Public Service Announcement

Attention ladies:

It is NOT, generally speaking, normal for you to be woken at night by your guy shaking the bed violently, turning blue, and peeing on the sheets. If he does this, and hasn't done it before, he needs medical attention.

You also should not allow this to go on for several nights in a row, and then call his mother to see if she can help you wash all the bedsheets, and (when she asks you why), let her be the one to make the CORRECT decision that he should go to ER.

It is also not cool that you sent him in by himself, so you could stay home and catch up on washing sheets. Your description of the events is usually helpful to those of us in the "med-biz".

Thank you.

Live! From ER! It's Dr. Grumpy!

I'm on call.

While rounding, I was paged overhead to come down to ER for a stroke that had just arrived. Guy who can't move his right side.

So I'm sitting here in ER, watching him from the nurses' station, waiting for my turn to go in. Nurses are hooking him up to stuff, techs in there drawing blood, an EMT going over info with another nurse.

In the middle of this all the patient is lying there, calmly texting with his left hand.

Starting and Ending With a Survey

Well, just as my day began with a strange marketing survey question, apparently it's going to end that way. I'm doing one tonight over the internet, and this question came up:

"When managing a male or female MS patient who wishes to become pregnant, what action do you typically take with their current MS medication?"

You Must Live REALLY Far Away

"I only get migraines when there's a full moon. In my neighborhood I think that's around once a week we have one."

Okay, Let Me Get A Blindfold

I did an online marketing study this morning, in which I was looking at various ad concepts to see which parts of the ads interest, and don't interest, doctors.

So at one point I came to these instructions:

"On the following screen, we'd like to know which parts of the picture did not get your attention. Please click only on those parts of the image that you don't look at."

Homecoming

I pull into the driveway, and walk down to the mail box to get the bills & junk. The neighbor family is out putting up some Christmas lights. Mr. Neighbor comes over to chat for a minute.

Suddenly, my front door flies open. Frank comes out, screaming at the top of his lungs.

Frank: "DAAAAD!!! THE FRONT HALL TOILET BACKED UP ON ME 'CAUSE I USED TOO MUCH PAPER AND NOW THERE'S POOP ON THE FLOOR AND SOME STILL IN THE TOILET AND PAPER EVERYWHERE AND IT SMELLS BAD AND THE TOILET KEEPS RUNNING AND..."

Dr. Grumpy: "Frank, calm down. Why didn't you tell Mom as soon as this happened?"

Frank: "I did. She told me to wait and tell you as soon as you got home."


Mr. Neighbor doubled over laughing. Perhaps for the first time he was glad to have teenagers.

Just Say No

Things are tough all over. Occasionally I get patients asking me if I'll forgive their appointment co-pay. Usually I can't, because most insurance contracts forbid it, and because I'm trying to stay afloat, too.

So today I had a lady tell me she can't afford her $25 visit co-pay, and could I PLEASE write it off? She used the "I need the money more than you do" line.

I know she has legitimate financial hardships, but I refused.

Why?

Do I need the $25 that badly?

I did it because she smokes 2 packs a day. And ADAMANTLY refuses to quit.

Let's look at this:

The average price of a pack of cigarettes in the U.S. right now is $5. This varies by brand & your state taxes, and whether you buy them by the pack or case. But roughly $5 a pack.

So for her, that's $10/day. Or $300/month. Or $3600/year.

I told her that. If she quits smoking, that would be like her getting a $3600 annual raise, without any additional taxes. Ignore the health benefits, just look at the money alone.

All that money for making one life change. That would help her financial situation A LOT. It's a hell of a lot more money than making a $25 co-pay once or twice a year.

She got pissed off and left. Told me that I "don't understand".

She's right. I don't.

For an excellent post on drug co-pays from the pharmacy view, check out this one from The Angry Pharmacist.

Now THAT'S Exciting!!!

From a fax on my machine this morning:


"Our company is looking for males over age 25 who do their own shopping. We're doing a very exciting market research study on the following topic:

PACKAGED SALAD

We think you'll find the discussion to be exciting and enjoyable, and will reimburse you for your time. Please contact us today, as spots will go fast!"

Edgar Allan Poe

Generally, I try not to copy things from other blogs.

But sometimes I MUST make an exception when I see something so good, so clever, that I want to share it and say LOOK AT THIS! IT'S FREAKING AWESOME!!!

And when I do that, I make sure I properly credit it.

Maybe it's because I'm a literature buff, and took too many of those classes in college. Edgar Allan Poe is featured in most of them, and his most famous work is The Raven.

So on reading other blogs today, I found this excellent post written by Maha. She's an ER nurse who writes Call Bells Make Me Nervous. Check her site out. And Maha, please forgive me, but I just had to share your remarkable piece of writing.

So, without further ado, I present Maha's satire on The Raven. It's called The Drunkard.

Had Edgar Allan Poe Been an Emergency Nurse…

The Drunkard

by Maha

Once upon a midnight dreary, while my back ached, weak and weary,
Over many a quaint and curious patient at the triage door.
While I nodded, nearly napping, suddenly there came a tapping,
As of someone rudely rapping, rapping at my triage door.
"'Tis no drunkard," I muttered, "tapping at my triage door--
A well man and nothing more."

Ah, distinctly I remember the bloody night before November,
And each and every staff member had brought a patient to the floor.
Eagerly I wished the morrow, vainly I had sought to borrow,
From my books of assessments thorough –to avoid the cookies from days of yore
And drink my latte from so long before.

But the stinkin’ sad uncertain shuffling of a drunkard’s gait that’s struggling
Thrilled me – filled me with supreme annoyance, never felt before.
So that now to still the beating of my heart, I stood repeating
“Tis no drunkard entreating entrance at my triage door –
Some late UTI-er entreating entrance at my triage door;
This is it, give Toradol galore”.

Towards the patient I finally headed, hope for sleep completely shredded,
“What,” barked I, “please don’t have a complaint I’ll deplore,
But the fact is I was napping and so intently you were tapping,
And so rudely you came slurring, ranting at my triage door”.
And without regard or thinking, he barfed upon my triage door,
Chunky vomit and lots more.

Then, of course, the air grew denser, thanks to the obscene Spencer,
A man now pickled, whose foot-falls dragged in the department’s floor.
“Wretch,” I cried, “why did God bring thee – by the devil he hath sent thee
Respite – respite and Valium please for thy abnormal CIWA score
Why, oh why this loud decree of your drunken presence on my door?!”
Screamed the drunkard, “I barfed some more”.

"Spencer!" said I, "this stench is evil!--Spencer this is the needle’s bevel,
Whether taxi sent, or whether ill-fate tossed thee here ashore,
Desolate, yet all undaunted, in this department un-enchanted,
In this hallway by Horror haunted--tell me truly, I implore--
Is there--is there calm from Gravol?--tell me--tell me, I implore!"
Quoth the drunkard, "I need lots more."

"Spencer!" said I, “more upheavals? - Spencer still, if man or devil!
By the score of twenty and eleven – by the Valium we both adore –
Tell this nurse with sorrow laden, who to call? Perhaps thy maiden?
Please, oh please, I beg thee, use the bucket on the floor.”
Quoth the drunkard, "Nevermore."

"Be that word our sign of parting, man or fiend!" I shrieked, upstarting.
"Get thee out of the department and save my night from being abhorred!
Leave no chunks of vomit as a token for my tolerance thou hast broken!
Leave here with this train token! – Quit the bed and leave the main floor!
Take thy stench as you depart, and take thy form from out the door!”
The drunkard started to loudly snore.

And the drunkard, unremitting, still is snoring, still is snoring
On the pallid stretcher mere inches from the door;
And his socks have all the seeming of a mold that is steaming
And the lamp-light o’er him streaming throws his shadow on the floor;
And my break retreating into shadows that was planned for four,
Shall be taken – nevermore!

How Hard Is This To Understand?

Okay. Your epilepsy has been stable for over 20 years. In fact, I only see you once a year for it, and refill your Tegretol while we chat about sports, weather, whatever.

Your medication dose hasn't changed since the 80's, back before I even went to med school.

I write you a new script once a year, that you fax to your mail-order pharmacy.

Normally I see you in January, but you had to move up your appointment since you'll be out of town next month. So you asked me to date your next Tegretol script for January 1, 2010, and you won't send it in until then. Fine. I did just that.

So, after I've given you a post-dated script DON'T FAX IT TO YOUR FREAKING PHARMACY WITHIN AN HOUR OF LEAVING MY OFFICE!!!

Now I've got the pharmacist calling, wondering if I'm demented and don't know the date (not an unreasonable thought). I'm pretty sure he doesn't think you have some sort of special time-traveling fax machine at home.

So don't do it again. Put the script on your refrigerator and don't cash it in until January 1, 2010 LIKE YOU TOLD ME YOU WOULD and we'll all be happy.

Thank you.

Memories...

The peanut post got me thinking...

When I was doing my internal medicine residency, another doc in my class was a girl named Christine. She was just doing a 1 year internship before going on to radiology.

She was a good person, and a good doc. But she was a HORRIBLE black cloud. Bad luck just followed her and her patients, in spite of the fact that she took damn good care of them.

She just had remarkably shitty luck. When she was on call, her service would always max out with admissions, and they were all really sick. Codes would occur. Her patients seemed to die more often then anyone else's. And, again, this was just bad luck. She was a good doc, just always seemed to get the sickest patients.

After the first 6 months of this, she was so burned out that she needed a vacation, and booked a cruise.

On the first night of her cruise, the guy sitting next to her at dinner collapsed and died from a peanut allergy.

How To Irritate Your Neurologist

Dr. Grumpy: "Any allergies?"

Mr. Cereal: "Nuts... Hey, do you know it's safe for me to eat Honey-Nut Cheerios?"

Dr. Grumpy: "Umm..."

Mr. Cereal: "I mean, I know it says 'nut' in the name, but I wasn't sure if they really have nuts in them, or if they just say that".

Dr. Grumpy: "Have you read the ingredient list on the side of the box?"

Mr. Cereal: "No, why?"


Obviously, I'm allergic to nuts, too, of a sort...

Tuesday Morning Patient Quote

"Sometimes, when I really hurt, I stop breathing. I mean, like, for hours, literally. It hurts so bad I just stop breathing. After my car accident I went 2 weeks without breathing."

This is the Dawning of the Age of Extavia

(I am not a marketing person. I don't have the personality, or the mindset, or the training. So this story only barely makes sense to me. I'm sure the marketing or business people out there will tell me this is perfectly logical).

Extavia!

Isn't that a great name?

I have to wonder how much they paid the person who thought it up. It has a cool ring and the letters "X" and "V" (according to my friends who do sales, these, along with "Z", are considered "power letters", and putting them in words is supposed to connote something impressive).

With a name like that you'd think the drug was new, powerful, groundbreaking.

Extavia! NEW! For Multiple Sclerosis!

Released to the neurology world recently with hoopla, ads, drug rep lunches, etc.

Would you believe that Extavia is over 15 years old, and is being used to launch a drug that isn't even on the market yet?

Here's the story: Betaseron (Beta Interferon 1b) has been on the U.S market since the early 90's. It was the first drug ever approved for MS, and certainly is a decent drug. I prescribe my share of it. It's manufactured by Bayer.

Novartis, another pharmaceutical company, is developing a new MS drug, which it hopes to bring to market in the next 6-18 months.

But Novartis has no MS drug currently out there (though they do have 3 big neurological ones under patent). So they decided that, to get a foot in the MS marketing door now, they should hire a bunch of new reps (though they already have a fairly well-trained neurology sales force), and train them to market MS drugs. This is hard to do when you don't have one.

So they bought a license from Bayer to sell Betaseron, too, to get their reps some practice. But, since they didn't want to market plain old, early-90's Betaseron, they renamed it Extavia! New name! New marketing! Same drug! Same dosing! Same everything except the name (actually, I think the price is slightly lower)!

And, of course, Betaseron is still on the market. In fact, Bayer is making all the Extavia, too. So Bayer is likely going to clean up on the deal, since they get paid regardless of which gets prescribed.

I suspect Novartis will not make money on this, and is using Extavia as a loss leader, hoping to make the money back when the new drug comes out in a year or two.

On the one hand, I think it's good that they're hiring a new sales force to sell Extavia and future drug. Certainly, jobs are good for the economic recovery.

But on the other hand, it still seems kind of silly to me. Like I said, though, I'm not a marketing person.