Beggars as Choosers

You people are in the damn Medicare donut hole, and I understand that. You call my office looking for free samples, and I try to help. Your internist has a "no samples" policy, but I try to be nice and help you guys save some dollars when you are in the Medicare donut hole, because I know how damn expensive your pills are, and I am trying to help. That's why I became a doctor.

I called my drug rep, and he was actually quite nice, and dropped off a case of your damn pills. It was easy, because his company accidentally sent him a case of samples labeled in Spanish that was meant for a neighborhood across town. So he was happy to contribute it to your care, instead of having to fill out the paperwork to send it back to his company.

They are the same damn pills. You can see them through the plastic. The same pill name and pictures are on the same damn box. You can see that for yourself.

I am trying to help you. So don't stand in my damn lobby and yell at me and Mary because you don't want "pills for Mexicans". You want free pills? Here they are. I wrote the instructions out in English, for crying out loud.

You are the losers who stomped out because I didn't have pills with English packaging, and now you're calling back. Sorry, but now that you've gone home and realized how much it costs to buy the same pills, it's too late to have a change of heart. I'm going to give them to a decent, non-bigoted person. And don't whine to me about how you may not have enough money to buy them. You had your chance at a damn month of free pills, and stomped out with attitude.

What a Drag!

This is too good not to post.

A criminal gang of cross-dressing gay bar performers, who stole over $30,000 in dresses and other feminine things to wear in their shows!

Check it out!

Catch-22, HMO Style

Reading the faxes from overnight.

Idiotic HMO, Inc., sent over a note saying that they were refusing to pay for a patient's MRI because "This does not meet our criteria for lumbar spine MRI's. The patient must undergo a minimum of 8 weeks of physical therapy, without benefit, before an MRI will be authorized."

Farther down on the same page, under guidelines for physical therapy, it says "Idiotic HMO, Inc., will not cover more then 6 weeks of physical therapy per calender year."

No, Not THAT Bible

We all have a book that is our "Bible". After an insane day like yesterday, I go home and read mine (and no, I don't read it in the john).

So what is Dr. Grumpy's bible? Some neurological work by Charcot? A medicine tome by Osler? Nope.

My staff has learned that when I refer to "The Bible" I mean a small book (I've given them all copies) called "Kill as Few Patients as Possible" by Oscar London, M.D. It's a remarkable collection of 57 essays on "how to be the world's greatest doctor". It's a scream. I first read it in 1992 in medical school, and it's since been kept at arm's reach. Any aspiring physician (or anyone who needs a good laugh) should get it.

(Disclosure- I do not know who Dr. London is, I am not selling copies of this, and I have no financial interest in any booksellers whatsoever).

So, Dr. London, if you are reading this, I just want you to know that I think you are awesome. And I continue to try to practice by your rules.

What a Day

The afternoon ended with me ordering an MRI on a 30-something guy.

I'm filling out the MRI form, and automatically checked "No" on the question "Is patient pregnant?"

The guy leans over and says, "Hey, you need to change that."

Dr. Grumpy: "Uhhh, are you pregnant, sir?"

Mr. Bozo: "No, but my wife is. Wouldn't that also affect an MRI that I'm having?"


That's enough insanity for one day. I'm giving up and going home.

Drug Rep Fun

Okay, gang, I've just finished lunch with a drug rep. He represents a narcotic drug, so as a result he can't give me samples for patients to try. The guy is originally from Germany, and the accent, for whatever reason, always adds an extra layer of formality to these meetings.

Under these circumstances most companies give out coupons for the patients to redeem for a week or so of pills, so I asked this guy if his company would be giving us those.

He gave me this horrified look and angrily said (in his German accent) "At my company ve do not believe in prostituting our drugs!"

Okayyyyyyyyyyy.....................

More Weirdities

Today just seems to be shaping up as weirdness in the medical world.

While I'm not trying to take sides online in the animal rights vs. medical research issue, this article today caught my attention.

A group of animal rights activist in Switzerland have targeted the CEO of Novartis pharmaceuticals by (among other things) stealing his mother's ashes!

Medical Research

The West Virginia branch of our Science Marches On Department has brought the following enormously important medical research to my attention.

(click to enlarge)



FOLLOW-UP COMMENT: The Texas branch of our Science Marches on Department, upon reviewing this article, had several questions which I thought were worth printing:

"(a) Does it matter what you read? Sci-fi, romance, action-adventure, military history, self-help, etc? More work in this field is needed.

(b) Since this was done in Israel, does it make a difference if you read left-to-right or right-to-left?

(c) Is this why they call Jews the People of the Book?

(d) Do you get the impression that the Primary Investigator did this research because his wife complained about his reading on the john and gave him some old wives' tale about how it's bad for you?

(e) I know (from personal experience) that Haifa isn't the most exciting city in the world, but how bored do you have to be to come up with this?"

Good Causes For All Things

On the way home from the Grumpy Neurology Emporium tonight I passed a sign: "This is National Stop-at-a-Red-Light Week. Remember to stop at red lights this week."

I'm not making this up (you can google it if you don't believe me).

I had no idea we were in need of this. Are there weeks for other traffic laws (Slam-on-the-Gas on Yellow Week, or Swerve-to-Avoid-Pedestrians week)?

And if I try to remember to stop at red lights this week, do I still have to do it next week?

Attention Other Specialists

I am a neurologist. This means I deal with brains and nerves. I do this for a reason, just like you have your reasons for doing whatever you do.

This means that I do NOT want you to send me any of the following:

From GI docs: vivid bright color endoscopic pictures of a mutual patient's hemorrhoids, the inside of his rectum, or a bleeding ulcer in his duodenum. I will take your word that he has problems, and you don't need to send graphic evidence. Sending it by fax, however, has helped Mary stay on her diet.

From OB/GYN's: close-up photos of herpes sores on a mutual patient's hoohah, shots of her cervix at 28 weeks, and slides from her pap smear.

From any surgeon: A DVD of you taking out Mr. Smith's gallbladder or fixing his inguinal hernia. I treat his migraines. You stay on your side of the body and I'll stay on mine.


I don't send you people samples of spinal fluid, EEG clippings, or a DVD of abnormal reflexes. So stop it.

Bad Ways to Wake Up

My cell phone beeps at 3:47 a.m. on a Monday morning. It's the coroner's office, urgently needing records on one of my patients.

Sunday in the Pool

I'm sitting on the pool steps today, watching the kids swim. Marie comes over and starts fanning water onto my submerged torso and legs. After a few minutes of this, I asked her what she was doing.

"I'm getting the barnacles off. On Spongebob, Mr. Krabs said old people have barnacles grow on them."

This parenting thing can be SO flattering at times.

Does Anyone Else Think This is Wierd? Or is it Just Me?

Mrs. Grumpy went to a funeral last week, and just returned yesterday.

I've never heard of this (and neither had she) but the family had hired a professional photographer! I am not making this up. As each group of guests came in they were asked to have their picture taken standing by the casket (mercifully closed) and widowed spouse ("say 'cheese' everyone!").

After everyone was there, the photographer filmed the whole ceremony, including burial. You could sign up to have a free CD of the funeral soundtrack sent to you, or (for only $9.95) also get a DVD with video so you can always revisit the excitement.

This was all part of the package that was offered by the mortuary.

I have nothing against photographers. They work at weddings, parties, Bar Mitzvahs, etc. But I've never heard of similar stuff being done at funerals.

Am I out of touch? Is this normal these days? Does anyone else think this is strange?

"When will my labs be back?"

Labs fall into 3 groups:

1. Regular tests (done at the lab, back within a few hours).

2. Local send-outs (done in the city, but we "send-out" the sample to another hospital. Can take a few days).

3. Major League send-outs (only a few places in the country, or even the world, may do these. Several weeks to get back).


So yesterday afternoon, around 4:00, I was trying to track down some results in category #3. The hospital lab kept switching me from person to person, and each time I had to tell them my story, the patient's name, etc.

Finally I reached a supervisor, who said: "Oh, those are rare labs. We had to send them quite a ways. I'm going to have to connect you to Israel."

I was quite surprised, but patiently held the line. After about 10 seconds it began ringing, and a male voice answered.

Male voice: "Lab, can I help you?"

Dr. Grumpy: "Um, I'm looking for some send-out results from about a month ago on Mr. John Smith..... Hey, what time is it there anyway?"

Male voice (surprised): "Uh, about 4 in the afternoon."

Dr. Grumpy: "Oh..... I thought I was being connected to Israel."

Male voice: "I'm Israel Nunez. I work in send-outs. What's the patient's birthday?"


At least he got me my lab results.