Thursday evening, 6:18 p.m.

Dr. Grumpy: "This is Dr. Grumpy. You called earlier?"

Mr. Husband: "Hi, doc. Hey, sorry my wife couldn't come to her appointment today. She's had such a bad migraine it's unbelievable. She's been so dizzy with it she can't drive or ride in a car. She can't even get out of bed."

Dr. Grumpy: "I'm sorry. Has it gotten any better this afternoon?"

Mr. Husband: "No, if anything it's worse. She's barely able to move."

Dr. Grumpy: "Can I talk to her?"

Mr. Husband: "Not right now. She's out in the yard climbing a tree, trying to get the cat down. Can she call you back when she's done?"

Anatomy 101

Yesterday I saw a guy who repeatedly mentioned that he's a nurse.

When he called he said he was having "carpal tunnel problems". That's fine, I can handle that.

But when he came in, all he wanted to talk about was his neck pain.

I can handle that, too. But I asked him why he'd said he was having carpal tunnel problems when he called.

He said "because the carpal tunnel is in the neck".

When I tried to correct him, he argued with me, then walked out. Said he was going to "find a doctor who knows his damn anatomy."

Who lives in a pineapple under the sea?

I'd like to thank my reader Linda for submitting this.

There are some things you never want to be stuck with.

Like finding out that you've been a habitat for SpongeBob Squarepants.

Or worse, that you're the one who left him there.

E-prescribing idiocy

I bitch about it. The Angry Pharmacist bitches about it. This is nothing new.


But yesterday afternoon I discovered a whole new reason to hate e-prescribing.


I have a lady who takes Fukitol 3mg, four times a day.

Fukitol only comes in 1mg pills. So she takes 3 pills, four times a day.

So 12 pills each day. OR 360 pills in 30 days.

HOWEVER, her insurance requires her to use Lostinthe Mail-Order pharmacy.

Like most mail-order pharmacies, this one only sends out 90 day pill supplies at a time.

So Mrs. Patient asked me to send it by e-script to Lostinthe Mail pharmacy.

12 pills x 90 days is 1080 pills. So I just transmit a script for 1080 pills.

Sounds easy, huh?

The online thing rejected the script, on the grounds that it won't allow pill supplies of more than 999 pills at a time.

I tried submitting it for 2 scripts of 540 pills each. It wouldn't allow 2 scripts of the exact same thing.

So I submitted it for 999 pills for 90 days, and figured Annie would just tell the patient the reason for this, and we could make up the difference with samples.

Of course, the online e-script program rejected this, too, and pointed out that a 90 supply for the patient is 1080 pills. It even asked me to resubmit it for that amount.

Which I did. And it was promptly rejected for being > 999 pills.

Catch-22.

I mailed a written script for 1080 pills to the patient and told her to send it to them. And scream.

Let's hope you aren't

Dr. Grumpy: "Does the hand pain wake you from sleeping?"

Mr. Carpal: "Sometimes."

Dr. Grumpy: "Does it bother you when you're driving?"

Mr. Carpal: "Why would I be driving while I'm sleeping?"

The joys of search engines

A doctor in my area died last week. Dr. Pissy and I were wondering what happened, so I typed his name into a search engine.

These were the first 3 links that came up:

1. Read the obituary for Dr. Unusualname.

2. Sign the online memorial book for Dr. Unusualname.

3. Make an appointment to see Dr. Unusualname.

Afternoon patient at Dr. Grumpy's

Mrs. Cuticle: "Harold! Stop chewing your fingernails! We're at the doctors!"

Mr. Cuticle: "Shut up! I'm hungry!"

Hmmm...

While I was at the hospital yesterday, I stopped in to read some EEG's. The studies always have a cover sheet attached, giving me a brief patient history. One had this on it's paperwork:

"Indication: Patient has spells of "tripping out" when he drinks heavily and smokes marijuana. Dr. Local ordered the study to make sure they aren't seizures."

Boob job

I got dragged in to the hospital today to see a patient, and was walking by the cafeteria.

The sign in front listed today's special as:

"Italian style roasted breasts, with rice."

Hygienic Horrors

It is a really scary, when catching up on the laundry, to realize that in the last 8 days your son has worn only 2 pairs of underwear.

How about a cheeseburger for stroke awareness?

15% off nfl scrubs with checkout code "nfl_jrl"

For various reasons this has been a CRAZY week at my office, and I'm still trying to catch up. So while I'm attacking the giant Pileofdictations Monster, I'm putting up this gripe sent in by Stacey, who's a radiology tech. At least that's what she says. For all I know she's another yak herder in the next valley over from me.

I was walking over to the fitness center on campus today when I was accosted by 3 women at a little sidewalk booth.

They were having a bake sale to raise money and awareness for heart disease. One women piped up as I walked by...she asked me if I would buy something to support their cause.

They were selling cupcakes, BIG cookies, thick slices of chocolate cake, and pastries. To raise money to fight heart disease. And they wanted me to support this fight by contributing to my own vascular risk.

I lost it. I said "Are you kidding me? Obesity is a major cause of heart disease! Don't you think that maybe, just maybe, you should be selling something healthy? Maybe you should try selling something healthy to promote heart health, awareness and raise money at the same time".

They all looked at me like I'd just bitten the head off a puppy and spit it on the sidewalk.

Finally one of them said "Well, we have oatmeal raisin cookies... they're kinda healthy..."

This could mean a lot...

From a patient intake form yesterday afternoon.

(click to enlarge)

Delay in game

I went up front to get a patient from the lobby.


Dr. Grumpy: "Mrs. Fourdown? Come on back to my office."

Mrs. Fourdown: "Oh dear. Can you take someone else ahead of me?"

Dr. Grumpy: "No, you're the only one here right now, and it's time for your appointment. Is something wrong?"

Mrs. Fourdown: "No, but I just started a crossword puzzle."

Annie's desk, September 8, 2010

Mr. Jade: "So what's my sed rate?"

Annie: "5".

Mr. Jade: "Is that good?"

Annie: "Yes".

Mr. Jade: "Did you ask the doctor?"

Annie: "Yes. He said 5 is fine."

Mr. Jade: "Was that today that you asked him?"

Annie: "This morning."

Mr. Jade: "Is 5 in the normal range?"

Annie: "Yes."

Mr. Jade: "What is the normal range?"

Annie: "Less than 20."

Mr. Jade: "So that's less than 20?"

Annie: "Yes."

Mr. Jade: "Which is normal, right?"