Neurology, 2011

Dr. Grumpy has lost his neurology mojo over time.

Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape.

Yesterday I turned away a good hospital case, and told them to find someone else.

The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.

28 year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). Within 2 days of admission he developed 2 separate cranial nerve palsies, on opposite sides.

Now, I know you residents and medical students are out there, holding up your hands and yelling "Oooh! Oooh! Mr. Kotter! He could have meningeal lymphomatosis with cranial nerve palsies! He needs an MRI and spinal tap."

Hell, you think I didn't know that? Like I said, these are the interesting cases that make the job fun.

So why did I tell them to find another neurologist?

Here's why:

The patient had seen another neurologist (who didn't come to my hospital) about a week before. He'd had an MRI done as an outpatient. He'd had a spinal tap done as an outpatient.

And yet, no one, including the patient and his family, had ANY FREAKIN' IDEA about which neurologist he saw (beyond "his office was on the west side"), or where the MRI was done, or where the spinal fluid had been sent for tests.

I don't care that someone else had already done the key parts of the work-up. I'm not looking to stand up as the great Grumpy, solver of the unsolvable. Any competent neurologist would know what to do.

And getting results is reasonably easy IF you know where to fax a release.

But in order to get the answer here I'd have had to try to track down a neurologist, an MRI facility, and a laboratory. And there are no shortage of any in Grumpyville.

And from personal experience (particularly involving tracking down labs) I knew it could easily take an hour or more of phone time to do this. I've found that when you want something specific, delegating it to an order in a chart ("please get outside labs from Planet Phlebotomy") will often get you nowhere, or some results you didn't want. So I'd likely be doing the calling, and getting transferred between departments, and then cut off, and having to call back... you get the idea.

When you have a full-time office practice, and a family of 5, adding an extra hour or two to the day isn't something you want to do. Especially when you're going to get paid the same amount for the consult no matter how much work you put into trying to track the results down.

And so I quietly told them to call another neurologist.

I still like what I do. But the realities of time, money, and frustration can dull the scientific curiosity of anyone. Even me.