Urgent matters

Last night I saw a hospital consult, with the following admission note:

"On Saturday, while packing his car, he suddenly felt lightheaded, followed by right-sided weakness and slurred speech. He didn't seek medical attention at the time. In fact, he and his wife drove to Connecticut that day for a short vacation. All symptoms have since persisted, and upon returning to Grumpyville this afternoon they went home, unpacked, and then came to ER for evaluation."

Balancing act

Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.

There are no easy answers. We're caught between doing what's best, without putting the patient through too much, and doing what's needed to protect ourselves from legal action.

Let's take Mrs. Summer. She's a nice 78 year-old lady I saw in the office last week.

Earlier this month she hurt her back. So she saw her internist, who correctly diagnosed her with a muscle strain. He gave her a muscle relaxant and Tylenol #3.

A few hours after she took the medications she became confused and sleepy. Her family called Dr. Internist, who said to stop them immediately.

She was absolutely fine the next morning, but her daughter is a nurse at the hospital, and wanted me to have a look at her for the episode. So she called Mary, and they came in last week.

The odds are that all she had was confusion due to Tylenol #3. So do nothing. It's most likely and least expensive.

BUT maybe she had a TIA. If I don't correctly diagnose that, and she has a big stroke, than they could sue me. So let's order a brain MRI, head & neck MRA, and echocardiogram. That's a few thousand dollars in tests.

Or maybe she had a seizure, and needs to be started on seizure medications. So lets order an EEG, too. Another $500.

Perhaps it was a metabolic event, with her blood sugar getting too low. So I'll order some labs. That'll be another $500-$1000 depending on how much I order.

This is the dilemma your doctor faces each day, many times over. None of us come to work saying "Oh boy! I can't wait to drive up the cost of health care today!" But we're faced with finding an (at times) impossible balance.

We don't get a 2nd chance, either. If we guess wrong we run the risk of getting sued. Another doctor is always willing to make a living as an expert witness and testify that we are incompetent.

And yet, with this sword of Damocles hanging over our heads, I and thousands of other doctors do this every day. And try to do the best we can, within the limits of human fallibility.

High speed chase

Look, people. If you're planning on being a crook, you need a decent getaway vehicle to outrun the cops.

You should NOT pick something that they can catch on foot.

Thank you, Jok!

Guess again

Dr. Grumpy: "Have you ever had surgery?"

Mr. Hollow: "Yeah, they took out my internal organs."

Dr. Grumpy: "Which ones?"

Mr. Hollow: "Um, I don't know. All of them?"

Maybe I should dress better

Yesterday a drug company hired me to do a lunchtime talk at an office down the street. It wasn't one I'd ever been to before.

I showed up at the appointed time, and politely waited at the front desk. After a few minutes a lady noticed me, and before I could speak, she said "Oh, glad you're here. Go through the door, and down the hall. It's the 3rd room on the right."

So I obligingly headed that way. I found myself in a room with a few business machines, and no people. An odd place to do a lunch talk, but some offices have very limited space. So I got out my speaker's notes and quietly glanced them over while I waited.

A few people walked by and looked at me, but didn't say anything. Finally the lady who sent me in came back.

Office Lady: "Uh, you can start whenever."

Dr. Grumpy: "But there's no one here yet to give my talk to."

Office Lady: "Talk? What do you mean?"

Dr. Grumpy: "I'm Dr. Grumpy, here to give a talk on Fukitol..."

Office Lady: "Oh, I thought you came to fix the copier."

Today's criminal tip

Okay, when committing a robbery, there are some things you shouldn't leave at the scene.

Like your diploma...

Life in line

I had to return something to the store last night, and was in line behind a lady carrying a large cardboard box with a picture of a table on it.

Counter Girl: "Can I help you?"

Mrs. Mesa: "Yeah, I bought this table that you have to put together, and I didn't like the way it looked when I assembled it. So I'm bringing it back."

Counter Girl: "Okay, do you have your receipt?"

Mrs. Mesa: "Right here." (hands over receipt)

Counter Girl: "Okay, and the table."

Mrs. Mesa: "Here you go." (hands over box)

Counter Girl: "Uh, this box is empty."

Mrs. Mesa: "Yeah. I put the table together, so it doesn't fit in the box anymore."

Counter Girl: "So where's the table?"

Mrs. Mesa: It's in my car. Do I need to bring it in?"

Counter Girl: "Yes, if you're returning it."

Mrs. Mesa: "Okay. But you should have that posted somewhere."

That doesn't sound good

Mr. Reaper: "Everyone in my family who's died, died of stuff."

Dr. Grumpy: "Like what?"

Mr. Reaper: "Bad stuff. I mean, the kind people die from."

Monday morning hospital rounds

I love it when I see contradictory stuff like this in a chart:

(click to enlarge)

Sunday Reruns

Mrs. Grumpy had a meeting tonight, so I had to feed the kids. Fortunately for me, a Big Pharma, Inc. drug rep brought lunch today to the office, and there were a lot of leftovers.

So as I was leaving this afternoon I grabbed a big bag out of the cabinet (with the Big Pharma, Inc. logo on it), tossed the leftovers in it, and headed out.

As I was passing a cardiologist's office on my way to the elevator, a pretty female rep I'd never seen before, wearing a Big Pharma, Inc. name tag, came out of his office. We made eye contact, and I nodded, smiled, and continued on my way.

Only to be stopped after another few steps by her saying loudly, "Oh MY GOD! What are you doing?"

I turned around to find Ms. Prettyrep looking at me, horrified, with her jaw agape. "Excuse me?" I said.

Ms. Prettyrep: "Are you taking food from a doctor's office?"

Dr. Grumpy: "Um, yeah, is that okay?"

Ms. Prettyrep: "NO! It's rude! It's unacceptable and inappropriate! And look at the way you're dressed!" (I tend to be on the casual side) "No name tag! What are the corporate people teaching you new reps, anyway?"

Before I could answer she went on: "I'm sorry. I suppose this isn't your fault. The training people must be slacking off." She offered me her hand. "You must be new. I'm Stacey, from the cardiology marketing division".

I shook her hand. "I'm Dr. Grumpy, from the neurology division down the hall."

Stacey from the cardiology marketing division looked even more horrified now then she had a minute ago. After a few stuttering attempts at saying something she answered her cell phone (which hadn't rung), mumbled "nice to meet you" and ran into the stairwell.

Random Saturday pictures

Thank you to everyone who sent in odd shots from everyday life.


Our first entry is a business that either needs a better speller, or has a strange inventory.





Next, we have a company that really needs a better acronym.





And finally, a reader whose car has a commentary on Driver 1's condition.

Minor details

Last month a local ER went to a Dragon-based dictation system that enters stuff in the chart as you type/talk, and you CANNOT undo anything. You can only dictate an addendum.

So I'm reading a note yesterday on a nice little old lady:

"When I went back into the room the patient was clearly intoxicated and verbally abusive. Her husband took off his belt and tried to hit me with it. Security was called and the husband was physically restrained, though he bit a guard in the process. The patient was put in 4-point leathers and given Haldol when she attempted to punch a nurse. Sorry, please ignore that, it's the wrong chart. Please rewrite it as: her head CT was normal, and I think she has benign positional vertigo. She and her husband were satisfied with this, and I gave her a prescription for Antivert. She'll follow-up with Dr. Grumpy next week in his office."

Attention patients:

Calling Mary "asshole bitch" for asking for your co-pay (or pretty much any reason) will not get you anything but the door.

Also, telling me "if you don't waive my co-pay I'll fire you", is not going to be taken as a threat.

Annie's desk, July 13, 2011

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

Ms. Whiney: "Yeah, I'm trying to get a lift chair, and the notes Dr. Grumpy furnished aren't getting it covered."

Annie: "Let me look at your chart... I don't see you having a neurological reason to have a lift chair."

Ms. Whiney: "I don't care. I want one. What's this line on the form that says 'neuromuscular disease'? Do I have one of those? Or can he at least check it off?"

Annie: "No."

Ms. Whiney: "I have migraines. Does that count as a neuromuscular disease?"

Annie: "No."

Ms. Whiney: "How about my bunions?"

Annie: "Goodbye."