Today's lesson: Never leave the patient alone.

Mrs. Ungal: "Hey doc, look at this!" 

Holds up small flat object, sort of a whitish-greenish-brown.

Dr. Grumpy: "What is it?"

Mrs. Ungal: "My big toenail. I pulled it off while you were talking to Mary."

Predictive humor

I was giving post-call checkout to Dr. Brain last night. The list was REALLY LONG.

Dr. Grumpy: "And that's it. Sorry about the list, it was insanely busy."

Dr. Brain: "Okay. Not your fault, but holy crap this is a lot of patients" (chuckles) "oh well, maybe some will die overnight."


3 of them did!

Sunday Reruns

So following the time-honored tradition of my Bible (Chapter 20- Execute Forms at Dawn) I'm sitting here doing miscellaneous paperwork.

For those of you who have never had to deal with employer health forms, they are a freaking nightmare. A remarkable collection of stupid questions, redundancy, and more redundancy.

Today I'm completing job forms for one of my epilepsy patients, who works in sales. Questions from his employer include:

Is Mr. Shakes capable of working in sales during a seizure? (depends on what he's selling)

Would a seizure at work impair Mr. Shakes' job performance? (No! Who could resist an unconscious salesman who just wet himself?)

Will Mr. Shakes need to leave work to attend doctor appointments? (Of course not, I'll just swing by in the Grumpymobile)

If Mr. Shakes has a seizure, will it be necessary for him to leave work? (No, just leave him lying in the aisle)

Between seizures, is it safe for Mr. Shakes to operate a golf cart for clients? (NO! Wait till he's having a seizure, THEN let him operate it)

We have a great deal for you! CLEAR!

I found this in a pile of scratch paper this morning. Obviously, I missed out on whatever fantabulous deal it was.

In medical language "coding" generally doesn't refer to someone who's in a good state of health. So if the customer is coding, having to pay full price on a book is the least of his worries.

Yes, medical coders, I know what it's really referring to. But it still give me a laugh.

I had no idea it ever was

Patient quote:

"Doctor, I've had so many of my friends die from brain cancer that it isn't funny anymore."

Chaucer, M.D.

There's a new hospitalist in Grumpyville, who's either a medieval time traveler or frustrated Renaissance Faire participant. In the last week I've seen these statements on his charts (and yes, he really does use the royal "we" when speaking):


"We shant deny neurology the pleasure of this consult."

"We beseeched the patient to stop using heroin, yet still she scorns our advice."

"Cardiology has been waiting in the wings, and we shall summon them forthwith."

AAN LOTR NOLA

This week is the AAN (American Academy of Neurology) annual meeting in New Orleans.

For neurologists, this is THE event. To outsiders, it is the largest collection of neurogeeks in the world.

This is where the majority of the participants registered with NCC-1701 as their password. Where you'll find people who don't know their kids' names, but can lovingly identify every structure on an axial slice of the pons. And where you'll find the last 5 people on Earth who wear bow ties to work.

I wasn't invited (they're angry at me for revealing our darkest secret), but I do have a spy there, sending me pictures with a camera cleverly disguised as a phone.

Agent SMOD took this picture in the exhibit hall:

It's a company that makes gadgets to measure nerve thickness at the back of the eye. So they have giant round screens surrounding the booth showing huge eyes. Big Brother is watching you spill coffee on the sales reps.

These things only reaffirm that neurology was the right specialty choice for me. Because my first thought was how much it reminded me of this image:

What would Frodo, do?

Or perhaps this one:

I'm sorry, Dave. We're out of Diet Coke.

(If you don't recognize the movies, ask a neurologist. If you can't find one, they'll be back from New Orleans next week).

Thank you, ladies!

Today is Administrative Assistant's Day (formerly Secretary's Day) and this is dedicated to my awesome staff, Annie and Mary.

Mary's Desk

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

Mr. Azz: "Yeah, I need to see Dr. Grumpy urgently today."

Mary: "Sir, you had a 10:00 appointment this morning, and didn't show up..."

Mr. Azz: "I know that. Obviously, I wasn't able to make it. But I still need to get in today."

Mary: Well, the rest of our slots are booked today. We can see you tomorrow at..."

Mr. Azz: "Maybe you didn't hear me. I said I want to be seen TODAY! So give me an appointment!"

Mary: "Sir, you had an appointment today, and you missed it. We don't have another. The best I can do is tomorrow."

Mr. Azz: "Screw this. Tell the doctor he's fired. I'm going to find a practice that helps people who need it."

Irony

This Saturday in Grumpyville was a fundraising walk for breast cancer research, so while I hauled the kids to various Boy Scout/Girl Scout/Junior Terrorist activities I frequently passed groups of women walking along the course.

In mid-afternoon I noticed one in particular.

She was standing in the middle of a busy street, with her back to oncoming traffic, talking on a cell phone.

And she was wearing a pink T-shirt that said "Early Detection Saves Lives!"

Can you be more specific? T-Bone? Rib Eye? Strip?

I stopped by the office today to get the mail and change Ed.

A patient for Monday had faxed over some of his records, which included this note:

'My migraines feel like someone is pushing a steak through my head."

Jesus. Now in uniform.

Gee, why do I think drugs are involved?

Questions

Medical marketing surveys usually ask, at the end, if I have any recommendations to improve them. But last night I took one that had the question on every freakin' page!

So I was faced with things like this:

(click to enlarge)



I mean, it's a pretty basic question, not some bizarre doublespeak. So let's try to think of ways to improve it:

"Oh great and exalted one, in which medical specialties do you practice?"

"Look, asshole, what kind of doctor are you?"

"Even if you're really a yak herder, what are you pretending to be?"

"Does this medical specialty make my butt look fat?"

"You're still practicing? After 15 years you still aren't good at it?"

Master Yoda: "Which medical specialties practice do you?"

The nerve!

Dr. Grumpy: "I haven't seen you in a few years."

Ms. Glunk: "Well, I didn't need to come back until now."

Dr. Grumpy: "At your last visit you were having neck pain..."

Ms. Glunk: "Right, and it got better, because I wished it away."

Dr. Grumpy: "So what brings you back?"

Ms. Glunk: "My ex-husband unwished it."