Fine, then call Google

Dr. Grumpy: "What you have is called Essential Tremor. It's a form of tremor that..."

Mrs. Parscompacta: "Wait, are you saying I don't have Parkinson's disease?"

Dr. Grumpy: "Correct. Essential tremor is a different disorder that..."

Mrs. Parscompacta: "This is ridiculous. Of course I have Parkinson's disease."

Dr. Grumpy: "Why do you say that?"

Mrs. Parscompacta: "Because the internet says I do!"

Dr. Grumpy: "Ma'am, I can assure you that you don't..."

Mrs. Parscompacta: "I DEMAND YOU DIAGNOSE ME WITH PARKINSON'S DISEASE!!!"

Dr. Grumpy: "Why do you want Parkinson's Disease?"

Mrs. Parscompacta: "I'm your customer, damn it! Haven't you ever heard 'the customer is always right'?"

Dr. Grumpy: "Yes, but for this..."

Mrs. Parscompacta: "You're the 3rd neurologist I've seen, too. Obviously, I've learned more from Google than you idiots did in training."

Dear Helen Keller Services for the Blind,

Yesterday you sent this email to one of my readers, who kindly forwarded it to me.

And beyond that, I'm not going to say anything.

Thank you, Dilbert!

Hmmm...

Mr. Skip: "My pain is better, but I still have bad days, about once a week. I don't know why."

Dr. Grumpy: "Any side effects on the medication?"

Mr. Skip: "No, but I just don't like taking pills."

Dr. Grumpy: "They seem to be helping you, though."

Mr. Skip: "Yeah, but I'm just not a pill person. I skip taking them every 5 days to see if the pain comes back. It does."

Front counter

A lady comes in to the waiting room, sits down, and grabs a magazine. Other patients come and go, and after a few minutes Mary goes to the counter.

Mary: "Hi, ma'am. Are you here to see Dr. Grumpy or Dr. Pissy?"

Lady: "Neither."

Mary: "Oh, are you picking someone up?"

Lady: "No."

Mary: "Do you need to make an appointment?"

Lady: "No, thank you."

Mary: "Is there anything I can help you with?"

Lady: "No, I'm just reading the magazines. I didn't like the ones Dr. Lung has across the hall, and told them they could find me over here."

Patient quote of the day

"It was dark. I mean, pitch black. I was afraid I'd completely lost my vision and was blind. But then I found the light switch, and flipped it. That made everything fine, and I could see again."

Money changes everything

Dear Dr. Cashpay,

I know you don't remember what it was like to be a peon. It's been several years since you last saw an average patient. Nowadays people pay you $5000/year to "belong" to your practice, and then another $400/hour if they actually have to see/speak/text/stand in your radiant aura.

And you normally don't refer to me, anyway. Since I take insurance, I get paid the same amount of money to see one of your self-important assholes as I do for a decent, but non-wealthy person. So I don't give your patients the priority attention you feel they deserve. But, occasionally, one of them will show up on my doorstep and I'll see them. As did Mr. Rich last week. Unlike most of your peeps, he was quite pleasant.


3 days later:


Mary: "Dr. Grumpy's office, this is Mary."

Lacey: "Hello, this is Lacey, calling from Dr. Cashpay's office. He wishes to discuss Mr. Rich's case with Dr. Grumpy."

Mary: "Hang on, he's between patients, so let me get him."

Lacey: "No, we don't work that way. He'd like to schedule a 15-30 minute appointment to discuss Mr. Rich by phone."

Mary: "Wait... You're actually trying to schedule a phone call for the doctors to talk?"

Lacey: "That's what we do here."


This was a first for my office. Mary grabbed me, and I got on the phone.


Dr. Grumpy: "Hi, this is Dr. Grumpy."

Lacey: "Dr. Cashpay would like to schedule a 15-30 minute phone appointment to discuss a mutual patient."

Dr. Grumpy: "That's a lot of time. Is Dr. Cashpay going to pay me for this phone call?"

Lacey: "Certainly not. He works for his patients."

Dr. Grumpy: "But he'll charge Mr. Rich for the time he spent on the phone on his behalf, right?"

Lacey: "Of course. And rightfully so."

Dr. Grumpy: "Look. I've get about 5 minutes on the phone between patients right now. So Dr. Cashpay can talk to me now, at no charge. But I really don't have time to set up phone appointments for this sort of thing."

Lacey: "He's with a patient, and doesn't allow interruptions."

Dr. Grumpy: "Then he can try later, and see if I'm available. Show him how to dial. Goodbye."

Overheard at the Nurses Station

It's shift change:


Nurse 1: "Beware of when she coughs."

Nurse 2: "Why? She really sick?"

Nurse 1: "No. When she coughs, she farts. And sometimes more."

Wrong Way Wooten

Dear Dr. Lazar,

One of my readers noticed an ad for your recently published book:

I'd like to make 2 points (so to speak).

1. While your book is on stomach cancer, and I understand anatomy is important, the breasts seem unusually voluptuous detailed for a book that focuses on an entirely different organ system.

2. In a book about stomach cancer, some details are more important than others. The anatomy of the stomach, for example, is pretty critical. And in this case, your cover art has it backwards. So, unless you've got an exceedingly rare patient born with reversal of the internal organs, or a previously undescribed form of malignancy that causes them to rotate a perfect 180°... I'd break out your Netter.

Thank you, Robyn!

Hmmmmm...

Dr. Grumpy: "Are you married or single?"

Mr. Shakes: "Um, do you think the girl who drove me can hear us? She's out in your lobby."

Dr. Grumpy: "No, not through these doors."

Mr. Shakes: "Then I'm single."

Correct!

Dr. Grumpy: "Have you had any surgeries?"

Mr. Cecum: "I've had a unilateral appendectomy."

Mary's desk

Mary: "Dr. Grumpy's office, this is Mary."

Mr. Sativa: "I need to make an appointment."

Mary: "Okay, what will you be seeing the doctor for?"

Mr. Sativa: "I need my transmitters or transistors checked in a test."

Mary: "I'm not sure what you're talking about. What symptoms are you having?"

Mr. Sativa: "I don't know if I'm having symptoms or not. See, I've been smoking weed for years, and 3 days ago I stopped cold turkey because I needed the money to get my car fixed, and I need that test to see if my brain is, like, really fried."

Mary: "And what test did you say it was?'

Mr. Sativa: "I want my transistors, or transmitters, or whatever those things are that radios and TV's and power stations have, you know, except they're in your brain. I read about it on the internet."

Mary: "I'm not sure..."

Mr. Sativa: "Also, I need to know how much it costs, too, because now that I'm not smoking weed I'm trying to save money, in case I need more tests, or go back on weed, or get my car repaired again because it still isn't working right. It makes this weird noise, like a rabbit is trapped in the glove compartment, and I looked and there's no rabbit there, or bird, or anything. Do you know what can make a noise like that? Or can you ask the doctor?'

Mary: "Why don't you call Dr. Hehatesusandwehatehim, down the street. He does this test."

Mr. Sativa: "Oh, cool. Does he know anything about cars, too?'

Texting with Frank

Frank and I are usually texting back and forth in the afternoon, as I have to pick him up and take him to Kumon, or home, or heaven knows where.

Unfortunately, this isn't nearly as easy as it sounds. For example, here's one where I wanted to know if he was going to stay at a friend's house, or was ready for me to come get him.

 

Another issue is the somewhat unusual messages he sends:

 Or his attempts to get out of going to Kumon:

Or the ones that warn me there's a mess waiting at the house:

And yes, he did use the SodaStream CO2 cartridge. A brand-new, sealed, one, completely emptied in Frank's attempt to build an anti-zombie weapon. You have no idea of the looks you get at Target when trying to exchange an empty SodaStream cartridge that has "DESTROY ZOMBIES!" painted on the side.

Monday night, 8:45 p.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mr. Quattro: "Hi, I'm a patient of Dr. Brain, and ran out of my pills. Can you call them in for me?"

Dr. Grumpy: "What pill is it?"

Mr. Quattro: "The tan one. It's from Dr. Brain."

Dr. Grumpy: "Do you know its name?"

Mr. Quattro: "It's on the Walmart $4 list. Does that help?"

Weekend on call

Early morning Sunday, I go in to see a new hospital consult.

I walk into the nurse's station, looking for the chart. One of the nurses is on the phone, looks up at me, and says, "Doctor, it's for you."

She shoves the receiver into my ear and disappears into a room with a blinking call light.

Dr. Grumpy: "Uh, hello?"

Voice: "What do you think of her?"

Dr. Grumpy: "Who is this?"

Voice: "This is Mr. Smith. Are you the neurologist seeing my wife?"

Dr. Grumpy: "Yes, but I literally just got here. I haven't been in the room, or even seen the chart yet."

Voice: "Well, what's going on with her?"

Dr. Grumpy: "Sir, I just got here. I have no idea yet. I can call you back..."

Voice: "Okay, what do you think is going on with her?"

Dr. Grumpy: "I haven't had a chance to..."

Voice: "Okay, you obviously don't have the answers we need. Don't bother seeing her, I'll have them call another neurologist."

(Hangs up)

Today's lesson from Snowball

Never knock over a trash can and walk in. Someone might stand it back up.

Truth or Consequences

Last night, trying to be a nice guy and participate in the hospital's community outreach program, I gave a talk to a roomful of senior citizens about Alzheimer's disease.

One guy interrupted me 3 times to ask what a neurologist does.

I'm still not sure if this was real, or if he was intentionally fucking with me.

Crossing over

 

A friend of mine, while traveling, recently took her son to a doctor in an unfamiliar area for a semi-urgent issue. While there the staff tried to sell her weight loss supplements (and she's slim), asked her (and she wasn't the patient) if she had foot numbness (giving her a brochure about a pseudo-NCV procedure they do), and tried to talk her into a sleep study. She hadn't raised any of these issues, but they were repeatedly brought up by the physician and his staff while treating her daughter.

Pissy and I call this "The Dark Side." And, unfortunately, it's a growing trend in medicine.

Insurance reimbursements dwindle, and so doctors try to find "alternative revenue" streams. Sometime they aren't a bad idea, but other times they're simply unnecessary tests and/or ineffective treatments done solely to increase profits. The worst are where they involve an invasive, potentially hazardous, procedure that has no proven benefit. Pointless biopsies that won't change a treatment plan, gadgets to relieve pain that aren't statistically superior to placebo, supplements sold at the front counter with extravagant claims to cure Alzheimer's, and other horseshit.

Doctors who do this likely start out as well-intentioned, and end up on a slippery slope. As the revenue stream increases they get greedy, adding more and more bells and whistles to the practice- at the cost of patient care. Like Anakin Skywalker, they become seduced by the Dark Side, needing to keep expanding their practice away from what's best for the patient.

Of course, they won't admit that. To them the new laser-magneto-hydrological thingamajig they put in to cure chronic halitosis at $100 a pop is medically necessary. It's not covered by any insurance, or even mentioned in any reputable publications, but the company that sells it has infomercials on TV and glossy booklets for the waiting room. Likewise, there are some procedures that are covered by insurance but have no real medical evidence to support them. And they're also done purely for profit.

Years of moving in that direction have convinced the doctors involved that these things are the standard of care. Like Darth Vader, once you cross the line there's no going back.

I get calls from companies selling this stuff, too. Usually Mary filters them out, but occasionally they reach me. Or fly in under the radar by claiming to be a drug rep. They show me graphs of start-up costs and how much money I can make (usually insane amounts, like $100K per month, with an asterisk noting that's only if you see patients 24/7).

I try to be polite, but in my mind I hear them speaking in a deep voice through slow, heavy, respirations, asking me to join them on the Dark Side,

Luke tossed his lightsaber aside and walked away. I just thank them and head back to my desk. I may not be getting rich, but at least after 15 years of this I can still face myself in the mirror and believe I'm doing what's right for my patients.

Crime in America

Thank you, Don!

Mary's desk, Tuesday afternoon

Mary: "Doctor Grumpy's office, this is Mary."

Mrs. Bland: "Hi, this is Katie Bland. Our daughters are in kindergarten together, and had a playdate last weekend at Local Park."

Mary: "Yes, she had a good time. I remember, you and I talked about the school's fundraisers."

Mrs. Bland: "Yeah. Anyway, my husband and I were wondering if you and your fiancé are interested in swinging with us at the Daisy Chain Club this weekend?"

I'd say you're doing pretty well

Dr. Grumpy: "Do you have any other health problems?"

Mrs. Octogenarian: "I have Hufnagel's disease."

Dr. Grumpy: "If I remember correctly, that's a pretty serious illness."

Mrs. Octogenarian: "It's fatal. I'm terminally ill."

Dr. Grumpy: "How long have you been terminally ill?"

Mrs. Octogenarian: "57 years."

Quiz time

A friend of mine was recently taking a practice test for the Emergency Medicine boards, and came across this question:

A day at my office

Thank you, Elmo!

Thursday afternoon

A touching mother-daughter moment in my office:

"Mom, when I get to heaven I'm going to kick Dad's ass for leaving me alone with you."

Uh, Dan... on the screen behind you, Dan...

From Huffpost.

Medical science marches on

This spring Local Hospital installed a new hand washing system. Apparently the old system of soap and water wasn't doing what they wanted (what they wanted I'm not sure, because we were using it to wash our hands).

The new system they installed involves, okay, soap and water (revolutionary, huh)? But it also involves a new technology- the hand-washing entertainment system. REALLY.

Studies have recommended that you wash them for 15 seconds to kill/drown the majority of germs, and most people don't do the full quarter-minute. So, in order to keep you washing, it tries to keep you entertained. And what better way to do that than with a screen? After all, in the 4 million years since we split off from the rest of the primates, staring at screens is what our species truly excels at.

As soon as you pump soap onto your hands, the show begins. Almost always there's a timer on it, counting backwards from 15, to make sure you scrub for your allotted time.

Usually it also involves telling you the weather outside. Which is, if you think about it, a real "fuck you." If you're washing your hands at the nursing station it means you're working, and there's no way you're getting outside to enjoy the day no matter how nice it is.

It also features all kinds of other stuff. Here's some examples.

If you like sports, it keeps you updated on scores while you think about your buddies with the day off having a tailgate at the game:

Sometimes you get a bit of semi-wisdom fortune-cookie-ish sayings. Like you really need that while trying to get an unhelmeted motorcyclist's shit out from under your fingernails.

 

Cute sayings are also common fodder. Who needs a self-help book when you can just get a daily dose of happy-happy joy-joy by washing your hands?

 

Ever find yourself suddenly struck by a panic attack that you'll be on a quiz show and not know the answers (or, if it's Jeopardy!, the questions)? Fear not! The magic handwashing gadget is happy to share pointless trivia.

For those at other hospitals using this system, feel free to send me shots of your hand-washing entertainment. I'll edit out any identifying info if needed, and perhaps make this a regular feature if popular enough.

NOTE - Dr. Grumpy, Inc. will not be responsible for any water damage your phone may suffer in the mad rush to scrub poop & blood off your hands and get your phone out during the allotted 15 seconds.

Still a few bugs in the system

Last night I was doing a survey about a new medication, and encountered this question:

The Long and Winding Road

 

Guy walks in, stands at counter.

Mary: "Hi, can I help you?"

Mr. Far: "Yeah, I have a new-patient appointment with Dr. Grumpy for 2:00."

Mary: "Oh! You must be Mr. Far. It's 1:30 now, but that gives you time to get started on your paperwork..." (hands over a clipboard) "and can I get a copy of your insurance card?"

Mr. Far: "Sure..." (take clipboard, rummages through wallet, hands card to Mary) "I left my house early to make sure I had plenty of time to get here."

Mary: "That's fine. If he's done with his current one early, he'll usually start with you."

Mr. Far: "I had no idea how far you were from my house."

Mary: "I'm sorry. I thought you lived in South Grumpyville?"

Mr. Far: "I do... It was a 30 minute drive here."

Mary: "Isn't that what I told you it would probably be?"

Mr. Far: "Yes... You were right. I just hadn't realized it was that far."

Mary: "Well, you made it here early, which is better than late. Here's your insurance card back, thank you."

Mr. Far: (puts card back in wallet) "My GPS even said it would be this far, so I left early to make sure I had enough time. Still... it seemed like a long drive."

Mary: "I'm sorry. Did you have a question about the forms? Or need a new pen? Let me get you another one..."

Mr. Far: "No, let me give this back to you" (hands clipboard and pen back) "I... I think this is too far for me. I'm just going to leave and try to find a neurologist closer to my house."

Mary: "Are you sure? I mean, you're already here, and have an appointment in a short while?"

Mr. Far: "Yeah, this is just too far for me to drive. Thank you, anyway." (leaves)