Dear Medscape and Duke University,

Thank you for your recent invitation to take my practice "to the next level":

Your five courses sound enticing, exciting, and insomnia-curing. I'm sure they're ideal for doctors who wear suits every day and use phrases like "reaching out," "think outside the box," "patient empowerment," "corporate values" (an oxymoron if I've ever heard one), and "evidence-based paradigm." They probably make more money than I ever will.

I like how the price is down at the bottom in the smallest print. $899, with "per course" intentionally faded, hoping no one realizes this ads up to $4495.

Once upon a time, like many other doctors, I incurred a large educational debt. I don't want to do that again.

I like what I do, and have no interest in learning how to be a boardroom doctor who watches Powerpoint presentations, argues about what payment models are best for the shareholders, and denies medical coverage that might cut into his year-end bonus. I'd rather make less money and sit at the bedside of someone who needs my help.

Actually, the ad gives me the impression that the best way to make money in medicine these days... is to sell educational courses to doctors on how to make money. It reminds me of an old SCTV piece featuring the awesome Joe Flaherty as a huckster. He said something along the lines of "I came up with a great idea to get rich. I'm not going to tell you what it is, but if you send me $100, I'll mail you a pamphlet with some other ideas I had." (I couldn't find it on YouTube. If anyone knows where it is, send me the link and I'll embed it in here. No "Doctor Tongue's 3-D House of Stewardesses," please).

I've sat in enough classrooms in my time. I'll stay where I'm needed - with patients.

But, I have to thank you. Because after reading your ad I've already figured out a way I can save $4495.

See you next Tuesday... at the lab

Thank you, Webhill! 

Placement

"We still need to run that ad for the funeral home. How about next to the funny pages?"




Thank you, Michelle!

I should hope so

Seen in a hospital chart:

Yes, that's all it said. I didn't cut anything out.

Support the staff cardiologists

Seen in a reader's doctors lounge:

Thank you, Bill!

Memories...

One of my favorite drug reps asked me to share a story from the early days of her career.


I was calling on a cardiologist's office. They said the doctor needed samples, and would be out in a few minutes to sign for them.

Being a rep is a LOT of waiting in lobbies, and I'm used to it. There was a sweet looking elderly lady in a chair, who'd been asleep when I came in. When I was talking to the front desk she woke up, and when I stepped away said "that's a beautiful necklace."

It's my grandmother's necklace, and is an unusual piece. I'm quite proud of it. She asked me the story behind it, so I sat down  and chatted with her for a few minutes. Then I had to take a call from my partner. She picked up a magazine, but quickly dozed off again.

A few minutes went by, a patient left, and the doctor came up front. He signed for my samples, then cheerily called "Mrs. Dozer, come on back!"

Mrs. Dozer, however, was still asleep. The good doctor said "Can you give her a gentle tap? She's quite hard of hearing."

So I went over and softly shook her shoulder. "Mrs. Dozer, time for your appointment."

She fell, limply, out of the chair.

The doctor leaped over the front desk into the lobby and yelled for his nurse to call 911. In spite of his heroic efforts, however, Mrs. Dozer was gone.

I called my boss and told her I was going home. I didn't go back to work the next day, either. And I still have a visceral reaction when an elderly patient asks about my necklace.

Dear Kids,

While mom and I appreciate your efforts to save money, judging from your homework table I think things have gone a little too far:

Quarter added for scale

 We can, I assure you, afford to buy new pencils.

On call, Sunday morning, 2:38 a.m.

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

Mrs. Insomnia: "Hi, I'm a patient of Dr. Brain, I saw him once, about 5 years ago."

Dr. Grumpy: "What can I do for you?"

Mrs. Insomnia: "Well for the last year or two I've been a little forgetful. You know, losing my keys, or going into a room and forgetting why I went there."

Dr. Grumpy: "Okay..."

Mrs. Insomnia: "I had dinner with my daughter tonight, and she suggested that maybe somewhere in that time I might have had a stroke. I didn't think much of it, but now I'm really wondering, and thought I better call Dr. Brain to see if I should go to the emergency room."

Dr. Grumpy: "How long did you say this has been going on?"

Mrs. Insomnia: "At least one year, maybe two."

Dr. Grumpy: "I'd just call Dr. Brain on Monday."

(mumbled conversation in background)

Mrs. Insomnia: "My daughter thinks I should go to ER, and she should know, because she works for a dentist. Anyway, we're on our way there now."

Ummmmmm...

While browsing Google books yesterday I noticed this:

Stayin' Alive!

Seen in a hospital chart:


"She was subsequently discharged from hospice care due to failure of her symptoms to progress."

Tales from the trenches

Dr. Coogie writes in:

This morning I was on the computer, reading overnight notes on my patients. These were the nursing notes on one guy:

00:23  Patient yelled at nurse for pushing Dilaudid "too slow."

01:00  Patient running up & down hall yelling for more Dilaudid.

01:25  Patient called nurse an ugly bitch because she hadn't pushed Dilaudid faster.

02:00  Patient apologized for calling nurse an ugly bitch and asked for more Dilaudid. When informed he could only have it within the schedule set by pain management, he called her an ugly bitch again.

02:10  Patient ran to another nurse's station trying to get more Dilaudid.

02:30 Patient yelled at nurse for giving Dilaudid too slow, said "It's like giving me low octane fuel instead of high octane fuel."

02:40 On call physician notified of patient's behavior.


02:49 Patient seen by on-call physician, who informed the patient he would not be getting more pain medication than the pain specialists recommended.

03:40  Pt escorted back to room by security, who found him downstairs in ER demanding Dilaudid from staff there.



I absolutely LOVE this nurse.  I ran up and gave her a high-five before shift change.

Advice

Dr. Grumpy: "So, at your last visit I prescribed Quiloxitab for the symptoms. How's that working?"

Mr. Rummage: "Actually, I never took it. I decided to try herbal Oil de Baculum instead."

Dr. Grumpy: "Has it helped?"

Mr. Rummage: "Not yet, but the guy who told me to said it can take a few months."

Dr. Grumpy: "Is he a doctor?"

Mr. Rummage: "Not sure. My wife and I were out looking for a used suitcase this weekend, and he was having a garage sale."

"Old lamps, some dishes, paperbacks, medical advice... We got it all."

That should do it

Seen yesterday afternoon in a hospital chart:

For non-medical readers: the effective sedating dose of Valium is typically 5mg-10mg.

Red, Red, Wine

Dear Western Intermountain Neurological Organization,

A reader kindly forwarded your recent conference invitation.

I have to say, I had no idea the "intermountain" states even had their own neurology organization. Why such an organization is necessary is beyond me, as I'm not aware of groups such as "Neurological Association of States that begin with an N" or "United Neurologists of Civil War Border States" or even "Neurologists Organized in Cities with Fewer than 10 Letters in Their Names."

But, I digress.

Anyway, what caught my eye on the invite was your acronym:

Generally, a title like that doesn't bring up images of a bunch of neurologists sitting in a darkened lecture hall learning about the latest research in mitochondrial disorders. Liver transplants, maybe.

Your site name, winomeeting.org, isn't bad, either. Sounds like an organization I'm ready to join after a crappy day at work. Or night on call. Or... Screw it, I'm ready to join now, provided your standards are above Night Train Express and Thunderbird. But I'm willing to negotiate.

I see this year's meeting is being held in Salt Lake City, generally not a place I think of for its widespread availability of alcoholic beverages. The last time I was there (2012) I saw a bleary-eyed dude standing on a street corner drinking from a bottle wrapped in a paper bag... and it was milk. I'm guessing he was an RM re-adjusting to big city life.

Your site says the meeting will "stimulate your thinking" and that my $150 registration fee includes breakfast and lunch. Will funeral potatoes be served? Fry Sauce? Green Jello? It would also be helpful if you noted what stimulants and beverage vintages are included with the meals, preferably ones I can mix with Diet Coke.

The idea of a room full of docs wearing nametags that say "WINO" is also entertaining. Especially if the featured speaker is unshaven, slurring, shabbily dressed, and tremulous.

The site also has this price list:

I have no idea which companies want to set up a booth at a WINO meeting, but I'd love to see what they're wearing. I'm imagining guys who look like they just spent the night sleeping on a bench in Temple Square (but without the black name tag) sampling beverages that can double as lighter fluid. Also, I think it would be cool to watch sales reps for Campral and Two Buck Chuck working the crowd together.

Lastly, while I don't live anywhere near a mountain, I'd still like to join your organization. Because nothing would be more impressive than to have a framed certificate that says "WINO" in big letters hanging amongst my diplomas.

It may actually improve my Yelp ratings.

Thank you, Mike!