Correlation and Causation

Mr. Homebody: "I only get these headaches when I'm here in Grumpyville."

Dr. Grumpy: "What about when you travel?"

Mr. Homebody: "Don't know. I've lived here my whole life. Never traveled."

Things that make me grumpy

The Israeli-Palestinian conflict is obviously a hot-button issue. And I'm not taking sides, nor am I proposing a solution. If you think this yak herder can help, you've come to the wrong place.

But here's where it affects me:

There's a Parkinson's Disease medication called Azilect. It has some unique properties, and there's no generic, or direct competitors, currently available. It's manufactured by Teva, a company that does most of their business in generic drugs. It's the world's largest generic drug manufacturer, and if you've taken ANY type of pill at some point in your life, the odds are you've used a Teva product.

Teva is an Israeli company. I personally don't care. From my view, they make a useful drug, and if I think you could benefit from it, I'll write for it.

Most people are fine with this. But I always get a handful of calls a year from people refusing to take it, or calling to yell at me, for prescribing an Israeli product. Some refuse to take it because they don't want to support Israel. Others have accused me of secretly prescribing it over other drugs as part of some vast Israeli conspiracy. I've even had one patient fire me because I wrote for it.

Here's the bottom line people: I don't care where your medication was made, who makes it, or the name of the chemist in the assembly line.

I am your doctor, and when you're here, my goal is to try and make you better. I'm not getting kickbacks for these scripts, nor are they my way of making a political statement.

Improving you is what I'm trying to do. So try to see it that way, and accept my help.

Crash course

No matter how good an idea it may seem at the time, it is NOT recommended that you let a 6 year old child drive your car.

Mary's desk, August 9, 2011

Guy walks in, stands up front.

Mary: "Hi, can I help you?"

Mr. Papers: "I have an appointment with Dr. Grumpy."

Mary: "Oh, yes. I mailed you our new-patient registration forms last week."

Mr. Papers: "I have them right here." (hands papers across counter)

Mary: "Thank you... Um, sir, these are completely blank."

Mr. Papers: "Was I supposed to fill them out?"

Hole-in-one

Due to the large number of people sending me this article, I'm sharing it with all of you.

Basically, some guy in Arizona blew a hole in his trouser snake when he mishandled a cute pink handgun.

Nothing says love quite like matching his & hers firearms.

Now THIS game just screams "excitement!"

This question was in an online survey I took last night.

(click to enlarge)

It's never a good sign...

When the new patient, on the sign-in sheet, writes their name as Ibee Grumpy.

Then, when questioned, has no idea who Ibee Grumpy is.

Caring

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

Mrs. Concern: "You see my Mom for back pain, and it's still pretty bad."

Dr. Grumpy: "I've tried a couple things, but she wasn't happy that they all made her sleepy."

Mrs. Concern: "Yeah, but you really need to call in something strong for her pain, regardless of how sleepy it makes her."

Dr. Grumpy: "Is she worse today?"

Mrs. Concern: "No, but if her pain doesn't get better she can't watch my kids tomorrow."

Important research

Several people found my challenging case on Friday to be so idiotic as to defy belief.

However, the Science Marches on Department has kindly brought my attention to a similar case that actually got published in a medical journal!

Yes, folks, here is the story of a lady with visual loss. After a work up found no clear cause, they discovered they could fix the problem simply by holding up her eyelids with tape.

Unfortunately, the abstract doesn't clarify what kind of tape. How would masking vs. Scotch vs. duct tap compare for this? Clearly, more extensive studies are needed.

Random Saturday pictures

All right, today I'm presenting a selection of pictures that you Grumpy fans have sent in recently:


First, here's a picture from a reader currently traveling in China, who noticed this window as he passed a building:





Next, moving closer to home, we find this interestingly-titled dog salon. With a name like that, one has to wonder what Tim's idea of "full service" is. And if it involves the store's rear entrance.






And last, we at Dr. Grumpy, Inc. wish to salute Hoboken, New Jersey. The city is boldly taking a stand to eliminate the stigma often associated with being a mentally healthy person.

Think, think... Brain blast!

Okay, it's time for all you armchair neurologists to help me solve a particularly difficult case. The following is, without any changes, the admitting note from Dr. Hospital, who asked for my help on this challenging case:

"88 year old male who woke from a nap with bilateral visual loss. Symptoms resolved when he
opened his eyes. We will admit for stroke work-up, and consult neurology."

Annie's desk, August 4, 2011

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

Ms. Loud: "HI! IS BILL GRUMPY THERE?"

Annie: "No, this is Ibee Grumpy's office. There's no Bill here."

Ms. Loud: "I NEED BILL. CAN YOU AT LEAST SEE IF SOMEONE NAMED BILL GRUMPY WORKS THERE? HE USED TO LIVE IN CHICAGO, IF THAT HELPS."

Annie: "Sorry, there's no Bill here, and Dr. Grumpy isn't from Chicago."

Ms. Loud: "OH NO! OKAY, I'M TRYING TO CALL EVERYONE NAMED GRUMPY THAT I CAN FIND IN THE COUNTRY TO SEE IF HE MAY BE THERE. MAYBE THEY'RE RELATED TO EACH OTHER OR SOMETHING LIKE THAT. I'M HAVING TO USE PHONE BOOKS BECAUSE THE DOG BROKE MY COMPUTER AND WON'T LET ME HAVE IT FIXED."

Annie: "Okay, well good luck, bye."

Ms. Loud: "WAIT! DON'T HANG UP. I NEED TO ASK YOU A FAVOR."

Annie: "What can I do for you?"

Ms. Loud: "IS BILL GRUMPY ALSO A DOCTOR? OR JUST IBEE GRUMPY?"

Annie: "I have no idea about Bill. You're the one looking for him, so you should know."

Ms. Loud: "I DIDN'T THINK SO, BUT IT'S NOT LIKE HE EVER TOLD ME HE WASN'T, SO I'M NOT SURE."

Annie: "Okay, have a nice day..."

Ms. Loud: "HANG ON! IF BILL GRUMPY DOES SHOW UP THERE CAN YOU PLEASE TELL HIM THAT ANGIE LOVES HIM?"

Annie: "Will do. Goodbye."

Things that make me grumpy

There are so many days that I want to put up a sign that says "Control Your Children or Leave".

I have kids. 3 of them. A rambunctious bunch. We generally avoid taking them anywhere like our appointments, and in the rare case where we have no choice we bring distractions: Nintendo DS, books, etc. I know that not everyone has easy access to child care, and understand that.

But...

It's amazing how many people come in thinking my staff and office supplies solely exist to keep their kids busy. Neither Dr. Pissy nor I see anyone under 18, so we don't keep kid stuff around.

I've seen people tell their kids to just go sit up by Mary's desk and play with her. Or give them scissors, crayons, and glue to "make something" out of the lobby magazines. Or ask me if they can play online games on my work computer. Or just let them run amok in my exam room with my stethoscope, hammer, tuning fork, whatever. Ed has been knocked over 3 times in the last year by kids.

I've had patients leave my practice because their kids caused trouble during the appointment, and I've told them they can't return unless they find a sitter. I don't care that it pisses them off. I can't treat you effectively if I'm chasing your child all over because you think it's my job.

In a pediatrics office this is more common, and they are prepared for it. I go to my kids' appointments, and they have all sorts of books and toys to keep them busy (but we still bring Nintendos). But I don't see kids, and don't consider that something I should provide.

Unfortunately, this kind of behavior is common elsewhere. You see kids running wild, knocking stuff off grocery shelves. I know a veterinarian who had a kid, with his parent's permission, urinate on his office floor, and the family thought the vet was being unreasonable to ask them to clean it up. They figured a vet would be used to dogs and cats doing that, so what's the big deal if they let their kid do it?

Although frequently told by patients under these circumstances that "you obviously don't like kids," that's not the issue.

The problem is parents who won't control them.

"Dude! Let's smoke some okra!"

Yes, sometimes you can be desperate. Or not very bright. Or both.

Thank you, Lauren!