Treating Foreigners , Part II | The Life of a Hotel Doctor

After a few years of hotel doctoring, I obtained an unmatched education in national styles in medical practice.

Critics claim American doctors overprescribe. They’re right, but in the national competition for excessive drug use, America makes only a modest showing. The Chinese take first place. In countries where statistics are available such as Taiwan, health expenditures for drugs far exceed those in the US.

I made a hotel visit to treat a Taiwanese eighteen-month-year old with a viral infection. My exam turned up nothing worse than a slight fever, so I handed over a bottle of Tylenol drops and gave my usual advice. It was not a serious illness, I explained. The child might feel bad for a few days then it would recover; staying in bed wasn’t necessary; they shouldn’t change their travel plans… The parents nodded politely as I spoke. At the end they remained where they stood, silent and respectful. After a few seconds I had the uneasy feeling they expected me to continue. I noticed the pair exchange a glance. Finally the mother summoned the nerve to speak.

“Baby having water from nose… Some medicine?”
The runny nose didn’t seem to upset the child, so I told her treatment wasn’t necessary.
“Not eat. Give medicine for eating?”
I repeated that sick children often lose their appetite. It was not an alarming sign; she should encourage him to drink.
“Not sleep…” As I patiently explained the danger of overmedicating children, the parents nodded respectfully but looked increasingly depressed. They were undoubtedly thinking “We come on this expensive trip. Our child gets sick. The American doctor doesn’t know the right medicine.” After a few unsatisfying encounters I began to carry small bottles of saline nose drops, vitamins, and weak cold remedies. I could never fulfill all their desires but these were enough to leave the impression I was not wildly incompetent.

Outside of industrialized nations, pharmacies sell antibiotics without a prescription. Everyone takes them when they have an “infection,” and since the infection goes away in a few days, everyone believes the antibiotic cured it.

An Argentinean businessman, already annoyed after visiting a Rite-Aid to discover he can’t buy amoxicillin for his cough, sat patiently through my explanation of the uselessness of antibiotics for viral infections and the terrible dangers of resistant bacteria now spreading over the world.

Despite the silence, I knew he was thinking, “You have to see a doctor in this country to get an antibiotic. American doctors have a real racket going. This fellow’s telling me I don’t need anything. Is he a real doctor?”

Americans believe that other nations admire American medicine. This is true for anything involving expensive technology or life-threatening diseases. It’s not true for common illnesses where everyone takes for granted doctors in their own country know better.

Like all Americans, I know that stress affects everyone in complex ways. A good doctor seeks out and treats the stress factors in any illness.

German physicians pay little attention to stress but know that low blood pressure affects everyone in complex ways. German doctors consider low blood pressure a significant physiological disturbance. They seek it out and treat it, often with big-league medicine such as adrenal hormones. At first I was puzzled when young Germans with fatigue, upset stomachs, headaches, or flu symptoms wanted me to check their blood pressure. Then I learned.

My French patients showed no interest in stress or blood pressure. They told me they suffered liver problems despite never having had hepatitis. French tradition asserts that subtle liver disorders underlie many common ailments. It’s reasonable to attribute this to the universal consumption of wine in France, although alcoholism and liver cirrhosis are much less common than in the US.

The English are the world’s best patients because, perhaps unique among nations, there is no English theory of disease. They blame the climate or food.

To be continued.