My, how did the Summer go by so quickly? Well here we are again, in the first week of school.
As always, I have the cherished task of sorting out the "medical information cards" you parents fill out. I'm sure in this day and age it could be done more effectively online, but apparently they tried that at another school last year, and the parents didn't bother. I guess the internet kiosk line at the bus station was too long.
So we're continuing with cards.
Since filling these things out is a surprisingly complex task for so many of you, I thought I'd offer a few pointers.
1. On the line where it says "name" write YOUR KID'S NAME. Not your name. Or his sister's name. Also, putting nicknames like "Raggy," "Dudette," and "Booger," while cute, do not help. Especially when you don't put on a last name. So, let's keep this in mind: Write your KID'S name, both first and last. Middle is optional, unless it's a name that ends in a Roman numeral (such as Harold Winthrop Higgleschweimer IV). Then it's required so the teachers know he's just killing time with school until he gets his inheritance.
2. On the line where it says "medications" please list any your kid is taking. Things your ex was taking at the time of conception that you believe explain junior's shitty math scores do not belong there. Nor am I looking for a list of EVERY FUCKING PILL BOTTLE IN THE HOUSE. Just what junior is presently on, not what he might get into because of crappy supervision by your baby-daddy's 9 year old watching him and playing Nintendo simultaneously.
3. Under allergies, please write your kid's allergies. That's all. How hard is that? Peanuts? Check. Penicillin? Good, you've got the point. So stop putting stuff in like "soap from a Motel 6," "the sunscreen my MIL bought," and (my favorite this year) "Disney backpacks."
4. I need a phone number where I can reach you in an emergency. 911 doesn't count, unless you work there. And even then, it's a stretch. Likewise, telling me that it changes from week-to-week doesn't help, and makes me wonder if CPS should be called.
5. A vaccination record is really helpful. Writing "I believe in Jenny McCarthy" doesn't make me think highly of you. But my REAL pet peeve here is those of you who are simply too damn lazy to actually look for the records, and just scribble "religious reasons" to save time in filling it out. If that many of you hadn't vaccinated your kids, most would be dead by now. I don't believe you, so get off your ass and look through the filing cabinet.
6. If junior takes pills, please bring them in a labeled prescription bottle. A plastic baggie that says "Give a blue pill to Joanie once a day" isn't helpful. Nor is dumping a handful of loose unidentifiable pills on the counter and mumbling "those are for Steve" as you rush out with a phone glued to your ear.
7. I am not the NSA. I am not trying to violate your privacy here. I really do need to know if your kid has epilepsy. Or diabetes. Or asthma. This is knowledge that can make the difference between Billy living or dying when he's brought to my office sick as shit. Writing "none of your business" or "PRIVATE!!!" on the medical history section doesn't make my job easier. If you're writing it because you're too lazy to call your ex and ask about medical history, grow a pair and and do it. This is about your kid, not you.
Dr. Nerve: "Hi, Ibee" (pant, pant, pant, loud thumping noise) "I'm just calling to give you the post-call check-out" (thump, thump, thump) "In room 752 is the guy you saw Friday..."
Dr. Grumpy: "Are you okay? What's all that noise?"
Dr. Nerve: "I'm running" (pant, pant, thump, thump, thump) "on my treadmill."
Dr. Grumpy: "Why don't you call me later? I can barely hear you."
Dr. Nerve: "No! (pant, thump) "I'm determined to get back in shape!" (pant, thump, pant, thump) "Anyway, the guy in 752, Mr. Smith, had another seizure last night..." (pant, pant, thump...)
Dr. Grumpy: "What did his MRI show?"
Dr. Nerve: (thump, pant) "Hang on, let me get the list. I set it next to..." (thump) "AAAAAAAHHH!" (crash, thud) "SHIT!!!
I've put up some of the weird/stupid/random questions I've seen on surveys in the past. Apparently these aren't limited to North America.
A reader from the other side of the planet (Australia) sent this excerpt from one he recently took:
It's the 4th item down that grabs my attention.
Let's face it: everyone has their own degree of what is and isn't comfortable. But if I've reached a point in my life where I'm having an autopsy, I'm pretty sure I'm not going to care one way or the other.
The Grumpyville city summer sports leagues are always popular, with different divisions for all levels of talent.
Usually one of the best teams in town is 8 guys who all work at Local Pizza. The manager there is the husband of one of my patients. The Pizza Boys have a feared reputation in their division, as they've been friends since high school and play together year round. They've only rarely been defeated.
Until this month.
Mrs. Pizza came in for a routine visit, and I asked how her husband's team did this year.
She paused, then began laughing. Hysterically. When she finally calmed down she told me they'd lost EVERY. SINGLE. GAME. By huge margins, too.
I asked her how this could happen. Was one sick? Injured? Dead? These guys are good (at least by city league standards).
And she began laughing again.
Apparently, due to a busy day at the restaurant, they sent one guy's girlfriend to sign them up at the city park that runs the leagues.
She signed them up for division 5 (normally they play in division 3) by mistake.
Division 5 is guys who are either recently-retired from the NBA, or who came really close to getting into the pro leagues, but weren't quite good enough.
But they are, however, a helluva lot better than a bunch of guys who run a pizza joint.
I was laughing so hard it pretty much ended the visit.
I hear that all the time. Apparently, standing by the bedside and giving medications isn't enough for some people.
There's a pervasive idea that a high-priced invasive procedure has to somehow be better than doing something simple and conservative. I suppose this is human nature. Our ancestors gravitated toward human sacrifice on the instinctive belief that a deity that demanded human life has to be more powerful than one who wanted rice.
And I'm not knocking surgery, or surgeons, or other invasive procedures. In many cases they are critically important and life saving.
But let me tell you some stories.
The cardiologists have a remarkable technology called the stent. It's a tiny piece of metal that can help prop open a closing artery to restore blood flow. It's changed a lot of the way heart care is practiced during my career.
So it's only natural to extrapolate this technology to arteries of the brain. Instead of doing surgery, or using ho-hum medicines, we started putting high-tech stents into arteries supplying the brain, too.
For acute strokes, TPA is the big thing (I'm not going to argue about how effective it really is). But there's all kinds of things we can do beyond just plain old TPA. After all, how exciting is it to slowly drip some liquid into an IV line?
But it can be so much more exciting! What if we give TPA by threading a catheter all the way up to the brain and drip it right onto the clot? COOL! Or we could also use REALLY flashy technology ("technology always implies it MUST be good, doesn't it?). There are tiny gadgets we can thread all the way up to the brain, screw them (gently) into the clot, and pull it out (WOW! Like a cork!). Or another gadget we can use to punch a whole in the clot and restore blood flow.
Sounds all science fiction-y, huh? Well, we DO have the technology to do all those things.
But does it work? (Wait, who DARES ask such a question of advanced technology?!!!)
That's it folks. 2 studies (here and here) found that all this advanced stuff was no better than boringly watching TPA drip into an IV line. Ho-hum.
Now, the companies who make the fancy gadgets, and the doctors who use them, will gladly point out all kinds of flaws in the studies, and some of them may be legitimate. But some complaints, like "we need to select patients better," translate simply as "let's stack the deck in our favor."
In medicine we hear the phrase "Do something!" a lot. But usually we already are doing something. The problem is that many people think that unless it involves a lot of razzle-dazzle and medical voodoo, we aren't.
And in some cases that's quite far from the truth.
This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.
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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.