Genetics

Dr. Grumpy: "Any major illnesses in your family?"

Mr. Flat: "My Dad was killed by a steamroller."

Wednesday afternoon

I'm at the nurses' station, writing a note. A cardiologist puts a chart next to me and sits down.


Dr. Snow: "Hi, Ibee."

Dr. Grumpy: "Oh, hi, Mike."

Dr. Snow: "You seeing the new guy with the stroke?"

Dr. Grumpy: "Yeah. Hey, how'd your family ski trip go?"

Dr. Snow: "We had to cut it short. My oldest son broke his leg on the second day."

Dr. Grumpy: "I'm sorry, is he okay?"

Dr. Snow: "Yeah, but he needed surgery. It was a compound fracture" (whips out iPhone) "See? There's the tibia sticking out below the knee, and this next one..."

Neurological nightmares

I have a pleasantly demented patient, Mrs. Tangle. She's very nice, but quite confused, and getting slowly worse. She's at an assisted living apartment.

Her husband died 2 years ago. They had a few old boxes in a closet that no one ever got around to unpacking. The family figured they were clothes, or pictures, or whatever. They were buried under blankets and photo albums and other stuff.

So a few days ago I got a call from the patient's son. He urgently needed to talk to me, and Annie told me that I needed to deal with this one personally. I trust her judgment when she says that. So I took the phone. At about the same time I picked him up, Mary said the police had just called wanting to talk to me about Mrs. Tangle, and were on another line.


Dr. Grumpy: "This is Dr. Grumpy."

Mr. Son: "I need to talk to you about Mom! She unpacked some old boxes in her closet!"

Dr. Grumpy: "Okay. What's the problem?"

Mr. Son: "We didn't know what was in them! We thought it was clothes or something!"

Dr. Grumpy: "And..?"

Mr. Son: "One had Dad's old gun, from when he was a policeman!"

Dr. Grumpy: "What! Is it loaded?"

Mr. Son: "I have no idea. The nursing home just called me! She's wandering around with it. She's not threatening anyone, but she's walking all over there waving a gun!"

Dr. Grumpy: "Has anyone tried to get it away from her?"

Mr. Son: "Um, I was hoping you would go over and do it."


I told him no, and grabbed the other line. It was the Grumpyville police, wanting to know just how mentally intact she was before they tried to reason with her.

Fortunately, the situation ended without incident. But when dealing with the aged, don't just assume that old box has harmless stuff in it. This isn't the first time I've had families tell me they've found previously unknown firearms hidden in a demented person's place. This was just the most potentially dangerous the situation got. I can only imagine what could have happened if instead of being pleasantly demented, Mrs. Tangle was paranoid/angry demented.

And yes, it was loaded.

Priorities

Brent writes in with this bit of drama from his practice:


Mr. Husband: "Can you make a house call for my wife? Her asthma is really bad, and she's having a tough time breathing. She won't go to ER, either."

Dr. Brent: "Just bring her to my office. I'll squeeze her in this afternoon."

Mr. Husband: Well, she's been coughing a lot. And, you know, she has that problem that when she coughs, she leaks urine. I can't have that in my truck."

Dr. Brent: "So bring her in her car."

Mr. Husband: "THE NEW BMW?!!! ARE YOU CRAZY???"

EHR: Making you look like an idiot

Okay...

Dr. Grumpy: "Let me order an MRI... Are you claustrophobic?"

Mrs. Orlok: "No. I lie in coffins routinely, and don't have a problem."

Dear Dr. Laser Surgery Scam,

Sorry I talked my patient out of letting you touch him. I understand you have to make a living, too. I know I hung up on you when you called to yell and threaten me yesterday, but, quite frankly, I don't give a shit.

My patient has pain in the right hand, which my EMG/NCV last week showed was simply carpal tunnel syndrome. I've scheduled him to see a hand surgeon in a few days.

I understand the MRI of his neck had a few disk bulges and all, which might cause hand pain. But, as is documented in the report and your own note, all those abnormalities are on the left. His symptoms are all on the right.

When he told me that you were insisting he have left-sided "laser neck surgery" for the right hand pain, I figured he'd simply misunderstood what you said, or maybe you'd read the MRI wrong. I do that myself here and there, and have to double check. Hell, I think everyone does.

But when he brought in your printed instructions, with some sort of bogus "referred dermatomal crossing" bullshit about how a pinched nerve on the left can cause "sympathetic allodynic crossover pain" and affect only the right... I told him to run away from you.

I also liked how your note specifically advised him against seeing me to discuss this, and instead recommended a neurologist you have "an affiliation" with. How much of the cut is he getting for being your partner in fraud? I can only assume you've been burned before by other outside docs (like me) telling patients the truth. The part of your note suggesting he not have an EMG/NCV "because it will only delay your pain relief" is a real piece of work. Heaven forbid someone should make the correct diagnosis and rob you of a case.

Your threat about not referring patients to me isn't particularly intimidating. You never have. Now I know why. I have nothing against surgeons. I refer patients to them (when needed) routinely. But I don't take that decision lightly, and keep a short list of surgeons I trust.

So, I don't feel particularly bad that I deprived you of a case. In fact, I hope I have the opportunity to do so again.

Yours truly,

Ibee Grumpy, M.D.

Why I love Mary

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

Ms. Tinfoil: "Hi, I need to see the doctor."

Mary: "Okay, we have an opening next Tuesday at..."

Ms. Tinfoil: "Does your office have WiFi?"

Mary: "No, we're a small practice and..."

Ms. Tinfoil: "That's good. My last neurologist was using WiFi to read my thoughts. He fired me when I told him I was reporting him to the police."

Mary: "Okay... What are you coming in for?"

Ms. Tinfoil: "I want someone to look at my MRI films. All the doctors say they're normal, but I know they work for the government. You can see the microtransistors they placed in my brain to use WiFi on me, and I need a neurologist who can see them, too."

Mary: "I'm not sure Dr. Grumpy is the kind of doctor you need..."

Ms. Tinfoil: "They put them there with special government-trained tics, that bit me and injected the receivers into my bloodstream."

Mary: "I'm sorry, you know, I completely forgot. Dr. Grumpy installed WiFi just last week, so people in the lobby could surf while waiting."

Ms. Tinfoil: "Oh shit, you're part of it, too!"

(click)

Why doctors drink

Mr. Badhair: "I'm here because I want to see an aneurysm specialist."

Dr. Grumpy: "Well, sir, I certainly can discuss them, but I'm a neurologist, not a neurosurgeon. So I can't claim to specialize in them."

Mr. Badhair: "Well, on your office website it says you do, and that you trained at UBS."

Dr. Grumpy: "Sir, I'm not an aneurysm specialist, I've never made that claim, and I didn't train at UBS. I went to BSU."

Mr. Badhair: "Liar! I can't believe you have the nerve to tell me that! I saw it on your site this morning!"

I call up my practice site and turn the iMac around.

Dr. Grumpy: "Sir, this is my site. It clearly says I went to BSU, and says nothing about aneurysms."

Mr. Badhair: "That's because you just changed it."

Dear WebCME,

I understand you're trying to do a medical education tie-in with Valentine's day, but perhaps next year you should stick with something a little less heartwarming:

Thank you, Tab!

Patient quote of the day

"I have to accept that I'm 40. That means I'm not 39 anymore."

Bwahahahaha

Dr. Grumpy: "Didn't you have a hysterectomy?"

Mrs. Giggle: "Yes, why do you ask?"

Dr. Grumpy: "Just to be safe. This medication can cause birth defects."

Mrs. Giggle: "Oh, that's not a problem. My birth defects are both in high school."

Great speech therapy reports

Life is a highway

Mr. Octane: "I need a note saying I had a doctor's appointment."

Dr. Grumpy: "Okay, for your job?"

Mr. Octane: "No, for the police."

Dr. Grumpy: "The police?"

Mr. Octane: "I got a speeding ticket on the way here."

Dr. Grumpy: "I don't write notes for that."

Mr. Octane: "If I hadn't been speeding I would have been late."

Dr. Grumpy: "You came in 15 minutes after your scheduled appointment time."

Mr. Octane: "Well, I would have been later."

Stating the obvious

Last year, for those of you who missed it, a large potato-chip company had a nationwide contest to come up with a new flavor.

So, although the contest is over, there are still some bags of chips announcing the results out there. Yesterday, at a Boy Scout meeting, some bags were opened and I noticed this on one. It showed the top 5 ingredient suggestions people had sent in for a new potato chip flavor:

I want to know how "potato" is the 2nd most popular ingredient suggestion. I mean, they're freakin' potato chips! While I like bacon, it's certainly not the first ingredient I think of if someone says "what should we use to make potato chips?"

And chocolate? Yeah, I know someone was selling chocolate covered potato chips over the holidays. But even chocolate has its limitations, and I'm not dipping it in ranch dressing or guacamole.

Ironic placement of a promoted tweet

CME har de har har

Patient Quote of the Day

"I have very little memory that I forgot that, whatever it was."

Tonight on National Geographic

These majestic creatures are some of the most faithful, devoted, servants a medical office will ever have. They endure daily burdens. They get twisted, tilted, leaned upon, smashed into desks and filing cabinets, and never complain about their lot in life.

Eventually, as happens to all things, their time comes to an end. Sometimes they tilt too far. Or stop rolling. Or dump their once-loyal masters one too many times.

And then, because no one seems to ever want to take them outside, or thinks that someday they'll have time to fix them, they go to their final, secretive, resting place:

This picture is a rare peek at the mysterious chair graveyard in the back of the Grumpy/Pissy medical compound. Every medical office, however, has one of these rooms. Every law office. Every office in general.

As the years go by they're joined by outdated computers, broken printers, seasonal decorations, telephones, and other aging items. Why we keep them is a mystery. Perhaps because no one wants to take them to the dumpster, or the recycling place. Or we're hoping the Smithsonian will call, needing one for their "Prehistoric Offices" display. Or we're simply afraid to toss them, with a strange belief that someday they'll magically fix or update themselves.

Anyone need a chair?

Attitude

Dr. Grumpy: "Also, since you had a seizure, you'll have to stop driving for 2 months."

Mrs. Imspecial: "That's ridiculous. My husband is a doctor."

Dr. Grumpy: "Yes, but that doesn't change anything. The law is pretty clear. No driving until you've been seizure-free for 60 days."

Mrs. Imspecial: "I'm married to a doctor. You work with him at the hospital. I'm sure there's some exemption you can get for me."

Dr. Grumpy: "No, there isn't. The only thing that matters here is that you had a seizure."

Mrs. Imspecial: "I'm very busy with our kids, and don't have time for such nonsense. My husband is a doctor."

Dr. Grumpy: "That doesn't place you above the law. Think about what would happen to the kids if you had a seizure while driving."

Mrs. Imspecial: "Don't play scare games with me. I'll have to get a second opinion. I can't believe he referred me to you. He's a doctor, you know."

Font issues

Dear Biogen,

Thank you for your Avonex demo pack.

In a recent nonscientific survey, 8 out of 11 people thought the C and L were a little too close together, and read the box somewhat differently.