Mrs. Pigg grabbed a McDonald's lunch on the way to my office, and chomped it down in my waiting room. That's fine, many of us live in a hurry.
So when I called her back for her appointment, she had a pile of empty wrappers, ketchup packets, a french fry container, some napkins, and a soda spread all over my lobby table. She got up to come back to my office, and I said, "Mrs. Pigg, you left your lunch stuff out there."
Without even looking backwards she said, "Yeah, I'm done with it".
Wednesday, September 30, 2009
Gee, Thanks
I was doing a market research phone conference this morning. They always start with some demographic info.
Market Research Guy: "Doctor, are you in solo or group practice?"
Dr. Grumpy: "Solo practice."
Market Research Guy: "Really? That's kind of quaint. I thought all you old guys were dead."
Market Research Guy: "Doctor, are you in solo or group practice?"
Dr. Grumpy: "Solo practice."
Market Research Guy: "Really? That's kind of quaint. I thought all you old guys were dead."
Tuesday, September 29, 2009
Ooooooo, Please Tell Me More..........
20-something pretty blond drug rep cheerleader:
"Doctor, our migraine medication is one of the fastest-acting pills in its class. It often starts working within 30 minutes, allowing for fast relief with an oral formulation. Wouldn't your patients like to have some fast oral relief?"
Annie kicked me under the counter to keep me from saying something I'd regret.
"Doctor, our migraine medication is one of the fastest-acting pills in its class. It often starts working within 30 minutes, allowing for fast relief with an oral formulation. Wouldn't your patients like to have some fast oral relief?"
Annie kicked me under the counter to keep me from saying something I'd regret.
Whatever
Mr. Phone: "I need to come in today!"
Mary: "We can see you at 1:15 this afternoon."
Mr. Phone: "That's too soon. How about tomorrow?"
Mary: "We can see you at 1:15 this afternoon."
Mr. Phone: "That's too soon. How about tomorrow?"
Dear Mr. Pantsoff,
Sorry I was kind of rude on the phone last night.
I wasn't able to be at Cub Scout camp this weekend, as I was on call. It obviously bothers you that my daughter Marie was there, but my wife didn't really have a choice but to take her, since I wouldn't be home to watch her. I can't haul her around to hospitals, and since she's 8 I can't leave her home alone for a weekend (although you clearly disagreed with the last point).
I'm also sorry that your kid is such a shit, but it ain't his fault. I mean, it was no secret last year when you and that other Mom began sneaking away during den meetings that you were shagging in the bathroom. I think it's nice that now you've both left your spouses to be together. Your boys have a lot in common, like the fact that they're both 10, and in the same scout den, and have skanky parents.
Anyway, I think it was entirely unreasonable for the scout master to have disciplined the boys for stealing and breaking other kids' projects this weekend. Apparently you and your squeeze were off balling in the bushes during that time, so it was inconsiderate of him to try and teach them some manners in your absence.
Also, why you were yelling at me last night about your kids not getting to make bows & arrows (and that being the reason they tried to steal the ones my kids made), makes no sense to me. I wasn't at camp this weekend, and am certainly not the reason you guys were 6 hours late getting there. The schedule clearly listed that project as being at 9:00 a.m., and you guys didn't show up until 3. I think it's downright unfair that the scout master didn't immediately put the other 15 kids on hold to take care of yours. After all, you and the lady (who I think may have recently been featured on CK Lunchbox) are clearly the most important people in the universe.
But, to address the reason you called me last night, I'm NOT going to replace your fancy digital camera. It's not my fault that you brought it to camp. Or that your creepy 10 year old boy took it out of your backpack. Or that your future sex-offender hid in the girls bathroom to try and get pictures of Marie naked.
If you want the camera back, I'd contact the camp's maintenance guy. I'm sure he could let you into the septic tank to get it out. Or you could try the pipes near where Marie flushed it. Maybe it's stuck there.
Likewise, I ain't paying your kid's medical bills. If the little freak had given the camera to Marie when she asked for it, she wouldn't have had to break his finger to get it. Maybe he'll learn something about respect for women. Maybe you will, too.
Anyway, I think it also added to the weekend that the scout master got to demonstrate first aid by splinting the finger with a hankie and popsicle sticks.
Have a nice day. Be prepared.
I wasn't able to be at Cub Scout camp this weekend, as I was on call. It obviously bothers you that my daughter Marie was there, but my wife didn't really have a choice but to take her, since I wouldn't be home to watch her. I can't haul her around to hospitals, and since she's 8 I can't leave her home alone for a weekend (although you clearly disagreed with the last point).
I'm also sorry that your kid is such a shit, but it ain't his fault. I mean, it was no secret last year when you and that other Mom began sneaking away during den meetings that you were shagging in the bathroom. I think it's nice that now you've both left your spouses to be together. Your boys have a lot in common, like the fact that they're both 10, and in the same scout den, and have skanky parents.
Anyway, I think it was entirely unreasonable for the scout master to have disciplined the boys for stealing and breaking other kids' projects this weekend. Apparently you and your squeeze were off balling in the bushes during that time, so it was inconsiderate of him to try and teach them some manners in your absence.
Also, why you were yelling at me last night about your kids not getting to make bows & arrows (and that being the reason they tried to steal the ones my kids made), makes no sense to me. I wasn't at camp this weekend, and am certainly not the reason you guys were 6 hours late getting there. The schedule clearly listed that project as being at 9:00 a.m., and you guys didn't show up until 3. I think it's downright unfair that the scout master didn't immediately put the other 15 kids on hold to take care of yours. After all, you and the lady (who I think may have recently been featured on CK Lunchbox) are clearly the most important people in the universe.
But, to address the reason you called me last night, I'm NOT going to replace your fancy digital camera. It's not my fault that you brought it to camp. Or that your creepy 10 year old boy took it out of your backpack. Or that your future sex-offender hid in the girls bathroom to try and get pictures of Marie naked.
If you want the camera back, I'd contact the camp's maintenance guy. I'm sure he could let you into the septic tank to get it out. Or you could try the pipes near where Marie flushed it. Maybe it's stuck there.
Likewise, I ain't paying your kid's medical bills. If the little freak had given the camera to Marie when she asked for it, she wouldn't have had to break his finger to get it. Maybe he'll learn something about respect for women. Maybe you will, too.
Anyway, I think it also added to the weekend that the scout master got to demonstrate first aid by splinting the finger with a hankie and popsicle sticks.
Have a nice day. Be prepared.
Monday, September 28, 2009
Thank You for Calling
"Hi, I think I saw Dr. Grumpy, or some doctor who knows him, at the hospital. It was either this weekend or last weekend. I was there for a stroke, or a headache, or something like that. Anyway, could someone please call me back to tell me if I need to see the doctor again? Also, if you guys know what hospital I was at, I want to know that too. Thank you."
And, of course, no name or phone number was left.
And, of course, no name or phone number was left.
Post-Call, Monday Morning
After rounds this morning I stopped by the doctors' lounge to get a Big-Gulp sized coffee. They were out of creamer, so when I got to the office I grabbed a couple packets that were lying around the break room and stirred them in.
When I began drinking it I choked. The packets weren't creamer. They were parmasan cheese, from a drug rep who brought pizza last week.
Coffee tossed, switching to Diet Coke.
When I began drinking it I choked. The packets weren't creamer. They were parmasan cheese, from a drug rep who brought pizza last week.
Coffee tossed, switching to Diet Coke.
Sunday, September 27, 2009
Pop Quiz
Okay, Grumpy fans. Put your books away and get out a #2 pencil. We're having another pop quiz. Mr. Knucklehead, please put away the issue of Boy's Life. We can all see you're hiding your mom's new Cosmo behind it.
Everyone ready? Good.
Question: You're a nurse at a major hospital. Your patient's white cell count (WBC) jumped from a horribly abnormal 44 yesterday to a frighteningly abnormal 79 this morning.
Do you call:
A. The hematologist treating the patient's bone marrow disorder.
B. The cardiologist following the patient's pacemaker.
C. The neurologist evaluating the patient's imbalance.
If you answered C, thank you for waking me up this morning. I greatly enjoyed your reasoning of "I called you because your name was the first one listed alphabetically."
Everyone ready? Good.
Question: You're a nurse at a major hospital. Your patient's white cell count (WBC) jumped from a horribly abnormal 44 yesterday to a frighteningly abnormal 79 this morning.
Do you call:
A. The hematologist treating the patient's bone marrow disorder.
B. The cardiologist following the patient's pacemaker.
C. The neurologist evaluating the patient's imbalance.
If you answered C, thank you for waking me up this morning. I greatly enjoyed your reasoning of "I called you because your name was the first one listed alphabetically."
Saturday, 11:57 p.m.
Dr. Grumpy: "This is Dr. Grumpy, returning a page."
Ms. Narc: "Yeah, I'm a patient of Dr. Notoncall. He has me on Vicodin, and I'm all out"
Dr. Grumpy: "I'm sorry, I don't call in controlled drugs after hours"
Ms. Narc: "But I'm hurting!"
Dr. Grumpy: "You'll have to call his office on Monday, or go to urgent care or ER if your pain is that bad."
Ms. Narc: "But I can't make it until then! I hurt all over!"
Dr. Grumpy: "I can't call in these pills for you. Sorry"
Ms. Narc: "Ummmm... But I don't need pills! Yesterday I had one of those, uh, gastric bypass surgeries, like the fat guy on TV once did, so I need liquid Vicodin. So it's not a pill. You can call that in, right?"
Dr. Grumpy: "Good night" (hangs up).
Ms. Narc: "Yeah, I'm a patient of Dr. Notoncall. He has me on Vicodin, and I'm all out"
Dr. Grumpy: "I'm sorry, I don't call in controlled drugs after hours"
Ms. Narc: "But I'm hurting!"
Dr. Grumpy: "You'll have to call his office on Monday, or go to urgent care or ER if your pain is that bad."
Ms. Narc: "But I can't make it until then! I hurt all over!"
Dr. Grumpy: "I can't call in these pills for you. Sorry"
Ms. Narc: "Ummmm... But I don't need pills! Yesterday I had one of those, uh, gastric bypass surgeries, like the fat guy on TV once did, so I need liquid Vicodin. So it's not a pill. You can call that in, right?"
Dr. Grumpy: "Good night" (hangs up).
Saturday, September 26, 2009
On Call, Again
Mrs. Bluehair: "I suddenly couldn't write with my left hand".
Dr. Grumpy: "Are you left handed?"
Mrs. Bluehair: "No, I'm very strongly right handed. I've really never been able to do anything coordinated with my left hand."
Dr. Grumpy: "Are you left handed?"
Mrs. Bluehair: "No, I'm very strongly right handed. I've really never been able to do anything coordinated with my left hand."
Friday, September 25, 2009
Isn't That the Point?
Being a brain doc, I don't keep up on the varying contents of the different birth control pills out there.
But today I saw a lady whose migraines had changed between pill brands, so I looked them up to see what the difference was between them.
Under side effects one of them listed "temporary infertility".
But today I saw a lady whose migraines had changed between pill brands, so I looked them up to see what the difference was between them.
Under side effects one of them listed "temporary infertility".
What the Hell?
Lady, if you leave your work number as where to call you back, and ask that I call you back immediately, DON'T FREAKING YELL AT ME OR MARY FOR CALLING YOU AT WORK!!!
Thursday, September 24, 2009
Dear President Obama,
I'm writing to you for the first time.
I don't want this to be a political blog. There are plenty of other sites for that. But we now face a national crisis of such serious proportions that it dwarfs other issues, such as global warming, health care, and middle-east peace. It now threatens the very fabric of our society, and directly affects every citizen. And I can remain silent no longer.
It's still September, and every store near me ALREADY HAS THEIR CHRISTMAS DECORATIONS UP!
I have nothing against the holidays, Mr. President. Peace on Earth and all that stuff. But moving them up as if they were being held in another time-zone or alternate universe is getting out-of-hand. As far as I know, Christmas hasn't budged in my lifetime. And treating every day like it was Christmas (like the stores seem to want me to do) is not helping.
The well-respected Nick documentary program, The Fairly Oddparents, has carefully researched what would happen if Christmas were held every day (Episode 107, air date 12-12-01 I have kids, OKAY!). Their conclusion? It would be catastrophic.
There also seems to be a degree of unintentional discrimination. For example, Hanukkah starts more than 2 weeks before Christmas this year, but I didn't see Hanukkah decorations going up 2 weeks before the Christmas ones. In fact, I haven't seen any at all yet. Or Kwanzaa stuff. Or Festivus. Or New Year's.
This seasonal perversion extends to other holidays, too. I mean, by January 2nd most stores are decked out with Easter junk, and on July 5th the Halloween crap is up.
So, Mr. President, I propose the following, federally mandated solutions (please note: I'm only including those holidays that retailers love. Let's face it, not many of us are out there buying gifts for Groundhog day or cards for Columbus day. I'm also leaving out local holidays like Delaware Statehood Day, the Montana Huckleberry Harvest Celebration, and the Byron, Illinois, Turkey Testicle Festival).
Valentine's Day Decorations will NOT be put up until the 3rd week of January.
St. Patrick's Day Decorations will NOT be put up until after March 1st.
Passover/Easter decorations will NOT be put up until after St. Patrick's day.
Independance day decorations (July 4th) will NOT be put up until the 3rd week of June.
Halloween stuff will NOT be put up before October 1st
Thanksgiving Stuff will NOT be put up before November 1st.
Christmas/New Year/Hanukkah/Kwanzaa/Festivus stuff will NOT be put up until the day after Thanksgiving.
(Please note: there should be some flexibility here, as Hanukkah and Easter/Passover may vary, but decorations should NOT be hung more then 3 weeks prior to holiday onset).
An alternative plan would be to have a single annual holiday combining all of the above, called St. Christmukahpasseastkwanpatfourthnewfestgivingween. Decorations for the combined holidays may be hung for 30 days prior to this event, and MUST be removed the day after.
Punishment for business owners who violate these laws would be on a 3-step basis:
1st offense: Business license revoked for one month.
2nd offense: Tarred, feathered, and forced to eat fruitcake.
3rd offense: Drawn and quartered, then served with fava beans and a nice chianti.
Yours truly,
Ibee Grumpy, M.D.
(A special THANK YOU to my reader Linda, who sent me this totally awesome picture)
I don't want this to be a political blog. There are plenty of other sites for that. But we now face a national crisis of such serious proportions that it dwarfs other issues, such as global warming, health care, and middle-east peace. It now threatens the very fabric of our society, and directly affects every citizen. And I can remain silent no longer.
It's still September, and every store near me ALREADY HAS THEIR CHRISTMAS DECORATIONS UP!
I have nothing against the holidays, Mr. President. Peace on Earth and all that stuff. But moving them up as if they were being held in another time-zone or alternate universe is getting out-of-hand. As far as I know, Christmas hasn't budged in my lifetime. And treating every day like it was Christmas (like the stores seem to want me to do) is not helping.
The well-respected Nick documentary program, The Fairly Oddparents, has carefully researched what would happen if Christmas were held every day (Episode 107, air date 12-12-01 I have kids, OKAY!). Their conclusion? It would be catastrophic.
There also seems to be a degree of unintentional discrimination. For example, Hanukkah starts more than 2 weeks before Christmas this year, but I didn't see Hanukkah decorations going up 2 weeks before the Christmas ones. In fact, I haven't seen any at all yet. Or Kwanzaa stuff. Or Festivus. Or New Year's.
This seasonal perversion extends to other holidays, too. I mean, by January 2nd most stores are decked out with Easter junk, and on July 5th the Halloween crap is up.
So, Mr. President, I propose the following, federally mandated solutions (please note: I'm only including those holidays that retailers love. Let's face it, not many of us are out there buying gifts for Groundhog day or cards for Columbus day. I'm also leaving out local holidays like Delaware Statehood Day, the Montana Huckleberry Harvest Celebration, and the Byron, Illinois, Turkey Testicle Festival).
Valentine's Day Decorations will NOT be put up until the 3rd week of January.
St. Patrick's Day Decorations will NOT be put up until after March 1st.
Passover/Easter decorations will NOT be put up until after St. Patrick's day.
Independance day decorations (July 4th) will NOT be put up until the 3rd week of June.
Halloween stuff will NOT be put up before October 1st
Thanksgiving Stuff will NOT be put up before November 1st.
Christmas/New Year/Hanukkah/Kwanzaa/Festivus stuff will NOT be put up until the day after Thanksgiving.
(Please note: there should be some flexibility here, as Hanukkah and Easter/Passover may vary, but decorations should NOT be hung more then 3 weeks prior to holiday onset).
An alternative plan would be to have a single annual holiday combining all of the above, called St. Christmukahpasseastkwanpatfourthnewfestgivingween. Decorations for the combined holidays may be hung for 30 days prior to this event, and MUST be removed the day after.
Punishment for business owners who violate these laws would be on a 3-step basis:
1st offense: Business license revoked for one month.
2nd offense: Tarred, feathered, and forced to eat fruitcake.
3rd offense: Drawn and quartered, then served with fava beans and a nice chianti.
Yours truly,
Ibee Grumpy, M.D.
(A special THANK YOU to my reader Linda, who sent me this totally awesome picture)
Too Much Information
It's my job to make up the schedule for my call group every 3 months. So, it's that time again.
On Monday I e-mailed the other docs I share call with, asking what weekends/holidays they don't want to be on call for next quarter. So their requests have been coming over the fax.
The last one showed up this morning, neatly typed up by Dr. Brain's secretary.
It said:
"Dr. Brain says he wants to get off on the weekends of October 17, November 8, and December 19."
On Monday I e-mailed the other docs I share call with, asking what weekends/holidays they don't want to be on call for next quarter. So their requests have been coming over the fax.
The last one showed up this morning, neatly typed up by Dr. Brain's secretary.
It said:
"Dr. Brain says he wants to get off on the weekends of October 17, November 8, and December 19."
Wednesday, September 23, 2009
Random Weirdness
So tonight we made a Costco run to stock up on life essentials like Diet Coke and cookies. Mrs. Grumpy was straight from work, and still in scrubs.
So we're loading up the minivan, and suddenly this wild-eyed lady runs up to us.
"Excuse me! Excuse me!" I'm always afraid this is going to be one of my patients, but she ignored me and went straight after Mrs. Grumpy (who was wrestling with a bag of dogfood).
Mrs. Grumpy: "Uh, can I help you?"
Ms. Wildpsycho: "Yes! Please! Do you work at Local Hospital?"
Mrs. Grumpy: "Uh, no..."
Ms. Wildpsycho: "Where do you work! What do you do! Please! Tell me!"
Mrs. Grumpy: "I'm a school nurse."
Ms. Wildpsycho: "JESUS FREAKING CHRIST! YOU ARE ABSOLUTELY NO HELP TO ME AT ALL, ARE YOU?!!! WHAT AM I SUPPOSED TO DO WITH THAT?!!!"
She stomped off.
I tossed the dogfood in the car.
WTF?
So we're loading up the minivan, and suddenly this wild-eyed lady runs up to us.
"Excuse me! Excuse me!" I'm always afraid this is going to be one of my patients, but she ignored me and went straight after Mrs. Grumpy (who was wrestling with a bag of dogfood).
Mrs. Grumpy: "Uh, can I help you?"
Ms. Wildpsycho: "Yes! Please! Do you work at Local Hospital?"
Mrs. Grumpy: "Uh, no..."
Ms. Wildpsycho: "Where do you work! What do you do! Please! Tell me!"
Mrs. Grumpy: "I'm a school nurse."
Ms. Wildpsycho: "JESUS FREAKING CHRIST! YOU ARE ABSOLUTELY NO HELP TO ME AT ALL, ARE YOU?!!! WHAT AM I SUPPOSED TO DO WITH THAT?!!!"
She stomped off.
I tossed the dogfood in the car.
WTF?
Thanks for the Co-pay. Go Home.
I was seeing this lady in her 30's today. She has migraines and neck pain. Fine.
So I offered her some Imitrex: "No! That's a migraine drug! I don't want that on my insurance record! That will raise my rates!"
So I recommended pain meds and/or muscle relaxants: "No! I've worked for insurance companies! If they see that on my record, I'll NEVER be able to get insurance! Ever!"
So I suggested she try physical therapy: "No! Never! Once they see I've been to physical therapy, I'll never be able to get coverage!"
Okay, Whatever.
Two issues, ma'am:
1. If you are so afraid of your insurance company finding out about your health, THEN WHY ARE YOU HERE, USING YOUR POLICY IN THE FIRST PLACE?
2. I'm pretty sure that your 3-PACK-A-DAY cigarette habit is going have a bigger impact on your health and premiums than ANY of my treatments ever will.
Just some thoughts. Have a nice day.
So I offered her some Imitrex: "No! That's a migraine drug! I don't want that on my insurance record! That will raise my rates!"
So I recommended pain meds and/or muscle relaxants: "No! I've worked for insurance companies! If they see that on my record, I'll NEVER be able to get insurance! Ever!"
So I suggested she try physical therapy: "No! Never! Once they see I've been to physical therapy, I'll never be able to get coverage!"
Okay, Whatever.
Two issues, ma'am:
1. If you are so afraid of your insurance company finding out about your health, THEN WHY ARE YOU HERE, USING YOUR POLICY IN THE FIRST PLACE?
2. I'm pretty sure that your 3-PACK-A-DAY cigarette habit is going have a bigger impact on your health and premiums than ANY of my treatments ever will.
Just some thoughts. Have a nice day.
My Daily Dose of Sympathy
Yesterday afternoon I was seeing a lady who'd called for an emergency work-in for her back pain.
Dr. Grumpy: "So, how did you hurt your back?"
Mrs. Snob: "My cleaning woman left me. Just left me. I've had the same cleaning woman for 10 years. So on Sunday I had to clean the whole damn house myself. And I wrenched my back. I've always had a bad back, that's why I have a cleaning woman. Then, yesterday, my husband and I were at a funeral, and there was no place to sit. You'd think they could have chairs or something. And standing for the whole thing made my back even worse."
Dr. Grumpy: "I'm sorry to hear that. Was it a relative's funeral?"
Mrs. Snob: "No, it was the cleaning woman's."
I was surprised she even went.
Mrs. Snob: "My cleaning woman left me. Just left me. I've had the same cleaning woman for 10 years. So on Sunday I had to clean the whole damn house myself. And I wrenched my back. I've always had a bad back, that's why I have a cleaning woman. Then, yesterday, my husband and I were at a funeral, and there was no place to sit. You'd think they could have chairs or something. And standing for the whole thing made my back even worse."
Dr. Grumpy: "I'm sorry to hear that. Was it a relative's funeral?"
Mrs. Snob: "No, it was the cleaning woman's."
I was surprised she even went.
Tuesday, September 22, 2009
Annie's Song
(If you think this post has ANYTHING to do with John Denver, you're in the wrong place. But it made a good title.)
I'm not taking sides in the health care debate, but I do want to clarify something.
I see people on the news screaming that they don't want "bureaucrats" between them and their doctor, and are afraid that's what government health care will bring.
WTF? THAT'S THE WAY IT IS NOW, PEOPLE!!! I hear my nurse Annie on the phone all day trying to get approval from non-government insurance companies for tests, medications, physical therapy, ANYTHING that I order.
Look at your insurance card. Doesn't it say things like "in-network" and "formulary"? Who the hell do you think came up with those? Not us docs. Dat be dem dere byoo-row-kratz!
Look back at some of my posts (like this, or this). I routinely have medications (both brand name and cheap generics) and tests refused by insurance companies. For an excellent commentary on this from the pharmacy side, this was written by FranticPharmacist.
So if you don't want bureaucrats between you and your doctor- TOO BAD. They've been there for years. THE ONLY PEOPLE WHO DON'T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING!
In fact, for those of you who don't want the government running this, THEY ARE ACTUALLY ONE OF THE BETTER ONES TO WORK WITH! Just ask Annie. Medicare doesn't question the majority of my tests, or meds. Yes, they don't cover everything, nor should they, but they don't fight with me over stuff like MRI's on stroke patients. Uncle Sam (unlike BCBS, Aetna, Cigna, United, Humana, and many others) tends to leave these things to the doctor's discretion. Annie prefers Medicare patients for this very reason - they make her life easier.
So what happens to you the way it works NOW, with your non-government insurance?
You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.
Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page "pre-auth" form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn't enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).
So a few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don't cover Capricorns when the moon is in Pisces. And we don't know this until Annie calls back after a few days, because they're hoping we forgot about it.
Eventually they'll deny the whole thing, on the grounds that you don't meet criteria for an MRI and MRA. This decision is usually made by a non-medically trained person with a minimum of a GED. They do this because they want to see just how badly I want the test.
So they tell me I can appeal this via "peer-to-peer" review. Which means I need to personally call their "physician reviewer" to argue with them as to why I want the study.
So, during my insanely busy day at the office I have to call them. I'm promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. In fact, it's usually something like a retired dermatologist, who hasn't done neurology since medical school in 1938. Or an OB/GYN who hated his job, and is doing this now instead. Or some doctor who immigrated from Lower Swazbodiaczk and can't get a U.S. medical license (but your insurance company hired him to decide what medical care you need). But it's almost NEVER someone actually in my field, who might understand why I want the study.
So after telling your life history to Dr. Denial, one of 2 things will happen. They'll deny both studies, and want you to try medication or physical therapy or psychotherapy or holistic reflexology or whatever, and if you fail that THEN I can try to resubmit a request for the test. OR they will flip a coin and say they will cover the MRI, but not the MRA. Or vice-versa. They'll say that if the first test is fine, THEN I can start over trying to get the other covered. Maybe.
And many of these companies actually pay these "reviewers" bonuses based on HOW MUCH MONEY THEY SAVED THE COMPANY BY DENYING TESTS.
This can at times become comical. One of my patients is a doc who works part-time as one of these insurance company "physician peer reviewers". And when he needed an MRI, guess what? HIS OWN COMPANY DENIED IT! He paid out of pocket for it (and yes, it was abnormal).
So how did I get on this tangent? Because yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.
Annie: "I'm calling because you people denied an MRI on a stroke patient?"
Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."
Annie: "Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."
Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."
Annie: "Oh, now THAT's a surprise."
Pinhead: "What do you mean?"
Annie: "Is this line really being recorded?"
Pinhead: "Yes. It's to improve customer satisfaction."
Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."
Pinhead: "We do this to save our customers money on unnecessary testing."
Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"
Pinhead: "Um, I hadn't..."
Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"
Pinhead: "No, but I..."
Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."
Pinhead: "Oh, but you can't mean that?"
Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."
Pinhead: "I..."
Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".
Pinhead: "No, wait! I..."
Annie hung up.
So bottom line here: if you don't think bureaucrats are currently between you and your doctor- THEY ARE! GET REAL! IT'S BEEN THAT WAY FOR THE LAST 10 YEARS OR MORE!
I'm not taking sides in the health care debate, but I do want to clarify something.
I see people on the news screaming that they don't want "bureaucrats" between them and their doctor, and are afraid that's what government health care will bring.
WTF? THAT'S THE WAY IT IS NOW, PEOPLE!!! I hear my nurse Annie on the phone all day trying to get approval from non-government insurance companies for tests, medications, physical therapy, ANYTHING that I order.
Look at your insurance card. Doesn't it say things like "in-network" and "formulary"? Who the hell do you think came up with those? Not us docs. Dat be dem dere byoo-row-kratz!
Look back at some of my posts (like this, or this). I routinely have medications (both brand name and cheap generics) and tests refused by insurance companies. For an excellent commentary on this from the pharmacy side, this was written by FranticPharmacist.
So if you don't want bureaucrats between you and your doctor- TOO BAD. They've been there for years. THE ONLY PEOPLE WHO DON'T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING!
In fact, for those of you who don't want the government running this, THEY ARE ACTUALLY ONE OF THE BETTER ONES TO WORK WITH! Just ask Annie. Medicare doesn't question the majority of my tests, or meds. Yes, they don't cover everything, nor should they, but they don't fight with me over stuff like MRI's on stroke patients. Uncle Sam (unlike BCBS, Aetna, Cigna, United, Humana, and many others) tends to leave these things to the doctor's discretion. Annie prefers Medicare patients for this very reason - they make her life easier.
So what happens to you the way it works NOW, with your non-government insurance?
You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.
Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page "pre-auth" form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn't enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).
So a few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don't cover Capricorns when the moon is in Pisces. And we don't know this until Annie calls back after a few days, because they're hoping we forgot about it.
Eventually they'll deny the whole thing, on the grounds that you don't meet criteria for an MRI and MRA. This decision is usually made by a non-medically trained person with a minimum of a GED. They do this because they want to see just how badly I want the test.
So they tell me I can appeal this via "peer-to-peer" review. Which means I need to personally call their "physician reviewer" to argue with them as to why I want the study.
So, during my insanely busy day at the office I have to call them. I'm promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. In fact, it's usually something like a retired dermatologist, who hasn't done neurology since medical school in 1938. Or an OB/GYN who hated his job, and is doing this now instead. Or some doctor who immigrated from Lower Swazbodiaczk and can't get a U.S. medical license (but your insurance company hired him to decide what medical care you need). But it's almost NEVER someone actually in my field, who might understand why I want the study.
So after telling your life history to Dr. Denial, one of 2 things will happen. They'll deny both studies, and want you to try medication or physical therapy or psychotherapy or holistic reflexology or whatever, and if you fail that THEN I can try to resubmit a request for the test. OR they will flip a coin and say they will cover the MRI, but not the MRA. Or vice-versa. They'll say that if the first test is fine, THEN I can start over trying to get the other covered. Maybe.
And many of these companies actually pay these "reviewers" bonuses based on HOW MUCH MONEY THEY SAVED THE COMPANY BY DENYING TESTS.
This can at times become comical. One of my patients is a doc who works part-time as one of these insurance company "physician peer reviewers". And when he needed an MRI, guess what? HIS OWN COMPANY DENIED IT! He paid out of pocket for it (and yes, it was abnormal).
So how did I get on this tangent? Because yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.
Annie: "I'm calling because you people denied an MRI on a stroke patient?"
Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."
Annie: "Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."
Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."
Annie: "Oh, now THAT's a surprise."
Pinhead: "What do you mean?"
Annie: "Is this line really being recorded?"
Pinhead: "Yes. It's to improve customer satisfaction."
Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."
Pinhead: "We do this to save our customers money on unnecessary testing."
Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"
Pinhead: "Um, I hadn't..."
Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"
Pinhead: "No, but I..."
Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."
Pinhead: "Oh, but you can't mean that?"
Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."
Pinhead: "I..."
Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".
Pinhead: "No, wait! I..."
Annie hung up.
So bottom line here: if you don't think bureaucrats are currently between you and your doctor- THEY ARE! GET REAL! IT'S BEEN THAT WAY FOR THE LAST 10 YEARS OR MORE!
Monday, September 21, 2009
My High School Class...
Have had some interesting comments about my high school reunion post from earlier today.
When my 20th reunion came around a few years ago, I heard about it quite indirectly- from my mother, who happened to run into somebody else's mother at Local Grocery.
When I looked at the 20th anniversary website, I was listed among the missing- students who, in spite of the best attempts of my classmates, couldn't be found (and this was well into the internet age).
I found this amazing, for many reasons:
1. I haven't changed my name.
2. My parents still live in the same house and have the same phone number as when I went to high school
3. My neurology practice is less than 5 miles from the high school I went to.
4. I am listed in the yellow pages under my own name.
5. If you type my real name into Google, one of the top hits is for my practice's web page.
So I personally felt the fact that none of them were able to find me was a comment on THEM more than ME.
And nothing further need be said.
When my 20th reunion came around a few years ago, I heard about it quite indirectly- from my mother, who happened to run into somebody else's mother at Local Grocery.
When I looked at the 20th anniversary website, I was listed among the missing- students who, in spite of the best attempts of my classmates, couldn't be found (and this was well into the internet age).
I found this amazing, for many reasons:
1. I haven't changed my name.
2. My parents still live in the same house and have the same phone number as when I went to high school
3. My neurology practice is less than 5 miles from the high school I went to.
4. I am listed in the yellow pages under my own name.
5. If you type my real name into Google, one of the top hits is for my practice's web page.
So I personally felt the fact that none of them were able to find me was a comment on THEM more than ME.
And nothing further need be said.
Religious Awareness 101
Dr. Jewish is an internist down the hall from me. A mutual patient is having problems, and I needed to talk to him about the case. Since I had a minute I walked over to see him, and was ushered back into his office.
While we were discussing things a young lady, one of his office staff, wandered in.
Dr. Jewish: "What's up, Cindy?"
Cindy: "Mrs. Goldbergstein called. You wanted to see her this week, but she just called to cancel it."
Dr. Jewish: "Did she say why?"
Cindy: "She said something about 'John Kipper is coming'. Maybe she's having a guy visit?"
Dr. Jewish: "You mean Yom Kippur?"
Cindy: "Whatever, yeah, his name was something like that, and she said he's coming. So she moved the appointment to next week."
After she walked out (and I started giggling) he put his head in his hands and said "Cindy is my office manager's daughter, too".
While we were discussing things a young lady, one of his office staff, wandered in.
Dr. Jewish: "What's up, Cindy?"
Cindy: "Mrs. Goldbergstein called. You wanted to see her this week, but she just called to cancel it."
Dr. Jewish: "Did she say why?"
Cindy: "She said something about 'John Kipper is coming'. Maybe she's having a guy visit?"
Dr. Jewish: "You mean Yom Kippur?"
Cindy: "Whatever, yeah, his name was something like that, and she said he's coming. So she moved the appointment to next week."
After she walked out (and I started giggling) he put his head in his hands and said "Cindy is my office manager's daughter, too".
Mrs. Grumpy Writes
She just emailed me this (she's a school nurse):
"One of the Spanish teachers just came into the office. She's putting together some sort of Luau themed class party for next week, and wanted to know if anyone knew how to say 'Aloha' in Spanish"!
"One of the Spanish teachers just came into the office. She's putting together some sort of Luau themed class party for next week, and wanted to know if anyone knew how to say 'Aloha' in Spanish"!
The Nerve!
One of my > 20 year High School reunions is coming up.
So I went to the website last Friday and filled in the updated "Where am I now form" (just in case anything had changed since the 20 year reunion).
Since then I've received 3 emails from former classmates asking questions about their headaches.
I responded with an email that said:
"Ibee Grumpy will be attending the reunion.
Dr. Grumpy can be seen by making an appointment. Call (999) 999-9999."
So I went to the website last Friday and filled in the updated "Where am I now form" (just in case anything had changed since the 20 year reunion).
Since then I've received 3 emails from former classmates asking questions about their headaches.
I responded with an email that said:
"Ibee Grumpy will be attending the reunion.
Dr. Grumpy can be seen by making an appointment. Call (999) 999-9999."
Sunday, September 20, 2009
Thanks, Craig
When I was young and active (i.e. before kids) I played pick-up basketball a lot. So I have a bunch of raggy mens tank-tops in my closet from those days.
I don't wear them anymore, because (between them shrinking and me expanding) they show off my midriff, sort of an unsexy Britney Spears look.
So yesterday afternoon Craig found one in my closet, held it up, and said "Dad, why do you own a dress?"
I don't wear them anymore, because (between them shrinking and me expanding) they show off my midriff, sort of an unsexy Britney Spears look.
So yesterday afternoon Craig found one in my closet, held it up, and said "Dad, why do you own a dress?"
Saturday, September 19, 2009
My Readers Write
I have the most boring lobby in the world. Chairs, table, water cooler, some magazines. If you want to wait amongst plasma screen TV's, Louvre-quality paintings, and free Wi-Fi, go see Dr. Bigtitz, the plastic surgeon upstairs.
I follow the advice of The Bible - no mirrors, clocks, or music out there.
Anyway, I'm rambling about this because last week I received an email from Dr. Stingray, who says he's an internist in Florida, commenting on office decor issues:
"Years ago I subleased from a neurologist, Dr. Sousaphone. He only saw Alzheimer's patients, and believed in having an office that would rival any art museum.
"One day, for whatever reason, he decided to install a fountain in the lobby. This wasn't some little desktop thing, but a fairly large contraption of copper and stone. He thought its gentle sounds would relax his demented patients.
"Unfortunately, it was more relaxing then he'd anticipated. 2 days after it's debut an elderly, demented man (to his wife's horror) walked over to it, unzipped, and drained his bladder into the relaxing waters. Another disinhibited gentleman thought this was a good idea and promptly joined him.
"This performance stunned Dr. Sousaphone (not to mention my waiting patients) who hadn't anticipated the fountain's effect on demented males with enlarged prostates. After they cleaned the fountain he had a sign installed that said "Please do not urinate in the fountain. It is for decoration only" (Dr. Grumpy comments: Wow! If you saw that sign in your doctor's lobby, what would you think?).
"The effectiveness of the sign was matched only by his patients' fading memories, and after 3 weeks Dr. Sousaphone's staff got sick of cleaning the fountain and made him remove it."
I follow the advice of The Bible - no mirrors, clocks, or music out there.
Anyway, I'm rambling about this because last week I received an email from Dr. Stingray, who says he's an internist in Florida, commenting on office decor issues:
"Years ago I subleased from a neurologist, Dr. Sousaphone. He only saw Alzheimer's patients, and believed in having an office that would rival any art museum.
"One day, for whatever reason, he decided to install a fountain in the lobby. This wasn't some little desktop thing, but a fairly large contraption of copper and stone. He thought its gentle sounds would relax his demented patients.
"Unfortunately, it was more relaxing then he'd anticipated. 2 days after it's debut an elderly, demented man (to his wife's horror) walked over to it, unzipped, and drained his bladder into the relaxing waters. Another disinhibited gentleman thought this was a good idea and promptly joined him.
"This performance stunned Dr. Sousaphone (not to mention my waiting patients) who hadn't anticipated the fountain's effect on demented males with enlarged prostates. After they cleaned the fountain he had a sign installed that said "Please do not urinate in the fountain. It is for decoration only" (Dr. Grumpy comments: Wow! If you saw that sign in your doctor's lobby, what would you think?).
"The effectiveness of the sign was matched only by his patients' fading memories, and after 3 weeks Dr. Sousaphone's staff got sick of cleaning the fountain and made him remove it."
Friday, September 18, 2009
Mrs. Grumpy Hates Me
Tonight Mrs. Grumpy took me and the tribe to an outdoor party for the kids at the school where she works.
So we're sitting up in the bleachers watching a free-for-all volleyball game with about 50 kids on each side hitting these HUGE oversized beach balls back and forth. While this is going on the Principal comes over, and Mrs. Grumpy introduces us.
Then Ms. Principal looks out at the game and says "those are the biggest balls I've ever seen."
I said "Why, thank you."
I'll be sleeping on the couch tonight. Possibly longer.
So we're sitting up in the bleachers watching a free-for-all volleyball game with about 50 kids on each side hitting these HUGE oversized beach balls back and forth. While this is going on the Principal comes over, and Mrs. Grumpy introduces us.
Then Ms. Principal looks out at the game and says "those are the biggest balls I've ever seen."
I said "Why, thank you."
I'll be sleeping on the couch tonight. Possibly longer.
Where Am We?
Introduction: Mr. Fried, a pleasant refugee of the 60's (think Reverend Jim, from "Taxi"), saw me 8 years ago, when he used to live here. He then moved away, but recently moved back and came in to re-establish care. Please note the state names have been changed to protect the identities of myself and the states. Mr. Fried needs no protection, as he has no idea who he is anyway.
Dr. Grumpy: "Good to see you again, Mr. Fried."
Mr. Fried: "It's good to be back in Minnesota, Doc".
Dr. Grumpy: "We're in Oregon, sir."
Mr. Fried: "Yeah, that's what I meant."
Dr. Grumpy: "So I last saw you in 2001, before you moved to Alabama."
Mr. Fried: "I didn't know you moved to Alabama. I was living there, too."
Dr. Grumpy: "No, I was here in Oregon the whole time. You moved."
Mr. Fried: "I know. I miss Minnesota already."
Dr. Grumpy: "How are your headaches?"
Mr. Fried: "Are they why I moved to Alabama?"
Dr. Grumpy: "I have no idea."
Mr. Fried: "Do you know if I had them when I lived in Minnesota?"
Dr. Grumpy: "Mr. Fried, I've never lived in Minnesota."
Mr. Fried: "Neither have I."
It was a really long hour.
Dr. Grumpy: "Good to see you again, Mr. Fried."
Mr. Fried: "It's good to be back in Minnesota, Doc".
Dr. Grumpy: "We're in Oregon, sir."
Mr. Fried: "Yeah, that's what I meant."
Dr. Grumpy: "So I last saw you in 2001, before you moved to Alabama."
Mr. Fried: "I didn't know you moved to Alabama. I was living there, too."
Dr. Grumpy: "No, I was here in Oregon the whole time. You moved."
Mr. Fried: "I know. I miss Minnesota already."
Dr. Grumpy: "How are your headaches?"
Mr. Fried: "Are they why I moved to Alabama?"
Dr. Grumpy: "I have no idea."
Mr. Fried: "Do you know if I had them when I lived in Minnesota?"
Dr. Grumpy: "Mr. Fried, I've never lived in Minnesota."
Mr. Fried: "Neither have I."
It was a really long hour.
Life in Retail
(Annie's daughter, Evie, started working at Target this week. Today Annie sent me this email about how she's doing)
"This is Evie's first retail experience. They have her managing lingerie.
"Yesterday, they had a corporate head guy come through at 10 am. The store manager told her at 8am there was to be this surprise inspection at 10 and unfortunately the night crew had left 5 full carts of merchandise in her department to be tagged and shelved. He knew it was not fair, but he needed it done.
"She got it done, but just as the head guy was coming to her department here comes a woman with 5 unruly kids. Knocking over the racks, grabbing the bras and screaming "look mom I have boobs". Horrified store manager got the bigwigs to move on while kids continued to destroy department. Mom of the kids went into melt down and started beating them all with both her purse and one she grabbed off a rack.
"An hour later, while trying to help an elderly woman on a cane, who could not find the type of bras from her day... Evie innocently asked 'well could you try and describe it to me so I can help you find something like it'. The woman lifted up her shirt to show her the bra she wanted.
"Welcome to retail."
"This is Evie's first retail experience. They have her managing lingerie.
"Yesterday, they had a corporate head guy come through at 10 am. The store manager told her at 8am there was to be this surprise inspection at 10 and unfortunately the night crew had left 5 full carts of merchandise in her department to be tagged and shelved. He knew it was not fair, but he needed it done.
"She got it done, but just as the head guy was coming to her department here comes a woman with 5 unruly kids. Knocking over the racks, grabbing the bras and screaming "look mom I have boobs". Horrified store manager got the bigwigs to move on while kids continued to destroy department. Mom of the kids went into melt down and started beating them all with both her purse and one she grabbed off a rack.
"An hour later, while trying to help an elderly woman on a cane, who could not find the type of bras from her day... Evie innocently asked 'well could you try and describe it to me so I can help you find something like it'. The woman lifted up her shirt to show her the bra she wanted.
"Welcome to retail."
Thursday, September 17, 2009
Helpful Radiology Results
This report came over the fax today:
"Impression: When compared to the previous study of January, 2009, the right carotid artery stenosis has significantly worsened and is entirely unchanged."
"Impression: When compared to the previous study of January, 2009, the right carotid artery stenosis has significantly worsened and is entirely unchanged."
I'm Impressed
My 9:00 patient this morning called at 8:45. Said she was having "car trouble", and asked if she could reschedule to later in the morning. So we moved her to 11:15.
She shows up at 11:15, with her forehead and arms darkened, smelling strongly of smoke.
She apologized for not having had a chance to shower, but by the time she gave up on trying to put out the car herself, and the fire department left after doing so, and she found a friend to give her a ride here, she just didn't have time.
Two points:
1. I am in AWE at your devotion to me that you only moved the appointment 135 minutes, instead of to next week or month.
2. When the fire department is putting out your car, I consider that beyond "car trouble". I'd have been running in circles & screaming, and likely wouldn't have bothered to call my doctor about the appointment under the circumstances.
She shows up at 11:15, with her forehead and arms darkened, smelling strongly of smoke.
She apologized for not having had a chance to shower, but by the time she gave up on trying to put out the car herself, and the fire department left after doing so, and she found a friend to give her a ride here, she just didn't have time.
Two points:
1. I am in AWE at your devotion to me that you only moved the appointment 135 minutes, instead of to next week or month.
2. When the fire department is putting out your car, I consider that beyond "car trouble". I'd have been running in circles & screaming, and likely wouldn't have bothered to call my doctor about the appointment under the circumstances.
Wednesday, September 16, 2009
Mary's Desk, September 16, 2009
Mary: "Dr. Grumpy's office. This is Mary."
Mr. Needshelp: "Hi! I need to make an appointment to see Dr. Grumpy!"
Mary: "Okay. When would you like to come in?"
Mr. Needshelp: "Um, I don't know, you mean to come see the Doctor?"
Mary: "Yes. You said you wanted to make an appointment?"
Mr. Needshelp: "I do, but, um, I don't think I'm quite ready to actually schedule it. I'll call back another day. Thank you!"
Mr. Needshelp: "Hi! I need to make an appointment to see Dr. Grumpy!"
Mary: "Okay. When would you like to come in?"
Mr. Needshelp: "Um, I don't know, you mean to come see the Doctor?"
Mary: "Yes. You said you wanted to make an appointment?"
Mr. Needshelp: "I do, but, um, I don't think I'm quite ready to actually schedule it. I'll call back another day. Thank you!"
Public Service Announcement
If you (hypothetically, of course) get a can of Diet Coke that has lost some taste due to sitting in a garage for too long, DO NOT pour a packet of sweetener into it.
The resulting reaction will cause the soda to foam up wildly, going all over your desk, keyboard, pens, MRI reports, notes, and anything else.
The tissue box on your desk will likely not have enough in it to stop it from pouring on the floor.
The patient across from you will be of no help whatsoever, and may post about it tonight on grumpypatientblog.com.
Again, this is a purely hypothetical situation.
Thank you.
The resulting reaction will cause the soda to foam up wildly, going all over your desk, keyboard, pens, MRI reports, notes, and anything else.
The tissue box on your desk will likely not have enough in it to stop it from pouring on the floor.
The patient across from you will be of no help whatsoever, and may post about it tonight on grumpypatientblog.com.
Again, this is a purely hypothetical situation.
Thank you.
Tuesday, September 15, 2009
What Does a Neurology Exam Involve?
Several of you have written in to ask what a neurology exam involves, and how it differs from what your regular doctor may do.
Neurologists learn to do very detailed exams, studying reflexes, strength, coordination, and many other systems. These involve great skill in noticing important, sometimes subtle, details.
To give you an example, today I was reviewing some notes from a neurologist across town. Here is a detailed complete neuro exam from her note:
Obviously, it takes years of training, and a great deal of time, to notice things like this.
To give you a more thorough picture, here is another very detailed exam by the same doctor on the same patient, done 1 month after the initial visit. Notice how she carefully documents changes in his condition:
So that's what a neurology exam involves.
Neurologists learn to do very detailed exams, studying reflexes, strength, coordination, and many other systems. These involve great skill in noticing important, sometimes subtle, details.
To give you an example, today I was reviewing some notes from a neurologist across town. Here is a detailed complete neuro exam from her note:
Obviously, it takes years of training, and a great deal of time, to notice things like this.
To give you a more thorough picture, here is another very detailed exam by the same doctor on the same patient, done 1 month after the initial visit. Notice how she carefully documents changes in his condition:
So that's what a neurology exam involves.
Because We're Nuts, That's Why
Yours truly was asked to write a guest post over at "Ask an MD" about why neurologists are so strange (good question, too).
So to see my answer (which really boils down to "I have no freakin' idea"), click here.
So to see my answer (which really boils down to "I have no freakin' idea"), click here.
Drug Rep Sunshine
Ms. Sunshine: "Doctor, Fukitol is the most prescribed drug in it's class."
Me: "Fukitol is the ONLY drug in it's class!"
Ms. Sunshine: "Um, yeah."
Me: "Fukitol is the ONLY drug in it's class!"
Ms. Sunshine: "Um, yeah."
Welcome to McGrumpys, May I Take Your Order?
"Hi, I'm on my way there for an 8:00 appointment. Anyway, I didn't have time to eat breakfast, and am hungry. Do you guys serve food in your office? And if you have bagels, what kinds?"
WTF? Am I a Marriott?
WTF? Am I a Marriott?
Monday, September 14, 2009
Take Her Down, Helmsman
People use different phrases to mean the same thing. Case in point: migraines.
Some patients say "I have migraines". Others say "I get migraines". Occasionally one will use the odd phrase (at least to me) "I take migraines" to mean the same thing (I always want to ask who they're taking them from).
But today I had a lady who used a more, uh interesting, phrase.
When she gets a migraine she has to go lie down in a dark room (which is common). So, for whatever reason, she uses this act to refer to the migraine.
In other words: when she gets a migraine, she calls it "going down".
It is remarkably hard to keep a straight face when the young lady across from me says things like:
"I went down 3 times last week."
"July was awful. I spent the entire month going down".
"I went down on Saturday. I had to do it in front of my kids, too."
And, as she was leaving, she said, "I feel another one coming on. I just know I'll be going down tonight, but have to wait until my husband gets home."
No comment.
Some patients say "I have migraines". Others say "I get migraines". Occasionally one will use the odd phrase (at least to me) "I take migraines" to mean the same thing (I always want to ask who they're taking them from).
But today I had a lady who used a more, uh interesting, phrase.
When she gets a migraine she has to go lie down in a dark room (which is common). So, for whatever reason, she uses this act to refer to the migraine.
In other words: when she gets a migraine, she calls it "going down".
It is remarkably hard to keep a straight face when the young lady across from me says things like:
"I went down 3 times last week."
"July was awful. I spent the entire month going down".
"I went down on Saturday. I had to do it in front of my kids, too."
And, as she was leaving, she said, "I feel another one coming on. I just know I'll be going down tonight, but have to wait until my husband gets home."
No comment.
Monday Morning, 1:18 a.m.
Tap tap tap tap tap tap tap tap
"Mmmm... whuzz......."
Tap tap tap tap tap tap tap tap
"mfffff... Craig..... What do you want?"
"Dad, I have a question."
"mfffff..."
Tap tap tap tap tap tap tap tap
"What?"
"If I peed in my pajamas while I'm sleeping around now, will they be dry by morning?"
"Mmmm... whuzz......."
Tap tap tap tap tap tap tap tap
"mfffff... Craig..... What do you want?"
"Dad, I have a question."
"mfffff..."
Tap tap tap tap tap tap tap tap
"What?"
"If I peed in my pajamas while I'm sleeping around now, will they be dry by morning?"
Sunday, September 13, 2009
Today's Test
Okay, Grumpyites. Get out a #2 pencil and a piece of paper. We're going to have a pop quiz.
Everyone ready? Okay, you, in the back. Please put the comic book away. Thank you.
Question: You are a 63 year old man. You wake up just after midnight with vertigo, double vision, and imbalance. You need help, so you call:
A. Your wife, who's asleep across the hall because your snoring keeps her awake.
B. Your grown son, who lives 2 blocks away with his family.
C. 911
D. Your 88 year-old mother, who lives across town, but still has a car and comes over to pick you up and drive you to ER, and wakes up your wife when she rings the doorbell at 1:35 am.
If you answered D, it was a pleasure meeting you and your Mom this morning, and dude, you have some issues you need to work on.
Everyone ready? Okay, you, in the back. Please put the comic book away. Thank you.
Question: You are a 63 year old man. You wake up just after midnight with vertigo, double vision, and imbalance. You need help, so you call:
A. Your wife, who's asleep across the hall because your snoring keeps her awake.
B. Your grown son, who lives 2 blocks away with his family.
C. 911
D. Your 88 year-old mother, who lives across town, but still has a car and comes over to pick you up and drive you to ER, and wakes up your wife when she rings the doorbell at 1:35 am.
If you answered D, it was a pleasure meeting you and your Mom this morning, and dude, you have some issues you need to work on.
Saturday, September 12, 2009
Let Me Prove It
I get your emails. Some of you write in that I must be making this shit up.
You write that there's no way people can be that stupid. Or crazy. Or whatever.
I'm not going to name any names (hell, I don't even know your real names, anyway). But you guys know who you are.
Therefore, as an exhibit for Dr. Grumpy's defense, I ask you to direct your attention to the remarkable site People of WalMart. After perusing their stunning collection of photos, and the fact that they encompass all corners of the continent, I think you'll come to the correct conclusion that there are more people of this type out there then you realize.
The defense rests.
You write that there's no way people can be that stupid. Or crazy. Or whatever.
I'm not going to name any names (hell, I don't even know your real names, anyway). But you guys know who you are.
Therefore, as an exhibit for Dr. Grumpy's defense, I ask you to direct your attention to the remarkable site People of WalMart. After perusing their stunning collection of photos, and the fact that they encompass all corners of the continent, I think you'll come to the correct conclusion that there are more people of this type out there then you realize.
The defense rests.
AAAUUUGHH!!! MR. PHONE JUST CALLED BACK!
He left a message asking if it's safe to take the multivitamins his ex-girlfriend bought him last month.
I am not returning his call. Dr. Notoncall can deal with him on Monday.
I am not returning his call. Dr. Notoncall can deal with him on Monday.
Weekend On Call- The Phone Calls
Dr. Grumpy: "This is Dr. Grumpy, returning your call".
Mr. Phone: "Um, yeah. I see Dr. Notoncall, and she has me on Aspirin 325mg once a day for a stroke, and, um, I was wondering if I can change it to the baby Aspirin 81mg size once a day instead?
Dr. Grumpy: "Are you having stomach problems or bruising, or another problem with it?".
Mr. Phone: "No."
Dr. Grumpy: "Then why do you want to change it? If Dr. Notoncall told you to take 325mg I assume she had a reason."
Mr. Phone: "Cuz my buddy, Phil at the paint shop, told me he thinks the 81mg is gonna be better for me. Ya see, my girlfriend bought me the bottle of 325mg after my stroke, but she and I broke up yesterday, and I'm not gonna see her again. So Phil pointed out that since she's the one who got me the 325mg size, maybe now that she's left it's not a good idea for me to be taking them, and so I should change sizes to something she didn't buy me".
(Long pause)
Dr. Grumpy: "Sir, I think you should stay on the 325mg pills. It's what Dr. Notoncall told you to take."
Mr. Phone: "Is that safe? Cuz my ex-girlfriend bought them, and Phil said..."
Dr. Grumpy (interrupting): "If it's that important to you, then you can buy your own bottle of the 325mg and get rid of the one she bought you."
Mr. Phone: "Am I allowed to do that?"
Dr. Grumpy: "Yes."
Mr. Phone: "Okay, but I'm gonna go to a different store than she did."
Mr. Phone: "Um, yeah. I see Dr. Notoncall, and she has me on Aspirin 325mg once a day for a stroke, and, um, I was wondering if I can change it to the baby Aspirin 81mg size once a day instead?
Dr. Grumpy: "Are you having stomach problems or bruising, or another problem with it?".
Mr. Phone: "No."
Dr. Grumpy: "Then why do you want to change it? If Dr. Notoncall told you to take 325mg I assume she had a reason."
Mr. Phone: "Cuz my buddy, Phil at the paint shop, told me he thinks the 81mg is gonna be better for me. Ya see, my girlfriend bought me the bottle of 325mg after my stroke, but she and I broke up yesterday, and I'm not gonna see her again. So Phil pointed out that since she's the one who got me the 325mg size, maybe now that she's left it's not a good idea for me to be taking them, and so I should change sizes to something she didn't buy me".
(Long pause)
Dr. Grumpy: "Sir, I think you should stay on the 325mg pills. It's what Dr. Notoncall told you to take."
Mr. Phone: "Is that safe? Cuz my ex-girlfriend bought them, and Phil said..."
Dr. Grumpy (interrupting): "If it's that important to you, then you can buy your own bottle of the 325mg and get rid of the one she bought you."
Mr. Phone: "Am I allowed to do that?"
Dr. Grumpy: "Yes."
Mr. Phone: "Okay, but I'm gonna go to a different store than she did."
Friday, September 11, 2009
Mr. Jackass- The Sequel
For those of you who've already forgotten who I'm talking about, click here. It's also only been 3 days, so you should probably go see a neurologist.
So his appointment was at 10:00 today.
10:00 - No Mr. Jackass.
10:05 - No Mr. Jackass.
10:10 - No Mr. Jackass.
10:15 - Phone rings. It's Mr. Jackass's secretary. She's calling to say that he's in the lobby of my building, but is tied up in a VERY IMPORTANT telephone meeting, and can't come up right now. Mary told her that we don't see new patients who are more than 20 minutes late. She says she'll tell him.
10:17 - Mr. Jackass, cell phone glued to head, shows up. Signs in. He looks at Mary and says, "There. I'm here. Now let me finish my meeting" and sits down in the lobby. Argues with someone on the phone.
10:18 - I go to door, call him back. He doesn't even look up, just gives me the "I'm on the phone, leave me alone" gesture.
10:20 - My 11:00 (a follow-up visit) shows up early. So I take her back. Mr. Jackass gives me dirty look when I call her back, but continues his meeting.
10:35 - Mrs. Follow-Up and I finish her appointment, and I walk her out. I give Mary the "Mr. Jackass is toast" gesture, 15 minutes after I should have.
10:40 - Mr. Jackass hangs up his phone
He goes up to the front desk and tells Mary that "He'll see Dr. Grumpy now". Mary tells him that he's missed his appointment, and can no longer be seen. He starts yelling at her, saying he was here on-time, and in my office by 10:20, like we told him. Demands to talk to the office manager.
I was standing out of sight behind a shelf, because I expected this to happen and wanted to hear it. So I made my appearance. He immediately laid into me about the fact that HE WASN'T BEING SEEN ON TIME BECAUSE HE'D BEEN SITTING IN MY LOBBY FOR A WHILE AND WAS A BUSY GUY WITH STUFF TO DO.
I told him that it's our office policy that we don't see, or reschedule, new patients who are more than 20 minutes late. He insisted he wasn't late. I told him he was, and pointed out that when I tried to call him back for his appointment he'd refused to come back because he was on the phone.
So he demanded to talk to Dr. Grumpy.
And I introduced myself.
For perhaps 10 seconds it was so quiet you could have heard a pin drop.
Then he picked up his phone, pressed a key, and said "Yeah, it's me. Patch me back into the meeting". And walked out the door.
At 11:45 the ER called me. He'd gone over there and told them he needed to be evaluated for a stroke. They asked me to come over and see him. I said no.
And to all a good night.
So his appointment was at 10:00 today.
10:00 - No Mr. Jackass.
10:05 - No Mr. Jackass.
10:10 - No Mr. Jackass.
10:15 - Phone rings. It's Mr. Jackass's secretary. She's calling to say that he's in the lobby of my building, but is tied up in a VERY IMPORTANT telephone meeting, and can't come up right now. Mary told her that we don't see new patients who are more than 20 minutes late. She says she'll tell him.
10:17 - Mr. Jackass, cell phone glued to head, shows up. Signs in. He looks at Mary and says, "There. I'm here. Now let me finish my meeting" and sits down in the lobby. Argues with someone on the phone.
10:18 - I go to door, call him back. He doesn't even look up, just gives me the "I'm on the phone, leave me alone" gesture.
10:20 - My 11:00 (a follow-up visit) shows up early. So I take her back. Mr. Jackass gives me dirty look when I call her back, but continues his meeting.
10:35 - Mrs. Follow-Up and I finish her appointment, and I walk her out. I give Mary the "Mr. Jackass is toast" gesture, 15 minutes after I should have.
10:40 - Mr. Jackass hangs up his phone
He goes up to the front desk and tells Mary that "He'll see Dr. Grumpy now". Mary tells him that he's missed his appointment, and can no longer be seen. He starts yelling at her, saying he was here on-time, and in my office by 10:20, like we told him. Demands to talk to the office manager.
I was standing out of sight behind a shelf, because I expected this to happen and wanted to hear it. So I made my appearance. He immediately laid into me about the fact that HE WASN'T BEING SEEN ON TIME BECAUSE HE'D BEEN SITTING IN MY LOBBY FOR A WHILE AND WAS A BUSY GUY WITH STUFF TO DO.
I told him that it's our office policy that we don't see, or reschedule, new patients who are more than 20 minutes late. He insisted he wasn't late. I told him he was, and pointed out that when I tried to call him back for his appointment he'd refused to come back because he was on the phone.
So he demanded to talk to Dr. Grumpy.
And I introduced myself.
For perhaps 10 seconds it was so quiet you could have heard a pin drop.
Then he picked up his phone, pressed a key, and said "Yeah, it's me. Patch me back into the meeting". And walked out the door.
At 11:45 the ER called me. He'd gone over there and told them he needed to be evaluated for a stroke. They asked me to come over and see him. I said no.
And to all a good night.
Mr. Jackass, Part Deux
Yes, he showed up... sort of.
Gotta see patients right now (blogging isn't my day job, though I wish it was), but thought I'd at least end the guessing.
I'll post full details later tonight or tomorrow, Grumpyites!
Gotta see patients right now (blogging isn't my day job, though I wish it was), but thought I'd at least end the guessing.
I'll post full details later tonight or tomorrow, Grumpyites!
Dear Insurance Bozo
Your patient recently had an extensive work-up (as an inpatient, no less) for her migraines. I wasn't involved in it, but it looks like she was in the hospital for 5 days, and had several MRI's, a spinal tap, and a bunch of other tests. I'm sure her bill was pretty damn high.
She came to see me yesterday for her headaches. She doesn't want any more tests, and doesn't want to go to ER, either. So it sounds like she's trying to save you guys some dough, too, at this point.
So it was really a surprise to find that you bozos refused to authorize my prescription for a CHEAP FUCKING GENERIC drug (which according to drugstore.com is priced at 11 cents a pill) to help her feel better, and stay out of the ER. Instead, you told me it was "experimental" (although it's been a standard treatment for over 20 years) and faxed me 5 pages of forms overnight to get it authorized.
You guys can eat my shorts. I prescribed a drug that's $1.25/pill, now, and you bozos actually cleared it. Way to save some money there.
Wait'll your CEO finds out how this is gonna impact his bonus this year. He won't be happy.
She came to see me yesterday for her headaches. She doesn't want any more tests, and doesn't want to go to ER, either. So it sounds like she's trying to save you guys some dough, too, at this point.
So it was really a surprise to find that you bozos refused to authorize my prescription for a CHEAP FUCKING GENERIC drug (which according to drugstore.com is priced at 11 cents a pill) to help her feel better, and stay out of the ER. Instead, you told me it was "experimental" (although it's been a standard treatment for over 20 years) and faxed me 5 pages of forms overnight to get it authorized.
You guys can eat my shorts. I prescribed a drug that's $1.25/pill, now, and you bozos actually cleared it. Way to save some money there.
Wait'll your CEO finds out how this is gonna impact his bonus this year. He won't be happy.
Thursday, September 10, 2009
OMG!
Thank you, Mrs. Monday-Attwo, for faxing over some information in advance about your symptoms.
I've seen a lot of neurology, and I'm sure what you have is called a Bell's Palsy. It's a common, usually self-limited, droop on one side of your face.
There are still neurological conditions out there that I haven't heard of, but I don't think you have one of them.
I'm not sure where you're getting your information from. Maybe you didn't hear the ER doc correctly. Maybe the ER nurse was in a hurry and her handwriting on your discharge instructions was sloppy. Maybe English is your second language.
But, as far as I know, this condition that you listed on your fax doesn't exist.
It says "Bell's Pussy".
If you do indeed have such an unusual condition, I recommend you either see my esteemed GYN colleague ER's Mom, or take your cat to a vet, depending on the circumstances.
See ya Monday!
I've seen a lot of neurology, and I'm sure what you have is called a Bell's Palsy. It's a common, usually self-limited, droop on one side of your face.
There are still neurological conditions out there that I haven't heard of, but I don't think you have one of them.
I'm not sure where you're getting your information from. Maybe you didn't hear the ER doc correctly. Maybe the ER nurse was in a hurry and her handwriting on your discharge instructions was sloppy. Maybe English is your second language.
But, as far as I know, this condition that you listed on your fax doesn't exist.
It says "Bell's Pussy".
If you do indeed have such an unusual condition, I recommend you either see my esteemed GYN colleague ER's Mom, or take your cat to a vet, depending on the circumstances.
See ya Monday!
Wednesday, September 9, 2009
Dear Dr. Sealfon,
Congrats on being named neurology chairman at Sinai.
I have no idea why you sent me an announcement. I mean, nothing against you, but we've never met (unless it involved a drunken encounter that I've forgotten). In fact, I hadn't heard of you until I got your lovely card in today's mail. I'm sure Mount Sinai is a fine facility, but I've never been there. After 20 years, I honestly don't remember if it was one of the many medical schools that rejected me in the late 1980's.
So I'm entirely lacking in ideas as to why your institution paid to kill a tree, print a card, and mail it to me to trumpet your news. Annie thought maybe you were fishing for a gift, like those cheesy "Hey! I Graduated from High School Again" notes that the kid who delivers the paper sends. But I have no idea what to get you. A $25 U.S. Savings Bond? A Chia Pet? A "Trees for Israel"* certificate? Given that I'm not exactly down the block from you I'm unlikely to be referring you any patients (nothing personal).
Anyway, good luck in your new job. If anyone at Mount Sinai has even the slightest idea as to why I'm on your mailing list, please let me know. They can also take me off it to spare future trees from any further announcements.
Yours truly,
Ibee Grumpy, M.D.
*For those who didn't grow up with Jewish friends in the 70's-80's, the "Trees for Israel" certificate was a remarkably lame gift for equally lame occasions. It basically was a paper with your (usually misspelled) name typed/written/crayoned on it, saying that in your honor a few bucks had been given to plant trees in Israel. It often misled you to believe that somewhere in Israel there REALLY WAS a tree with a plaque and your name on it, which is a story in itself. Anyway, they made incredibly disappointing gifts ("Wow, Ibee! Mark got you a GI Joe super-charged missile-action tank set, and Joe brought you a "Trees for Israel" certificate." And Joe would be so embarrassed that his Mom got you one that he'd be hiding in a paper bag). So now you know.
Whatever
"Look! I'm not stupid! I'm not a doctor, but I know A LOT about medicine. I mean, my brother-in-law's cousin is married to an optometrist!"
(No offense to optometrists is intended).
(No offense to optometrists is intended).
Tuesday, September 8, 2009
I Love You People
Mr. Jackass, I'm sorry we couldn't accommodate your busy schedule to work you in today.
I understand you're frustrated. I mean, I would be too if I'd been walking around since yesterday with slurred speech and mild arm weakness. It's a real pisser that you're having trouble texting your real estate clients with your thumb being clumsy like that.
Yeah, I can guess you had a stroke. I'm a neurologist, and I didn't need you to tell me that. I agree that under most circumstances this would be urgent, but my day is full, and having you walk in and start yelling obscenities at Mary because she told you we were booked solid today doesn't increase your sympathy rating around here.
I'm also sorry you were unable to take the appointment she did offer you, tomorrow morning at 8, because you have a meeting with a homeowner's association. I know those things are important. And you have that finance meeting on Thursday at 1, so you couldn't come in then, either. So I guess I'm seeing you on Friday at 3. I know you told Mary that was unreasonably long to have to wait for a stroke, and I'm sorry. Because of my casual dress habits you obviously didn't guess that the doctor was the guy standing in the lobby next to you, because I'd gone up to refill my water bottle.
Mary suggested, several times, that you go to ER, and I was standing there when you refused because you didn't have time for "that sort of nonsense". I told you to go to ER, too, but when you said "who asked you, Buttinski?" I decided to let you keep thinking I was another patient or a drug rep or something. Mary should get a raise for keeping a straight face.
I bet it would surprise you to know that while you were arguing with Mary I walked back to my office to log into the hospital system to see if you'd been there, and, SURPRISE there you were! It looks like you actually went in yesterday, after you'd finished cleaning your pool, and left AMA. The ER doc clearly documented that he wanted to admit you for an inpatient work-up, and you told him he was being unreasonable because then you'd miss the Labor Day barbecue you'd spent all week preparing for. I hope you didn't burn too many burgers with the bad hand.
I'll see you on Friday. Bet you'll be surprised to see what I'm wearing.
I understand you're frustrated. I mean, I would be too if I'd been walking around since yesterday with slurred speech and mild arm weakness. It's a real pisser that you're having trouble texting your real estate clients with your thumb being clumsy like that.
Yeah, I can guess you had a stroke. I'm a neurologist, and I didn't need you to tell me that. I agree that under most circumstances this would be urgent, but my day is full, and having you walk in and start yelling obscenities at Mary because she told you we were booked solid today doesn't increase your sympathy rating around here.
I'm also sorry you were unable to take the appointment she did offer you, tomorrow morning at 8, because you have a meeting with a homeowner's association. I know those things are important. And you have that finance meeting on Thursday at 1, so you couldn't come in then, either. So I guess I'm seeing you on Friday at 3. I know you told Mary that was unreasonably long to have to wait for a stroke, and I'm sorry. Because of my casual dress habits you obviously didn't guess that the doctor was the guy standing in the lobby next to you, because I'd gone up to refill my water bottle.
Mary suggested, several times, that you go to ER, and I was standing there when you refused because you didn't have time for "that sort of nonsense". I told you to go to ER, too, but when you said "who asked you, Buttinski?" I decided to let you keep thinking I was another patient or a drug rep or something. Mary should get a raise for keeping a straight face.
I bet it would surprise you to know that while you were arguing with Mary I walked back to my office to log into the hospital system to see if you'd been there, and, SURPRISE there you were! It looks like you actually went in yesterday, after you'd finished cleaning your pool, and left AMA. The ER doc clearly documented that he wanted to admit you for an inpatient work-up, and you told him he was being unreasonable because then you'd miss the Labor Day barbecue you'd spent all week preparing for. I hope you didn't burn too many burgers with the bad hand.
I'll see you on Friday. Bet you'll be surprised to see what I'm wearing.
Pancake Time
Mr. Syrup, I have absolutely NO IDEA WHATSOEVER if the IHOP* down the street is a "participating restaurant" in the coupon deal that you have folded up in your wallet.
Do these people ask their other doctors questions like this?
*For my non-North American readers: IHOP (International House of Pancakes) is a restaurant chain in the US and Canada.
Do these people ask their other doctors questions like this?
*For my non-North American readers: IHOP (International House of Pancakes) is a restaurant chain in the US and Canada.
Back to Work
Greeted by this headline list on the morning online news:
Hmmm, looks like the headline writer wasn't paying attention in class.
(Please note- this post is to get a giggle off an untimely spelling error. Political comments from either side will not be posted. There are plenty of political blogs for that).
Hmmm, looks like the headline writer wasn't paying attention in class.
(Please note- this post is to get a giggle off an untimely spelling error. Political comments from either side will not be posted. There are plenty of political blogs for that).
Monday, September 7, 2009
The Tale of the Gold Clip
In honor of Labor Day (celebrated as May Day in other countries) I present this nonpartisan story to remind all of us where our hard-earned tax dollars go. Although I'm American, insanity of this type is universal to all governments, and likely always will be.
I have a gold-colored binder clip on the wall. This is what it looks like:
"Dr. Grumpy, why on Earth would you keep something as odd as a binder clip on your wall?" you ask. So gather round, open up a Diet Coke, and I'll tell you my story.
There have been 3 presidential elections since I went into practice.
During one of these elections a presidential debate was held at a university in my state.
One of my patients is a supervisor at that university's media department. He came in for an appointment, with a bunch of his old test reports. They were held together by a binder-clip. It caught my eye because it was gold-colored (likely made of brass), and I hadn't seen one like that before. I'm used to the standard black clips with silver prongs.
So I mentioned that I'd never seen one like that before, and he told me this story:
When the university was preparing for the presidential debate, the campaigns gave them a list of things the Presidential gentlemen needed on the podium in front of them (the list had been pre-agreed on, so each would have the same stuff).
On top of each podium each Presidential person had paper and pens and a glass of water, which we all saw. But on the shelf underneath the podium, each had the following items, which had been jointly agreed upon. He showed me the memo.
More paper
2 black pens
2 blue pens
3 sharpened No. 2 pencils
A pencil sharpener
Big paper clips
Small paper clips
A stapler
Extra staples
A scotch tape dispenser
An extra role of scotch tape
Yellow post-it notes
Binder clips
So the university dutifully put all this junk on the shelves under each podium, in case either Presidential person wanted to do collating, decorating, or origami on national television.
During the final check of the stage, both campaigns went berserk when they discovered the university had thoughtlessly supplied them with standard black binder clips, as apparently men of Presidential stature should only be using gold-colored binder clips (at least on national television). So the university had to go out and find some (the one I have says 'OfficeMax' on the side) at the last minute.
During the debate, I didn't see either gentleman take any of the above-mentioned items out from the podium. In retrospect, in the 22 Presidential debates I remember seeing in 9 elections, I don't recall seeing anyone using anything from the list other than a pen and paper.
So the university was left with all these office supplies, including gold binder clips.
So now I have the gold binder clip hanging on my wall to remind me of where my hard-earned tax dollars are going.
I have a gold-colored binder clip on the wall. This is what it looks like:
"Dr. Grumpy, why on Earth would you keep something as odd as a binder clip on your wall?" you ask. So gather round, open up a Diet Coke, and I'll tell you my story.
There have been 3 presidential elections since I went into practice.
During one of these elections a presidential debate was held at a university in my state.
One of my patients is a supervisor at that university's media department. He came in for an appointment, with a bunch of his old test reports. They were held together by a binder-clip. It caught my eye because it was gold-colored (likely made of brass), and I hadn't seen one like that before. I'm used to the standard black clips with silver prongs.
So I mentioned that I'd never seen one like that before, and he told me this story:
When the university was preparing for the presidential debate, the campaigns gave them a list of things the Presidential gentlemen needed on the podium in front of them (the list had been pre-agreed on, so each would have the same stuff).
On top of each podium each Presidential person had paper and pens and a glass of water, which we all saw. But on the shelf underneath the podium, each had the following items, which had been jointly agreed upon. He showed me the memo.
More paper
2 black pens
2 blue pens
3 sharpened No. 2 pencils
A pencil sharpener
Big paper clips
Small paper clips
A stapler
Extra staples
A scotch tape dispenser
An extra role of scotch tape
Yellow post-it notes
Binder clips
So the university dutifully put all this junk on the shelves under each podium, in case either Presidential person wanted to do collating, decorating, or origami on national television.
During the final check of the stage, both campaigns went berserk when they discovered the university had thoughtlessly supplied them with standard black binder clips, as apparently men of Presidential stature should only be using gold-colored binder clips (at least on national television). So the university had to go out and find some (the one I have says 'OfficeMax' on the side) at the last minute.
During the debate, I didn't see either gentleman take any of the above-mentioned items out from the podium. In retrospect, in the 22 Presidential debates I remember seeing in 9 elections, I don't recall seeing anyone using anything from the list other than a pen and paper.
So the university was left with all these office supplies, including gold binder clips.
So now I have the gold binder clip hanging on my wall to remind me of where my hard-earned tax dollars are going.
Sunday, September 6, 2009
Sunday, 2:10 pm
"Hello, I need to leave a message for Dr. Grumpy. I'm a patient of his, and the rainstorms we've had this week have been making my migraines terrible! I want to know what he's going to do about it!"
Saturday, September 5, 2009
Saturday, 4:59 pm
"Hello, this is Mrs. Bimbo, leaving a message for Dr. Grumpy. I'm catching up on my to-do list today, and you guys had called me on August 17, 2009 at 2:17 pm. I don't remember what the message was that you left, so I'd like a call back today to tell me what it concerned and if there was an emergency you needed to discuss with me. Thank you."
Cooper, the WonderDog!
He's bitten my mother-in-law 3 times in the last 2 weeks.
Is this dog awesome or what?
Is this dog awesome or what?
Friday, September 4, 2009
Today's Winner!
Last patient of the day, and the week for that matter. 51 year old lady.
Dr. Grumpy: "Any changes in your medications since your last visit?"
Mrs. Friday: "Yes, I'm not taking birth control pills any more."
Dr. Grumpy: "Oh, are you menopausal?"
Mrs. Friday (puzzled look): "No, Doctor, I'm Hispanic."
Dr. Grumpy: "Any changes in your medications since your last visit?"
Mrs. Friday: "Yes, I'm not taking birth control pills any more."
Dr. Grumpy: "Oh, are you menopausal?"
Mrs. Friday (puzzled look): "No, Doctor, I'm Hispanic."
Thursday, September 3, 2009
Phrazzled Pharmacist
This afternoon Mary flagged me down to tell me Greg, from Local Pharmacy, was on the phone.
I picked up the line. Greg sounded frazzled, was speaking quickly, and trying to clarify stuff on a patient who'd brought in several scripts. One of his questions required me to do some research on the chart, so I asked him for his phone number, jotted it down, and told him I'd call him back in a minute.
So I looked through the chart, found what I needed, grabbed his phone number, and dialed it.
It rang 5 times, then:
"Hi! You've reached Laurie, Greg, and Sassy. Please leave us a message and we'll call you back!"
I picked up the line. Greg sounded frazzled, was speaking quickly, and trying to clarify stuff on a patient who'd brought in several scripts. One of his questions required me to do some research on the chart, so I asked him for his phone number, jotted it down, and told him I'd call him back in a minute.
So I looked through the chart, found what I needed, grabbed his phone number, and dialed it.
It rang 5 times, then:
"Hi! You've reached Laurie, Greg, and Sassy. Please leave us a message and we'll call you back!"
Mary, You Are SO Fired!
Yes, it's time to renew the Grumpy Neurology, Inc. employee health insurance plan. So we all get to fill out forms listing how many packs a day we smoke, how much fatter we are since 2008, and how many surgeries we've each had in the last year.
So I gave one to everybody (except Ed), and they scribbled them out and gave them back.
I was double-checking them before faxing to our insurance company. As I glanced over Mary's, I noted some of her answers:
Height: 5'1". Weight: 540 lbs.
Pregnant: Yes, due in March, 2010.
Medications: Lithium, Haldol, Valium, Oxycontin, birth control, Methadone, Heroin
Medical conditions: Bipolar, ADHD, closed head injury, brain damage, breast problems, illegal drugs, alcoholism
I turned around just in time to see her completely lose it and start laughing hysterically.
Between the patients and my staff... I don't have a chance.
So I gave one to everybody (except Ed), and they scribbled them out and gave them back.
I was double-checking them before faxing to our insurance company. As I glanced over Mary's, I noted some of her answers:
Height: 5'1". Weight: 540 lbs.
Pregnant: Yes, due in March, 2010.
Medications: Lithium, Haldol, Valium, Oxycontin, birth control, Methadone, Heroin
Medical conditions: Bipolar, ADHD, closed head injury, brain damage, breast problems, illegal drugs, alcoholism
I turned around just in time to see her completely lose it and start laughing hysterically.
Between the patients and my staff... I don't have a chance.
Wednesday, 9:05 p.m.
I had a cancellation for the 8:00 spot this morning, so when a new patient called last night to make an appointment, I called them back to see if they wanted to come in.
Dr. Grumpy: "Hi, this is Dr. Grumpy. You called for an appointment?"
Mrs. Frantic: "YES! I need to come in for headaches and neck pain from a car accident!"
Dr. Grumpy: "Okay, what insurance..."
Mrs. Frantic: "Hey! Back off! I'm talking to my lawyer here!"
Dr. Grumpy: "Hello?"
Mrs. Frantic: "Sorry, the dick who hit me was coming over here. I don't want him to know I called a doctor."
(siren in background)
Dr. Grumpy: "Ma'am, where are you?"
Mrs. Frantic: "I'm in my car! I told you! I was in an accident and need to see a neurologist!"
Dr. Grumpy: "When was the accident?"
Mrs. Frantic: "Uh, like maybe 5 minutes ago. Oh good, the cops are finally here. What takes them so long?"
Dr. Grumpy: "You called me instead of 911?"
Mrs. Frantic: "No, the dick said he called 911, so I figure I don't need to. You saw my dad last year, and I still have your card in my purse. I have a headache now and my neck hurts, so I thought I should make an appointment. When can I come in?"
Dr. Grumpy: "Ma'am, you should go to an ER tonight to get this checked out. That should be your first step."
Mrs. Frantic: "Damnit, I gotta go talk to the cop now. Where's my insurance stuff? I'll call you back."
I didn't hear from her the rest of the night, but suspect she'll call today.
Dr. Grumpy: "Hi, this is Dr. Grumpy. You called for an appointment?"
Mrs. Frantic: "YES! I need to come in for headaches and neck pain from a car accident!"
Dr. Grumpy: "Okay, what insurance..."
Mrs. Frantic: "Hey! Back off! I'm talking to my lawyer here!"
Dr. Grumpy: "Hello?"
Mrs. Frantic: "Sorry, the dick who hit me was coming over here. I don't want him to know I called a doctor."
(siren in background)
Dr. Grumpy: "Ma'am, where are you?"
Mrs. Frantic: "I'm in my car! I told you! I was in an accident and need to see a neurologist!"
Dr. Grumpy: "When was the accident?"
Mrs. Frantic: "Uh, like maybe 5 minutes ago. Oh good, the cops are finally here. What takes them so long?"
Dr. Grumpy: "You called me instead of 911?"
Mrs. Frantic: "No, the dick said he called 911, so I figure I don't need to. You saw my dad last year, and I still have your card in my purse. I have a headache now and my neck hurts, so I thought I should make an appointment. When can I come in?"
Dr. Grumpy: "Ma'am, you should go to an ER tonight to get this checked out. That should be your first step."
Mrs. Frantic: "Damnit, I gotta go talk to the cop now. Where's my insurance stuff? I'll call you back."
I didn't hear from her the rest of the night, but suspect she'll call today.
Wednesday, September 2, 2009
Let's Stick With Your Visit
Look, people. I am a neurologist. Specifically, when you come to see me, I am your neurologist.
I am here to try and help you.
I am NOT here:
1. For you to sell me a timeshare.
2. To discuss the rising price of bus passes.
3. To render a 2nd opinion on your friend's 3rd cousin with MS in Wyoming.
4. To look at > 2 pictures of your children, grandchildren, dogs, doll collection, spouse, car, trailer home, or the fish you caught last weekend.
5. To look at the catalogue of huge, 3-wick, foul-smelling candles that you sell.
6. To help you decide what to do with your investment portfolio.
7. To tell you if your new dress makes your ass look fat. Let's face it- the dress has nothing to do with it.
8. To hear about your great blackjack strategies at the local Indian casino. If you were that good at it, you wouldn't keep asking me to waive your $15 co-pay.
9. For you to sell girl scout cookies, campfire candles, chocolate bars, or any other of your kid's school fundraising stuff to.
10. To answer your questions about getting a passport.
11. To listen to the great deal you got on bedroom furniture in 1959.
Thank you.
I am here to try and help you.
I am NOT here:
1. For you to sell me a timeshare.
2. To discuss the rising price of bus passes.
3. To render a 2nd opinion on your friend's 3rd cousin with MS in Wyoming.
4. To look at > 2 pictures of your children, grandchildren, dogs, doll collection, spouse, car, trailer home, or the fish you caught last weekend.
5. To look at the catalogue of huge, 3-wick, foul-smelling candles that you sell.
6. To help you decide what to do with your investment portfolio.
7. To tell you if your new dress makes your ass look fat. Let's face it- the dress has nothing to do with it.
8. To hear about your great blackjack strategies at the local Indian casino. If you were that good at it, you wouldn't keep asking me to waive your $15 co-pay.
9. For you to sell girl scout cookies, campfire candles, chocolate bars, or any other of your kid's school fundraising stuff to.
10. To answer your questions about getting a passport.
11. To listen to the great deal you got on bedroom furniture in 1959.
Thank you.
Sharing the Love
Okay, gang, generally I try not to borrow/steal from other blogs, but sometimes one of them has something so remarkable I just HAVE to share it.
So, to give credit where credit is due: The following awesome post was written yesterday by my esteemed colleague Big 'N Tasty RPh, over at Fast Food Pharmacy.
"Ding Ding Ding! We have a Winner!
Plan B is available at the pharmacy for purchase with a photo ID proving the purchaser is 18 years old. The message on the box states 'Prescription required for women under age 17.'
A man called because he came in earlier in the evening and purchased a box of Plan B. He called very concerned that we had sold him the one for under 17 year olds and needed to know if it would still work for someone over 17 years old. I was speechless.
This guy must have swam out of the shallow end of the gene puddle. You know, the "gene puddle." Definition: a minute puddle cut off from the gene pool by global warming that allowed for the most severe degradation of the human genetic sequence resulting in acts or words of stupidity that defy even an every day Joe's imagination.
So I firmly and simply replied that the pill labeled Plan B is the same, only the law needs a prescription for a young girl. He expressed great relief and after he hung up the phone I laughed so hard I almost peed myself. This guy is ready for plan C (i.e. castration). If there is a God he will never allow that guy's genetic material to be passed along but we all know from experience that the people who want kids have the hardest time getting pregnant while those who have no business with children breed like rabbits. Another winner indeed."
So, to give credit where credit is due: The following awesome post was written yesterday by my esteemed colleague Big 'N Tasty RPh, over at Fast Food Pharmacy.
"Ding Ding Ding! We have a Winner!
Plan B is available at the pharmacy for purchase with a photo ID proving the purchaser is 18 years old. The message on the box states 'Prescription required for women under age 17.'
A man called because he came in earlier in the evening and purchased a box of Plan B. He called very concerned that we had sold him the one for under 17 year olds and needed to know if it would still work for someone over 17 years old. I was speechless.
This guy must have swam out of the shallow end of the gene puddle. You know, the "gene puddle." Definition: a minute puddle cut off from the gene pool by global warming that allowed for the most severe degradation of the human genetic sequence resulting in acts or words of stupidity that defy even an every day Joe's imagination.
So I firmly and simply replied that the pill labeled Plan B is the same, only the law needs a prescription for a young girl. He expressed great relief and after he hung up the phone I laughed so hard I almost peed myself. This guy is ready for plan C (i.e. castration). If there is a God he will never allow that guy's genetic material to be passed along but we all know from experience that the people who want kids have the hardest time getting pregnant while those who have no business with children breed like rabbits. Another winner indeed."
Another Fine Medication List
My Tuesday ended with me asking an elderly gentleman what pills he was taking.
He stood up, dug through his pockets, and finally handed me a wad of paper.
It said:
"lettuce.
American cheese
laundry soap
paper towels
ketchup"
He stood up, dug through his pockets, and finally handed me a wad of paper.
It said:
"lettuce.
American cheese
laundry soap
paper towels
ketchup"
Tuesday, September 1, 2009
Allergies
A popular topic on all medical blogs, it seems, but always fun. This (almost) alphabetical list was given to me by today's 9:00:
"I'm allergic to Ambien, Aspirin, Axert, Bextra, Butalbital, Caffeine, Celebrex, Codeine, Pistachio Ice Cream, Darvocet, Depakote, Fentanyl, Amitriptyline, Hair Spray, Erythromycin, Fosamax, Imitrex, Keppra, Marinol, Klonopin, Lamictal, Lyrica, Mountain Dew, Mirapex, Mobic, Breathing Strips, Morphine, Treated Leather Products, Cardizem, Neurontin, Model Glue, Oxycodone, Penicillin, Jell-O, Relafen, Vanilla flavoring, Relpax, Requip, Artificial Cookie Dough, Sinemet, Sonata, Sulfa, Peanuts (but peanut butter is okay), Steroids, Talacin, Tetenus, Artificial Creamer Stuff, Topamax, Toradol, Some M&M colors, Tramadol, Hydrocodone, Vioxx, Xylocaine, Zoloft, Zomig, and Zonegran"
I can only assume this person has kids at the school Mrs. Grumpy works at.
"I'm allergic to Ambien, Aspirin, Axert, Bextra, Butalbital, Caffeine, Celebrex, Codeine, Pistachio Ice Cream, Darvocet, Depakote, Fentanyl, Amitriptyline, Hair Spray, Erythromycin, Fosamax, Imitrex, Keppra, Marinol, Klonopin, Lamictal, Lyrica, Mountain Dew, Mirapex, Mobic, Breathing Strips, Morphine, Treated Leather Products, Cardizem, Neurontin, Model Glue, Oxycodone, Penicillin, Jell-O, Relafen, Vanilla flavoring, Relpax, Requip, Artificial Cookie Dough, Sinemet, Sonata, Sulfa, Peanuts (but peanut butter is okay), Steroids, Talacin, Tetenus, Artificial Creamer Stuff, Topamax, Toradol, Some M&M colors, Tramadol, Hydrocodone, Vioxx, Xylocaine, Zoloft, Zomig, and Zonegran"
I can only assume this person has kids at the school Mrs. Grumpy works at.