Mary's Desk, October 9, 2009

Mary: "Dr. Grumpy's office. This is Mary."

Mrs. Parent: "Hi. My 13 year old son needs to see a neurologist."

Mary: "I'm sorry. Dr. Grumpy doesn't see anyone under 18."

Mrs. Parent: "Oh... But we'd heard such good things about him, too."

Mary: "I'm sorry. We recommend Pediatric Neurology, Inc."

Mrs. Parent: "Okay. But when my son turns 18, can he see Dr. Grumpy then?"

Mary: "Of course."

Mrs. Parent: "Can I make that appointment now?"

Early Morning in Grumpyland

So following the time-honored tradition of my Bible (Chapter 20- Execute Forms at Dawn) I'm sitting here doing miscellaneous paperwork.

For those of you who have never had to deal with employer health forms, they are a freaking nightmare. A remarkable collection of stupid questions, redundancy, and more redundancy.

Today I'm completing job forms for one of my epilepsy patients, who works in sales. Questions from his employer include:

Is Mr. Shakes capable of working in sales during a seizure? (depends on what he's selling)

Would a seizure at work impair Mr. Shakes' job performance? (No! Who could resist an unconscious salesman who just wet himself?)

Will Mr. Shakes need to leave work to attend doctor appointments? (Of course not, I'll just swing by in the Grumpymobile)

If Mr. Shakes has a seizure, will it be necessary for him to leave work? (No, just leave him lying in the aisle)

Between seizures, is it safe for Mr. Shakes to operate a golf cart for clients (NO! Wait till he's having a seizure, THEN let him operate it)

Feeling Down?

Hot off the fax machine! Invite to a drug company dinner meeting about Cymbalta.

With a typo...

It says the topic is "Treating Depression with Cumbalta"

Thanks, Nurse X.

A common method of non-urgent hospital communication between doctors and nurses is the post-it note. I'll open a chart, and find a post-it in the progress notes saying: "Dr.- Can patient take his fish oil pills from home?" or "Dr.- Patient says she also takes Synthroid. Can you please order this?"

So this afternoon on rounds I found the following note in one of my hospital patient's charts. (NOTE- for my non-medical readers, PRN means "when needed")




Hmmm. That depends, Nurse. What are you planning on doing with him?

This is Not Helpful

Look, folks. I understand that your back pain started sometime during your 6 week "Drive our big-ass RV all over the damn country across 28 states and 5000 miles trip."

However, without a clearer idea of WHEN you were WHERE, or having an idea of your intinerary, telling me things like "the problem started in Georgia, though maybe it was there in Ohio, and was definitely worse by Texas" is NOT a lot of help.

Suicide Mission

As my regular readers know, I moonlight as a consultant for various medical market research companies. It's a thankless job, but somebody has to pay for the tomatoes.

So last night I had a dinner meeting with neurologists and sundry other specialists to review data on an up-and-coming product.

These are never fun, because neurologists by nature are a remarkably pathological group of personalities. Back when I worked at Humungous Neurology, Inc. the partners would argue if it was dark or light outside. I think they invite the other specialties to these as a buffer.

But I digress.

So I was seated next to Dr. Harangue, who I'd had the good fortune of not having seen in at least 5 years. In his own mind he's a giant in his field. To those outside his mind he's an obnoxious boil. He may have once been a good doc, but as they say in Hollywood "you're only as good as your last picture". And his was made before Casablanca.

Neurologists will argue over anything. The meal started with a dispute across from me over who's bread plate was who's (right or left? GET YOUR BREAD OFF MY PLATE!) followed by a fight over which fork is used for salad. Somebody actually dragged the maitre d' to the room to settle the issue (no, it wasn't me. I sit still and keep my mouth shut as much as possible).

I'm not much into the swanky places they have these meetings at. I ordered a steak. I had no idea how complex this was.

Waiter: "How would you like that cooked?"

Dr. Grumpy: "Medium."

Waiter: 'That involves a light red center. Is that okay?"

Dr. Grumpy: "As opposed to..."

Waiter: "Well, rare is a pink center."

Dr. Grumpy: "Medium is fine."

Waiter: "I can do medium rare, too. That's a pink/red combo".

Dr. Grumpy: "What's wrong with medium?"

Waiter: "I'll just do medium-rare-plus for you. That's a pinkish-red."

Whatever. I'm trying to order a steak, not pick out draperies.

Then the talk began. Every time a doc involved in the study was mentioned, Dr. Harangue felt the need to interrupt and say "I know that doctor personally. We've been close friends for over 25 years." By the end of the meeting I was hoping they'd mention a study done by Hippocrates or Woodrow Wilson to see if he knew them, too.

After 15 minutes of talking, the speaker stepped out from behind the podium to show us all that his zipper was down, with his tucked-in shirt hanging out of it. A tactful internist promptly yelled "Christ! Your fly is open!" to drop a subtle hint.

Then they brought dinner. The cardiologist next to me had ordered prime rib (no comment), and the waiter accidentally set my steak in front of him, and his prime rib in front of me. I pointed this out, and he quickly switched plates.

The cardiologist had a freakin' FIT! "I don't want that now! It was in front of him! He could have H1N1, or worse! Doesn't the heath department check you places anymore?!!!" It was, literally, in front of me for less than 5 seconds.

So I quietly started my steak, while they went to get Dr. Germaphobe a new prime rib (actually, I think they just brought him back the old one).

The next speaker showed us a seemingly endless series of graphs. After 20 minutes of this, she asked if anyone had any comments. Dr. Phlame at the end of the table immediately raised his hand. "Yes, I want to know why you chose red and blue as the main colors for the graphs. I think mauve and maybe yellow would be much more aesthetically pleasing. Also, I think some ruffles or curvy lines around the slide border would be nice."

This was immediately followed by Dr. Harangue chipping in "Dr. Phlame, do you live under a freaking rock? This company has been using those colors for years. But back to the data, did any of you people think to compare these results to a 1954 study by Longdead, et al?" The speaker (and everyone else there) had absolutely no clue what he was talking about, and Dr. Harangue chewed us out, as if it had just been published last week. When I looked it up, the study investigated a drug (that's no longer in use) for an unrelated condition.

Throughout this excitement the waiters kept refilling our glasses (ENDLESS DIET COKE HEAVEN!), so dysfunctional personalities were not improving with repeated doses of Burgundy and other wines.

In one discussion, to argue a point about a competing drug, an internist actually reached into his pocket and pulled out a product insert. I swear! He had it with him, all scrunched up. After reading from it like it was a bible he sat down and began arguing with a pulmonary doc about when daylight savings time starts.

We made it through another 15 minutes of polite discussion before Dr. Germaphobe cardiologist began tapping my shoulder. "Hey, Ibee!"

I turned around "What's up?"

"Are you gonna finish your roll?"

Stunned, I looked at the bread roll I'd absently left on my plate. It was buttered, and I'd taken a few bites out of it. "Uh, no, I'm full".

"Thanks!" And he grabbed it. So the guy who'd refused to eat an untouched steak was now chomping on my partially eaten dinner roll. Amazing what a bottomless glass of white wine will do.

As we sat through another set of slides, Dr. Harangue's cell phone rang. He answered it, speaking loudly enough to be heard in the next county (i.e., his usual volume). "What? Yeah. No, I've got another half hour of this shit. The drug company people won't shut up."

The dinner ended 20 minutes later. To make sure all points were covered, the moderator specifically asked "Dr. Harangue, are there any other comments?"

No answer. It was the only time he'd been quiet all night. He was in a burgundy stupor, slumped face down next to his creme brulee. He was still there when I collected my paycheck and left.

Thank You!

I'd like to personally thank the reader who was kind enough to come by today to bring me a bottle of Diet Coke with a packet of Sweet-N-Low.

Forgive me for not mixing them together in front of you...

Hunting the Handicapped

This letter from a patient was on my fax machine this morning:

"Dear Dr. Grumpy,

"Since my injury I haven't been able to go hunting, which used to be one of my favorite things. I found out that the state has a program for disabled deer hunting. Could you please complete the attached forms to let me participate in this?"

I hope this is simply a misplaced adjective, and not some bizarre new state program.

It's the 5th, Again

I've had my current office number since 2000.

I have no idea who had it before. But apparently she was quite active in doing monthly breast exams. So much so that she subscribed to a phone service (run by a local celebrity) to remind her.

So, for the last 9 years, on the 5th day of each month, at 8:00 p.m. sharp (who picked that time?) when the office line is rolled over to my cell phone, I always get this recorded message: "Hi! This is Pamela Perky! Calling to remind you that it's time to do your monthly breast check! And call a buddy, and remind her to do it, too!"

I once called the service. They refused to take me off the list, since I didn't know the name of the original subscriber.

I Wish

Miss Nutbag: (panicked on the phone) "I was in the ER yesterday, and they gave me Newpill! I think it's interacting with my Fukitol because I feel weird!"

I frantically check Epocrates and do a literature search from my desk.

Dr. Grumpy: "Hmmm. Should be okay together, I'm not finding any reported interactions between Newpill and Fukitol."

Miss Nutbag: "Oh no! What's wrong with me then?!!! Then why do I feel weird?!!!"

My inner voice: BECAUSE YOU ARE WEIRD! YOU'RE A FREAKING WHACKJOB! OKAY?

Dr. Grumpy: "Not sure, but it doesn't appear to be these medications. Why don't you call Dr. Anna, your psychiatrist?"

Happy to Have Your Opinion

Apparently Happy Hospitalist was offended by my MasterCard post, and felt the need to tell his readers that I've "failed incredibly" by feeling the way I do.

When I wrote that post I figured someone would be offended by it. Just didn't know it would be you, Happy.

That's Dedication!

At the hospital this morning I saw a guy who was admitted for a seizure. He'd bitten his tongue and wet himself.

The admitting internist wrote this note:

"The patient states he was incontinent. To personally verify this, I checked his underwear. It was wet, and smelled of urine."

I have to tell you guys. In 11 years of doing this, I have never been that thorough. If someone tells me they wet or pooped themselves, I take their word for it.

Grosseries

Mrs. Grumpy sent me to Local Grocery for ice cream, tomatoes, and other stuff.

The guy in front of me in line had Tardive Dyskinesia and kept leaning over my cart to see what I was buying and DROOLED ON THE TOMATOES! THEN THE ICE CREAM! THEN THE OTHER STUFF!

I understand you can't control Tardive Dyskinesia, sir. I do this for a living. But you don't need to repeatedly drool on my groceries.

Research

Glancing through a pile of old journals, articles, magazines, etc. while sitting outside watching the kids play.

Found this great article.

So now, just so you know, marijuana CAN impact your thinking process. In case you hadn't figured that out already.

(click to enlarge)