Guy Anatomy Issues

Mr. XY: "I have prostate cancer."

Dr. Grumpy: "Is it being treated?"

Mr. XY: "Yeah, they said it had spread to my uterus or something."

H1N1

Dr. Grumpy has now had his H1N1 vaccine. And I have to say that I'd have preferred a shot to the H1N1 vaccine I got, which involved having a few drops of liquid sprayed up each nostril.

It tickled like hell, and made me sneeze constantly for the next 5 minutes. I'm pretty sure that anyone who'd like to be vaccinated could get treated by licking my desk, phone, pens, and anything else that was in front of me during my sneezing fit.

Nevertheless, I'm glad I got it.

Sometimes Breast Isn't the Best

Yesterday afternoon I was seeing a lady who'd recently had a baby. She came in to talk about resuming her migraine medications after pregnancy.


Mrs. Nursing: "I couldn't wait for this appointment, so I restarted Topamax after I got home from the hospital."

Dr. Grumpy: "Are you breastfeeding?"

Mrs. Nursing: "Of course! You know what they say, 'breast is the best'."

Dr. Grumpy: "You shouldn't be taking Topamax while you're breastfeeding."

Mrs. Nursing "Oh, I don't. I wait till the baby is done".

Reality Check

"I don't want to pay for insurance for illegal aliens."

"I'm not going to pay for someone else's insurance."

"I have good insurance! Why should I pay for somebody else's medical care?"


I hear crap like this everyday. Somehow people really believe this, too.

GET REAL PEOPLE! YOU PAY FOR IT NOW! AND GUESS WHAT? THERE IS NO MODEL OF HEALTH CARE WHERE YOU WON'T!!!

Let's look at this: Mr. Poorsap has no insurance. Maybe he's unemployed. Or an illegal immigrant. Or he's working his ass off, but his job doesn't give him benefits.

Mr. Poorsap has a heart attack. Or gets cancer. Or falls down a manhole. Whatever. He goes to Local ER, and needs to be admitted. Legally, Local Hospital can't turn him away.

He's sick as shit. He needs surgery, maybe more than one. A lot of medications. He has a lot of tests. And a few complications. He's in the hospital for a month before he's finally able to go home.

His bill is $1 million dollars (hypothetical number). There's no way in hell he'll ever be able to pay a significant portion of that.

Local Hospital has to pay the nurses who took care of him, and the companies who sold them medical supplies and drugs to take care of him. They really can't afford to write off that $1 million. So they raise the rates on EVERYONE who comes to the hospital, to help offset the costs of the uninsured.

So they send all these bills to Giant Insurance, Inc., who pays them. Of course, Giant Insurance, Inc. has staff and rent and office supplies to pay for. They need to make-up the money to offset their losses on what the hospital charged them to make up their uninsured patient losses. And so Giant Insurance, Inc. passes the increased costs on to YOU, by raising your premiums.

And multiply this by tens of thousands uninsured Mr. Poorsaps every day, across the country.

Look at this like shoplifting, people: I don't shoplift (well at least not non-Diet Coke items), and I hope you don't shoplift. But somebody does. So if over the course of a year Local Grocery loses $100,000 to shoplifting, they need to make up that loss by increasing their prices. And we ALL pay those when we go grocery shopping.

So regardless of whether you oppose or support the current plans, or voted red or blue, the bottom line is that YOU ALREADY DO, AND ALWAYS WILL, pay for someone else's insurance. The only people who don't are the ones who have no coverage in the first place. Any politician on either side who tells you otherwise is full of shit.

This is a standard model of business (and health care is a business), and has been since the first business opened its doors a long time ago. You have to make up your losses somewhere.

Ideas From TAP. And Spooky Polls.

Nobody has an ideal health care solution.

BUT

My esteemed colleague over at The Angry Pharmacist put up an excellent post a few days ago. I want to direct everyone's attention over to it. He makes some valid points and backs them up with reasonable arguments, and I think it's worth reading.

AND

What makes health care reform so hard, and so scary, is stupidity on both sides.

I missed this story when it first came out, but my awesome reader Lisa was kind enough to send it to me.

Basically a firm called Public Policy Polling surveyed 900 voters here in the USA, asking them if the government should stay out of Medicare.

To my horror, 39% said "Yes"! So, more than a third of eligible voters are entirely unaware that Medicare IS a government program, and always has been.

This poll cut across a frighteningly broad swath of income and education.

At least I get blog material from them.

And a great big DR. GRUMPY THANK YOU TO MY READER LISA K. for bringing this to my attention.

We Have Medication For People Like You

I saw a new patient today, who brought his briefcase. I don't care. Maybe he hates leaving it in his car. Maybe he's a courier. Maybe he's a part time nuclear "bag-man" for the President. Whatever.

I asked him if he'd had any headaches recently.

He opened the briefcase, pulled out a HUGE notebook, flipped through it for a minute, then said:

"Yes, mid-afternoon on October 10, 2003. I took 1/2 of one of my wife's Percocets for it, and it resolved in 45 minutes".

The notebook and briefcase can't come back here anymore.

Boredom, Redefined

One of you wrote in this morning that you're trapped in a boring teleconference, and so to kill time you decided to add up my monthly posts over time, and graph them.

And then you sent it to me.

(click to enlarge)



While I appreciate this kind of devotion, I have to say a few things:

1. I hope you're not a pilot flying a plane that's just overshot your destination because you're playing on a laptop doing this.

2. If you aren't really in a meeting, and do things like this for fun, you need a life.

Fun With Patients

Attention! Alert! Local Grocery has Coke stuff on sale for $2/12-pack!

When this happens I stop by pretty often after work. They only allow you 5 cases per person, so I make repeat trips, with varying combinations of Diet Coke, Coke Zero, and Vault Zero being thrown into my trunk until:

1. My rear tires are squashed flat.

2. My arms fall off.

3. The store runs out

4. I max out my credit card.

So today I was there, deciding what my next soda run should consist of. I was so engrossed in this serious issue that I didn't see it coming.

I was sighted and approached by a patient.

An Alzheimer's patient.

Bill.

Bill: "Uh, excuse me? Hello."

Dr. Grumpy (looking up): "Yes, I (oh shit!), oh, uh, hi"

Bill: "I know you, um" (he leaned forward, and to my horror I realized I had my hospital ID clipped to my shirt) "You look familiar, um Ibee Grumpy?"

Dr. Grumpy: "Yes, Bill, how are you?"

Bill: "Don't tell me, it'll come! I know! You work here!"

Dr. Grumpy: "No, Bill, I'm..."

Bill: "Can you tell me where cereals are? My wife told me to get some Corn Flakes."

Dr. Grumpy: "Uh, aisle 16, that way, about halfway down."

Bill: "Thank you."

As he walked away, and I was stunned at my good fortune, I realized he had a box of Corn Flakes in each hand.

"I've been aware of the time going by,
They say in the end, it's the blink of an eye."

(If you recognize the title- congratulations!

For those who remember, one of my 20+ high school reunions has been coming up, and it was this past weekend. [If you don't remember, I commented on it last month here and here.]

The following is a personal letter I wrote to a friend after my 20th reunion a few years back (he didn't attend). I re-read it last night, and decided my feelings haven't changed since then. So I'm putting it up for your perusal. I should note that in the 20 years prior to the reunion I'd had only incidental contact with anyone from my high school class, except for the one I wrote the letter to.

It was interesting. I didn't go to any of the previous ones, and almost didn't go to this one. But I'm glad I did.

20 years is a long time. It erases a lot of animosity. At some point you find that the majority grew up and became (reasonably) mature, decent human beings. I found there was no competition like there might be at 5 or 10 years. At this point most everyone is set in their lives and has answered the elusive questions of "who am I and what do I want to be?"

Even people who I hated once and never wanted to see again I was glad to see, oddly enough. Instead of being enemies they're now simply people I share a common background with, and it's interesting to talk to them and see where life took them. You don't really have time to sit and talk to anyone for more than a few minutes, because everyone is constantly running to the next vaguely familiar face (or name tag) to say "Hi". Most conversations are long enough to cover your spouse, your job, your kids, and where you've lived in the past 20 years, and then it's on to the next person. In a strange sort of way I imagine an afterlife would be the same way.

I was amazed at how many people came from all over the country just for this, also at how many are on their 2nd and 3rd marriages already. Some have kids who are taking the SAT's themselves. A lot of people (including me) had twins.

Cindy, that girl we were both chasing back then, looked about the same, very thin, same face, just a few more lines. Her short brown hair is now long and dyed raven black. She never married, never had kids, and is still looking for Mr. Right. In fact, she asked me if I knew anyone. I think the whole thing is interesting. As you pointed out in our phone call, she came across as unattainable to everyone back in high school. And now she's the rare one who's still alone.

What's interesting is that on talking to them now, I found that almost all the girls I had crushes on back then are so unbelievably incompatible with me that any relationship with them would have been short-lived, if it had actually happened at all. It's amazing what hormones did then, and what the retrospectoscope shows now.

Ron wasn't there, though he lives locally. Some people had gotten his phone number, but he never returned their calls (said his voice on the machine was still the same, though). No one has had any contact with him for over 10 years, and the ones who had the most recent contact said he'd become very bitter and unhappy, which is why they'd stopped keeping in contact with him. Diane commented that she felt like "he'd become someone who needed rescuing, but nobody else could help him".

Phil and Lisa married and had kids. Phil was an obnoxious jackass in HS. Now I found him to be a polite, decent person who was actually interesting to talk to. He has some sort of administrative job. He's very quiet and down to Earth. Time, raising kids, and having a mortgage and bills has a way of doing that to people. Lisa is now thin as a rail. Phil must weigh 300 lbs.

Pete works locally for an insurance company. He is the same personality as he was then, but pleasant and mature. Not married, no kids. Looks about the same but now has long hair down his back. Mrs. Grumpy, who'd never heard of him before, saw him come in and said "Who is that guy? He looks like the missing link." I think that sums it up.

In high school Pete had this POS 1972 Toyota jeep, that looked like it was about to fall apart. He still has it, was parked next to my car. Oddly, after 20 years, his once-POS 1972 Toyota Jeep is now likely worth more than my 2000 Maxima. Time is a great equalizer.

One of the girls, Laurie, I went back to 6th grade with. Others I went as far back as 4th grade with. The night after the reunion, Laurie was on the local news in a feature story on what it's like to be fighting breast cancer and be raising young children. She hadn't mentioned any of it to anyone there all night.

Sunday afternoon was the final reunion event, a family picnic at Local Park. It was a lot of fun. You realize from watching everyone that the only accomplishments and achievements that really matter to everyone are their kids.

The low-point of the reunion was when I introduced Mrs. Grumpy to Cathy, an old friend from the school paper. Mrs. Grumpy asked her when she was expecting. She wasn't. I told Cathy that Mrs. Grumpy had had too much to drink (actually she doesn't drink at all, but Cathy didn't know that).

We all got a 2-CD set of top hits from our high school days. Scary to think the songs are 20 years old. In front of the ballroom was a table, where several current Local High band students were selling raffle tickets for a fundraiser. Later in the evening I was returning to the ballroom after using the restroom, and the students at the table were looking over the songs on the CD they gave us. They were making comments such as "who is Duran Duran?" and "Boy, I think my dad listens to these guys.".

Perhaps more frightening was when the MC pointed out that when we were in HS "Born in the USA" by Springsteen was released as the FIRST CD SOLD IN THE US.

They had a slideshow going on in one corner the whole night, with various old and new pictures. The most interesting slides:

Arnold Schwarzenegger as Conan the Barbarian then and now as governor.

Michael Jackson on the cover of Thriller, and on his mug shot (remember- this letter was written several years ago).

Madonna then, and still Madonna, now.

In an ironic note, an item on the "Onion" recently was "What did we think we'd be doing with our lives by now:

"1. Dancing professionally
2. World famous truck driver
3. Overseeing vast empire of some sort
4. Making at least assistant manager
5. Presenting own line of designer handbags
6. Owning a car with gull-wing doors
7. Not this telemarketing shit, that's for sure."

It's just amazing how time flies. As cliched as the phrase is, it's really true. When I was 7 and first learned about Halley's comet, the wait for it's next visit seemed like forever. Now, in the blink of an eye, it's been here and gone. My 3 kids are all temporally closer to high school graduation than I am now. Life happens, so enjoy it.

If there was one thing I learned, it was that I wouldn't change anything. You find yourself thinking about all the alternate paths your life might have taken. What if I had asked this girl out, or gone on that trip, or taken that class. I came to realized that if I could go back and do it all over again, I wouldn't change anything. I'm very happy with where life has taken me, and for all the ups and downs of growing up and growing old I wouldn't trade any of it for anything.

Sunday Afternoon, 4:35 p.m.

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

Mrs. Sickandtired: "Yeah, um, I didn't get any sleep last night, because my kids were both up sick, and now I'm exhausted and have a headache and shaky all over."

Dr. Grumpy: "What's your question?"

Mrs. Sickandtired: "Do you think it would help if I got some sleep tonight?"

My inner voice: "No! I think you should stay up all night tonight, too! Stay up for the next week! Make a big pot of coffee and guzzle it! See how long you can go without sleep, and see what it does to you! Suck it up!"

Dr. Grumpy: "Yes, I'd try to get some rest and see how you feel tomorrow."

Mrs. Sickandtired: "Okay, thank you."

My Dog is Stupider Than Your Dog

I ordered a bunch of books last week and they came yesterday. I opened the box and absently tossed a big sheet of bubble wrap on the floor of my home office.

This afternoon Snowball wandered in, and apparently noticed it for the first time. He went over and walked on it. And a plastic bubble popped.

Snowball leaped back like he'd been shot. He barked and growled at the bubble wrap, going into attack position, ready to lunge if it so much as breathed (it didn't).

After a few minutes of glaring intently at it, he was apparently sure he'd killed it, or scared it into submission. So he went over to walk on it again.

And a few more bubbles popped.

He leaped off it, howling in terror. Ran like hell for the far end of the house. He's now hiding under Marie's bed, shaking all over.

Your Insurance Premiums Hard At Work

One of my normally stable Multiple Sclerosis patients (Mike) went south on me today, so I saw him emergently over my lunch hour.

When this happens, the standard treatment is to give high doses of steroids through an IV line for 3 consecutive days. Generally it's done either with home health going to the patient's house to do the infusions, or the patient goes to an outpatient infusion center each day for 3 days to have it done there.

So I got Annie on it fast. Miracle worker that she is, she found both a nursing service and an outpatient infusion center that could do this over the weekend, giving me both options. Then she called the patient's insurance to get approval for one or the other.

Guess what? Mike's insurance company didn't have a supervisor available to authorize either one of these on a Friday afternoon. And the underling Annie spoke to (and then I got on the phone to argue with them) told me she wasn't allowed to give approval for this, and there was no one else around who could. So what did she suggest? She told me to admit Mike to the hospital over the weekend to do this, since that didn't require pre-authorization!

So let's think about this:

Home health OR an outpatient infusion suite would cost roughly $200-$400 per day (including nurse time, supplies, and drug) for 3 days.

BUT since Bozo Insurance, Inc. didn't have some magical person around on a Friday (which is a workday last time I checked) or anyone else who could approve this, they told me to admit Mike to the hospital.

I called a friend in hospital accounting. The rate for the basic room Mike is now in is roughly $1800/day. This does NOT include the costs of drug, supplies, or physician fees for docs having to round on him (since we're required to). All together, the hospital stay will cost the insurance $2500-$3000 per day for 3 days.

And Mike is pissed, too. Because he'd rather be at home.

And this is where your insurance premium dollars are going, and how your insurance company is working hard to cut back on costs and save you money.

Personalized Medicine

These electronic chart systems are so amazing. This came over my fax a few weeks ago.

The only thing I've done to it is delete the patient's name and hack off the other doc's letterhead. Otherwise what you see is what I got.


(click to enlarge)


For the record, the "copies of my chart notes" never showed up.

Drug Rep Training FAIL!

Yesterday we had lunch from a drug rep marketing an antidepressant. He was new to the office, and the lunch had been set up by his predecessor.

To my astonishment, about halfway through the sales spiel he suddenly asked, "Hey, what kind of doctor are you, anyway?"

"Uh, I'm a neurologist."

"Really? What does a neurologist do? I didn't even know I was calling on one."