Another satisfied customer

My 2:00 new patient yesterday didn't show up. It happens. I forgot about it and moved on.

Last night I got the following message on my voicemail:

"Dr. Grumpy, I'm never coming to see you again, and am going to complain about you to my internist. I had a 2:00 appointment with you today, and I waited in your lobby for 2 hours, and nobody called me back. I kept pointing this out to the girl at the front desk, and what did she do? NOTHING! She kept telling me that I didn't have an appointment there, and that I had the wrong office, and that you were in a different building! If this is how you treat new patients, then I don't see how you're still in practice."

And it looks like you failed, too

I'd like to thank the reader who sent in this picture. She says the cake was at a "School's Out/Birthday" party she took her kids to today.

(click to enlarge)

Dr. Grumpy, uncaffeinated jackass

It's early morning. I need some caffeine. I'm in the little kitchen on Local Hospital's neurology floor. And I'm pissed off.

Dr. Grumpy (yelling at no one in particular): "This is bullshit!" (slams cabinet) "Who the hell puts stuff away here?!!!" (slams drawer).

Nurse Understandablyannoyed comes into the kitchen: "What's wrong?"

Dr. Grumpy: "All I want is some freakin' sweetener for my coffee! And I've been through every damn cabinet and every damn drawer in here! And there's none! I thought they were keeping these stocked!"

Nurse Understandablyannoyed: "They do. It's..."

Dr. Grumpy: "Then where is it?!!! I've looked everywhere in here!"

Nurse Understandablyannoyed: "... it's in the box on the counter, about a foot in front of you, out in the open."

(Long pause)

Dr. Grumpy (red-faced): "Yes. I knew that. I was, uh, just testing you."

Clarity

I'm reviewing some records today, and found this quote:

"This EEG is normal. But it may also be abnormal."

Dr. Cortex is out of town...

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

Mr. Tuningfork: "Hi! I see Dr. Cortex! And my face feels like it's vibrating!"

Dr. Grumpy: "How long has your face been vibrating?"

Mr. Tuningfork: "25 years!"

Dr. Grumpy: "So why are you calling now?"

Mr. Tuningfork: "Because it's REALLY bad today! I'm afraid it may fall off!"

Dr. Grumpy: "Sir, I assure you that your face won't fall off."

Mr. Tuningfork: (angry) "How do you know?!!! Has your face ever vibrated?!!!"

Dr. Grumpy: "No, but..."

Mr. Tuningfork: "Look! I didn't call to argue with you! I just want to know what to do if my face does fall off? Should I get help? Or tape it back on? Or what?"

Long pause

Dr. Grumpy: "If it falls off, put it in an ice chest and go to the nearest ER immediately."

Mr. Tuningfork: "Okay! Cool! Thanks doc! I'll get one ready, just in case!"

(hangs up)

Irony

Last night I was watching a video of the freighter Algoport sinking in 2009 (no lives lost).

As the ship began it's final plunge, comically, a pop-up ad for Consumer Reports appeared at the bottom of the screen.







I guess this freighter isn't going to be rated particularly high.

Memories...

I don't watch doctor shows. I just don't care. But my Mom has always been a sucker for them.

"Pimping" is a longstanding tradition on teaching rounds. An attending physician routinely grills residents and medical students, partially to make them squirm and partially to teach them. The questions can be about medicines, diseases, conditions, or totally random ("the song that's playing in the elevator, what year is it from, and who was the group's lead singer?" I'M NOT MAKING THAT UP!).

In the mid-90's I'd graduated from medical school and was in residency training to become a neurologist. In the time-honored tradition of wayward children, I'd gone to my parents' house to do laundry. I was folding it in the family room, while mom watched a medical show.

On TV a bunch of white-coated figures were on rounds. Suddenly a senior physician looked at a medical student and asked "He's an alcoholic. Why do we give him thiamine, and not just glucose?"

Without thinking, I answered the question aloud (you get conditioned to do that). A few seconds later, a guy on TV said the exact same thing I just had.

And my mother, in wide-eyed astonishment, looked at me and said "Hey! How did you know that?"

Rebuttal

Since I believe in fairness, I'd like to publish a response to my post about research in the lay press. A professional journalist was kind enough to mail me his take on the subject:


Dear Dr. Grumpy

To defend my profession:

You scientists DO understate the results of studies to "may possibly". It's not until you see lots of people die of something called "cancer" that you state the disease "isn't even a single disease- it's hundreds."

And a good scientist needs to have his or her nails removed without painkillers before one will state that, "XYZ causes ABC." How long did it take to figure out smoking causes cancer? That too much fat is not good for the heart?

That leaves Marty Anyreader wondering what the heck cancer is, and why, after throwing all that money at the problem, medical folks can't cure Cousin Tillie's breast cancer.

And you expect us journalists to explain that? We, who were the champion spitballers in the back of the room while you guys were soaking up all the teacher's attention? The ones who didn't take a single science course or even (gasp) statistics and probability in college?

Now, multiply that problem throughout the population of newspaper readers and television viewers. You have less than 30 seconds to explain a complicated scientific discovery to Marty Anyreader before he loses interest. So, editors think they have to "punch up" the story. Heaven forbid that he/she/it misses the Cure For Cancer!

Remember, as a journalist, our understanding of the basic science involved is sketchy at best. Readers/viewers is less than that (I know there are PhDs and the like out there, but ...)
Anyway, I think you see the problem. It's like explaining to Ms. Anypatient that she has Glioblastoma Multiforme. You have more time than we do. A little more at least. And your patient has more interest

My suggestion (besides requiring basic science for journalism students) is that scientists keep writing for other scientists. The research is valuable even if it does wind up in "Genetics Research and Lab Decor." However, when the article is published know that there will be a writer from "Dead Rat Weekly" who is having "Pulitzerchosis" and is itching to be the next Woodward or Bernstein.

In defense of my hungry colleague: Dr. Hodgkin's results, no matter how obscure, still suggest SOMETHING that might stop the cancer's spread.

To a scientist that is promising. Worth looking at further. I don't know if the result in the math sense is a significant number, but to a layperson, it is interesting. To someone with ovarian cancer or a loved one with ovarian cancer, it's a lifeline.

Maybe (or maybe not) it's something that will treat human ovarian cancer. But at least it will add to our store of knowledge.

But remember what I said about the science background of most journalists. To Reporter Hungry and Editor Avarice, this is big stuff. So it gets headlines.

And then doctors get women and their families wanting to know why YOU aren't using Dr. Hodgkin's' latest advance.

*sigh*

There is your audience and your "translator" to the masses. Good luck.


Dr. Grumpy responds:

Thank you for your letter. I appreciate you sharing your side of the issue.

I agree with you. All research, and every breakthrough, has to start somewhere. People focus on Penicillin being discovered by accident, but ignore that those situations are exceedingly rare. The majority of medical breakthroughs take a lot of time, patience, and money.

The trouble isn't in the research, it's how people make a huge leap of illogic from preliminary findings in non-humans, and suddenly want that treatment TODAY! A lot of treatments that looked remarkably good in preliminary stuff (look up Dimebon if you wish) have later fizzled in large scale human trials.

One topic that I did NOT touch on is the number of times you guys are screwed over by an unscrupulous Dr. Hodgkin. It wasn't really the main theme of the post, but I could have written this instead:

"Let's say Dr. Hodgkin does some research on rat ovarian cells. He finds that in 25% of rats with ovarian cancer, there is a gene that may be able to stop cancer spread.

He gets published in the obscure journal Genetics Research and Lab Decor. But no one pays attention. And to continue his research, he needs money. And he'd also like a promotion. But his stuff is obscure enough that he doesn't get a grant.

So he calls Mr. Hungry Reporter, and "leaks" his results in a way that makes them sound far more promising, and immediate. Mr. Reporter isn't a scientist, and has to take the story at face value. So he publishes what Dr. Hodgkin told him, making it sound like the cure of ovarian cancer is close.

Now the attention is on Dr. Hodgkin. His university is in the spotlight, and suddenly wants to put money into his program (after all, they don't want to look like they're ignoring a cure for cancer), so they solicit donors and promote Dr. Hodgkin. When his research is, in fact, anything but groundbreaking. He's simply manipulated the media in a way that is unethical (or pretty damn close)."

IG

Today's tip

Okay, folks. Keep this in mind:

When visiting deceased ancestors at the nice, quiet cemetery, PLEASE wait until you get back to the car before getting your funk on.

You might piss them off by romping on the grass, and they'll get even.

Thank you, Don!

Catch-22

Dr. Heller: "This is Dr. Heller, on behalf of Major Illness Insurance test authorizations. Who am I speaking to?"

Dr. Grumpy: "Hi, this is Ibee Grumpy. I'm calling to get an MRI authorized on a lady."

Dr. Heller: "Okay, let me check her file... It looks like we denied the MRI because it isn't clinically indicated."

Dr. Grumpy: "Well, I'm worried this lady has MS, and want to do an MRI to find out."

Dr. Heller: "So does she have MS? We'll cover the MRI if she already has a diagnosis of MS."

Dr. Grumpy: "I don't know. I want to do the MRI to find out if she has MS."

Dr. Heller: "Our policy is only to do MRI's on patients with known MS."

Dr. Grumpy: "So how am I supposed to find out if she has MS in the first place?"

Dr. Heller: "You're the neurologist."

Feed issue

I have NO idea how another blog, a non-English one, got linked to my feed. I haven't touched the settings since I set up the feed 6 months ago. I'm looking into it now. All the settings appear to be correct, and the feed source codes haven't been changed. So I'm hoping this is some odd technical glitch.

Hopefully this is a temporary issue that will be fixed soon.

Sorry.

Too bad it wasn't one of those damn gnomes

A group of devoted policemen successfully defend a quiet neighborhood.

Thank you, Diana!

Things that make me grumpy

In case you live under a rock and missed it, the World Health Organization recently announced that cell phones "may possibly" cause cancer.

Now, I'm neither a researcher or statistician, and personally think the jury is still out on this one. I'm not going to take sides.

But here is what I am pissed off about: Notice that the story said "may possibly" cause cancer. But the way we think, it somehow becomes "does cause cancer", and so we panic, and hold our cell phones a yard from our head, and scream into them (that's gonna make driving while talking into one a helluva a lot safer, huh?).




"I can't hear you, Dave, but at least I may possibly not get cancer."


In my opinion a lot of the way this stuff gets played up as the top story on news outlets is just bullshit. It's no different than if I put "SEXXX" in screaming letters at the top of this post. It sure as hell would get your attention, and snag a few search engines, but the post has little, if anything, to do with sex (unless you're into setting the phone on vibrate and...)

This is the nightmare of medical research in the lay press. Let's say Dr. Hodgkin does some research on rat ovarian cells. He finds that in 25% of rats with ovarian cancer, there is a gene that may be able to stop cancer spread.

So he gets published in the journal Genetics Research and Lab Decor. A hungry reporter finds the article, and sees a great way to sell papers with a story on how ovarian cancer has been cured!

Now this isn't what Dr. Hodgkin said. His research had a 25% success rate in curing mice with a certain type of ovarian cancer. The most he might say is that someday this might lead to new methods of treating some types human ovarian cancer.

But, of course, nobody gives a shit about mice with cancer. A headline saying "25% Of Mice with Ovarian Cancer May Someday be Cured!" wouldn't get anyone's attention. But if you make a huge leap of illogic, extrapolate it to humans, and put up "CURE FOR OVARIAN CANCER NEAR!", it will sell newspapers and draw readers, no matter how far off from the truth it is.

For those of you who remember, in the mid-80's there was a HUGE media circus about how Interleukin-2 was THE cure for cancer (an absurdity, if you think about it, considering that cancer isn't even a single disease- it's hundreds). Major news magazines and TV networks ran stories about it. It made the front page... and that was about it. Not to take anything away from Interleukin-2. It eventually did settle down and find a place in malignancy treatment. But was it the miracle breakthrough that it got played up as? Not even close.

By the same token, in the 1970's EVERYONE knew Saccharin caused cancer. So it got a big black box on every product that contained it. And after several years it was quietly found that it DIDN'T. Of course, when the second story came out it was relegated to the back page, and people didn't notice when the warning labels disappeared. Because it's more interesting to scare people, or give them false hope, than to reassure them.

Certainly there are plenty of things that are clearly proven to cause cancer: cigarettes, for example. But hell, at this point we all know that. So it's not going to get attention. But put up a headline about something we believe is harmless (unless you're trying to pass a cell phone talker on the freeway) and it will get a lot of readers.

So let's get back to the cell phones.

What really grates my crank is the use of "may possibly" or "possibly" or "may be linked to..." that the articles about this are so full of. NOT "does" or "doesn't" but simply different variations on ambiguity which, while getting your attention, DON'T REALLY SAY A FUCKING THING!!!

Look at it this way. "Cell phone use may possibly cause cancer". How is that different from "cell phone use may or may not cause cancer"? But if the second sentence was used, you'd say "No shit, Sherlock" and skip the article.

To take it a step further, let's use the "may possibly" phrase in other circumstances, and see how definitive that sounds:

"Mrs. Smith, you may possibly be pregnant."

"Dave, you may possibly be fired."

"You're going to see Dr. Grumpy? I heard he may possibly be competent."

"The Grumpyville Faceplants may possibly win the Super Bowl."

"Congrats, Cindy. You may possibly be getting a promotion."

"Dude! There may possibly be beer and girls at the party!"

"OMG Buffy! Your new boyfriend may possibly be HAWT!"

"KIDS! You may possibly be punished if you don't clean up your damn rooms!"


Doesn't give you a lot of confidence, or clarity, does it?

So next time you see a medical research news story, think about how accurate it may possibly be.

Great office moments

Dr. Grumpy: "Hi, Phil. Head back to my office, second door on the right. You've been here before, just follow your wife."

Phil: "I have been following her. That's why I'm in this shit hole"