But does it treat syphilis?

I'd like to thank a pharmacist, who I suspect wishes to remain anonymous, for sending in this allergy note that a patient handed her.

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"You want that plain, glazed, or with sprinkles?" (wink, wink)

When Dunkin Donuts picked "America runs on Dunkin" as their slogan, I bet they didn't think of this lady.

To make it even better, while searching for the story, I discovered this review of that DD franchise:

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Great moments on rounds

I had a hospital consult on a pregnant lady with migraines. I recognized the name as being one of my drug reps.

The door was closed, so I knocked, and someone yelled for me to come in.

I went in. "Hi, it's Dr. Grumpy, they asked me to..."

I stopped.

She was having a trans-vaginal ultrasound, her legs up and apart in the stirrups. The ultrasound tech had the probe up in her...

I was embarrassed, and began to retreat. "I'm very sorry, I'll come back this afternoon..."

She said "You might as well stay. I'm being transferred to a new territory, anyway."

Sunday afternoon

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

Mike: "Hi, this is Mike Hormone. You saw my girlfriend a few weeks ago for a left arm injury? She had a lot of trouble using her arm? I was with her at the appointment?"

Dr. Grumpy: "What can I do for you?"

Mike: "Well, she's getting a lot better, like you said she would and, um, I..."

Dr. Grumpy: "Yes?"

Mike: "Is there anything that might, like slow down her recovery? Not a lot, 'cause she's my girlfriend and all, but maybe just make it take longer?"

Dr. Grumpy: "Um, we're trying to get her better."

Mike: "Yeah, but she can use the arm for almost everything now, and when it was really weak she had me come in the shower to shampoo her hair for her, and that sort of got things going if you know what I mean..."

Weekend reruns

English is an odd language. Being a native speaker, it seems pretty easy to me. But I'm generally lousy at other languages. I took 2 years of Spanish in high school and 4 in college, and I still can't speak it worth crap.

As you guys know, I moonlight doing medical market research interviews. Some are over the internet, some are in person, and some are by phone.

Some of the phone meetings have been outsourced overseas, so occasionally I find myself chatting with someone who speaks English, but with a non-American accent. Occasionally it's someone to whom English is a second language, though usually they're still quite good at it. And that's the situation I found myself in yesterday morning.

The study was on my interactions with drug reps, given by a lady with a mild, nonspecific, accent, but her English was still quite good and understandable. Unfortunately, it was also very old-style, and oddly formal, with phrases and words that aren't used much among modern English speakers. Understandable words, just a little odd.

Most of them were minor, but one was an issue. She used the old word for personal interaction.

Which is "intercourse".

Yes, I know it can mean ANY kind of personal interaction, and the technical phrase for sex is "sexual intercourse". But it's been shortened over time, to where now intercourse just means you're doing the wild thing.

And I'm a veteran of crazy patients, and having to keep a straight face. And I freaking lost it here, (thank heavens for the phone mute button) and at one point had to run to the john to keep from peeing myself (I told her I was going for a Diet Coke).

Here are some of the questions:



"How many times a day do you have intercourse with drug reps?"

My inner voice: It's variable, depending on the time left after I have intercourse with patients.



"If a drug rep provides lunch for your office, are you more likely to have intercourse with them?"

My inner voice: My standards aren't that high. If she's hot, I don't care if she brings prime rib or Taco Bell.



"Do any of your staff members also have intercourse with drug reps?"

My inner voice: Oh yeah, we have a non-stop orgy here. Nowadays I just wear a silk robe to work.



"During intercourse, did the rep provide you with insurance formulary information?"

My inner voice: If she did, I was too preoccupied to notice.



"Following intercourse, did the rep provide you with medication samples?"

My inner voice: No, but we shared a cigarette.



Wait until Mary and Annie find out I had intercourse with a marketing person yesterday. Of course, then I'll be having intercourse with them, too.

Overheard at home

Marie: "See? Here's a picture. I told you it looked like this."

Craig: "Well figgle my newtons!"

Marie: "What does that mean?"

Craig: "I don't know."

Bad ways to meet girls

Whatever happened to the good old "What's your sign?" or "Do you come here often?"

Apparently this guy needed to try his own method.

Then why did you come here?

Mrs. Tech: "The headache is over the entire right side of my head, I get horrible nausea, and I can't stand light or noise."

Dr. Grumpy: "That's a migraine."

Mrs. Tech: "No, it's absolutely NOT a migraine! You should know better!"

Dr. Grumpy: "Why are you so sure it's not a migraine?"

Mrs. Tech: "The iPhone app says so."

Driver's Ed

Dr. Grumpy: "Anything else I can do for you?"

Mr. Bozo: "Yes, I need you to write a letter to the state, to get my 13 year old son a driver's license."

Dr. Grumpy: "The state driving age is 16, and your son isn't my patient."

Mr. Bozo: "I know, but you're treating my back pain, and when it really hurts I'm not comfortable driving. My son is the only one who's available."

Dr. Grumpy: "But he's not old enough to drive."

Mr. Bozo: "He drives those motor cart things all the time at the fun park. He does fine. Can't you just send the state a letter to get him a license?"

Dr. Grumpy: "I can't do that."

Mr. Bozo: "Why can't you be reasonable?"

Checkmate!

I found this in a hospital chart today.

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Neurology, 2011

Dr. Grumpy has lost his neurology mojo over time.

Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape.

Yesterday I turned away a good hospital case, and told them to find someone else.

The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.

28 year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). Within 2 days of admission he developed 2 separate cranial nerve palsies, on opposite sides.

Now, I know you residents and medical students are out there, holding up your hands and yelling "Oooh! Oooh! Mr. Kotter! He could have meningeal lymphomatosis with cranial nerve palsies! He needs an MRI and spinal tap."

Hell, you think I didn't know that? Like I said, these are the interesting cases that make the job fun.

So why did I tell them to find another neurologist?

Here's why:

The patient had seen another neurologist (who didn't come to my hospital) about a week before. He'd had an MRI done as an outpatient. He'd had a spinal tap done as an outpatient.

And yet, no one, including the patient and his family, had ANY FREAKIN' IDEA about which neurologist he saw (beyond "his office was on the west side"), or where the MRI was done, or where the spinal fluid had been sent for tests.

I don't care that someone else had already done the key parts of the work-up. I'm not looking to stand up as the great Grumpy, solver of the unsolvable. Any competent neurologist would know what to do.

And getting results is reasonably easy IF you know where to fax a release.

But in order to get the answer here I'd have had to try to track down a neurologist, an MRI facility, and a laboratory. And there are no shortage of any in Grumpyville.

And from personal experience (particularly involving tracking down labs) I knew it could easily take an hour or more of phone time to do this. I've found that when you want something specific, delegating it to an order in a chart ("please get outside labs from Planet Phlebotomy") will often get you nowhere, or some results you didn't want. So I'd likely be doing the calling, and getting transferred between departments, and then cut off, and having to call back... you get the idea.

When you have a full-time office practice, and a family of 5, adding an extra hour or two to the day isn't something you want to do. Especially when you're going to get paid the same amount for the consult no matter how much work you put into trying to track the results down.

And so I quietly told them to call another neurologist.

I still like what I do. But the realities of time, money, and frustration can dull the scientific curiosity of anyone. Even me.

Do not try this at home

No matter how easy surgery looks on your favorite TV show, it should only be done by trained professionals.

Also, it is not recommended that you try to staunch blood loss with a lit cigarette.

Like this guy.

Thank you, Lee!

Helpful

Dr. Grumpy: "Do have your MRI report here?"

Mr. Lumbar: "No, but it said I have disks in my back."

Dr. Grumpy: "Everyone does. Did it say anything more specific?"

Mr. Lumbar: "Um, it mentioned bones, too."

Fun with drugs

Wild times with hallucinogens.