Pop Quiz

Okay, Grumpy fans. Put your books away and get out a #2 pencil. We're having another pop quiz. Mr. Knucklehead, please put away the issue of Boy's Life. We can all see you're hiding your mom's new Cosmo behind it.

Everyone ready? Good.

Question: You're a nurse at a major hospital. Your patient's white cell count (WBC) jumped from a horribly abnormal 44 yesterday to a frighteningly abnormal 79 this morning.

Do you call:

A. The hematologist treating the patient's bone marrow disorder.

B. The cardiologist following the patient's pacemaker.

C. The neurologist evaluating the patient's imbalance.


If you answered C, thank you for waking me up this morning. I greatly enjoyed your reasoning of "I called you because your name was the first one listed alphabetically."

Saturday, 11:57 p.m.

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

Ms. Narc: "Yeah, I'm a patient of Dr. Notoncall. He has me on Vicodin, and I'm all out"

Dr. Grumpy: "I'm sorry, I don't call in controlled drugs after hours"

Ms. Narc: "But I'm hurting!"

Dr. Grumpy: "You'll have to call his office on Monday, or go to urgent care or ER if your pain is that bad."

Ms. Narc: "But I can't make it until then! I hurt all over!"

Dr. Grumpy: "I can't call in these pills for you. Sorry"

Ms. Narc: "Ummmm... But I don't need pills! Yesterday I had one of those, uh, gastric bypass surgeries, like the fat guy on TV once did, so I need liquid Vicodin. So it's not a pill. You can call that in, right?"

Dr. Grumpy: "Good night" (hangs up).

On Call, Again

Mrs. Bluehair: "I suddenly couldn't write with my left hand".

Dr. Grumpy: "Are you left handed?"

Mrs. Bluehair: "No, I'm very strongly right handed. I've really never been able to do anything coordinated with my left hand."

Isn't That the Point?

Being a brain doc, I don't keep up on the varying contents of the different birth control pills out there.

But today I saw a lady whose migraines had changed between pill brands, so I looked them up to see what the difference was between them.

Under side effects one of them listed "temporary infertility".

What the Hell?

Lady, if you leave your work number as where to call you back, and ask that I call you back immediately, DON'T FREAKING YELL AT ME OR MARY FOR CALLING YOU AT WORK!!!

Dear President Obama,

I'm writing to you for the first time.

I don't want this to be a political blog. There are plenty of other sites for that. But we now face a national crisis of such serious proportions that it dwarfs other issues, such as global warming, health care, and middle-east peace. It now threatens the very fabric of our society, and directly affects every citizen. And I can remain silent no longer.

It's still September, and every store near me ALREADY HAS THEIR CHRISTMAS DECORATIONS UP!

I have nothing against the holidays, Mr. President. Peace on Earth and all that stuff. But moving them up as if they were being held in another time-zone or alternate universe is getting out-of-hand. As far as I know, Christmas hasn't budged in my lifetime. And treating every day like it was Christmas (like the stores seem to want me to do) is not helping.

The well-respected Nick documentary program, The Fairly Oddparents, has carefully researched what would happen if Christmas were held every day (Episode 107, air date 12-12-01 I have kids, OKAY!). Their conclusion? It would be catastrophic.

There also seems to be a degree of unintentional discrimination. For example, Hanukkah starts more than 2 weeks before Christmas this year, but I didn't see Hanukkah decorations going up 2 weeks before the Christmas ones. In fact, I haven't seen any at all yet. Or Kwanzaa stuff. Or Festivus. Or New Year's.

This seasonal perversion extends to other holidays, too. I mean, by January 2nd most stores are decked out with Easter junk, and on July 5th the Halloween crap is up.

So, Mr. President, I propose the following, federally mandated solutions (please note: I'm only including those holidays that retailers love. Let's face it, not many of us are out there buying gifts for Groundhog day or cards for Columbus day. I'm also leaving out local holidays like Delaware Statehood Day, the Montana Huckleberry Harvest Celebration, and the Byron, Illinois, Turkey Testicle Festival).

Valentine's Day Decorations will NOT be put up until the 3rd week of January.

St. Patrick's Day Decorations will NOT be put up until after March 1st.

Passover/Easter decorations will NOT be put up until after St. Patrick's day.

Independance day decorations (July 4th) will NOT be put up until the 3rd week of June.

Halloween stuff will NOT be put up before October 1st

Thanksgiving Stuff will NOT be put up before November 1st.

Christmas/New Year/Hanukkah/Kwanzaa/Festivus stuff will NOT be put up until the day after Thanksgiving.

(Please note: there should be some flexibility here, as Hanukkah and Easter/Passover may vary, but decorations should NOT be hung more then 3 weeks prior to holiday onset).


An alternative plan would be to have a single annual holiday combining all of the above, called St. Christmukahpasseastkwanpatfourthnewfestgivingween. Decorations for the combined holidays may be hung for 30 days prior to this event, and MUST be removed the day after.


Punishment for business owners who violate these laws would be on a 3-step basis:

1st offense: Business license revoked for one month.

2nd offense: Tarred, feathered, and forced to eat fruitcake.

3rd offense: Drawn and quartered, then served with fava beans and a nice chianti.


Yours truly,

Ibee Grumpy, M.D.

(A special THANK YOU to my reader Linda, who sent me this totally awesome picture)

Too Much Information

It's my job to make up the schedule for my call group every 3 months. So, it's that time again.

On Monday I e-mailed the other docs I share call with, asking what weekends/holidays they don't want to be on call for next quarter. So their requests have been coming over the fax.

The last one showed up this morning, neatly typed up by Dr. Brain's secretary.

It said:

"Dr. Brain says he wants to get off on the weekends of October 17, November 8, and December 19."

Random Weirdness

So tonight we made a Costco run to stock up on life essentials like Diet Coke and cookies. Mrs. Grumpy was straight from work, and still in scrubs.

So we're loading up the minivan, and suddenly this wild-eyed lady runs up to us.

"Excuse me! Excuse me!" I'm always afraid this is going to be one of my patients, but she ignored me and went straight after Mrs. Grumpy (who was wrestling with a bag of dogfood).

Mrs. Grumpy: "Uh, can I help you?"

Ms. Wildpsycho: "Yes! Please! Do you work at Local Hospital?"

Mrs. Grumpy: "Uh, no..."

Ms. Wildpsycho: "Where do you work! What do you do! Please! Tell me!"

Mrs. Grumpy: "I'm a school nurse."

Ms. Wildpsycho: "JESUS FREAKING CHRIST! YOU ARE ABSOLUTELY NO HELP TO ME AT ALL, ARE YOU?!!! WHAT AM I SUPPOSED TO DO WITH THAT?!!!"

She stomped off.

I tossed the dogfood in the car.

WTF?

Thanks for the Co-pay. Go Home.

I was seeing this lady in her 30's today. She has migraines and neck pain. Fine.

So I offered her some Imitrex: "No! That's a migraine drug! I don't want that on my insurance record! That will raise my rates!"

So I recommended pain meds and/or muscle relaxants: "No! I've worked for insurance companies! If they see that on my record, I'll NEVER be able to get insurance! Ever!"

So I suggested she try physical therapy: "No! Never! Once they see I've been to physical therapy, I'll never be able to get coverage!"

Okay, Whatever.

Two issues, ma'am:

1. If you are so afraid of your insurance company finding out about your health, THEN WHY ARE YOU HERE, USING YOUR POLICY IN THE FIRST PLACE?

2. I'm pretty sure that your 3-PACK-A-DAY cigarette habit is going have a bigger impact on your health and premiums than ANY of my treatments ever will.

Just some thoughts. Have a nice day.

My Daily Dose of Sympathy

Yesterday afternoon I was seeing a lady who'd called for an emergency work-in for her back pain.

Dr. Grumpy: "So, how did you hurt your back?"

Mrs. Snob: "My cleaning woman left me. Just left me. I've had the same cleaning woman for 10 years. So on Sunday I had to clean the whole damn house myself. And I wrenched my back. I've always had a bad back, that's why I have a cleaning woman. Then, yesterday, my husband and I were at a funeral, and there was no place to sit. You'd think they could have chairs or something. And standing for the whole thing made my back even worse."

Dr. Grumpy: "I'm sorry to hear that. Was it a relative's funeral?"

Mrs. Snob: "No, it was the cleaning woman's."


I was surprised she even went.

Annie's Song

(If you think this post has ANYTHING to do with John Denver, you're in the wrong place. But it made a good title.)

I'm not taking sides in the health care debate, but I do want to clarify something.

I see people on the news screaming that they don't want "bureaucrats" between them and their doctor, and are afraid that's what government health care will bring.

WTF? THAT'S THE WAY IT IS NOW, PEOPLE!!! I hear my nurse Annie on the phone all day trying to get approval from non-government insurance companies for tests, medications, physical therapy, ANYTHING that I order.

Look at your insurance card. Doesn't it say things like "in-network" and "formulary"? Who the hell do you think came up with those? Not us docs. Dat be dem dere byoo-row-kratz!

Look back at some of my posts (like this, or this). I routinely have medications (both brand name and cheap generics) and tests refused by insurance companies. For an excellent commentary on this from the pharmacy side, this was written by FranticPharmacist.

So if you don't want bureaucrats between you and your doctor- TOO BAD. They've been there for years. THE ONLY PEOPLE WHO DON'T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING!

In fact, for those of you who don't want the government running this, THEY ARE ACTUALLY ONE OF THE BETTER ONES TO WORK WITH! Just ask Annie. Medicare doesn't question the majority of my tests, or meds. Yes, they don't cover everything, nor should they, but they don't fight with me over stuff like MRI's on stroke patients. Uncle Sam (unlike BCBS, Aetna, Cigna, United, Humana, and many others) tends to leave these things to the doctor's discretion. Annie prefers Medicare patients for this very reason - they make her life easier.

So what happens to you the way it works NOW, with your non-government insurance?

You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.

Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page "pre-auth" form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn't enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).

So a few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don't cover Capricorns when the moon is in Pisces. And we don't know this until Annie calls back after a few days, because they're hoping we forgot about it.

Eventually they'll deny the whole thing, on the grounds that you don't meet criteria for an MRI and MRA. This decision is usually made by a non-medically trained person with a minimum of a GED. They do this because they want to see just how badly I want the test.

So they tell me I can appeal this via "peer-to-peer" review. Which means I need to personally call their "physician reviewer" to argue with them as to why I want the study.

So, during my insanely busy day at the office I have to call them. I'm promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. In fact, it's usually something like a retired dermatologist, who hasn't done neurology since medical school in 1938. Or an OB/GYN who hated his job, and is doing this now instead. Or some doctor who immigrated from Lower Swazbodiaczk and can't get a U.S. medical license (but your insurance company hired him to decide what medical care you need). But it's almost NEVER someone actually in my field, who might understand why I want the study.

So after telling your life history to Dr. Denial, one of 2 things will happen. They'll deny both studies, and want you to try medication or physical therapy or psychotherapy or holistic reflexology or whatever, and if you fail that THEN I can try to resubmit a request for the test. OR they will flip a coin and say they will cover the MRI, but not the MRA. Or vice-versa. They'll say that if the first test is fine, THEN I can start over trying to get the other covered. Maybe.

And many of these companies actually pay these "reviewers" bonuses based on HOW MUCH MONEY THEY SAVED THE COMPANY BY DENYING TESTS.

This can at times become comical. One of my patients is a doc who works part-time as one of these insurance company "physician peer reviewers". And when he needed an MRI, guess what? HIS OWN COMPANY DENIED IT! He paid out of pocket for it (and yes, it was abnormal).

So how did I get on this tangent? Because yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: "I'm calling because you people denied an MRI on a stroke patient?"

Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."

Annie: "Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."

Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."

Annie: "Oh, now THAT's a surprise."

Pinhead: "What do you mean?"

Annie: "Is this line really being recorded?"

Pinhead: "Yes. It's to improve customer satisfaction."

Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."

Pinhead: "We do this to save our customers money on unnecessary testing."

Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"

Pinhead: "Um, I hadn't..."

Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"

Pinhead: "No, but I..."

Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."

Pinhead: "Oh, but you can't mean that?"

Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."

Pinhead: "I..."

Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".

Pinhead: "No, wait! I..."

Annie hung up.


So bottom line here: if you don't think bureaucrats are currently between you and your doctor- THEY ARE! GET REAL! IT'S BEEN THAT WAY FOR THE LAST 10 YEARS OR MORE!

My High School Class...

Have had some interesting comments about my high school reunion post from earlier today.

When my 20th reunion came around a few years ago, I heard about it quite indirectly- from my mother, who happened to run into somebody else's mother at Local Grocery.

When I looked at the 20th anniversary website, I was listed among the missing- students who, in spite of the best attempts of my classmates, couldn't be found (and this was well into the internet age).

I found this amazing, for many reasons:

1. I haven't changed my name.

2. My parents still live in the same house and have the same phone number as when I went to high school

3. My neurology practice is less than 5 miles from the high school I went to.

4. I am listed in the yellow pages under my own name.

5. If you type my real name into Google, one of the top hits is for my practice's web page.

So I personally felt the fact that none of them were able to find me was a comment on THEM more than ME.

And nothing further need be said.

Religious Awareness 101

Dr. Jewish is an internist down the hall from me. A mutual patient is having problems, and I needed to talk to him about the case. Since I had a minute I walked over to see him, and was ushered back into his office.

While we were discussing things a young lady, one of his office staff, wandered in.

Dr. Jewish: "What's up, Cindy?"

Cindy: "Mrs. Goldbergstein called. You wanted to see her this week, but she just called to cancel it."

Dr. Jewish: "Did she say why?"

Cindy: "She said something about 'John Kipper is coming'. Maybe she's having a guy visit?"

Dr. Jewish: "You mean Yom Kippur?"

Cindy: "Whatever, yeah, his name was something like that, and she said he's coming. So she moved the appointment to next week."

After she walked out (and I started giggling) he put his head in his hands and said "Cindy is my office manager's daughter, too".

Mrs. Grumpy Writes

She just emailed me this (she's a school nurse):

"One of the Spanish teachers just came into the office. She's putting together some sort of Luau themed class party for next week, and wanted to know if anyone knew how to say 'Aloha' in Spanish"!