Sucker!

Dr. Grumpy is always looking for junkies. I try not to deny pain meds to those who need them, but at the same time I hate people who abuse them. They make it harder for those who need them to get them.

Every doctor has been taken by a junkie at some point.

A few years ago one of the ER docs called me. He had an old lady at the hospital, who was visiting from out of town, and had a flare-up of her Trigeminal Neuralgia (a condition with awful facial pain). He asked if I could work her in that day, so I told Mary to put her on the schedule.

She came over from ER. She was very sweet, in her mid-late 70's. Fully dressed in a Salvation Army uniform (even with a little hat with the red badge). She had a long history of Trigeminal Neuralgia, which hadn't bothered her in several months. It was late November, and she was a ranking member of the Salvation Army who'd come to town to help organize the annual holiday bell-ringing campaign.

She gave a good history for Trigeminal Neuralgia. I put in a call to her regular neurologist, but the office was closed for lunch. She'd left her Neurontin and Percocet back home, and needed refills, so I wrote her for some and sent her on her way.

I went on with my afternoon. After about an hour Mary nabbed me between patients. While straightening up the lobby she'd noticed sweet old lady had left the Neurontin script sitting on top of the water cooler. I figured it was an accident, and she'd call looking for it.

Then her "regular neurologist" called. They'd never heard of this patient.

Ten minutes later the ER doc called me. He'd just gotten a call from a police department in another state. They were looking for my patient. She'd stolen a Salvation Army uniform several weeks earlier, and was traveling around, using it to collect as many narcotics as she could. She'd take some, and sell the others, and keep on the move. They'd found she'd filled a script in my city, and were calling local ER's to alert them.

I have no idea whatever happened to her. On one hand, I felt sorry for this old lady who's life was reduced to being a traveling fugitive junkie. On the other hand, I was pissed for having gotten taken, and certainly she was giving the Salvation Army (for all the jokes about bell-ringing, they're a good organization) a bad name.

And, in some strange way, I had to respect her ingenuity and skill as the opponent she was. And laugh at how I'd been beaten by my own view that a sweet little old lady, especially one in a Salvation Army uniform, couldn't possibly be a junkie.


Junkie's and other low-lifes are a common source of amusement on medical blogs. But in reality they're far from funny. For an excellent look at this forgotten, but more realistic side, I recommend this post by my colleague Phathead.

YOU! YES! YOU!

Let's look at this:

1. YOU are the one who lives 140 miles from here.

2. YOU are the one who refuses to move your demented mother into a home closer to you, in spite of the fact that she has no connections here at all.

3. YOU are the one who frantically called last Friday demanding an immediate appointment for Mom's behavioral changes.

4. YOU are the one who went apeshit because you called at 3:30 p.m. on a Friday and I didn't want to keep my office open until 6:00 so you could drive here, pick her up, and bring her to see me.

5. YOU are the one who refused my suggestion of admitting her to the hospital last Friday to work this up.

6. YOU are the one who demanded an appointment for today, so I agreed to work Mom in over lunch.

So don't come in and chew me out for making you spend 2 hours driving here and bring your Mom to see me! And don't chew Mary out and tell her that I did this only to get your Mom's $15 co-pay!

And, when YOU just decided you don't want any more tests done or medications started on Mom, don't freaking yell at me for wasting your time on this visit!

Another bright part of my day

Dr. Grumpy: "Do you still see Dr. Internist?"

Mr. Beeph: "Yeah, I'm due for my special exam."

Dr. Grumpy: "Special exam?"

Mr. Beeph: "You know, where he uh, puts his finger in the, um, hole I poop out of."

Monday Morning

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

Mrs. Confused: "Yes, I have an appointment for this morning, but that must be wrong."

Dr. Grumpy: "No, I remember from the schedule. It's at 9:00."

Mrs. Confused: "But it's a national holiday. The post-office is closed."

Dr. Grumpy: "Yes, but I'm open."

Mrs. Confused: "You must be wrong. So if you're office is closed, I'd like to reschedule."

Dr. Grumpy: "We're open! Most doctors are."

Mrs. Confused: "But the post office is closed!"

Dr. Grumpy: "Ma'am, I'm not the post office."

Mrs. Confused: "Okay. I'll be in then."


Five minutes passed. Then the phone rang. It was Mrs. Confused again, so I answered it.


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

Mrs. Confused: "Doctor, I'm just not comfortable with this. I'd like to reschedule, just in case your office is closed today."

Dr. Grumpy: (heavy sigh) "Okay, I'll have Mary call you later."

Mrs. Confused: "Will she be in today if you're closed?"

Dr. Grumpy: "Have a nice day." (hangs up, watches hairs leap off his head like lemmings)

Sunday Funday

So I had a hospital consult this lovely Sunday. The patient was an EXTREMELY drunk lady.

Dr. Grumpy: "How much do you drink?"

Mrs. Smashed: "Oh maybe 3, sometimes 4 a day."

Dr. Grumpy: " 3 or 4 what? Beers? Bottles of wine? Six-packs?"

Mrs. Smashed: "You're getting warmer."

Elevator Stories

My favorite drug rep and I were talking about my elevator encounter from a few days ago, and she sent me this story:


In my old job I made hospital calls to talk to cardiology nurses. One day I was in the elevator, and this short, squat, unattractive guy in scrubs got in with me.

Dr. Scrubs: "You must be a rep. What company do you work for?"

Ms. Nicerep: "Notsobig Pharma, we make cardiac surgical devices. What field are you in?"

Dr. Scrubs: "Plastic surgery is my game. Here's my card. Why don't you come by my office? I could do something about that nose and breasts of yours."

Ms. Nicerep: (GASP!): "Umm, no thanks, I'm happy with how I am..... But if that's your marketing schpiel, you might want to get some work done yourself!"

Then I got off the elevator.

Friday afternoon quiz

You woke up this morning with severe back pain, completely paralyzed from the waist down. You immediately:

A. Call 911.

B. Call a friend to take you to the hospital 2 blocks from your home.

C. Drag yourself to your car and drive yourself down the freeway to a hospital over 1 hour from your home because you saw a TV ad last night on how it delivers "Premium Quality Healthcare"

D. When you discovered you couldn't drive because your legs were paralyzed, you grabbed a broomstick you had in your garage and used it to operate the pedals as you sped down the freeway at 75 mph.

E. Both answers C & D.

If you answered E, it was a pleasure meeting you this afternoon in the neurosurgical recovery room, sir. I hope they can get those wood splinters from the broomstick out of your hand.

But did he dress like a pimp?

Seeing a new patient this morning


Dr. Grumpy: "So what brings you in today, sir?"

Mr. Mouth: "My previous neurologist was an asshole."

End of the day

After rounds last night I got in the hospital elevator on my way to the parking lot. The only other person in it was a sweet-looking elderly lady, with a pleasant smile.

The doors closed, and she looked at me.

Mrs. Olde: "Excuse me, sir, but are you a doctor?"

Dr. Grumpy: "Umm, yes..."

Mrs. Olde: "Oh. Because that shirt makes you look like a pimp."

Drug Rep Lunch Quote

"Dr. Grumpy, if you look at this data, you'll notice that as pain relief improves, the patients hurt less".

Mary's Desk, January 14, 2010

A lot of patients have Mary's email. They use it to schedule and confirm appointments.

So my 8:30 was running a few minutes late today. Using her cell phone, she sent Mary an email that she was running late because she spilled soda on her pants. Whatever.

A few minutes later, while driving down the freeway, she took a picture of the stain and emailed it to Mary.

I couldn't make this stuff up if I tried.

Shining Lights of Education

The twins (Craig and Marie) routinely beat the crap out of each other. This is such a normal occurrence at our house that we just ignore it unless at least one liter of blood is spilled.

So after I got home from work today, the phone rang.

Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Marie Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Marie was involved in a playground fight today, with a boy at school."

Dr. Grumpy (glancing out the window at the twins gouging each others eyes out on the trampoline): "Is she in trouble?"

Mrs. Playground: "Yes, she has to miss recess tomorrow. She and the boy suffered some minor scrapes, so I need to notify the parents of both children."

Dr. Grumpy: "Okay, thank you."


I hung up the phone, looked at Mrs. Grumpy, and began counting. "5-4-3-2..." As soon as I got to "1", the phone rang. I bit my tongue, hard.



Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Craig Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Craig was involved in a playground fight today, with a girl at school..."


I can see why she's the "playground supervisor", whatever the hell that means.

Going in circles

Dr. Grumpy: "Do you have high blood pressure?"

Mr. Brainless: "No."

Dr. Grumpy: "Do you take any medications?"

Mr. Brainless: "Zestril."

Dr. Grumpy: "What do you take that for?"

Mr. Brainless: "My high blood pressure."

Dr. Grumpy: "I thought you said you don't have high blood pressure?"

Mr. Brainless: "I don't if I take the Zestril."

Things that make me grumpy

If I'm still prescribing medications for a patient, I want to see them once a year (give or take a month). I'll see them more than that if needed, obviously, but for a stable patient I think once a year is reasonable if I'm still the one writing their scripts. Dr. Darth, a neurologist downstairs from me, makes everyone come in every 8 weeks, and Dr. Ivyleague across the street requires monthly visits. But I think that's just digging for a co-pay.

Mrs. Bagge is an elderly lady who I see for benign tremor. I see her once a year, and refill her Inderal, and she goes on her way. But she always bitches and complains about her $25 HMO co-pay to see me once a year. I'm not that desperate for the $25, but if I'm taking the legal liability of writing her pills, I want to see and examine her once a year.

She was due for a return visit in early November, 2009, so I had Mary call her. Mrs. Bagge said she'd just had surgery on her bunions, and couldn't get in then. So, to be nice, I wrote her for another month.

So in early December, her next refill came up. This time Mrs. Bagge had family in town through the holidays, and so asked if I'd give her until January. I don't want to be Scrooge, so I said fine.

Last week another refill came up. Mary called her, and Mrs. Bagge wanted to make an appointment, but she needed an insurance authorization from her internist to see me. So Mary called Dr. Internist (twice) to ask for one, and said she'd call Mrs. Bagge to schedule the appointment as soon as we got it.

In the meantime she was out of Inderal. I told Annie to give her 15 days worth of pills, and no more until she was seen. Annie argued with me that Mrs. Bagge is on a fixed income, and we shouldn't put her in the position of having to make 2 medication co-pays for one month of pills. Since we were in the process of getting the auth for her to see me, and I'm a soft touch, and (most importantly) because I never argue with Annie, I said fine. Give her a whole month.

So yesterday afternoon her insurance auth showed up for her visit, and Mary called her.

Mrs. Bagge refused to make the appointment. She said she was tired of dealing with my greedy office, and accused us of harassing her with phone calls and holding her Inderal hostage. She then sent over a request to fax her records to Dr. Darth, because she has an appointment with him next week.

Good riddance.