Wednesday, July 6, 2011

Dear Ms. Patient,

I'm sorry to hear you've fired me, and that you're irate you owe me $200.

You've been here 3 times in the last 6 weeks for various issues. Each time, as per office procedure, Mary asked if your insurance or address had changed, and each time you said no.

Last week we learned that not only HAD your insurance changed, but it was to a plan I don't take.

When my billing service called you about this, your reaction was "well, if my last insurance covered him, my new one should." Wrong.

And you just left Mary a scathing voicemail claiming that it's OUR fault for just taking your word on the insurance, instead of demanding that we see a copy of your card at every visit. Silly us, we assumed you'd tell us if it changed. That's why we ask each time.

I also loved the part about you threatening to turn me into the state board and "giving you bad reviews on all the internet rating sites" if I didn't forgive the $200.

This is no different than shoplifting. If you stole $200 worth of merchandise from a store, they'd press criminal charges. I can't do that, but I can turn you over to collections. I don't care if you're stupid, pretending to be stupid, or just malicious, but this is what I do for a living. You were more than happy to accept my treatments, and signed a bill after each visit.

Have a nice day.

Tuesday, July 5, 2011

Mary, give this man an appointment

My office has 3 overhead fluorescent light fixtures. When I came in today the one over my desk had burned out.

No biggie. I called maintenance, and they sent Mr. Repairman over.

He comes into my office, and looks at all 3 light fixtures. After a minute he points to the dark one over my desk and says "Doc, is this the one that isn't working?"

Show him the BaRF!

Medicine is full of rating scales. This is a new one to me.

It's used to ask kids how nauseous they are. And it is, I swear, called the Baxter Retching Faces (or BaRF) scale.


Monday, July 4, 2011

July 4th history lesson

Covert operations, while recently famous due to the hunt for Bin Ladin, have been an integral part of militaries since the dawn of time. The technology changes, but the people don't. Out of many remarkable ones, probably the most successful operation of this type (in my opinion) was the British commandos who knowingly went on the one-way Operation Chariot (which is rarely mentioned in schoolbooks today).

But, since it's July 4th, I'm going to write about an American most of you have probably never heard of. Although he certainly wasn't the first American to carry out a dangerous mission, he did what many thought was impossible.

During the American Civil War the new technology of iron warships was being repeatedly put to the combat test- with stalemate results. Although metal ships could easily destroy wooden ones, clashes between ironclads typically resulted in a lot of smoke and noise, but both opponents survived. Sinking a solid ironclad remained a challenge.

In 1864 a single, dangerous, Confederate warship, the Albemarle, was guarding the North Carolina Sounds from Union forces. She was small by today's standards, and had been built in a cornfield because of a lack of shipyards. But in her iron hull she had 2 powerful cannons, and had proven herself in combat. Her existence was a thorn in the side for Union forces, who didn't have an available ironclad that could travel far enough to reach her. Her location, and potential to get out and cause trouble, prevented more extensive military plans from being carried out.





Even when young, William Barker Cushing was a chronically ill man, with recurrent respiratory infections and headaches. He was, nevetheless, admitted to the U.S. Naval Academy- only to be expelled in his 2nd year for pranks. But when the Civil War started 3 weeks later officers were needed, and he was reinstated. In spite of his multiple health problems he proved himself to be a relentless warrior, and at age 19 was given command of 2 ships that had been taken as prizes.

He excelled in daring missions, leading a raid into a confederate harbor to burn ships, and later several missions behind enemy lines to destroy military supplies. He was promoted rapidly, and was even brought to meet President Lincoln to give him a personal appraisal of the war. A few weeks later Cushing's brother was killed in the fighting at Gettysburg.

In 1864 he led a covert raid to capture a Confederate general, Louis Hebert. The raid was almost successful- but Hebert had traveled to Wilmington on business the day before. Cushing took other prisoners, and left a signed note on Hebert's desk saying "I deeply regret that you were not here when I called."

Cushing thought about the Albemarle hiding upriver, and how to stop the seemingly invincible ironclad. He finally came up with the idea of a surprise attack using a small boat and explosives.

It seemed like a suicide mission, and hadn't been done before. But the Albemarle was a problem that had to be dealt with, and Cushing had shown a remarkable ability to do the impossible. His commanding officer recorded that he personally felt Cushing's idea was "a forlorn hope... I have no great confidence in his success" but, since a failed mission would cost the Union only 2 boats and a small group of men, was willing to proceed.

Cushing went from ship-to-ship in the blockading Union squadron, asking for volunteers. He told them of the dangers: traveling up the Roanoke river, trying to slip by confederate outposts and sentries, and sinking an ironclad.

On October 27 he and his handpicked crew had a champagne dinner to celebrate the coming success of their mission (or their last meal) before leaving. They sailed at 11:00 p.m. on a small wooden steam-powered boat, with an explosive charge mounted on a long pole in front.

It was a dark night, with rain. Cushing and his men managed to slip past several Confederate stations before the Albemarle's night watch saw him and rang the alarm He was too close at that point for the ironclad's cannons to be used, but her crew, and shore troops, opened up a withering fire.

Cushing continued on, only to discover the Albemarle was surrounded by a floating log boom, linked by heavy ropes. It was too far away from the ship for his explosive to work. By this time one of Cushing's men had been wounded by enemy fire, and Cushing himself, while unharmed, had his clothes shot through in 3 places.

He turned his boat away - and for a few minutes the Confederates thought he'd been driven off. But Cushing just wanted to build up speed. After traveling 100 yards downriver he turned around, and throttled to full speed. He and his men knew there was no way to get back over the boom once they crossed it.

The heavy fire continued. Cushing was shot in the left hand, and the back of his jacket and sole of one shoe had been shot off. But he didn't flinch. His boat struck the logs and went over, driving the explosive charge into the Albemarle. The force of the blast "blew a hole you could drive a wagon through" and the ironclad rapidly settled into the mud as her crew jumped to shore.

Their boat trapped, Cushing and his crew abandoned it. Only Cushing would return to safety, the others all surrendering or drowning. But they had done what no ship had been able to: sink an ironclad.

Cushing swam downriver that night, and spent the next day evading Confederate patrols in a swamp. That evening he stole a rowboat and paddled back out to the waiting Union fleet. With the news of the Albemarle's loss the Union forces moved rapidly, and successfully, upriver.

Cushing's star was bright, but brief. After the Civil War he began having debilitating attacks of hip pain, and his headaches and respiratory problems worsened. He married and had children. In spite of his health issues he tried to remain in active service. At age 30 he became the youngest man in U.S. history (up to that time) to become a Commander.

His pain worsened, and spread. The medical science at the time didn't find a cause for his worsening (now suspected to be either Tuberculosisis or metastatic cancer). On Thanksgiving 1874 it was incapacitating, and he became delirious. He died 3 weeks later, and was buried at the U.S. Naval Academy Cemetery.

He was 32.

New page announcement

Due to several requests, I've compiled all the Grumpy vacation adventures into a single page, joining my history and artisanal pages. You can find it down in the right sidebar. Enjoy!

Some have written wondering when the 2011 vacation will be. Don't worry, it's coming (sighs, looks at credit card bill).

Sunday, July 3, 2011

Sunday reruns

Dr. Unka is in my office complex. When he refers a patient to me, he often walks them upstairs to my office and waits with them up front (while his own waiting room backs up) until Mary has scheduled the patient. He often asks that I drop everything I'm doing to come meet his new referral, instead of just having them call us to make an appointment.

So today Mary called me to say Dr. Unka was up front, and wanted me to come meet a new patient. So I excused myself from my current patient and went up front, to see him standing there with a familiar, somewhat irritated-looking, older lady.

Dr. Unka: "Ibee, I'd like you to meet Mrs. Ancient. I'm referring her for memory loss."

Dr. Grumpy: "Uh, Mrs. Ancient was here 3 weeks ago for that."

Mrs. Ancient (glaring at Dr. Unka): "I told you! Why didn't you listen to me?"

Dr. Unka: "She was?"

Mrs. Ancient: "Yes!"

Dr. Grumpy: "Yes, I sent you a note."

Dr. Unka: "You did?"

Mrs. Ancient: "Yes! He did! It was even in my chart at your office! I pointed it out to you!"

Dr. Unka: "You did? Um, I mean, then have her make a follow-up." (leaves).

Saturday, July 2, 2011

Random pictures

All right, due to me being tired and it being a holiday weekend, I'm going to put up some random shots I've been sent.

To show that the hated autocorrect feature is everywhere, this picture shows how a computer interpreted the phrase "IP-joint" (it stands for interphalangeal joint)

(click to enlarge)





Next, we have this page that was sent as an urgent-lab-results-please-call-nurse-ASAP to a doctor (for those of you not in medicine, this result is normal).






And finally, a neurologist who was trapped in an airport took this picture of brain-shaped chocolates for sale. I can only assume that (amongst other advantages) they have a lower risk of causing Jakob-Creutzfeld Disease than eating a real brain.


Friday, July 1, 2011

I stand corrected

Dr. Grumpy: "Hi, I'm Dr. Grumpy. Have a seat... What can I do for you?"

Mrs. Newpatient: "You wrote me a script for physical therapy, and I lost it. When I finally found it last month the therapy place said it was too old, and that I needed a new one."

Dr. Grumpy: "Hang on, ma'am... "(frantically searching computer) "um, I've never seen you before, let alone ordered therapy for you. We don't have anyone by your name or birthday in the system."

Mrs. Newpatient: "That's not true! I have your script right here!"

And she pulls out a discolored, dog-eared, wrinkled, physical therapy order from freakin' 1994, written, by me, on the order forms from the hospital I did my residency at.

Thursday, June 30, 2011

Reasons to throttle children

Dr. Grumpy: "How'd things go with the new camp counselor today?"

Craig: "Fine. He's nice. He looks a little like you, with that same tinning hair style."

Dr. Grumpy: "Tinning hair style?"

Craig: "Yeah, Mom says it's called tinning. Where you have skin in front and hair in back."

Mary's desk, June 29, 2011

Lady walks in, writes name on sign-in sheet.

Mary: "Hi, Mrs. Chronos. Your appointment was 45 minutes ago."

Mrs. Chronos: "I know. Your office is near my Mom's nursing home, so I stopped to visit her."

Mary: "Okay, but he's already with his next patient, and we're packed full today. I'm going to have to reschedule you..."

Mrs. Chronos: "So you have something against my Mom?"

Mary: "No, but regardless of why you're late..."

Mrs. Chronos: "You just don't care about the importance of family!" (walks out).

Wednesday, June 29, 2011

Leggo my Eggo!




Thank you, Bob!

EEEEEYYYAAAHHHHHHHHHHH!!!!!!!!!!!!!!!!!

Sir, I think the test you're referring to is the PSA for prostate cancer.

While it is, like a mammogram, part of preventative health care, the two tests are not at all similar.

It is NOT called a "penogram", and doesn't involve having your winkie squashed between metal plates.

Thank you. Now go get your blood drawn.

Tuesday, June 28, 2011

Mary, order another case of Rogaine for me

Dr. Grumpy: "Anything that triggers these spells?"

Mr. Dieffenbachia: "Yes. A plant."

Dr. Grumpy: "Do you know which plant?"

Mr. Dieffenbachia: "That one that grows outside."

Critical medical points

As my readers know, I go to great lengths to avoid other neurologists. I do this because this branch of medicine is just chock full of personality disorders.

Don't believe me? Allow me to introduce exhibit A, which was published in the January/February 2011 issue of Practical Neurology.

click to enlarge



Because, let's face it: It takes a really special kind of whackjob to write a letter complaining about using both the words "preventive" AND "preventative" in the same article. They even get bonus points for being able to cite an article from freakin' 1964 on such an important point.

p.s. You guys spelled "inconsistency" wrong.
 
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