Thank you for your note on my migraine patient.
I've tried several medications for Mrs. Hedhurtz, including Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn, all without success.
I've done MRI's, MRA's, and a spinal tap on her. I sent her to an ophthalmologist.
I was frustrated. She was more frustrated. I wasn't having a lot of success helping her. And she seems like a nice lady.
So, since you advertise yourself as a neurologist who specializes in treating difficult headaches, and cite your 2 years of headache subspecialty fellowship training, I decided to refer her to you. You opened up shop near me last month, so I thought I'd give you a chance to earn my referral business. Your marketing person dropped off some cards here 2 weeks ago.
And yesterday I got your faxed note about her.
At the beginning of your note it says that "I've reviewed Dr. Grumpee's notes and tests in detail." That was your second lie (your first lie is in calling yourself a headache specialist, or even a doctor). I also loved the fact that you spelled my name wrong.
Your note ends with the following, which I've paraphrased.
"Impression: Mrs. Hedhurtz suffers from chronic headaches. She's previously failed trials of Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn. I suggest she be referred to an ophthalmologist. A spinal tap should also be considered.
For future treatment, I suggest she be started on a medication that she hasn't previously tried before. I've referred her back to Dr. Grumpee's care to follow my recommendations.
Yours truly,
I. M. Worthless, M.D."
Thank you SO much for your helpful advice. I'd normally say "thanks for nothing", but what you've done doesn't even amount to that much.
As my late grandfather would have said, "this is the second time I've sent you a patient. First and last."
Sincerely,
Ibee Grumpy, M.D.
22 comments:
I have seen Dr. Worthless before. He "fired" me after I tried Depakote for 6 months with no improvement and asked to try something else.
"I have nothing more to offer you," he said. It was amazing how many other things the next neuro I saw had to offer me.
I am glad to hear Worthless is gone from your list. You should give him YOUR card for referrals. Would be doing patients a favor.
I'm guessing the patient either refused botox injections or has insurance that won't cover them. Without a source of renumeration, there's nothing more Dr W can do.
I've tried all those medications except the Fukitol and would love to know where I can get some?
Out of curiosity, did you send a version of this note to Dr.WTF? He certainly will never improve in his methodology and treatment ideas if someone doesn't let him know he's a dumbass.
Oh, I can't believe you'd make Mary go to Dr. Worthless....now we all know how you really feel about your best employee.
Nice. Gotta love IMW...bet he's busy (not)!
If he uses EHR, bet he cuts and pastes his notes from patient to patient.
That's what the truly lazy specialists do at the Hotel. They only get in trouble if they piss off Dr. P., who reported one to the chief of staff, the privacy officer and information security officer when the lazy arse did that to one of her patients and left in the other patient's name (a HIPAA violation--great post here: http://www.kevinmd.com/blog/2012/07/copy-paste-electronic-medical-records-affects-patient-care.html).
Typical...
Really, SMOD? I'm guessing botox wasn't even on the table, because it's only marginally more effective than placebo, and has the potential for nasty side effects. Nothing else the doc can do? Seriously?
Don!, Botox is remarkably effective, if the result the physician is aiming for is the generation of high-impact CPT codes. That might be Dr W's chief criteria for selecting therapy.
For relief of headaches, not so much.
I get this when submitting bug reports for software or hardware computer problems.
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Dear COMPANY,
I have discovered ISSUE with YOUR-PRODUCT. I have tried X, Y, Z, and ABC to fix it. X and Z did nothing, Y did thisthing, and ABC gave the following error message: [message].
Per your guidelines I have included the technical details of my system and run your diagnostic tool, the results of which are attached.
Moose
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I get back:
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Dear Moose,
We're sorry to hear you're having problems with OUR-PRODUCT. We cannot look into it further until you send us required information.
Please send us the specifications for your system. Then please run the tool located at [URL] and send us back a copy of the results, which can be found by [Details for finding the file, written with the assumption that reader has a 1st grade education.]
You can be sure we are taking your report very seriously and giving it our utmost attention.
-------
Generally I then start hunting for Mr Bat.
Mind you, I have gotten this runaround for professional level computing equipment, not just generic consumer stuff where the person sending the email is making minimum wage.
In my professional past I had more than a few conversations with managers of support teams about assuming that the people running a $35M computer system need instructions written for Grandpa Where's-the-enter-key.
Maybe the fault was with you Dr Grumpy. You did everything that was available for this patients without success but rather than be honest with the patient and say that nothing more can be done, you dodge this responsibility and pass it on to another doctor, who doesn't really have anything else to offer but also won't accept that nothing else can be done so simply repeats what you've done and sends her back.
Between you, you have done this patient a disservice.
Well, you had to try him, to know for sure.
Anon, what you're saying makes no sense, given that Dr W apparently advertises himself as a neurologist with a subspecialty in difficult headaches. If he can't think of anything any other neurologist would to treat a difficult headache case, then what would it even mean to specialize in difficult headache cases?
Oooooh, Dr. G., please tell me you tried injectable Imitrex. It changed my life. Previously, was always out of sick time, with magical Imitrex, almost norma,(or as close as I will ever be).I can wake up at 400am with the pukes and the feeling of a fork stuck in my eye, get a shot(need help, cant sequence the task) and within an hour I am 90% improved.
Folks don't want to read anymore. It starts in grades 1-12. I "reap the benefits" as a professor. Very frustrating.
Agreed Don, what IS the point of having subspecialist neuros (or any other type of subspecialist doc for that matter), if the subspecialist doesn't have even more specific and useful knowledge than the general specialists do.
On the other hand, I go to a large subspecialist clinic for MS and for the over 65 percent of us who have NO treatment options available to us, many of us do not find that the subspecialists really do know more, or have any obscure treatment options waiting in the wings, than any other general neuro would have. Nothing for you means nothing for you.
They may read more of the current studies and have more of an interest, but in the end, the litany still remains "we don't know and we cannot do, but we sure will squeeze every drop of insurance reimbursement or private pay monies we can, while doing absolutely nothing for you and you and you."
I know I'm jaded and cynical but often, (the majority of the time), I feel that even the alleged subspecialist neuros seem to be living in the first century B.C., when it comes to having an understanding of what they purportedly treat. No doubt some migraine patients may feel the same way.
Despite seven tesla MRIs and PET scans, we simply are not all that advanced yet, when it comes to neurology. "I can't get no satisfaction from neuros."
Maybe there's a better migraine subspecialist neuro out there for this person, as people tell me that migraines are absolutely horrible beyond belief. She's probably better off with you though Dr. G., as you seem to care about your patients.
Maybe the patient should get her gas fire checked to see if it is leaking exhaust fumes, or maybe there is some other enviromental factor.
Anon, based on my own experience with several general neuros and a headache specialist, my thinking is that subspecialists who have knowledge and/or experience that general neuros really do exist; this guy just wasn't one. It's not Dr G's fault he took him at his word and gave him a shot. Now if he referred a patient to this same clown again, then that would be Dr G's fault.
I have a friend (yeah, I know surprising but true) and his wife believes her migraines are hormonal and she thinks that taking a viagra which dilates blood vessels helps her. Helps her headaches that is.
My daughter used to take Excedrin Migrain and it worked for her and it contained caffein.
Curious if you have ever actually written “Nomigraine” or one of your other medication pseudonyms on a Rx pad? “Fukitol 2.5 mg TID s food”
Thought about it, but not yet.
While not realizing it, the "headache expert" showed that you were as good at managing headaches as he was. You'd already done all the things he suggested.
FWIIW, some migraines are pretty obviously hormonal. Anyone check this persons teeth/sinuses?
Dr Worthless:
Pretty much every neurologist in my metropolitan area. I am sick and tired of managing issues that fall into the realm of neurology because of the laziness of your specialty. I really miss the days when a neurologist could actually make a diagnosis without an MRI.
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