Sunday reruns

Thank you for coming in on this lovely Friday afternoon, ma'am. I guess you called around 1:30 today, and since we didn't have a 4:00, which is my last slot of the day, Mary put you in. Let me just open another Diet Coke, and we'll get started.

So you've had headaches for the past 20 years? And never seen a doctor before for them? What made you come in today, of all days, for this? Oh, you did a Google search.

Thank you for this printout of all the horrible types of brain tumors and aneurysms that can cause headaches and kill people. I appreciate it, because as a board certified neurologist with over 10 years of experience I really have no idea what sorts of things can cause headaches.

If you'd read it you might have noticed that the average survival from these awful things is 1-2 years, not 20. But I'm sure you're busy and didn't have time to actually read the articles you were printing up. After all, you had your hands full calling every neurologist on your insurance plan trying to find one who still had openings on this lovely Friday afternoon.

Of course we can get an MRI. I understand it would make you feel better, and allows me to cover my own legal butt, too.

Oh, you're claustrophobic? No, an MRI is really the best test we have right now for evaluating this sort of thing. I'm sorry that Reader's Digest somehow gave you the impression that I had a gadget in my office I could wave over you to make sure everything is okay, but I don't. Dr. McCoy borrowed my tricorder a while back and hasn't returned it yet. But we can do the MRI with Valium to relax you, if such a thing is possible.

I'll have my staff schedule the test for next week. No, I'm sorry. It's now 4:00 on a lovely Friday afternoon. Your insurance company requires an MRI request to be approved by a panel of dart-throwing chimpanzees before agreeing to pay for one. All of their offices are in another time zone, and have closed by now on this lovely Friday afternoon.

You really feel you need it immediately? Then the only thing I could suggest would be to go to an ER, and tell them you need an MRI right now. I'm sure, that after hearing your story and realizing how urgent this is, as opposed to a guy with chest pain, the ER doc will be happy to waste spend time and money on your case. Just don't tell him that I'm your doctor.

Oh, I had no idea your ER co-pay was so high. $50 does seem a bit extravagant for a lady with diamond rings on every finger and Porsche keys hanging out of your LV purse. I certainly can understand your refusal to go there.

Then it will have to be next week. My staff will call your insurance first thing Monday morning to get this authorized and scheduled.

Your insurance coverage runs out at the end of this month? My calender shows that today, May 29, is a Friday (which is a lovely afternoon by the way) and the last workday of the month. So Monday will be June, and we won't be able to get the MRI from your current insurance then, since it will have run out.

What insurance will you have on Monday? I'm sorry, I'm not contracted with that plan. I can send your internist a letter asking him to order the MRI. Oh, he's not contracted with it either. I see.

Yes ma'am, I agree it was entirely unreasonable of Mary to not have foreseen that you'd be changing to an insurance I don't take next week. You didn't mention that to her when you called for this appointment a few hours ago, but she really should have known, anyway. I'll discuss her suboptimal psychic powers with her at her next job evaluation in 2018.

I'm sorry you have to go already. Well, try to take it easy over the weekend, and I'll send my records to a neurologist on your next insurance, so they can help you out.

Going to a hockey game tonight sounds like fun, and it's great that you have such good seats. That looks like a nice air horn in your purse. I'm sure that sort of quiet, relaxed environment will help improve your headaches in the meantime. Thank you for sharing this lovely Friday afternoon with me.

WTF?

My wife bought this recently. It makes no sense to me.

It's like saying "Denver-style Texas BBQ." Or "Seattle-style New York Cheesecake."

Miscommunication

Dr. Grumpy: "When did the migraine start?"

Mrs. Armoire: "Monday, when my husband and I were talking. He'd just come out of the closet."

Dr. Grumpy: "That must have been quite a shock."

Mrs. Armoire: (gives me weird look) "Not really. He was putting away his jacket."

Technical support

Thank you to the reader who sent me this picture.

Because, ya, know, maybe there is someone out there who's never seen one of these, and needs a tip about what it's for.

But then WTF are they doing buying home electronics?

Trouble brewing

I got dragged in to ER last night to see an acute stroke. In the next room there was a 16 year old guy wailing and screaming uncontrollably.

He'd taken the family car without permission. Wrecked it. Knocked over a traffic light, broken both legs. And (of course) didn't have a license.

He was fine and quiet with all this until he found out his mom was coming to the hospital. And then he REALLY freaked out. Not over the wreck... but because she'd see that he'd gotten a tattoo on his chest.

"Oh my God! She's going to kill me! She hates tattoos! Please! Somebody, give me a gown, a shirt, a towel, anything, please, I gotta cover this! Please! Why did you guys have to cut my shirt off? This is going to get me in such deep shit. Somebody! A blanket! Or even a big band-aid! Or something, anything, to put over it."

Details. I need details.

Dr. Grumpy: "Are the new headaches like your migraines?"

Mr. Hedpayne: "No. They're different."

Dr. Grumpy: "In what way?"

Mr. Hedpayne: "They aren't the same."

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