different matter). I pressed a finger to his temple in front of the ear and asked him to open his mouth. That hurt badly. He had pain in the temperomandibular (jaw) joint.

The jaw joint is no different from the knee, ankle, or shoulder joint. You can injure it, or it can hurt for no obvious reason. This is common, but I can’t remember the last time someone complained of jaw pain. They tell me it’s an earache.

Flying with a middle-ear infection is a bad idea but no problem with jaw pain, so the diagnosis is good news, but guests are skeptical. Ear pain means an ear infection, and pain medicine lacks the cache of an antibiotic. Guests often make it clear that they’re not getting their money’s worth.

Tuesday, October 28, 2014

Extremely Easy Housecalls

A guest at Howard Johnson’s wanted my services at 3 o’clock on a Sunday afternoon. I had no plans till dinner. Freeway traffic would be no problem. It was a perfect time for a housecall. What a great job….

The desk clerk added that the guest was not in the hotel. He would return at midnight. Could I come then? So I set the alarm that evening and dozed until it went off.
                                                                                    *          *          *          *  
I regularly complain of how far I drive, but sometimes I hit the jackpot. Last week I saw a patient in my own neighborhood, a mile away. He suffered the most common illness I see, a respiratory infection, so I was there and back in half an hour. As I congratulated myself on my good fortune, the phone rang.

“Did the patient pay the deductible?” asked the dispatcher for the insurance service.

“You didn’t mention a deductible.”

“I forgot. There’s a $75 deductible.”

That was annoying. Cheap travel insurance requires a deductible, and guests never remember to pay. When dispatchers forget to tell me to collect it, I insist the carrier pay the full amount. They always agree but never tell the billing department, so it requires several pestering calls after the check arrives. Since this patient wasn’t far, it was easier to get in my car and make a second trip.