Memories...

My first rotation as a 3rd year medical student (determined randomly at my school) was psychiatry.

Your first day on clinical rotations you never know what to expect. I was assigned to evaluate Mr. Binford, who'd been picked up by police (for vandalism) the night before.

I sat down and nervously spoke to Mr. Binford. He was a bit disheveled, but seemed intelligent and reasonable. He owned a home improvement company. He employed several handymen (including himself) and had a central dispatch office. They did all ranges of home and yard work.

It all sounded pretty reasonable to me. So, being young and naive, I presented the case to my attending psychiatrist. When he asked me what I thought, I told him that this person didn't seem to need psychiatric care.

Then he asked me if I'd read through his past chart. Sheepishly I admitted I hadn't, because I'd been in a hurry to interview the patient early on my first day.

So he handed me the chart.

OMG

The patient owned no such business. He had a remarkably intricate delusional system.

He owned a truck full of power tools, paint, and various other home repair supplies. Of which he had some knowledge about using them.

He drove around the city, day and night, and would randomly stop at houses where he thought they'd called him for work.

People would come home (or be woken up at night) to find him doing unneeded work on their houses. Cutting down trees. Painting their outside walls. Knocking holes for windows in their homes. Taking apart pool filters. In one case he'd actually painted a guy's car with house paint.

I learned that old charts were useful.

I also learned that even the incredibly delusional could make a lot of sense when you didn't know their background.

We called him "Psycho Home Repairman".

And to this day, if one of our neighbors turns on a lawnmower or other loud equipment after dark, I go to the window... Just to make sure.

Crime fighting apps

Okay, crooks, when planning to rob a place, it is generally NOT a good idea to accidentally call the cops so they can listen to you make plans.

Like these guys.

Thank you, Sarah!

Lost & Found

While reading another doctor's office note this morning I found this line:

"Vital signs were taken and documented somewhere in the chart. I have no idea where."

Annie's desk, May 5, 2011

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

Mrs. Seeker: "Yeah, my husband sees Dr. Grumpy, and knows a lot about his case."

Annie: "Okay, let me open his chart... What can I do for you?"

Mrs. Seeker: "Where do you think he'd have put our car title? I can't find it anywhere."

Wild times

SEX!

DRUGS!

EXPENSIVE CARS!

OLDER MAN!

YOUNGER WOMAN!

AND A 6 HOUR SEXUAL MARATHON!

Is it a typical day at the Playboy Mansion?

Nope. Just an Endocrinologist and his P.A.

The Mind of a Neurologist

Between patients I'm sitting here listening to iTunes on the computer, and it picked Supertramp.

At the end of "It's Raining Again" there's a chorus of kids singing "It's raining, it's pouring, the old man is snoring. He bumped his head and went to bed and didn't get up the next morning."

And I immediately think "Huh. He must have had a subdural hematoma."

Sigh.

I've been doing this for too long.

Online learning

Last night I did some online CME (Continuing Medical Education), which featured a webinar. The speaker was discussing ways to improve patients' overall health.

One of the techniques he recommended was having them keep monthly exercises diaries, and reviewing them at each visit. He called them, logically enough, "Patient Exercise Diaries" or PED.

His suggestion was to keep older diaries in files at my office, and at each appointment compare them to a patient's most recent one. Then he put up a slide summarizing this idea:

It said "COMPARE PED-FILES AT EVERY VISIT." (try saying "PED-files" out loud).

It's a good thing they couldn't see or hear me. Because I lost it.

I bet you did

Dr. Grumpy: "Have you had any surgeries?"

Mr. Webster: "Yes. When I was five I had an autopsy."

More Doctor's Lounge Horrors

Coming on the heels of the Doctor's Lounge Muffin Massacre...

This morning, as usual, I started at the doctor's lounge. I grabbed some Diet Cokes and a bagel, and trundled off to see patients.

This is the bagel I randomly picked up, without paying much attention:





Later, at the nurses station, I unwrapped the bagel, to discover this:





I'd like to thank my anonymous colleague who bit/tore a hunk out of this bagel, wrapped it back up, and returned it to the tray, for helping to support my diet.

Annie says I'm causing trouble.

Mrs. Azul: "I'm allergic to everything blue. Blue paint, blue berries, pills with blue dye."

Dr. Grumpy: "You're wearing blue jeans."

Mrs. Azul: "I am? Oh, I'm color blind. I'll have to change when I get home, so I don't get a rash."

Patient quote of the day

"The pain is constant, but not all the time. It's intermittently constant."

Relativity

Last night Mary called me at home to ask a question about the week. Craig was in the room, and overheard the conversation.

After I got off the phone he came over to me.

Craig: "Dad, how old is Mary's little girl?"

Dr. Grumpy: "She'll be 5 this year."

Craig: "5! Wow! That makes me feel so old!"

Voodoo doll

An anonymous reader says she works for a group of surgeons, and keeps this near her desk to take frustrations out on.




Having to deal with neurosurgeons, I sympathize. I thought about getting my own, but would likely destroy it after a weekend on call.

Saturday Re-runs

Due to various amounts of family junk this weekend, I'm re-posting this from a while back.


As my regular readers know, I moonlight as a consultant for various medical market research companies. It's a thankless job, but somebody has to pay for the tomatoes.

So last night I had a dinner meeting with neurologists and sundry other specialists to review data on an up-and-coming product.

These are never fun, because neurologists by nature are a remarkably pathological group of personalities. Back when I worked at Humungous Neurology, Inc. the partners would argue if it was dark or light outside. I think they invite the other specialties to these as a buffer.

But I digress.

So I was seated next to Dr. Harangue, who I'd had the good fortune of not having seen in at least 5 years. In his own mind he's a giant in his field. To those outside his mind he's an obnoxious boil. He may have once been a good doc, but as they say in Hollywood "you're only as good as your last picture". And his was made before Casablanca.

Neurologists will argue over anything. The meal started with a dispute across from me over who's bread plate was who's (right or left? GET YOUR BREAD OFF MY PLATE!) followed by a fight over which fork is used for salad. Somebody actually dragged the maitre d' to the room to settle the issue (no, it wasn't me. I sit still and keep my mouth shut as much as possible).

I'm not much into the swanky places they have these meetings at. I ordered a steak. I had no idea how complex this was.

Waiter: "How would you like that cooked?"

Dr. Grumpy: "Medium."

Waiter: 'That involves a light red center. Is that okay?"

Dr. Grumpy: "As opposed to..."

Waiter: "Well, rare is a pink center."

Dr. Grumpy: "Medium is fine."

Waiter: "I can do medium rare, too. That's a pink/red combo".

Dr. Grumpy: "What's wrong with medium?"

Waiter: "I'll just do medium-rare-plus for you. That's a pinkish-red."

Whatever. I'm trying to order a steak, not pick out draperies.

Then the talk began. Every time a doc involved in the study was mentioned, Dr. Harangue felt the need to interrupt and say "I know that doctor personally. We've been close friends for over 25 years." By the end of the meeting I was hoping they'd mention a study done by Hippocrates or Woodrow Wilson to see if he knew them, too.

After 15 minutes of talking, the speaker stepped out from behind the podium to show us all that his zipper was down, with his tucked-in shirt hanging out of it. A tactful internist promptly yelled "Christ! Your fly is open!" to drop a subtle hint.

Then they brought dinner. The cardiologist next to me had ordered prime rib (no comment), and the waiter accidentally set my steak in front of him, and his prime rib in front of me. I pointed this out, and he quickly switched plates.

The cardiologist had a freakin' FIT! "I don't want that now! It was in front of him! He could have H1N1, or worse! Doesn't the heath department check you places anymore?!!!" It was, literally, in front of me for less than 5 seconds.

So I quietly started my steak, while they went to get Dr. Germaphobe a new prime rib (actually, I think they just brought him back the old one).

The next speaker showed us a seemingly endless series of graphs. After 20 minutes of this, she asked if anyone had any comments. Dr. Phlame at the end of the table immediately raised his hand. "Yes, I want to know why you chose red and blue as the main colors for the graphs. I think mauve and maybe yellow would be much more aesthetically pleasing. Also, I think some ruffles or curvy lines around the slide border would be nice."

This was immediately followed by Dr. Harangue chipping in "Dr. Phlame, do you live under a freaking rock? This company has been using those colors for years. But back to the data, did any of you people think to compare these results to a 1954 study by Longdead, et al?" The speaker (and everyone else there) had absolutely no clue what he was talking about, and Dr. Harangue chewed us out, as if it had just been published last week. When I looked it up, the study investigated a drug (that's no longer in use) for an unrelated condition.

Throughout this excitement the waiters kept refilling our glasses (ENDLESS DIET COKE HEAVEN!), so dysfunctional personalities were not improving with repeated doses of Burgundy and other wines.

In one discussion, to argue a point about a competing drug, an internist actually reached into his pocket and pulled out a product insert. I swear! He had it with him, all scrunched up. After reading from it like it was a bible he sat down and began arguing with a pulmonary doc about when daylight savings time starts.

We made it through another 15 minutes of polite discussion before Dr. Germaphobe cardiologist began tapping my shoulder. "Hey, Ibee!"

I turned around "What's up?"

"Are you gonna finish your roll?"

Stunned, I looked at the bread roll I'd absently left on my plate. It was buttered, and I'd taken a few bites out of it. "Uh, no, I'm full".

"Thanks!" And he grabbed it. So the guy who'd refused to eat an untouched steak was now chomping on my partially eaten dinner roll. Amazing what a bottomless glass of wine will do.

As we sat through another set of slides, Dr. Harangue's cell phone rang. He answered it, speaking loudly enough to be heard in the next county (i.e., his usual volume). "What? Yeah. No, I've got another half hour of this shit. The drug company people won't shut up."

The dinner ended 20 minutes later. To make sure all points were covered, the moderator specifically asked "Dr. Harangue, are there any other comments?"

No answer. It was the only time he'd been quiet all night. He was in a burgundy stupor, slumped face down next to his creme bruleé. He was still there when I collected my paycheck and left.