Sunday, June 30, 2013

History reruns

June 30, 1908.

One of the most remarkable events in history happened on this date. And it's mostly forgotten.

At 7:14 a.m. a MASSIVE explosion occurred near the Tunguska river in Russia. I'm not exaggerating. The force was somewhere between 5-30 megatons. Think about that: an explosion between 150 to 1000 TIMES the power of the Hiroshima nuclear bomb. And it happened 37 years before the nuclear age began.

And, purely by chance, it happened in a fairly uninhabited part of the Earth.

To this day its exact cause is unknown, and it's simply called "The Tunguska Event." It's generally believed to have been a meteorite or comet that exploded before hitting the ground.

The shock wave it sent through the ground was a 5.0 on the Richter scale. Every tree in an 8 km (5 mile) radius from the center was killed, and the force of the explosion covered a total of 830 square miles (2,130 square km). An estimated 80 million trees were knocked over by the force- all of them pointing away from the center. A few were left standing, scorched black, with all their branches stripped off. People were knocked off their feet, and windows shattered, hundreds of miles away. The pressure wave was measured as far away as England. For the next several months there was a change in the density of the planet's upper atmosphere.

An eyewitness 40 miles south of the explosion, reported that "At breakfast time I was sitting by the house at Vanavara Trading Post, facing north. I suddenly saw that directly to the north, over Onkoul's Tunguska Road, the sky split in two and fire appeared high and wide over the forest. The split in the sky grew larger, and the entire northern side was covered with fire. At that moment I became so hot that I couldn't bear it, as if my shirt was on fire; from the northern side, where the fire was, came strong heat. I wanted to tear off my shirt and throw it down, but then the sky shut closed, and a strong thump sounded, and I was thrown a few yards. I lost my senses for a moment, but then my wife ran out and led me to the house. After that such noise came, as if rocks were falling or cannons were firing, the earth shook, and when I was on the ground, I pressed my head down, fearing rocks would smash it. When the sky opened up, hot wind raced between the houses, like from cannons, which left traces in the ground like pathways, and it damaged crops. Later we saw that many windows were shattered, and in the barn the iron lock had snapped."

There have been other impacts in recorded history, but none this powerful. And, over 100 years later, the scars are still there.



1921: 13 years after the event.







2008: 100 years after the event.


And, just remember: we live in a solar system full of flying objects.

Friday, June 28, 2013

Dear Mrs. Soda,

Please do not leave a message that you changed your mind and want to take a medication.

And, when we call you back 20 minutes later, say that you changed your mind again and now you don't want anything.

Then call just after closing to say you've changed your mind again, and would like me to call something in.

And not have a pharmacy number, or even know what pharmacy you want it called too, when I dial you back.

Then yell at me for not knowing which pharmacy accepts your insurance.

Thursday, June 27, 2013

The guilt is strong with this one


It's 4:00. A guy comes in, stands at the counter.

Mary: "Can I help you?"

Guy: "Um... Yeah, I had an appointment today at 1:00, and I got called into work, and called you at around 9:00 to cancel it."

Mary: "Yes... I see that on the schedule. Did you need to reschedule?"

Guy: "I'm not sure... I mean, you're not angry at me, are you?"

Mary: "Uh, no, these things happen."

Guy: "Okay, I've been really worried about that. Thanks!"

(leaves)

Wednesday, June 26, 2013

Lalataw

I saw this in a hospital chart note this morning:










No, I have no idea what it means.

I've never heard of Lalataw. And I don't know why someone would, or wouldn't, want to be active in it.

Or what it has to to do with a stable guy admitted for a headache, anyway.

Tuesday, June 25, 2013

No fireworks

Sorry, people.

For all those writing in wanting to know what happened with Mrs 9:30, the answer is... nothing.

After getting off the phone with Mary that afternoon she looked at my office website, and realized just who the male receptionist was.

She called back and cancelled the appointment, then went to a doctor-rating site and wrote a scathing review of me and the appointment that never happened. I suspect she broke her caps-lock key in the process.

Don't ask

Dr. Grumpy: "What was your last hemoglobin A1c?"

Mr. Insulin: "7.1."

Lady Insulin: "Was it? I thought it was 8.2?"

Mr. Insulin: "No, Dr. Endocrine said it was 7.1 at my appointment last week."

Lady Insulin: "That was my appointment. Yours was in March."

Mr. Insulin: "I thought your A1c was 7.9 in March?"

Lady Insulin: "No, that was your appointment."

Mr. Insulin: "Mine was 7.1. You put it in your phone."

Lady Insulin: "I thought you put it in your phone?"

Mr. Insulin: "Why would I put yours in my phone?"

Lady Insulin: (takes out a phone) "Whose phone is this, anyway?"

Mr. Insulin: "I think the 8.2 was Sylvia's. She mentioned it at dinner last night."

Lady Insulin: "Dr. Grumpy, can you call Dr. Endocrine for us?"

Monday, June 24, 2013

We're gonna turn it on. We're gonna bring you the power.

Holy crap! Is that Morgan Freeman?

For those of you who absolutely can't bear to lose at videogames, you now have a new way to win.

For only $249 the company FOC.US is selling a headset that will run an electric current through your brain (specifically, the prefrontal cortex). Their website says it will "increase the plasticity of your brain. Make your synapses fire faster." They're marketing it as a way to improve your videogame skills for the "ultimate gaming experience."

Really.

It also comes with an iPhone app to control your jolts. And it's in your choice of red or black.


"Now I can kick my boyfriend's ass at Call of Duty."

Now, I'm not going to knock the uses of electrical brain stimulation. This is an area that's currently undergoing a lot of research as a way to treat disease and help people recover from strokes and other causes of brain damage.

But, on the other hand, let's keep a few things in mind:

1. This is electricity, for fuck's sake. It's dangerous.

2. We used to execute people with this.

3. If winning at Halo is that important, you need to get out more.

I'm sure people from FOC.US will point out that their gadget uses a low level of juice, which isn't going to hurt you (on the other hand, I have no idea if it will help. The last video game I mastered was Atari Adventure).

I have to be a bit skeptical about its benefits. I mean, the internet is full of people selling herbs, magnets, and who knows what else as ways to improve your performance at work, the gym, and in bed. Most of them have nothing more behind them than some half-assed data and anecdotal claims. While I think the jury is still out on cortical electricity, that doesn't make their claims true.

Another issue is that for many people, after you've plunked down a boatload of money for a game system, they don't have $249 to blow on this gadget. So what do they do?

Well, according to a recent editorial in Nature there's concern that people will start doing this as a do-it-yourself project. You could wire up with some batteries at home, or whatever you can find in the garage. There are even companies selling DIY kits for it online. This is where I think the editorial has its best line:

"That’s ‘could’ as in ‘you might be able to’, by the way; not ‘could’ as in ‘it’s a good idea’."

Granted, that's never stopped anyone from doing stupid stuff. Bigger, in the general perception, must be better. If a little battery can improve your score, then shouldn't plugging into your home's AC current be great? By the time you're playing an X-Box hopefully your parents have pulled those plastic things from the outlets that kept you from sticking a fork in them. The target audience here isn't known for being averse to risk.

What could possibly go wrong?


"Mario and Luigi, here I come!"


I also have to worry about how far this could go. What if electricity does clearly improve brain performance? Can't you just see pushy parents wanting to plug their kids in to get a better SAT score? Or a med school gunner wearing some shockware into a test, disguised as earplugs?

This could end up as the academic equivalent of athletic steroids. The next cheating scandal could be some guy tossed out of a math competition for illegal wiring.


Lance was stripped of his high school math letters when it came out he'd been "volting."


So, in closing, my point is this: low-level trans-cortical electrical may have medical utility (personally, I suspect it does). But if that "may" makes you want to shell out more money just to beat your brother at Grand Theft Auto V, then I've got some buildings in Rungholt to sell you.



"Superman warned me the electrodes would do this. Why didn't I listen?"


Thank you, SMOD!

Saturday, June 22, 2013

Hazards of "V" and "C" being next to each other on the keyboard


Thank you, M!

Friday, June 21, 2013

"I'd like to buy a comma, Pat."

What are "heart joints?"


"I don't remember those from Netter."

Thursday, June 20, 2013

Excuses

"Well, officer, I was in a hurry to get home and start waxing it."

Why I call him that

Drug rep: "Hi, Dr. Pissy. Lunch today is from Dave's Deli."

Dr. Pissy: "Dave's Deli? Why? What did I ever do to you?"

Wednesday, June 19, 2013

Ooooh! Fireworks!

Yesterday Mary had to take her kids to an early dentist appointment, and wasn't able to get here until 10:00. Annie was stuck in traffic, so I took over the front desk since the first patient, a new one, was scheduled for 9:00.

The patient showed up at 9:30, WAY too late (in my opinion) to try and see a new patient. So I told her she'd have to reschedule. She wasn't happy about it, and asked to see a different doctor, or a PA or NP. I told her we don't have anyone else, and so she finally rescheduled to next Tuesday.

Later in the afternoon:

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

Mrs. 9:30: "Yeah, I had an appointment this morning, and had to reschedule it to next week."

Mary: "Yes?"

Mrs. 9:30: "I just want to complain. The male receptionist who was working this morning wouldn't let me see the doctor. I didn't like that at all."

Mary: "Male receptionist... Oh, that was..."

Mrs. 9:30: "I don't care what his name was. The doctor needs to know his staff is turning patients away. Even if they show up late, it's still inappropriate. My time is valuable."

(long pause)

Mary: "The doctor is aware of what happened."

Mrs. 9:30: "Good. Because I want to be sure to tell him about that guy at my appointment."

Mary: "You'll definitely have the opportunity."

Looking forward to Tuesday!

Tuesday, June 18, 2013

The joy of Dragon

Seen in a hospital note while on-call this past weekend:


And no, I have absolutely NFC what they meant to say.

Monday, June 17, 2013

Never a dull moment

On Friday we had an unusually exciting afternoon.

A sweet octogenarian waiting for her appointment suddenly developed chest pain and shortness of breath in the lobby.

Mary, knowing how good Pissy and I are at handling REAL medical emergencies, immediately called 911. I'd run over to the hospital for a minute, and so the staff got him to check her blood pressure and hold her hand until paramedics arrived.

By the time I returned paramedics were loading her onto a stretcher to go to ER.

She immediately grabbed my hand and said "Dr. Grumpy, I'm so glad to see you. Before I leave could you get me more samples of Nomohurtz? It seems to be helping."

Saturday, June 15, 2013

In days of yore...




Thank you, Ms. Donna!

Friday, June 14, 2013

Sigh

Local hospital decided last week to re-paint the "Reserved Doctor" parking spaces in the front lot.




Thursday, June 13, 2013

Mary's desk

Mrs. Damadian: "Hello?"

Mary: "Hi, Mrs. Damadian. This is Mary, at Dr. Grumpy's office."

Mrs. Damadian: "Yes?"

Mary: "We got your MRI report in - the doctor says it's fine - so I'm calling to make an appointment for you guys to discuss your treatment plan."

Mrs. Damadian: "How did he get it?"

Mary: "Well, he said it was fine, but..."

Mrs. Damadian: "I don't care what it showed. I want to know how he got the report."

Mary: "What do you mean?"

Mrs. Damadian: "Did a courier bring it? Or was it faxed to him? Or mailed? Or e-mailed? Or did a radiologist call him? Or did he look it up online?"

Mary: "I believe he looks them up, but it depends on..."

Mrs. Damadian: "This is stupid. I can't believe you don't know. Why don't you find out, then you can call me back and we'll discuss me making an appointment."

(hangs up)

Wednesday, June 12, 2013

Once upon a time

Wirth-Liss Phramaceuticals makes a hideously expensive drug that has to be administered once a month at the doctor's office. The patient co-pay on most plans is anywhere from $50 a month and up (granted, that's cheap compared to what the insurance company is paying for the rest).

So Wirth-Liss came up with a patient assistance program, where the patient gets $600/year covered by the insurance company, to help lessen the cost burden. Their idea was that this way more patients could afford the drug, so more doctors would order it. I can see the logic.

But the implementation left much to be desired.

Some company genius, with apparently no grasp of reality or human nature, decided the best way to do this was to send every person who qualified for the plan a prepaid credit card with $600 on it. The idea was that Mr. Patient would hand it to the doctor's staff at each visit, it would be swiped for $50 each time, and at the end of the year the card would be empty.

Unfortunately, it didn't occur to them to lock-out the accounts so that they could only be used at a doctor's office...

Basically, they sent patients pre-paid giftcards with $600 on them.

Of course, given human nature, most patients saw this as a windfall, and went on spending sprees. They bought groceries, beer, clothes, toys, a tank of gas, whatever.

Then, when it was time to go to the doctor, they didn't have any money left for the drug. So they opted not to receive it. So the drug wasn't given, and Wirth-Liss Pharmaceuticals, Inc. wasn't able to bill an insurance company for it. And, in fact, they now had a new corporate loss of $600 per irresponsible patient.

Of course, the patients thought this was grossly unfair. They couldn't understand why they couldn't have the drug, when, after all, they'd qualified for the assistance program. The fact that they'd blown their co-pay was beside the point. They also didn't see why they now had to pay cash for the co-pay, since the program person told them they wouldn't have to.

And, of course, they wanted another card.

When the above was explained to them, suddenly they remembered they'd never received the $600 drug card, or it had been stolen, or they hadn't seen it since an alien abduction on the way home from Las Vegas.

The program has since been replaced with one where the card can only be used at a specific doctor's office.

The executive behind it, I hope, has been canned.

The drug reps have the difficult job of explaining the program changes, and why they were made, to doctors and their staffs. Who are laughing hysterically.

Tuesday, June 11, 2013

Moon river

Dr. Grumpy: "How did the medicine I prescribed work?"

Mrs. Solanaceae: "I never tried it. I looked it up on the internet, and found out it can cause liver problems."

Dr. Grumpy: "Okay... but that's pretty rare."

Mrs. Solanaceae: "I don't care! It's my body, and I'm not going to take a pill that might harm it."

Dr. Grumpy: "You told me you smoke 2 packs a day."

Mrs. Solanaceae: "That's different. It's not a pill."

Monday, June 10, 2013

"Mavericks"? WTF?

Obviously, I'm bored tonight to even be taking a few minutes to type the following.


Apparently Apple is now switching randomly from feline names to beaches. I assume they ran out of cat subspecies.

I'm going to point out that there are still a LOT of felidae names to choose from:

Caracel

Smilodon

Margay

Geoffrey's Wild Cat

Serval

Colocolo

Norwegian Forest Cat

Ocelot

Kodkod


And many others.


NOT only that, but 10.3 was "Panther." Which is a genus. Not a species (okay, so was Smilodon, and they're extinct. But they were COOL).

And 10.1 (Puma) and 10.8 (Mountain Lion) are the same damn animal (Mountain Lion, Cougar, Puma, are all the same creature). For the record, this particular animal has more known names than any other, with at least 40. "I'll take felidae trivia for $200, Alex."

All right. Enough procrastinating. I'm going to go see what Frank spent the day building on Minecraft.

That's why they call it a "blood gas"

Apparently, calling it "Arterial pH" used too many letters...


Saturday, June 8, 2013

June 8, 1971

J. I. Rodale (1898-1971)

On this day in history... a man died (big surprise, huh?).

Like the late James Ferrozzo, it wasn't so much that he died, but how he left us. In death, as in life, style and timing are everything.

Jerome Rodale was an early proponent of healthier eating, and his legacy continues today. He was one of the first to support sustainable agriculture, and believed crops should be grown without pesticides. His publishing empire lives on today, with the magazine Prevention, which he founded, and more recent additions such as Men's Health, Women's Health, and Runner's World.

On this day in 1971 he appeared on the then-popular television talk show, The Dick Cavett Show. It aired late-night, but was taped earlier each day in front of a live studio audience.

Mr. Rodale (age 72) was the first guest interviewed, and happily went over his beliefs in living a healthier lifestyle. He promoted the benefits of organic farming, and expressed his optimism over its effects on himself. Things he said during the show included:


"I'm in such good health that I fell down a long flight of stairs yesterday and I laughed all the way."

"I've decided to live to be 100."

"I never felt better in my life!"

"I'm going to live to be 100, unless I'm run down by some sugar-crazed taxi driver."


After the interview, Mr. Rodale sat back in his chair as Dick Cavett brought the next guest onstage (New York Post writer Pete Hamill). As Cavett and Hamill chatted, Rodale made a loud snoring noise, and appeared to doze off in his chair. The audience thought he was pretending to be bored, and laughed.

According to witnesses, Cavett asked "Are we boring you, Mr. Rodale?" (Cavett to this day denies making that remark). Hamill looked at Rodale, then turned to Cavett and said "This looks bad."

Two production interns ran onstage and began doing CPR (unsuccessfully) on the healthy-lifestyle advocate as Cavett took the microphone and asked "Is there a doctor in the audience?"

Cavett, in a 2007 interview with the New York Times, said "I thought, 'Good God, I'm in charge here. What do I do?' Next thing I knew I was holding his wrist, thinking, I don't know anything about what a wrist is supposed to feel like."

Mr. Rodale was later found to have suffered a heart attack. The episode was never aired, with the network choosing to show a re-run in its scheduled place.

Friday, June 7, 2013

But is it artisanal?

Seen on a bowl of drug rep fruit:


Thank you, Karen!

Thursday, June 6, 2013

To err is human

Dear American public,

I apologize.

I accidentally cost you $470 last month, and so I owe each of you a $0.000000076.

I actually feel quite bad about this, but more in terms of the money lost and the inconvenience to the patient.

What happened, you ask? Well, I meant to order a lumbar spine CT scan. But due to a busy day and multitasking, accidentally wrote an order for a cervical spine CT. No one questioned it, and so it got done. I didn't realize the error until the report showed up on my desk. I apologized to the patient, and ordered the correct study.

The whole thing is overall harmless. The patient is elderly, and a few additional units of radiation are inconsequential. The 1 week delay in getting the proper test didn't have an adverse impact on his condition.

But still, I feel bad. I'm certainly not out to rip anyone off, especially other taxpayers.

This is, as far as I know, only the second error I've made in ordering the wrong imaging study in the last 10 years. I assume I have the same error rate as other docs for this sort of thing, and the total for mine is around $1100. Given that there are roughly 900,000 practitioners in the U.S., that comes out to $990 million dollars wasted every 10 years. That's enough to pay 20,000 school teachers for a year, or buy the Air Force eight F-35 fighters. Even by government standards it's still a decent chunk of change.

I don't have an easy answer for this. Should I be responsible? If a doc orders the wrong test, should he have to eat that cost? I guess that makes some sense, but someone is going to argue at some point that a test shouldn't be ordered. What happens if I did order a correct test, but then an insurance company claims it wasn't necessary - so should I pay for it?

Or what if the patient (after getting a test bill, of course) claims that I shouldn't have ordered a test, and wants me to pay for it? I've had that happen (I refused) and have learned it's common. I know another doctor who was threatened with a malpractice lawsuit to get her to pay for a study (she stood her ground, and they backed down).

So, I guess the only easy answer is to leave it as it is, and accept the fallible nature of humans. If ordering the wrong CT scan (at no harm to the patient) is the worst mistake I ever make in this business, I'll take it.

Wednesday, June 5, 2013

Doctors behaving badly

I'm with a patient, when Mary knocks on my office door.

Dr. Grumpy: "What's up?"

Mary: "Sorry, it's Dr. Promissory. He says he needs to speak to you urgently."

Dr. Grumpy: "Okay." (picks up phone) "This is Dr. Grumpy."

Dr. Promissory: "Hi, sorry to interrupt you."

Dr. Grumpy: "What's going on?"

Dr. Promissory: "My wife recently started her own business as a mortgage agent, and I was wondering if you'd considered refinancing your home?"

Tuesday, June 4, 2013

Mary's desk, June 3, 2013

Guy walks in, stands at counter.

Mary: "Can I help you, sir?"

Counter Guy: "Yeah, um, is this Dr. Grumpy's office?"

Mary: "Yes, sir. Do you have an appointment?"

Counter Guy: "No, I'm looking for another office. Thanks."

(leaves)

Monday, June 3, 2013

Maaaaaaaaaarrrrrrrrrrrrryyyyyyyyyyyyyyy!

Dr. Grumpy: "Can you smile for me?"

Mr. Poligrip smiles a little.

Dr. Grumpy: "Smile wider. Can you show me your teeth?"

Mr. Poligrip takes out his teeth and holds them up.

Sunday, June 2, 2013

Those were the days


 
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