I Ain't Coming

I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.

So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?

Because.

The consult was for an 88 year old lady with advanced Alzheimer's Disease. Her sad life was reduced to lying in bed staring at the ceiling.

The patient had been seen by 2 other neurologists during this admission, and 3 others in the year previously. All had told the family the same sad facts of the case.

Yet, the family called me last night for a 6th opinion. A granddaughter poured out this sad story to me, and begged me to come see Grandma.

I asked her exactly why she wanted me to come in, since it didn't sound like I had much to add. Grandma has already had every test in the book.

So granddaughter said "Because the other neurologists just keep giving us bad news, and tell us to call hospice. We're looking for someone who will tell us this can be reversed, and who can fix her."

And that's why I turned down the consult. Because I'm not going to be a party to this insanity just to collect $100 from Medicare. It's not fair to anyone, especially Grandma. I bet she'd be horrified if she knew what was being done.

This is sad. But I won't be part of this family's denial issues. Me telling them the bad news for a 6th time obviously isn't going to change their actions. They'll just keep looking for someone who is either incompetent or willing to lie.

And that's why I turned it down. Because I respect Grandma. I'll never know who she was, but I doubt she'd want more docs being a part of her family's inability to let her life go with dignity.

Random Saturday Moments

Random moment #1

We took the kids to a sporting event today. After a while Mrs. Grumpy sent me to get drinks and nachos.

So I'm standing in line at the counter, with one guy ahead of me, buying a hot dog. I overheard this:

Mr. Hotdogbuyer: "It's $5.95 for THAT dinky hot dog! Geez, my dick is bigger than that!"

Counter girl: "I certainly hope so, sir."



Random moment #2

We stopped at Target to get assorted junk. Up in front they had various holiday gift sets. One of them was a "sampler set" in a green and red box with snowflakes on it.

What was it a bunch of samples of? Beer? Chocolates? Coffee?

Nope. Deodorant. Had 5-7 things of deodorant, different brands and scents. I swear.

If someone gave that to you, what would you think?

We're Not There Yet

Mrs. Technophobe, I understand that this "internet" and "email" thing look kind of magical, as you only sent your first email last week, with your granddaughter's help.

And I appreciate you telling me that you can look up movie show times online. I tried my best to look impressed. I didn't have the heart to tell you that you may be the last person in a G8 country to find this out.

And you're clearly fascinated by the fact that I can send your prescriptions in by email. Obviously, being a net newbie, you haven't read posts by myself or The Angry Pharmacist bitching about how much we HATE e-Scripts.

But, as much as you apparently think this is going to happen (because in your mind what else could "e-prescription" mean), your pills ARE NOT going to come to you by email. I swear. The matter-to-energy-to-matter conversion technology isn't there yet. And arguing with me and Annie about this is not going to make it happen.

Keep an eye on your mailbox. The metal one, yes, that thing, in the front yard, and your Plavix will magically appear there in about a week.

You Idiot

Dr. Grumpy: "At your last visit I started you on Neurontin for the pain. How's it working?"

Mr. Idiot: "It works fine, but I don't like the side effects."

Dr. Grumpy: "What kind of side effects are you having?"

Mr. Idiot: "If I stop taking it, the pain comes back."

Progress Note Addendum

William, a medical student, has submitted the following, more detailed, chart for your perusal.

I still think we neurologists should have a special "Freaks and Greeks" heading for our field, though.

Thank you, William!

(click to enlarge)

Why Did You Decide To Become a Neurologist?

I get that question a lot, people wondering why I'm a doctor, how I got into neurology, if this is my real hair or just a cheap rug, and... but I digress.

Anyway, I'd like to present this flow chart which explains the complex process by which a medical student (sort of like a stem cell) eventually transforms into their specific field. It was sent to me by an anonymous reader, so thank you whoever you are.

You'll notice neurology isn't listed here, likely due to space constraints. I'd put it somewhere under internal medicine, with a special "Freaks and Geeks" section leading to my field.

(click to enlarge)

Turkee and Grayvie! Yum!

Alright, my kids school district sent a flyer home with them tonight.

They're having a Thanksgiving lunch next week, and are inviting parents to join their kids at it. The flyer included the following:


"Please join you child during they're regular lunch schedule"

"Includes choice of desert" (Sonoran? Sahara? Gobi?)

"Sliced turkey brest"

Holy Electric Boner Batman!

The Science Marches on Department has brought the following medical research breakthrough to my attention:


Penile Shockwave Therapy Shows Promise For Erectile Dysfunction

Thursday Morning 2:48 a.m.

Today's Quiz

I (and most of my neighborhood) were blasted out of bed this morning.

I was woken by:

A. Phone call from a deranged patient.

B. Phone call from a frantic ER doc.

C. Phone call from a bored nurse.

D. My 8-year-old son Craig, who for whatever reason thought it would be funny to turn on his CD player in the middle of the night, playing "YMCA" at full volume.

(If you guessed "D", congratulations! And I had no idea Mrs. Grumpy and the neighbors even read this).

It's fun to stay at the...

That's The Way It Is

My esteemed colleague ERP put this up today, and I thought it was worth sharing.

Family Math Issues

Mrs. Hyper: "I have 3 kids."

Dr. Grumpy: "That's nice. Boys? Girls?"

Mrs. Hyper: "One of each."

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.