Dear Medicare Patients,

After February 28, 2010, I (and A LOT of other doctors) will be unable to see you.

This isn't your fault, but on that day Medicare will be cutting doctor reimbursements by 21%. Superimposed on the 15%-20% cuts already made at the start of the year, this will bring the reimbursement rate for your care to where it's LESS than my overhead for the time needed to see you. So I won't be taking any new Medicare patients.

You may be wondering how this happened, but don't go blaming this administration, or even the previous one, or congress, or the guys who write medical coding books, or the cycles of the moon, or whatever. Annual cuts have been programmed into Medicare for a long time (Medicare uses a formula that gradually reduces doctor reimbursements over time, ignoring the obvious fact that overhead costs will increase due to inflation) and the government (both parties) kept finding ways to do creative financing to work around them. After all, it's easier to put a band-aid on it then to actually fix the underlying problem. The problem with creative financing is that it's a house of cards, and sooner or later it falls apart.

And right now BOTH sides aren't doing a fucking thing to try and prevent these cuts from happening. Oh, sure, they pay some lip service and form committees, but lets face it: It's so much easier to argue over REAL issues, like gay marriage, school prayer, who's fornicating with who, if a guy on the other side is wearing unpatriotic cuff links, and whose fault everything is, than to actually try and solve minor problems like trying to keep the health care system afloat in the long run.

This isn't about the government. It's about your insurance. If any insurance company cuts its payment rates below what my overhead costs, I drop that insurance. Medicare is just another insurance, regardless of who's running it. I know this may surprise you, but I have to pay office rent, and staff salaries, and my own mortgage, and all kinds of other things. If I'm not making money, then I can't stay in business to help you. I didn't get into this job to get rich, but I do have to support my family.

So when you can't get in to see a doctor next month, I'm sure you'll find yourself saying "Well, I can't find anyone to treat my Parkinson's disease, but it doesn't matter because I know it was SO much more important that my legislators spent their valuable time arguing for/against gay marriage than trying to maintain jobs and health care."

I'm sure some of you will be angry at me, but look at it this way: If you ran Local Grocery, and had to pay $3 per tomato from a farmer, and the best price you could sell them at was $1, you'd either stop selling tomatoes or find another farmer.

Some of you may elect to pay cash to stay with me, and I'll be flattered.

Some of you will be pissed off (after all, it's just totally unreasonable of me to want to support my family), but I'm sure you'll find another neurologist. Some sucker who thinks he can make a fortune by collecting Medicare patients: all he has to do is make it up in volume. So he'll see 4 new patients in an hour OR 12 follow-ups in an hour. And you'll wait 3 hours in his lobby reading a 1987 issue of People magazine, and when you do get in to see him he'll give you exactly 5 minutes of his time to listen to your story, examine you, and decide what he's going to do. And don't expect him to have time to answer your questions.

You get what you pay for.

Yours truly,

Ibee Grumpy, M.D.

Lunch with a drug rep

"Doctor, Sleepalot is safe and effective for insomnia. Research shows that people who are more awake are less likely to be asleep, and therefore may benefit from Sleepalot."

Monday night, 8:15 p.m.

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

Mr. Wet: "Um, I have an appointment for tomorrow morning, and it's supposed to rain."

Dr. Grumpy: "Yes?"

Mr. Wet: "I don't like to drive in the rain. Do you know what the chance for rain is?"

Dr. Grumpy: "No sir, I don't. My office will be open, regardless."

Mr. Wet: "Yeah, but... I just don't want to take chances. I hate rain. I'd like to reschedule."

Dr. Grumpy: "Okay, I'll have Mary call you tomorrow."

Mr. Wet: "Do you know what the forecast is for the rest of the week?"

Dr. Grumpy: "No, but I'm sure you can find it on TV, or the newspaper, or the internet."

Mr. Wet: "Can Mary look it up and have it handy when she calls?"

Dr. Grumpy: "Have a good night, sir."

Department of Redundancy Department

"Doctor, I have high blood pressure AND hypertension."

Counting, the lost art

Mr. Number: "I only take one pill."

Dr. Grumpy: "What is it?"

Mr. Number: "Coumadin, Toprol, and Metformin."


(On the other hand, I'm glad he didn't say "a round white thing that I put in my mouth and swallow")

Paging Sue, in Michigan

Discussing a lady found comatose at home.

Dr. Grumpy: "Does she have any family?"

Social worker: "Nothing. No kids, siblings, anything. Not even friends we can find. Her landlord says she once mentioned a 2nd or 3rd cousin in Michigan."

Dr. Grumpy: "Do we have a name?"

Social worker: "Thought the first name is Sue. That's all he knows."

Dr. Grumpy: "Well, that definitely narrows it down."

Dear ICU Nurses,

I'm really, really, really, sorry.

I feel terrible. And I know I will pay for the consequences of my actions.

But it's been a horrible shitty awful weekend on call.

And it isn't MY fault that one of you put A WHOLE BOX of Reese's peanut butter & chocolate valentine hearts next to the phone I was dictating on.

So I'm sorry there aren't any left now.

Yours truly,

Ibee "Dr. Fatso" Grumpy

Today's Quiz

You're in the ER with your grandmother and the rest of the family. The neurologist, while hacking & sneezing, has informed you that Grandma has suffered a massive bleed into the brain, and is going to die. You cope with this by:

A. Crying, and holding your grandfather.

B. Silently hugging your parents and kids.

C. Offer the neurologist some Sudafed and a Kleenex.

D. Looking up at the ceiling and yelling, "WHY?" repeatedly.

E. Complain loudly that you've noticed the wall sink in the ER room (which you're being moved out of, anyway) is broken, and demand to talk to a maintenance supervisor immediately.


If you answered E, it was a blast meeting you this morning. As you requested, a plumber and a neurosurgeon have been called, in that order. I think we can fix the sink.

Sunday Morning Rounds

Dr. Grumpy: "They told me you had a seizure last night. What do you remember?"

Mrs. Ictal: "I remember that bitch nurse waking me up. She kept asking me if I was okay. Of course I'm not okay. I'm in a fucking hospital, and seizure or not it was the first decent sleep I've had since I got here, and she had to ruin it."

Deja vu all over again

A stroke is very sad and serious. But sometimes all you can do is see the humor in a situation.


Dr. Grumpy: "Hi, I'm Dr. Grumpy. I'm a neurologist and..."

Mr. Stroke: "IT'S SATURDAY! FUCK OFF!"

Mrs. Stroke: "George! Calm down!"

Dr. Grumpy: "I'm sorry, they said..."

Mr. Stroke: "IT'S SATURDAY! FUCK OFF!"

Mrs. Stroke: "Sorry, doctor. He can't help it."

Dr. Grumpy: "I understand. What happened?"

Mrs. Stroke: "Well, he was fine last night, but since waking up this morning all he's been able to say is..."

Mr. Stroke: "IT'S SATURDAY! FUCK OFF!"

Mrs. Stroke: "... like that."

Dr. Grumpy: "Anything else you've noticed?"

Mrs. Stroke: "No. Why does he do that? He's actually very polite."

Mr. Stroke Jr.: "Yeah, normally Dad would never swear."

Dr. Grumpy: "Well, the stroke has affected the speaking part of his brain, so even though he may want to say something nice, the damaged part can only produce a few words, like..."

Mr. Stroke: "IT'S SATURDAY! FUCK OFF!"

Mrs. Stroke: "This is so awful!"

Dr. Grumpy: "That's true, you're absolutely right."


REALLY old SNL fans may recognize the humor in my last comment, but no one in the room, or the nurse outside, did. Which is probably good.

On call and sick

Call is not joyful,
And fun it is not
When you have to take call
With a nose full of snot.

With a throat full of phlegm
The constant clearing (ahem)
And a head full of pain
And a fuzzy clogged brain

It is so hard to round
When you want to fall to ground
Your muscles are mud
With bad bugs in your blood

And you go home to rest
But the ER knows best
And they dial your cell
So you drive back to hell

But your throat feels sore
So you're a Tylenol whore
With boogers you abhor
Give me Sudafed- MORE!

This fucking sucks
Regardless of the bucks
I hate being on call
That is all.

Dear Middle-of-Nowhere Medical Center

Thank you for faxing me Mr. Crunch's hospital records from his overnight stay there last week.

You can stop now. I swear. We faxed the release 5 hours ago. So far we've received back 22 faxed copies of MY OWN RELEASE (it was a fax, I promise we have the original) from you and 18 copies of his 14 page hospital records. At this rate I'm going to have to send Mary to Costco for more paper.

I'm sure getting a release from a real gosh-durn big city doctor-o-medicine was the most exciting thing to happen at your hospital since a paint truck overturned there in 1999, but you should try to curb your enthusiasm. I have all that I need now, and you can stop.

But can you see Russia from the ship?

Dr. Grumpy: "Where are you guys going?"

Mrs. Geography: "We're taking a cruise out of New York. We fly to Niagara Falls, and board the ship. From there it goes up to Alaska, and we spend a few days there, and after a week we're back in New York. I'm looking forward to it, because I've never been to Alaska before."

How NOT to get in to see Dr. Grumpy

Yesterday afternoon.


Mary: "Dr. Grumpy's office, this is Mary."

Mrs. Hag: "Yeah, I have a 4:00 appointment today."

Mary: "Yes... It's 3:55 now. Where are you?"

Mrs. Hag: "I'm leaving my house now. I'll be there in about 30 minutes or so."

Mary: "Uh, we close at 5. Dr. Grumpy has to go to the hospital."

Mrs. Hag: "Bullshit. You can wait for me. I'd have been there sooner, but had a lot of laundry to put away, and lost track of time."

Mary: "No, we can't, but I can reschedule you for..."

Mrs. Hag: "LOOK, BITCH! DIDN'T YOU HEAR ME? I AM ON MY FUCKING WAY AND YOU ARE GOING TO WAIT FOR ME!"

Mary: "Don't speak to me like that."

Mrs. Hag: "I'll talk to you however I want! I'm a paying customer."

Mary: "You..."


Dr. Grumpy reaches over Mary's shoulder, silences the speaker phone, and picks up the receiver.


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

Mrs. Hag: "Yeah, I'm on my way to my appointment, I'll be there in about half an hour, and your phone bitch is telling me I can't come in today! I need help, and you're going to wait for me!"

Dr. Grumpy: "No, I'm not. Since you weren't here on time, we are leaving."

Mrs. Hag: "Then you damn well better see me tomorrow!"

Dr. Grumpy: "No. You are not coming to see me. Today, tomorrow, or ever. I will not see anyone who treats my staff like this."

Mrs. Hag "WHAT KIND OF ASSHOLE ARE YOU TO TREAT A SUFFERING PERSON LIKE THIS? I'M GOING TO REPORT YOU TO THE MEDICAL BOARD AND POLICE AND CITY AND HOSPITALS AND MY INSURANCE AND..."

Dr. Grumpy: "Have a nice day." (Hangs up)