New Olympic Sport

When I got home today all 3 kids were playing Wii "Dance Dance Revolution" on a difficult setting to a fast song. They each were on a dance mat, and were wildly trying to keep up.

I thought it looked like a new sport for the Neurology Olympics: Synchronized Seizing.

Dragonisms

What is a Dragonism? I'm not sure who came up with the word, but think it was my old chairman, Bob (who I doubt reads this, but if you do, I'm crediting this to you).

A Dragonism is an unintentionally comical error made by voice recognition (VR) software. Many physicians, including myself, use them for dictating. The programs are great, they don't make spelling errors, BUT (and this is HUGE) they often mistake one word for another, especially when the words are long, or you're talking too fast, or they just want to piss you off. Usually they're simply stupid, but occasionally can be quite hilarious.

This is why it's CRITICALLY IMPORTANT for anyone using VR dictation to proofread VERY VERY CAREFULLY. Because many physicians don't. If you're one of them, I've seen your notes. They look like crap, and make you sound like a complete idiot.

The word Dragonism was coined because Bob used Dragon Dictate, which remains the most commonly used program of this type. Dragonisms, however, are NOT restricted only to Dragon Dictate. They also occur with it's competitors, such as ViaVoice and iListen. I've used all 3 at various times. Dragonisms just sounds so much better then "ViaVoicisms" or "iListenisms".

Anyway, today my VR system was out to aggravate me, and coughed up 3 gems:


Dr. Grumpy said: "She has an upper respiratory infection."
The computer said: "She has an upper breast infection."


Dr. Grumpy said: "Her symptoms are likely from lumbar disease."
The Computer said: "Her symptoms are likely from Wal-Mart disease."


Dr. Grumpy said: "I've ordered an echocardiogram with bubble study."
The Computer said: "I've ordered an echocardiogram with Bible study."

Hello, Mrs. Geritol

Mrs. Geritol, I'm terribly sorry that my prescription for Vicodin didn't help your back pain and made you so sleepy.

In reviewing the shoebox full of medications you brought in today, it's now clear that you were really taking Valium instead. I was unaware that you had some, as it wasn't on the medication list you provided at your last visit. How you got it is anyone's guess, as it's actually in your husband's name, and the doctor who prescribed it retired and moved away in 2003.

I really do suggest you give the Vicodin another shot, especially considering that you haven't yet taken it in the first place.

I can understand you confusing the two medications, since they both begin with "V" and have 3 syllables. Anyone would have made the same mistake. I must suggest that you exercise caution in the future, as between you and your husband you also have prescriptions for Vytorin, Vagifem, and Viagra.

Thank you for coming in today. I need to go pull out my few remaining hairs now.

Why? Why? Why? Why? Why?

If I ordered physical therapy, and told you to come back afterwards to see how you were doing, DO NOT come back to me 4 weeks later, complaining of how you are no better WHEN YOU DIDN'T EVEN BOTHER TO GO TO THE FREAKIN' THERAPY.

Saying "I dunno" when I ask why you didn't go is NOT an acceptable answer.

Telling me you needed the co-pay money to buy cigarettes is not going to get you any sympathy, either.

Crazy Scale

I generally try not to steal from other bloggers, but this time I'm gonna have to.

ER's Mom wrote this excellent post a few weeks ago, and I just have to reprint it here. But I take no credit for it. It will, however, be remarkably useful in my practice (and likely most others).


Levels of Crazy

Been thinking about this for awhile. I now have the "ER's Mom Official Guidelines for Assigning Levels of Crazy".

1. Normal. They exist, even constitute the majority of patients. They make poor blog fodder however, so you wouldn't know that that they even exist from reading any medical blog.

2. Crazy. These are the "fun crazy" folks. A little off, but you don't cringe when you see them on the schedule.

3. Bat-shit crazy. Your stomach drops a little when you see the name on the schedule.

4. Fucking Nuts. These folks seem intent on driving YOU nuts too.

5. Mouth agape and head shaking. You are lost for words upon meeting these folks. Fortunately, they are rare.

ER's mom: Please don't be offended I used this. It was just too good not to share.

Monday Morning, 12:08 a.m.

My cell phone beeps. Someone has left this message:

"Hi, I have an appointment with Dr. Grumpy. I think it's this Monday, or maybe it's next Monday. Anyway, it's on some Monday, and I won't be able to make it. Thank you!"

And, of course, no name or number left.

Marieeeeeeeeeeeeeeeeeeeeeeeee!!!!!!!!!!!!!!!!!!!!

Marie wanted to talk to my parents this morning, for whatever reason. So I dialed the phone and handed it to her.

After a pause, she said "Hi, it's Marie.... okay, Grandpa" and handed it back to me. She said my dad had answered and said he was busy, but would call her back.

After a while we didn't hear back from them, which is odd. So I called them, to find they'd just gotten in from shopping, and neither had spoken to Marie.

As it turned out, she'd reached their answering machine.

Intellectualism and Discount Retailing

We went to Target last night for some school clothes for the kids (we have SUCH exciting Saturday nights). At check-out Mrs. Grumpy had this discussion with the cashier:

Mr. Cashier: "Is it raining outside?"

Mrs. Grumpy: "No, just very cloudy."

Mr. Cashier: "Yet, I do sense the je ne' sais quoi of coming rain."

My Readers Write

Scarlett was kind enough to send me this picture, which she says was taken in a doctor's office in the building where she works.

Except for the bottled water (maybe it's for the office staff?) I'd have to say this is a physician after my own heart. There's enough Diet Coke and Coke Zero there to hold me for at least 45 minutes.

Happy Friday

Driving home at the end of the work week, and my cell phone chimes. Someone left this message:

"Hi, I'm calling for Dr. Grumpy. I'm not a patient of yours, but I found your name on my insurance list. Can someone please call me back before dinner? I need to know if sandwiches left in my car for 15 minutes can still be eaten. Thank you."

Anatomy 101

Reviewing some records on one of today's patients. I found this note from another doctor:

"His numbness is in the right arm, covering the area from the thigh to the knee."

My Readers Write

Wick, one of my readers, was kind enough to send in a story for a prescription recently handled at his pharmacy.

It was for the Nuva ring, (a rubbery ring with birth control hormones, that's placed intravaginally once a month).

The script was written for Nuva Ring, 1 po qD (that means 1 ring taken BY MOUTH each day).

What's scarier is that when Wick called the GYN's office to clarify this, the "nurse" there (could also be an MA or secretary for all I know) argued with him about how the Nuva ring should be used.

I can picture this happening:

Jenny: "Hey Suzy! What are you chewing?"

Suzy: "It's my new birth control gum!"

Jenny: "Wow! I had no idea there was such a thing!"

Suzy: "Yeah. It's kind of rubbery, and you wouldn't believe what the pharmacy idiot told me I was supposed to do with it! Good thing I called to ask my doctor's office what the right way to use it is!"

Death to Junkies!

I hate my junkies. I don't have many. Every doc has at least a few, and you just learn to deal with them. Some you created by accident (though your original intentions were good) and some you inherited from some other neurologist who had the audacity to die, retire, or move.

What drives me nuts, though, are the ones who come in that way, and try to play you from the word go. And today I had one.

He came in, and after listening to his pathetic story (complete with violin music) I ordered an MRI. He said he was claustrophobic, so I gave him a script for 2 Valium tablets.

After the appointment he walked out to the check-out desk, which is roughly 20 feet from my office. He then told my secretary that he'd lost the Valium script while walking up front, and could she write him a new one (last I checked, my staff ain't allowed to issue scripts for controlled substances).

So she said she'd go look for it, whereupon he suddenly "discovered" it was in his shirt pocket the whole time. Bozo. So he went on his way.

Within an hour Local Pharmacy had called me to query the script. The one that he brought to them was for 200 Valium tablets, not the 2 I'd written for. And was altered in a different ink color.

Sorry, dude. Game over. Go play with someone else.

I Don't Remember Who's Forgetting

Dr. Unka is in my office complex. When he refers a patient to me, he often walks them upstairs to my office and waits with them up front (while his own waiting room backs up) until Mary has scheduled the patient. He often asks that I drop everything I'm doing to come meet his new referral, instead of just having them call us to make an appointment.

So today Mary called me to say Dr. Unka was up front, and wanted me to come meet a new patient. So I excused myself from my current patient and went up front, to see him standing there with a familiar, somewhat irritated-looking, older lady.

Dr. Unka: "Ibee, I'd like you to meet Mrs. Ancient. I'm referring her for memory loss."

Dr. Grumpy: "Uh, I saw Mrs. Ancient 3 weeks ago for that."

Mrs. Ancient (glaring at Dr. Unka): "I told you! Why didn't you listen to me?"

Dr. Unka: "She did?"

Mrs. Ancient: "Yes!"

Dr. Grumpy: "Yes, I sent you a note."

Dr. Unka: "You did?"

Mrs. Ancient: "Yes! He did! It was even in my chart at your office! I pointed it out to you!"

Dr. Unka: "You did? Um, I mean, then have her make a follow-up." (leaves my office).

So in this situation, who REALLY needs to be seeing the neurologist?