The other side of the sample case

Drug reps get a bad rap, though I often try to stand up for them. Certainly, some are ill-mannered, but I like most.

And today, I like them, or at least sympathize with them, even more.

As my regular readers know, I have a few side jobs outside of my regular practice. Most involve research and consulting, but occasionally a drug company will ask me to do a speaking gig about their product (if you have a problem with me doing this, sorry).

So yesterday, I got to be a drug rep (sort-of) for one hour. I was asked to accompany a guy named Mike, who's a nice rep, to give a brief talk & answer questions during a lunch he was hosting at Large & Soulless Internal Medicine, P.C.

And guess what I found (as if I didn't already know): A LOT OF OTHER DOCTORS ARE ASSES!

Now, I know that doesn't come as a surprise to many of you (especially the nurses), but I was a bit stunned to see it from a drug rep's view.

During my hour in that office's break room, I encountered 5 physicians. Keep in mind that this was a scheduled event for the physicians' day, NOT a drop-in.


Physician #1:

Dr. Rushed: "HelloI'mDoctorRushedwhatproductdoyouhave?"

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side, and..."

Dr. Rushed: "Goodtomeetyoudoyouknowmyhusbandhe'sacardiologistonthewestside?"

Dr. Grumpy: "Yes, I..."

Dr. Rushed: "Goodtomeetyouthankyouforlunch." (Grabs sandwich, runs out of room).



Physician #2:

Dr. Rood: "Yeah, what?" (grabs sandwich, stuffs in mouth)

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side, and..."

Dr. Rood: (still chewing) "mmf yourf a doctor? You came to my office dreffed like that?"

Dr. Grumpy: "Yes, I just came from my office."

Dr. Rood: "Whatever. I don't talk to you drug people, anyway" (leaves)



Physician #3:

Dr. Unseen: (loud voice outside breakroom) "It's a rep? I don't want to see a fucking rep! I hate reps! They're all sleazy. I'll just wait till they leave, then go get something to eat."



Physician #4:

Dr. Whine: "Okay, so what is this?"

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side.."

Dr. Whine: "I used to not treat Neuropriapism. But now I do."

Mike: "Well, several studies have shown the efficacy of Limpeter for..."

Dr. Whine: "Mr. Grumpy, do you treat this?"

Dr. Grumpy: "Yes, I..."

Dr. Whine: "I'm sorry, did you say you're a PA?"

Dr. Grumpy: "No, I'm a doctor, a neurologist, and I use Limpeter in my practice for..."

Dr. Whine: "You know, Dr. Newmom, who works here, sort of, treats a lot of Neuropriapism patients. But she took a month off to have a baby, which is pretty damn unreasonable of her if you ask me, and so all her fucking Neuropriapism patients are seeing me now, so I could use this."

Dr. Grumpy: "Well, in several studies..."

Dr. Whine: "Don't you think that's ridiculous to take a whole month off to have a kid? I mean, it's not like she was in labor for the whole damn time, or had a C-section. I could see a 3-day weekend, but not a whole month."

Mike: "I..."

Dr. Whine: "Do either of you guys know anything about computerized chart systems? Our practice just switched to FubarMED, and I can't get it to work."

Dr. Grumpy: "No, I use..."

Dr. Whine: "Thank you for lunch." (grabs sandwich, walks out)



Physician #5:

Dr. Magnon was a guy who kept sticking his head in the breakroom. He'd yell "I'll be back in a minute! I have a question for you guys!" Then disappear, stick his head back in 5 minutes later and yell the same thing, and did this repeatedly. Mike hadn't gotten to talk to Dr. Magnon before, so we waited for him.

Finally, after 40 minutes, Dr. Magnon runs in.

Mike: "Hi, Dr. Magnon, I'm here with Dr. Grumpy and..."

Dr. Magnon: "Hey, do you guys know where the nearest gas station is?"

Mike: (whips out iPhone) "Sure, hang on... here it is, 1 block south and right around the corner."

Dr. Magnon: "Thank you." (grabs a sandwich, runs out. Through the window Mike and I watch him walk to his car and drive off).



When I got back to my office I told Dr. Pissy that I had no idea how benign he and I were until today.

I can fix that!

Dr. Grumpy: “What brings you in to see me?”

Mr. Auth: “My doctor says my back hurts.”

Dr. Grumpy: “Does your back hurt?”

Mr. Auth: “He told me it did.”

Dr. Grumpy: “But do YOU have pain, in your back, or anywhere else?”

Mr. Auth: “Nope. I’m fine.”

Why I'm not good enough to work at Mayo

I was flipping through some records from a patient who was worked up last year at Mayo, and came across a form with this heading:

(click to enlarge)





See, this is why I'm not good enough to work at Mayo. I just assume that my patients know how to discharge things from their gastrointentestinal system (one way or another). But at Mayo, they go above and beyond to give you a form that tells you.


(I'm being silly, obviously. The form had instructions on what to do after a colonoscopy. But I thought the heading could have been worded better)

Thank you all

I was surprised at the number of opinions, from both sides of the political aisle, that came out yesterday over my Medicare post. Many of you posted, others wrote to me privately.

I appreciate the majority of you who were able to keep it polite, and offer well-written comparisons of different systems, with the pros and cons of both. The input from those who have personally experienced both sides was especially helpful.

It's obvious that all feel something needs to be fixed, and I suspect the majority of "real people" out there would collectively find an answer, rather than just yelling about it.

Statistically, the political views of most Americans are purple, to varying degrees. Unfortunately, once elected it's more important to immediately become either fiery-red or bright blue, and those of us in the middle are forgotten. And that, to some extent, is why shit never gets done. It's easier to yell, scream, and argue over pithy things than to work together to fix the big ones. And a few screaming voices on either side are allowed to drown out a reasonable majority.

In closing, let me post a few addresses. Write your own emails. Feel free to send a link to my "Dear Medicare patients" post if you wish.

Maybe I'm just optimistic. But I'd like to think the health care issues we face can be solved in a way that benefits most, if not all of us. And in a civil manner, too.


The President: email contact

Click here to write to your Senator

Click here to write to your Representative.

Corporate Downsizing WTF?

Left to right: 7.5 oz, 8 oz, 12 oz


Dear Diet Coke,

Okay, I like the 12 ounce size. It lasts me at least 10-60 minutes (depending on how thirsty/ caffeine-deprived I am). It fits nicely in my hand and (when first opened) has a decent heft to it. Makes a good, "click-hiss" when you open up.

For years you've also offered the 8 ounce size, which several local hospitals stock. Not as tall, or as much, but same diameter so still fits nicely in my hand and has a nice "click-hiss"when you pop it. 3 of these equals 2 big ones.

BUT NOW YOU'VE GONE TOO FAR. The new pissy little "tall and thin" 7.5 ounce (how much money does that 0.5 ounce difference really save, for cryin' out loud?) is a disgrace. Look at it! It looks like a little silver can of fucking V8 juice!

This is SO not acceptable. It makes this high pitched "click" when you open. The can is so small and dainty I feel like I should drink it in little sips, pinched delicately between my thumb and index finger, with the pinkie sticking out, like I'm at one of my daughter's freakin' doll tea parties.

In short, THIS IS NOT A MANLY WAY TO DRINK DIET COKE!

Yours truly

Ibee Grumpy, M.D.

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."