Let's Stick With Your Visit

Look, people. I am a neurologist. Specifically, when you come to see me, I am your neurologist.

I am here to try and help you.

I am NOT here:

1. For you to sell me a timeshare.

2. To discuss the rising price of bus passes.

3. To render a 2nd opinion on your friend's 3rd cousin with MS in Wyoming.

4. To look at > 2 pictures of your children, grandchildren, dogs, doll collection, spouse, car, trailer home, or the fish you caught last weekend.

5. To look at the catalogue of huge, 3-wick, foul-smelling candles that you sell.

6. To help you decide what to do with your investment portfolio.

7. To tell you if your new dress makes your ass look fat. Let's face it- the dress has nothing to do with it.

8. To hear about your great blackjack strategies at the local Indian casino. If you were that good at it, you wouldn't keep asking me to waive your $15 co-pay.

9. For you to sell girl scout cookies, campfire candles, chocolate bars, or any other of your kid's school fundraising stuff to.

10. To answer your questions about getting a passport.

11. To listen to the great deal you got on bedroom furniture in 1959.


Thank you.

Sharing the Love

Okay, gang, generally I try not to borrow/steal from other blogs, but sometimes one of them has something so remarkable I just HAVE to share it.

So, to give credit where credit is due: The following awesome post was written yesterday by my esteemed colleague Big 'N Tasty RPh, over at Fast Food Pharmacy.


"Ding Ding Ding! We have a Winner!

Plan B is available at the pharmacy for purchase with a photo ID proving the purchaser is 18 years old. The message on the box states 'Prescription required for women under age 17.'

A man called because he came in earlier in the evening and purchased a box of Plan B. He called very concerned that we had sold him the one for under 17 year olds and needed to know if it would still work for someone over 17 years old. I was speechless.

This guy must have swam out of the shallow end of the gene puddle. You know, the "gene puddle." Definition: a minute puddle cut off from the gene pool by global warming that allowed for the most severe degradation of the human genetic sequence resulting in acts or words of stupidity that defy even an every day Joe's imagination.

So I firmly and simply replied that the pill labeled Plan B is the same, only the law needs a prescription for a young girl. He expressed great relief and after he hung up the phone I laughed so hard I almost peed myself. This guy is ready for plan C (i.e. castration). If there is a God he will never allow that guy's genetic material to be passed along but we all know from experience that the people who want kids have the hardest time getting pregnant while those who have no business with children breed like rabbits. Another winner indeed."

Another Fine Medication List

My Tuesday ended with me asking an elderly gentleman what pills he was taking.

He stood up, dug through his pockets, and finally handed me a wad of paper.

It said:

"lettuce.
American cheese
laundry soap
paper towels
ketchup"

Allergies

A popular topic on all medical blogs, it seems, but always fun. This (almost) alphabetical list was given to me by today's 9:00:

"I'm allergic to Ambien, Aspirin, Axert, Bextra, Butalbital, Caffeine, Celebrex, Codeine, Pistachio Ice Cream, Darvocet, Depakote, Fentanyl, Amitriptyline, Hair Spray, Erythromycin, Fosamax, Imitrex, Keppra, Marinol, Klonopin, Lamictal, Lyrica, Mountain Dew, Mirapex, Mobic, Breathing Strips, Morphine, Treated Leather Products, Cardizem, Neurontin, Model Glue, Oxycodone, Penicillin, Jell-O, Relafen, Vanilla flavoring, Relpax, Requip, Artificial Cookie Dough, Sinemet, Sonata, Sulfa, Peanuts (but peanut butter is okay), Steroids, Talacin, Tetenus, Artificial Creamer Stuff, Topamax, Toradol, Some M&M colors, Tramadol, Hydrocodone, Vioxx, Xylocaine, Zoloft, Zomig, and Zonegran"

I can only assume this person has kids at the school Mrs. Grumpy works at.

Marketing Moments

I'm doing a marketing study tonight over the internet, and got this question:

"What percentage of your untreated epilepsy patients are untreated?"

Skool Nerse Time

Mrs. Grumpy is a veteran school nurse. This year, she's starting at a new (to her) elementary school.

So she spent this morning sorting through all the medical cards parents have turned in.

Under allergies, some listed for kids at her school include:

"unwashed lettuse"
"sugar, fake sugar, and artificial sugar sweets"
"byprodukts"
"rubber bands or glue and/or whatever stuff like that"
"no Aspirin, but Aspirin is okay"
"that drug that killed Michael Jackson" (hell, this district doesn't even supply Tylenol)
"band-aids"
"metal cans"
"ear thermometers"
"that bad kind of paper I read about"


On the line marked "Other medical concerns you'd like us made aware of":

"Don't let him eat Legos again this year, PLEASE!"

"Can I get a copy of the district's swine floo plan?"

"I don't like her getting junk food. Can you make sure she doesn't bring any for lunch" (who's packing her lunches? Not the nurse, you bozo)

"He doesn't like beer or coffee" (on a 2nd grader)

"Please don't make him swallow goldfish. I saw that on TV once."

If he faints in PE, no blood transfusions"

Sunday Morning, 5:51 a.m.

I suddenly sit bolt upright in bed. My 3rd year of medical school starts the Tuesday after Labor day, and I'm not even ready. A horrible feeling of dread comes over me.

It's a 2 day drive from my parents' house to my medical school. My roommate Enzyme is likely already back there, and wants to kill me (I've got the stereo with me). After I get there I have to buy one of those short white coats that the medical students are required to wear on rounds, and a boatload of clinical textbooks. The school bookstore isn't open on Sundays and holidays. So I'll have to leave here by Thursday at the latest.

I'm not even packed with all the clothes and crap I need for my 3rd year. I don't even own a tie. My car needs an oil change before the 1500 mile drive. I have no idea where the stethoscope I bought last month is.

I jump out of bed in a panic and cold sweat, and call to my Mom if she knows where my suitcase is. Mrs. Grumpy yells "What the hell are you doing?!?"

Suddenly I'm wide awake. The only drive I have to face is the 2 miles to my office on Monday. This isn't my parents' house. I've been an attending physician for 11 years. I've just woken up the dogs. Snowball starts barking his stupid head off, waking up the kids.

No more deep fried ice cream before bedtime for me.

Early Saturday Morning, 12:47 a.m.

I'm deep asleep. My cell phone chimes. A voice message has been left.

Loud music and people talking in background.

"Hello? This is Suzy Kyoo. I see Dr. Grumpy for migraines and I'm out with my girlfriends and some asshole stepped on my foot and the nail polish came off my big toe and the nail is really brown and gross when I looked at it and I showed it to the bartender and he said he thinks it's like some sort of fungus or something nasty like that and I'm not sure if it's safe to paint over it again and I once saw this TV ad for pills or a spray or lotion or something like that to treat toenail fungus and I've got a date on Saturday night and I don't want to scare the guy off with this disgusting toenail and I was wondering if Dr. Grumpy could call in some of the toenail stuff I saw advertised on TV for me and hey Cindy can you get me another daiquiri I'll pay you back Monday at work oh I love this song I'm gonna go dance to it hang on let me get off the phone."

More Forms

I love crap like this, and I get a lot of it.

Here's a form that I need to sign, then fax back to a drug company to get medication samples.

Notice how, in the same paragraph that says I'm supposed to sign and fax, it also says that a signature stamp isn't allowed.

It's a freakin' fax! How would they know?

(click to enlarge)

Screw You, Dr. Rude

Whenever another doc calls and tells Mary to interrupt me, I take the call. I do this because I assume there's an urgent patient matter they need to discuss with me.

Likewise, I'll usually take a few minutes between patients to talk to new docs who call looking for business. When I started in 1998 I went to every medical plaza I could find to hand out cards and ask for work, and still appreciate those docs who were willing to meet with me.

So today I'm with a new patient and Mary comes back to flag me down. She says Dr. Rude is on the phone (I've never heard of him) and told her he urgently needs to talk to me about a case.

So I apologize to the patient sitting in my office and pick up the phone. "This is Dr. Grumpy."

Dr. Rude: "Hi, I'm Dr. Rude. I'm a new specialist in your area, and have just opened my office. I wanted to make you aware that my practice is accepting new patients, and I'd appreciate any referrals you might send my way".

I thanked him and hung up. With a patient across the desk from me, I'm not going to start yelling at another doc.

Piss on you, Dr. Rude. I'm not sending you any damn patients. Having me interrupted by lying to Mary about the reason for your sales call is just wrong. You may be a good doc, but manners mean a lot, too.

I Hope He Didn't Have Anything Serious

Timely communication between doctors is (at least in my opinion) important for good patient care.

So yesterday, this letter from a local kidney specialist showed up on my fax machine. I can't put the whole thing up, but this is the key paragraph.

Besides what it says below, the letter itself was marked as having been dictated on July 4, 2009 (which was both a holiday and a Saturday) and was promptly transcribed on August 18, 2009, then quickly faxed to me on August 27, 2009.





I guess it's also notable that it doesn't mention which January is being referred to.

Medical Resources

Sir, I certainly understand you wanting to find out more about your Parkinson's disease and it's treatments. In fact, I encourage it.

I am, I swear, a board-certified neurologist with over 10 years of combat experience at this desk. While you are welcome to get information from whatever sources you choose, I'm concerned that you're basing your decisions on opinions rendered from non-medical people who may not even have neurological illness. Specifically:

1. The stockboy at Local Grocery who thinks his aunt in Buffalo has Parkinson's disease.

2. The lady you met in line at the movie theater who's hands were shaking a little and told you medications were the work of the devil.

3. The retiree handing out ravioli samples at Costco who told you her last customer had a tremor like yours.

4. bigdavesparkinsonsdiseaseandroofingmaterialsinformation.com

5. The guy who flipped you off in traffic and yelled that you should stop whatever medications you're taking.


These are just suggestions, though. You can do whatever the hell you want.

No Thanks, I'm Trying to Cut Down

Mrs. Oldbird, I'm truly sorry that the medication trial for your husband's Alzheimer's disease caused him to have diarrhea. That is, unfortunately, a known side effect of the drug. I'm glad he got better after we stopped it.

I really do take your word that it gave him the runs. You didn't need to bring in a pickle jar full of his week-old liquid shit to show me. And I really don't want to know what you did to collect it. And I don't need to keep it here to run tests on it. And, if you even THINK about loosening the lid, so help me I'm going to leap over my desk and throw you out the window.

We All Live in a Yellow CME...

I get ads in the mail for CME (Continuing Medical Education) courses. They're generally boring-looking brochures, listing courses like "Stroke Update- 2009" or "Epilepsy Review". They're held at places like "Headupyourbutt University Medical Center" or "Insanely Expensive Resort & Spa". So I toss them in the paper recycling bin.

Yesterday, however, a remarkable one came in the mail for a music themed neurology CME! Featuring hits of the 60's, 70's, 80's and 90's!

I'm still not going to the meeting, but you guys at Case Western get a big Dr. Grumpy "A+" for creativity.

Check it out! Test your classic rock trivia!

(click images to enlarge)