Tuesday, March 31, 2015

Mary's desk



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

Mrs. Urgent: "My daughter needs to get in to see Dr. Grumpy right away!"

Mary: "Okay. We have an opening on ..."

Mrs. Urgent: "It's an emergency. She needs to be seen urgently."

Mary: "Okay, we can see her tomorrow at..."

Mrs. Urgent: "No, she can only do a Friday, because of her school schedule.”

Mary: "Okay... Well, this Friday, at 3:15 she can..."

Mrs. Urgent: "No, that won't work. She works on Friday afternoons. The only time she can come in is on a Friday, before noon. But it's really urgent."

Mary: "All right, let me look... Our next Friday morning opening is in 2 weeks on..."

Mrs. Urgent: "Didn't you hear me earlier? This is urgent! She needs to get in right away!"

Mary: "Yes, and like I said, we do have an opening tomorrow at..."

Mrs. Urgent: "Obviously you're not listening, don't care, and aren't willing to help her."

Click

Monday, March 30, 2015

Catch-22

From a medication denial fax I received last week:


Friday, March 27, 2015

Define "valuable"

Invitation a reader recently received for a market research survey:




Thank you, Dr. M!

Thursday, March 26, 2015

Things that make me grumpy

This is an actual note I had to dictate today.


Dear Dr. Intern,

Mrs. Payne returns today. I haven't seen her since March.

She says she never had any of the tests I ordered, and transferred care to another neurologist in North Grumpyville. She says she was unhappy with me and my staff, and didn't want to continue care here.

She continues to have a constant headache and intermittent arm tremors. She says the other neurologist is managing all these symptoms with medication, and has ordered further studies. I wasn’t previously aware of any of this.

The reason she comes in today is because she needs disability forms completed, but the other neurologist is on vacation for the next 2 weeks. Therefore she made this appointment with me to have them filled out since they're due before then. She's then planning to return to the other neurologist for future care.



Yes, Mrs. Payne, I did send that to your internist.

I'm sorry you felt it was unreasonable of me to refuse your request, but in good conscience I can't fill out forms on a patient I'm not treating. I'm sure some less ethical doc would have agreed to do so, and billed you $50 for it, but I won't even play that game. It just isn't worth it to me.

I didn't charge for your ludicrous visit, either. I probably could, but if it gets audited, or the insurance (or you) complain, I'm sure doing so would make me look bad. So I took a loss on the 30 minutes you'd booked "to discuss my case."

I'm not offended you don't like me. You learn early on in this job that you can't please everyone. But if you change docs, don't waste my time coming back here for bullshit reasons.

There simply aren't enough hours in my day as it is, and life is too short for that kind of crap.

Yours truly,

Ibee Grumpy, M.D.

Wednesday, March 25, 2015

Research

"In other words, do not try this at home."

Thank you, Webhill!

Tuesday, March 24, 2015

Can't hold it back anymore

Does your daughter love "Frozen"? Does she dream of being friends with Elsa? Has she ever told you that, when she grows up, she wants to be a neurosurgeon?


Well, now she can have it all!


Love the toenail polish
 
Yes, for the first time in forever, your little princess can be the attending neurosurgeon on call at Arendelle Regional (the area's only Trauma One center), when the queen presents with a hemiparesis after a skiing accident. She has an evolving epidural hematoma, and only YOU can save her!


Of course, neurosurgery isn't all brains (in fact, I've known a few neurosurgeons that may not have one at all). You could also be the pediatric spine specialist working when the royal family presents to discuss their young daughter's scoliosis.


I'm not making this up. Google it yourself.

Helluva pic, isn't it? Apparently someone forgot to call anesthesia before they started cutting. Also, if your surgery scars look like this, I'd probably find a surgeon who isn't in DT's during the procedure. Granted, some weekends that can be a challenge.


Oh, wait, now the anesthesiologist came in, so we can proceed. Who needs to intubate when you've got a binkie?


"A few Harrington rods and we'll have the spine frozen in place. Get it? Frozen?"



Of course, maybe brains and backs aren't your thing. Perhaps you prefer to work at the opposite end of the body. Well, there's a game for that, too:


"He does look a lot like Kristoff, Anna, but I swear it's just a coincidence."

Isn't that just wonderful? I mean, if you're sick of this shitty winter weather, here's your chance for payback with a big honking episiotomy. And with Elsa, you don't have to worry about warming the speculum. She's probably colder than it is, and it's not like the cold ever bothered her... Anyway.


Of course, the fun is only beginning with these skanky games. What else can give your little princess a healthy idea for a female role model than seeing a heavily-pregnant member of Arendelle's royalty doing housework?


"Hey, babe, can you get me a beer while you're up? Oh, and Sven shit in the hall, when you get a chance."

Apparently the pregnant midriff look is what's hot in Arendelle these days (probably the only thing that is). I'm pretty sure none of these sites are officially endorsed by Disney. And that one definitely isn't sanctioned by Kate, Duchess of Cambridge, either.


Of course, there's always the chance that Elsa will get sick of vacuuming and deck the cad (Prince Hans, I bet) who did this to her. One good punch and he's headed back to the Southern Isles. Let's just hope she doesn't hit him too hard or else...


"Hey! What the fuck is Dora doing in the picture?"

It may be expected that you kiss the Queen's hand when meeting her... But I'd have to decline. Looking at those sores, I don't know where it's been. For that matter, I don't want to know, either. Especially if it's reindeer Brucellosis.


No matter what happens, Elsa is likely going to need time to get back to normal. Which brings us too...

"Wait. Why the hell is there a paintbrush in here? Some horrible crafting accident?"


 And, I think it's about time to... let it go.
 

Thank you, Craig, for bringing these horrifying games to my attention.

Friday, March 20, 2015

Quote du jour

"My Dad suffered a fatal stroke when he was 68, but lived for another 15 years."

Thursday, March 19, 2015

Annie's desk

Ms. Recite: "Major Illness Insurance medication review, may I help you?"

Annie: "Hi, I'm calling to get a seizure medication, Spykenwayv, covered for our patient Amy G'Dala for 2015."

Ms. Recite: "Certainly, let me look at her records... Has she failed the required generic medications?"

Annie: "Yes, same as last year when we went through this."

Ms. Recite: "Okay. I still have to ask, as some of our policies have changed for 2015. How long has she been on Spykenwayv?"

Annie: "Since 2010, same dose as last year.”

Ms. Recite: "And is it still working for her?"

Annie: "Yes. She's been seizure-free since she started it."

Ms. Recite: "Good. Now, for 2015 we have quantity limits of 30 pills per month on all of our tier 4 medications."

Annie: "But Spykenwayv can't be taken only once a day. It has to be twice a day because of its half-life. So she'll need 60 pills, technically 62, since most months are 31 days."

Ms. Recite: "Well, for 2015 Major Illness will only pay for 30 per month. That's the best we can do."

Annie: "Can I talk to..."

Ms. Recite: "Perhaps she could try taking it every other day? Maybe use a cheaper medication for the days between?"

Annie: "Uh, you can't do that with epilepsy medications. You have to maintain a stable blood level because..."

Ms. Recite: "Could she skip it on days when she isn't working? If she has a seizure at home would that be a big deal?"

Annie: "Yes. It would. She could have multiple seizures and end up in ER. She could die. She could injure her kids, or have a car accident."

Ms. Recite: "Since you mentioned ER, please remember that for 2015 Major Illness strongly recommends you go to one of our approved urgent care centers instead. They have convenient locations throughout the greater Grumpyville area and are staffed from 8:00 am to 6:00 pm weekdays and 9:00 am to 4:00 pm Saturdays by trained medically-affiliated professionals."

Annie: "I'd like to talk to a supervisor, please. This is an issue that seriously affects a person's life and well-being, and you're reading to me from a script."

Ms. Recite: "It may take a few days for her to get back to you. We only have one right now, and she's swamped. The other 2 both quit last week."

Wednesday, March 18, 2015

Workin' on a...

With spring coming and the snow finally receding, Mrs. Grumpy sent me out last night to buy gardening crap so she can try growing tomatoes at home (if this works, it could save us a fortune in tire wear and gas).

At the store I passed this sign:




Does it make anyone else think of the song "Sex Farm" by Spinal Tap?



"Gettin' out my pitchfork."

Tuesday, March 17, 2015

Neurologists telling neurology jokes

Jake is an elderly widower who lives at Shady Acres Care Home.

One day Sadie, who lives down the hall, comes over. "Jake," she says, "tomorrow the group bus is going over to see that new movie, and I'd like to go. But I haven't been to a movie since my husband died, and I'm nervous about going alone. Will you go as my date?"

Jake thinks for a moment. "You know, I haven't seen a movie since my wife died. I'd like to... But I have a request. Whenever we'd go to movies, I'd unzip, and my wife would hold my winkie during the film. Would you do that for me?"

Sadie thinks about it. "Why not? We're both in our 80's. What have I got to lose?" So they go to the theater, she holds his penis for the whole 90 minutes, and they both have a good time.

This goes on for the next several months, at every Wednesday movie outing.

Then, one day, Sadie calls to make sure they're on for that afternoon's trip, but Jake can't go. "I have a cold, Sadie. Sorry."

And the next time. "Sadie, I have a doctor's appointment."

And the next: "Oh, Sadie. I can't. I have to wash my hair."

"Jake, you don't have hair."

"I mean, the hair on my back."

This continues for another few weeks. Finally, Sadie confronts Jake outside the day room.

Sadie: "Jake, what's really going on? Why aren't you going to the movies with me anymore? No excuses."

Jake: "I... I've been going to them with Irma instead. I didn't know how to tell you without hurting your feelings."

Sadie: "IRMA? In room 507? Why? What does Irma have that I don't?"

Jake: "Parkinson's disease."

Monday, March 16, 2015

SOLD!

Dr. Grumpy: "So, what are you guys up to next?"

Mrs. Discount: "My daughter and I are going to run a few errands, then stop at Schit HaĆ¼s for lunch."

Dr. Grumpy: "Didn't you guys go there after your last visit?"

Mrs. Discount: "Yeah, we have lunch there a few times a month."

Dr. Grumpy: "That's funny, my wife and I tried it once, and didn't like it at all."

Mrs. Discount: "Honestly, I don't think it's very good, either, and my daughter can't stand it."

Dr. Grumpy: "Then why do you guys keep going there?"

Mrs. Discount: "She buys their Groupons. She says it's a good deal."

Friday, March 13, 2015

Thursday afternoon whatever

Ms. Chlorophyll: "I have migraines, with photosynthesis."

Dr. Grumpy: "You mean photophobia."

Ms. Chlorophyll: "Whatever."

Thursday, March 12, 2015

Rambling

The following voicemail was left on my phone last night.

"Hi, Ibee, It's Rick Radar, on call in radiology tonight. You ordered a CT scan on Mrs. Confused, and it looks okay, no stroke or bleed (pause) okay, next report, chest X-ray on Seymour Phlegm, AP and lateral views, study done for persistent cough. File number 67874. No acute findings. Heart size normal (pause) next is an IVP on Kid Neestone, diagnosis is flank pain. File number 71985. Study done with iodine contrast shows a large renal stone partially obstructing the right ureter (pause) next is a 3 view cervical spine series done for neck pain. File number 37495. Normal alignment of neck vertebrae, no fractures or other abnormalities (pause) next...

He ran out the full 4 minutes of time, too. You just know he's going to be down in transcription today, wanting to know how they lost last night's dictations.

Wednesday, March 11, 2015

Seen in a chart

Recently I picked up a fellow who had a serious accident a few years back, and was thrown from his car. He landed on his head, and required emergency neurosurgery and a LONG course of rehab.

So, as usual, I got a copy of his previous neurologist's records. In one of the notes was this comment:


Tuesday, March 10, 2015

Reverse polarity

Dr. Grumpy: "Do you have any major illnesses?"

Mr. Negative: "No, just diabetes and high blood pressure."

Dr. Grumpy: "Do you take any medications."

Mr. Negative: "No, only Coumadin, Insulin, and Lisinopril."

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Negative: "No, just Iodine and Penicillin."

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

Mr. Negative: "Yes, they're all healthy."

Monday, March 9, 2015

Holiday Road




Last week, there was a mention over on Cartoon Guide to Becoming a Doctor about never telling patients that you're on vacation, always say you're at a conference. While it wasn't the main point of the post, it caught my eye.

I know a lot of doctors who do that. Hell, I think my Dad (a lawyer) used to do it, too.

But me? No. If I take a vacation, I have no issue with patients knowing. If they don't like it, or get upset when I'm out sick, they can eat rocks. Or, better yet, find another neurologist, one who (as Annie puts it) "can provide for your very special needs better than we can."

Here's my weekday schedule: Alarm goes off at 4:00 a.m., so I can begin hospital rounds and see new consults that came in overnight. I get to the office between 6 and 7 so I can review stuff that came in overnight, look at charts for people coming in that day, and finish up any dictations from the day before.

Starting at 8, I see patients straight through, finishing up around 5:00 p.m. Unless there's a drug rep bringing lunch I usually have a noon patient, too. Crammed into the gaps I'm reviewing test results, returning calls, dictating notes, and exchanging insults with Pissy and the staff.

Then I have another 1-2 hours of hospital stuff to go back for. EEG's to read, test results to check, patients to send home, new consults to see. Then I get to head home. So, by the end of an average week, I've logged 60-70 hours.

Weekends? If I'm not on call, it's relatively quiet. That's good, because I need the time to catch up on all the crap that got tossed on my home desk during the week I didn't get a chance to look at. But if I'm on call (once every 4 weekends) I'm pretty much stuck at the hospital. I'm required to be able to be there within 30 minutes if called urgently. Since I live about that far away, it's easier to just stay there and deal with the pile of consults as they come in, rather then try to return home to do anything but sleep.

I'm not looking for sympathy. I signed up for this. I'm not bragging, either. This is what I do. I have a family, staff, and patients who depend on me.

But after living like that, week in and week out, I never feel guilty about taking time off. Besides, I don't actually go to conferences. With my schedule the last thing I want to do with my free time is use it to hang out with other doctors.

I work pretty hard. Like most of my patients, I have a family and a life outside of my work. And if they don't like that, or have a need to think that I live for this shit 24/7, then they're welcome to find a doc who does. It isn't me.

Friday, March 6, 2015

Overheard in ER

Ms. Viridae: "I want to get checked out, you know, down there, because my roommate has herpes, type 2, and I'm afraid I caught it from her. We were sharing the same fork."

Dr. ER: "Uh, what exactly were you doing with the fork?"

Thursday, March 5, 2015

Skool Nerse Time

This is Mrs. Grumpy.

Due to the number of cases of head lice that crop up over the course of the school year, I'd like to make some recommendations based on my experiences.

1. There are several reputable products that remove lice. Gasoline, wood varnish, and Draino are not among them. While I'm sure Draino did get rid of them, you now have a meeting with a state agency.

2. Chiropractic manipulation will not make the lice go away, regardless of what Dr. Cracker may have told you.

3. Rubbing garlic on your child's head will not harm the lice, though it may protect them from vampires, werewolves, and pretty much anything with a nose.

4. Having your kid drink Red Bull, hoping she'll run around more and make the lice fall off, will not get you anything but sleep-deprived. And I will call you to come take your moth home until she reverts to a child.

5. Bringing kids to my office and demanding I "do something" will only get you a list of products. I don't carry them here. The district doesn't even cover bandages, FFS (yes, I have to buy those myself, thanks, Governor). I don't have a magic wand.

6. Local Pharmacy is not going to give you lice-removal products for free. Saying your kid caught them at a public school, their store, or on a school bus will not change that. Neither will asking them to call me to try and bill the school district for them.

7. Screaming, yelling, and blaming the school, the teachers, other parents, other kids, "those Arab people near the bus stop," the President, and society in general will not change the fact that your precious has lice, and you have to deal with it. In spite of this, I'd have to say it appears to be the most common method of dealing with the situation.

8. Threatening to scare lice off by shooting firearms near junior will only result in me calling the state. And the lice won't care.

9. If you choose to shave them bald, the school is not responsible for other kids making fun of them.

10. Calling your pediatrician for Amoxicillin will not help. They may laugh at you.

This has been a public service announcement.

For an even better PSA involving lice, read this, by the Skeptical OB.

Tuesday, March 3, 2015

Modern medicine

The horseshit chart systems that most hospitals use these days are full of crap that's automatically stuffed in there, no matter how irrelevant it is to the case.

Last night I received a hospital consult on a 92 year-old man with severe, end-stage Alzheimer's disease. He'd been found unresponsive (at least, more unresponsive then usual) in his wheelchair at a nursing home (where he's lived since 2009), and was subsequently found to have a huge stroke.

Of course, the computer chart program inserts this paragraph IN EVERY DOCTOR'S NOTE on him (including my neurology consult), regardless of whether we actually want it in there. Because, it's what the hospital admin people say is important for good patient care. And who knows more about good medical care than an administrator with a business degree?






Monday, March 2, 2015

Memories...

Back in my residency, MRI's were printed on this stuff called "film" that would be hung on a reading board. Like most neurology programs, we did MRI's pretty much around the clock, and so there were a lot of films to be read and reviewed on any given day.

Each day, around 1:00, the residents and attending physicians would all cram into a small room with the neuroradiologists to review that day's studies, then make decisions on what the next step was for each case.

One of the other residents, Paul, began having migraines during training. Like most young doclings, he was convinced something was horribly wrong (migraines are actually common among neurologists).

So he conned one of the radiology techs into doing a brain MRI. Like all the other scans, it got hung up on the reading board to be reviewed for the 1:00 meeting.

While my team went to get lunch before the MRI session, I ran to the pediatric neurology clinic across the street. I dug through their film room, trying to find the most horrifyingly abnormal, congenitally malformed, brain MRI study I could. Then I hurried back over and switched it out with Paul's films.

He screamed when it first came up. After about 10 seconds he hit me with a clipboard and said "There's a special place in hell for you, Ibee."
 
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