Dear Mr. Attorney,

I appreciate you sending payment for Mrs. Jones' medical records.

As you know, her chart was quite large, so printing it up took quite a bit of time and paper. You also wanted me to have it notarized, so I had to drag it down to Local Bank and wait in line.

Then postage was a fortune, since you wanted it sent certified.

Anyway, because it took some time and effort, I enclosed a cover letter asking for $50 payment. Your office manager was kind enough to send me a check for $50 last month to cover this, on the same day she received the packet.

So it was quite a surprise to get a personal note from you yesterday, saying that you felt the $50 was excessive. You did some calculations in your letter, and said that (based on state law) you only owed me $27.45, instead of the $50 I'd previously asked for (and received).

But it was still nice of you to send a check for $27.45 attached to your letter, paying me what you thought was "reasonable, and more than fair" for Mrs. Jones' records.

I've deposited both checks, and thank you and your law firm for having paid me a total of $77.45 for a chart I'd only asked $50 for in the first place. Extra money around the holidays is always nice.

Yours truly,

Ibee Grumpy, M.D.

Packing Overkill

One of the things that drives me nuts is shipping stuff. Not mailing stuff out, though that can be a pain, but more the way stuff gets sent to me in containers that are insanely out of proportion.

Lets take Axert. This is a migraine drug that has no drug reps. So when I need samples I have to call them, asking them to ship me some.

Last week I called for samples, and they showed up today. It comes in a blue and yellow package with 4 little tablet packages in it. But it always ships in a freaking HUGE box, surrounded by a crapload of paper, like 2-5 trees worth.

So here's a picture of the entire Axert package and the box it was shipped in. I put a Diet Coke in the picture to give you some idea of size.




Of course, the Axert people aren't the only ones guilty of this insanity. I have a patient coming in for Botox injections later this week, so I ordered a bottle. ONE dinky bottle (which is freaking $560, too). Now, I understand Botox has to be kept cold during overnight shipping, and needs some styrofoam and ice, but even still the shipping seems to be a little excessive. So here, for your perusal, is a bottle of Botox, the box it came in, and another Diet Coke.





So, now you know how many trees it takes to ship a package of Axert or bottle of Botox.

Crap! That Hurts!

Purell- It isn't just a great hand sanitizer anymore.

It also does a fucking AWESOME job of letting you know where every single damn cut & skin crack is on your hands.

Tuesday Morning, 1:58 a.m.

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

Mr. Sleepless: "Hi, I take Compazine for nausea, and wanted to know if it's safe to take with my epilepsy?"

Dr. Grumpy: "Haven't you taken it as needed for several years? It's never caused you to have a seizure before, has it?"

Mr. Sleepless: "No, never had a problem before, and I've been using it here and there since the mid-90's"

Dr. Grumpy: "Then it shouldn't be a problem."

Mr. Sleepless: "Oh good. Sorry to bother you, but I couldn't sleep, so I started googling all my medicines, and saw that Compazine could do this."

Um, Okay...

Mr. Hedhurtz: "I had a horrible migraine this weekend. Worst I've had in years. It was so bad I was thinking of going to the emergency room."

Dr. Grumpy: "Did you?"

Mr. Hedhurtz: "No, I went to the casino instead."

Damnit, Jim, I'm a Doctor, Not an Electrician

I finally had the time today to fire up the Grumpy family hot tub for the winter.

So I cleaned it out, filled it up, added chemicals, put in a new filter, etc.

For whatever reason, though, I couldn't find the power cord that comes with it. Because I'm a guy (and therefore inherently stupid) I just grabbed an extension cord out of the garage. Mrs. Grumpy kept telling me I wasn't supposed to do that, because the special hot tub cord had extra circuits or fuses or breakers or whatever in it, and you couldn't use something else.

But I wanted to get the hot tub going, so I told her it would be fine, and hooked it up.

The kids were excited, so I had them out in the yard with me. They counted down from 10 for me to flip the switch, turning it on for the winter.

"5-4-3-2-1- HOT TUB!". I pressed the button. The jets whirled, the water swirled, the kids laughed.

For about 5 seconds.

Then there was a loud "POP!"

And the hot tub turned off.

And the kids stopped laughing.

And all the lights in the house went out.

Another 5-10 seconds of absolute silence went by, finally broken by Mrs. Grumpy saying "You bozo."

She went around to futz with the switch box. She found the correct power cord in the garage. And I am in trouble.

Sunday Reading

Catching up on some reading today and found:

A study on patients with bleeding into the brain, which found that patients with only 1 type of brain hemorrhage had a better prognosis than patients with 2 types of brain hemorrhages.

Really. I'm not making this up. Archives of Neurology, January 2009, page 79.

Suckered In

This summary is not available. Please click here to view the post.

The Germ Theory and Netflix

Okay, one of my alert readers has brought a, um, interesting website to my attention.

We all know about Netflix. You rent a movie, they mail it to you, you keep it until you watch it (or realize you'll never get around to watching it), mail it back, and then get another movie.

Well...

There is (I swear I am not making this up) a sex toy business based on the same idea. It's called Rent-A-Dildo.com

Basically, you pay $19 a month. You pick out whatever sex toy floats your boat. Use it to your heart's (or whatever) content. And then send it back and request another. You can have one sex toy out at a time unless you join their premium service (called the "Golden Dildo Plan", I swear to God!).

The site even says "Each toy is tested for quality and performance before it is added to our collection." Unfortunately, it doesn't show you a picture of the tester ("Hey Pa, see if the cow likes this one!"). If you party hard you can also pay for the "extra batteries" option.

So the sex toy that you've had up in your body parts gets sent to someone else, and you get to use a sex toy that's been up in somebody (or something) else's naughty bits.

It's been roughly 150 years since Louis Pasteur and Robert Koch proved the germ theory of disease pretty conclusively, but hey, I suppose it could still be wrong. Maybe STD's are just from bad humors and demons, like the ancients believe.

But fear not! The site says "We've developed a patent-pending process for thoroughly cleaning each toy before it is sent out to a customer." I mean, they certainly could be doing something pretty advanced (anything less would be bad for business), but details aren't listed. For all you know they could just be soaking them overnight in a kiddie pool filled with water and bleach. Or running them through a dishwasher. Or wiping them off with a paper towel and doing a quick sniff test. Or maybe the "patent-pending process" involves somebody else's fetish.

I wonder if they have a recommendations feature, like Netflix or Amazon?: "Since you previously enjoyed the 'Black Mamba Rabbit' you may want to try the 'Rabid Jungle Rhino'."

Are future product lines going to include rent-a-toothbrush, rent-a-condom, and rent-a-tampon?

The site also features this notice , which Dr. Grumpy doesn't have the nerve to put up here in it's entirety.

Caveat emptor.

Now THIS is a Christmas Tree Ornament

Granted, it would be cheaper to just make your own with string and a paperclip.

(click to enlarge)



And a big Dr. Grumpy thank you to alert reader EE, who submitted this.

Say WHAT?

I'm reading through hospital records on a patient who's coming in later today. They include a consult note from another local neurologist, which contained this statement:


"This patient's confusion is from a multifactorial toxic-metabolic encephalopathy. This is primarily caused by, but not limited to, multifactorial causes from multifactorial medical issues, multifactorial medications, and other multiple multifactorial factors. Multifactorial treatments focused on addressing these multiple multifactorial issues may or may not result in a polyfactorial and/or multifactorial improvement in his multifactorial toxic-metabolic encephalopathy."

Tactful Invitations

Gotta love these charity ball things.

Beware of the Staff

You piss off my office crew at your own risk!

Lunch today was from a new drug rep, pushing a sleeping pill.

She made the MAJOR mistake of rudely talking down to my staff, letting them know they are peons, and that she only deals with doctors. This pisses me off, and even worse, it pisses them off.

Anyway, her sleeping pill's claim to fame is that patients who take it get an average of 7.8 hours of sleep. As a result, they have little pamphlets with this fact, and the rep had a big button on her jacket that said "Are your patients getting 7.8 hours every night?"

During lunch she left her jacket over the back of a chair outside our break room. While she was talking I noticed 2 of the girls disappear for a few minutes.

When Ms. Drugrep was leaving she put her jacket back on, and brought me a pad to sign for samples. As I scribbled I noticed that the button on her jacket had been altered, and now said "Are your patients getting 7.8 inches every night?"

She has no clue, either. And I'll likely never find out what happens.

Thursday Morning, 2:23 a.m.

My cell phone chimes. It's the hospital.

Dr. Grumpy: "This is Dr. Grumpy."

Nurse Wurse: "Hi, I'm calling about Mr. McAclot, the gentleman in room 742."

Dr. Grumpy: "Umm, I'm not..."

Nurse Wurse: "He had a stroke yesterday, and because he's been getting worse Dr. Hospitalist ordered a repeat head CT tonight that..."

Dr. Grumpy: "Hang on, I..."

Nurse Wurse: "Doctor, will you PLEASE let me finish! This is urgent! His CT showed a large bleed, which is new. Dr. Hospitalist told me to call neurology for further orders."

Dr. Grumpy: "He's not my patient."

Nurse Wurse: "Well he's somebody's patient. I mean, there's a note in the chart from a neurologist from yesterday."

Dr. Grumpy: "Why didn't you call that neurologist?"

Nurse Wurse: "I can't read their handwriting, and... LOOK! I'M JUST FOLLOWING DR. HOSPITALIST'S ORDERS! HE TOLD ME TO CALL NEUROLOGY, AND I DID! YOU WERE THE FIRST NEUROLOGIST LISTED IN THE STAFF DIRECTORY!"

Dr. Grumpy: "But I'm not the neurologist taking care of this patient!"

Nurse Wurse: "What does that have to do with it?"