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.

More Guests I Didn't Help

A travel insurer asked me to see nine sick hotel guests. My first thought was food poisoning, but their symptoms turned out to be coughing and sore throat.

I love multiple visits at the same hotel, but I wouldn’t love these. I visualized the scenario: a large group arrives for an expensive vacation where many fall ill, and in America you need a prescription for an antibiotic. Luckily, they tell themselves, we have travel insurance. The doctor will come and give us our Amoxicillin, and we’ll be fine.

My philosophy on antibiotics is that I prescribe them if they’ll help, and I don’t prescribe them if they won’t. This puts me at odds with doctors around the world not excluding the US.

When I see victims of a respiratory infections (fifteen percent of a family doctor’s business) I do my best. Almost all seem satisfied, but a few make it clear that I have failed them.

Luckily, there was a nearby walk-in clinic where these guests would get their antibiotics.

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 Hotel Doctor's Database, Part 2

Men travel more than women but are less likely to call a doctor so I’ve seen more women (9833) than men (8483). My database contains 124 patients under age one and seventeen over 90, the oldest 97. The smallest of the small hours are not silent. I’ve made 858 housecalls between midnight and 5 a.m.

My leading diagnosis is the same as that of any family doctor: respiratory infections, 4700 visits. In second place are upset stomachs with vomiting and diarrhea: 2672.

I’ve been around long enough to see 77 patients with chicken pox, another 83 with gout, 12 with mumps, 61 with herpes, 29 with poison ivy, and 149 suffering a kidney stone. Victims of kidney stones rarely delay calling a doctor, and since they are rarely emergencies I visit a fair number.  I’ve seen 82 guests with chest pain and sent fifteen to the hospital. Far more of my 30,000 callers complained of chest pain, but I work hard weed out emergencies over the phone. Those fifteen were mistakes.

My most numerous foreign patients are from Argentina, 1854, barely surpassing Britons at 1821. That’s because South American travel insurers mostly began there and are still mostly based in Buenos Aires. But they are expanding, and since 2000 I’ve seen more Latin American guests from Brazil. 

I’ve cared for guests from Andorra, Tonga, Malta, New Caledonia, and Curacao but not from Latvia, Estonia, Yemen, and half a dozen African nations. Russians didn’t travel until the fall of the Soviet Union. I saw my first in 1991. The Chinese don’t appear until 1998. So far Cuba has sent one.

Six guests died – fortunately none in the room after my visit. One was dead when I arrived. Four died soon after I sent them to the hospital and one after the ER doctor (mistakenly) sent her back. I called the paramedics after examining sixteen guests. To my great distress (because that means no payment) paramedics were there when I arrived six times. Many more guests needed attention but weren’t urgent. Leaving after obtaining their promise to go to an emergency room is a bad idea. If the guest decides to wait, and something dreadful happens, I’m the last doctor he or she saw, a situation that focuses the attention of malpractice lawyers. When a guest needs an emergency room, I offer to drive them. I’ve done this 48 times.

28 guests cancelled while I was still driving. 47 weren’t in the room when I arrived. 60 refused to pay. 21 paid with a bad check, but not all were deliberate. I eventually collected on 8. Four times, when I arrived, another doctor was there.  I don’t record guests who get a discount but 173 paid between $5 and $50. 110, mostly hotel employees paid nothing. I will not deny that I have a category for “celebrity.” It has 95 entries although that includes their wives and children. I try to head off drug abusers, but 78 slipped through. The diagnosis on four was “drunk,” but that’s certainly too few.