I hear this now and then when a guest learns my fee, more often in the form of a hint ("I'll talk to my husband and call you back…").

My routine is to listen to a guest's symptoms, deliver an opinion and advice, and discuss options (only half my callers require a housecall). Once a guest agrees to a visit, I reveal the cost.

Hearing a reluctance to pay, I mention local walk-in clinics. Their basic charge is less than mine, although that difference disappears if the doctor does anything (i.e. order a test, give a shot, write a prescription).

I feel uncomfortable suggesting leaving the hotel room if it's a struggle - for example if someone is vomiting. This guest had been throwing up for several hours. In these cases, I insist on coming, telling them they can pay whatever they feel is fair.

Many guests end up paying the usual, but I've taken as little as $5.00.

Since she had already protested the fee, my expectations were low. They dropped to zero when I approached the hotel and saw paramedics loading her into an ambulance.

The guest's symptoms were not life-threatening, but paramedics lean over backwards to take patients to the hospital, having been burned in the past when they didn't.

I wondered if she had called them because of worries about my fee. She may not have realized that paramedics will send a bill far greater than mine.

Mike Oppenheim