You Can’t Make a Diagnosis Over the Phone - The Life of a Hotel Doctor
By Mike Oppenheim, MD
Phone diagnoses do require caution. If a fifty year-old describes chest pain that doesn't sound like a heart attack, it's unlikely I'll tell him that it's OK to wait. It's also unlikely that I'll make a housecall because an examination rarely helps, and I hate collecting a fee and then telling a guest to go somewhere else and pay another fee. On the other hand, chest pain in a twenty year-old is almost never a serious matter.
Abdominal pain is tricky at any age. Guests suggest gas, indigestion, and constipation. I worry about a dozen conditions that require urgent attention. Oddly, it's reassuring when vomiting or diarrhea accompanies the pain. Provided the guest is in good health, that's usually a short-lived stomach virus, my second most frequent reasons for a housecall. Without vomiting or diarrhea, I'm likely to send the guest where a doctor can get more information than a housecall provides.
"I can walk on it, so it's not broken…" "I can move it, so it's not broken…." These are as accurate as most popular health beliefs. I walked on a painful foot for a week before getting an X-ray that revealed the fracture. Hotel guests yearn to hear that their injury is not serious, and I sometimes comply. Doctors do little for cracked ribs and broken toes except to relieve pain, so X-rays aren't essential. All bets are off with the elderly, but it requires a good deal of violence to break a young bone. Lifting a heavy suitcase won't do it; experts urge doctors (in vain) not to order spinal x-rays unless pain persists for six weeks. My greatest service is not in diagnosing fractures (usually impossible) but saving guests the misery of spending hours in an emergency room. Most injuries are not emergencies, even if a bone is fractured. If the guest is willing to wait, I can send him to the more civilized atmosphere of an orthopedist's office.