Happy New Year!

Wishing all a happy Rosh Hashanah.

Patient quote of the day

"When it's really dark outside, and I've closed all the window shades, and all the lights are out, then things look really dark to me. Especially if I close my eyes."

Today's criminal tip

When trying to use a stolen credit card, don't hand it to the guy you just stole it from.

Thank you, Don!

Behavior

The twins, for whatever reason, are both running for student council this year. Elections are next week.

Last night they had to attend a mandatory "election rules" class. So, while Mrs. Grumpy picked up Frank from jail the bus stop, I took Craig and Marie to the meeting.

(There were some touchy issues. Craig's Hair, his running mate, had threatened to leave the ticket in a dispute over the newest member of his entourage, Craig's Cast, recently receiving more attention. The situation was defused by an agreement that Craig's Cast will be removed in 4 weeks. Craig's hair has now agreed to stay onboard for another 20 years, after which it will have the option of leaving at its own discretion and be replaced by Craig's Cheap Rug.)

Anyway, all kids were required to shake hands with the people they're running against, and then the following points were covered:

1. Keep it positive.

2. No negative statements. Give people a reason to vote for you, NOT a reason to vote against your opponent.

3. Don't make promises you know you can't keep.

4. Stick to the real issues (I have no idea what "real issues" there are in student council).

5. Be honest.

6. No screaming, blaming, or finger-pointing.

7. Be a good sport.

8. All campaign posters must be removed by the end of the day after the election.


I know I've touched on this before. And listening to the talk, I wonder: Why can't we do this on a national level? What the hell kind of world is it where grown-ups behave worse than kids? Aren't we supposed to be the ones setting a good example?

I still like my idea of a reality show called "Modern Sandbox:" Politicians who espouse screaming and yelling at the opposition will be dropped into a desert with an equal number of equally stubborn people from the other side, under circumstances where their mutual survival depends on finding ways to work together and be polite. Advertising revenue and T-shirt sales will go toward the national debt.

Serious WTF*ckery

Words fail me.

Dedication

Dr. Grumpy: "How you doing? You look tired."

Mrs. Colostrum: "It was a long night."

Dr. Grumpy: "Aren't you supposed to have your baby soon?"

Mrs. Colostrum: "Yeah, I delivered her this morning."

Dr. Grumpy: "THIS MORNING?"

Mrs. Colostrum: "Yeah, at Local Hospital next door."

Dr. Grumpy: "And they discharged you already?!!!"

Mrs. Colostrum: "Oh, no." (opens jacket, shows hospital gown underneath) "I just hate to miss scheduled appointments, so I walked over to your office. They think I'm at the gift shop."

Today's contest

Okay, folks, since Dr. Killpatient gave me the idea...

A catalog pushing Halloween-themed nursing scrubs was lying around the hospital yesterday, with this picture on the cover:

So let's see what captions you guys can come up with. I'll toss out a few:


"Dr. Grumpy is sending a patient to the ER!"

"Dr. No Bullshit is on vacation again!"

"Shipping charges on Halloween scrubs are how much?!!!"

Mary's desk

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

Mr. Bling: "Yeah, this is Mr. Bling, and I need to make an appointment to see Dr. Grumpy."

Mary: "Mr. Bling, you sent us a letter 2 weeks ago saying you were firing Dr. Grumpy, and wrote a number of unkind things about him."

Mr. Bling: "Yeah, I know. But I decided it's too much of a pain to find another neurologist."

Mary: "I'm sorry, sir, but our policy is that once a patient has dismissed us, we won't take them back. It's just not good for the doctor-patient relationship after that."

Mr. Bling: "That's bullshit! I need a neurologist, and you're refusing to see me! I don't have time to find another one."

Mary: "Sir, you should have thought of that before you fired Dr. Grumpy."

Mr. Bling: "See, it's reasons like this that I fired you guys in the first place."

Hangs up.

Saturday at the park

Dr. Grumpy: "What's going on? Why are you fighting?"

Craig: "FRANK ATE ALL THE BROWNIES!!!

Marie: "YEAH! I PACKED 3 BROWNIES FOR US TO HAVE AS SNACKS AND HE ATE ALL OF THEM!"

Dr. Grumpy: "Frank, did you eat all the brownies?"

Frank (with chocolate all over his face) "Mmmph. Yeah, but I had to."

Dr. Grumpy: "Why?"

Frank: "Because! Look at this wrapper! They all expired last month, so it wasn't safe for them to eat! I did it to make sure they'd be okay."

Nudge nudge, wink wink, say no more

Dr. Grumpy: "Anything that makes the symptoms worse?"

Miss Carpal. "Um... I'd say the hand falls asleep whenever I'm holding long, slender, objects."

Rebuttal

In late July I re-ran my "Dr. Worthless" post, about the (alleged) migraine specialist who didn't do shit for one of my patients.

On August 28, nearly a month after I put it up, the following comment was posted:

"Dr Worthless: Pretty much every neurologist in my metropolitan area. I am sick and tired of managing issues that fall into the realm of neurology because of the laziness of your specialty. I really miss the days when a neurologist could actually make a diagnosis without an MRI."

Here is my rebuttal:

Dear Dr. Whoever You Are:

Thank you for kindly painting all neurologists with the same brush.

I'm sorry some in your area aren't up to your personal standards in work ethics. By a similar definition I know some "lazy" internists who seem to feel that I should be treating bladder infections, sinus problems, or foot ulcers simply on the grounds that the patients also have a neurological disorder, and therefore tell them to call me for their general medicine needs. So I suppose I could say I'm sick and tired of managing issues that fall into the realm of general medicine because of the laziness of your specialty.

But I won't do that. To make generalizations based on 1 or 2 people is what leads to idiotic stereotypes. I'm sorry you feel that way based on the few neurologists you've encountered. So stop referring to them and find others.

Please try to keep in mind that medicine is a team sport. When you view other doctors (or nurses, or whatever) as the opposition, the only person who really loses is the patient.

Diagnosing people without an MRI is fairly easy. I (and many other hard-working neurologists) do it every day. Bear in mind that many neurological conditions (migraines, Parkinson's disease, epilepsy, Bell's palsy, and Alzheimer's disease, to name a few) are clinical diagnoses. This means they're based on what the doctor thinks after taking a history and doing an exam. The purpose of MRI's (which, I admit, are often overused) is usually to exclude other causes, rather than confirm the diagnosis.

MRI's, like all forms of technology, are like genies. You can't put them back in the bottle. If you don't like it, perhaps you should consider going back to the days when an internist could actually make a diagnosis without a CBC. Or CMP. Or stethoscope (after all, in 1840 the flexible binaural stethoscope was cutting edge). MRI's may be overused, but I find them to be more effective at excluding/confirming serious neurological disorders than sacrificing chickens over the patient and dancing naked under the moon.

I'm going to guess that you've never been sued (I have). Nowadays you can get legally reamed out for NOT ordering tests, regardless of any guidelines that say it's fine not to do them. You can tell me that I'm practicing defensive medicine, and guess what? I don't care. If doing everything I can to protect my family and my livelihood is being lazy, than so be it.

Ordering a test often has more to do with CYA than diagnostics in ANY branch of medicine. If you have some magic power that exempts you from legal action and allows you to make 100% accurate diagnoses without using that newfangled stuff, than you have my respect for being a better physician than little old me.

Yours truly,

Ibee Grumpy, M.D.

Germ theory

Mr. Bassi: "I'm surprised I caught a cold. I've been washing my hands a lot."

Dr. Grumpy: "These things can spread through the air, too."

Mr. Bassi: "Yeah, but I was hoping the washing would help me ward off anything."

Dr. Grumpy: "What do you mean?"

Mr. Bassi: "Well, they say washing hands helps prevent disease."

Dr. Grumpy: "That's true..."

Mr. Bassi: "Isn't it because water and soap boost your immune system?"

Why do I see this causing trouble?

I just know I'll hear:

"Well, I read an article about it, so I took mine out and rubbed it all over my forehead. But it didn't make the migraine any better, and the other people on the subway all started staring at me." *

*Admittedly, I've seen far stranger things while riding the Grumpyville Subway System.

Back-to-school reruns

Dr. Grumpy's Guide to Life: Shopping for school supplies

Today I'm going to focus on what I discovered to be a horribly traumatic life-altering experience: Back-to-School week at OfficeStaplesMaxDepot. There's one right across the street from my office, so I go there regularly for supplies. It's quiet, the employees are generally helpful, and I know my way around it pretty well.

I naively thought this would be easy.

So on to the lesson:

1. Do NOT volunteer for this job (flip a coin, or arm wrestle, or have a duel to decide instead).

Silly me. When Mrs. Grumpy was wondering when she'd have time to get the school supplies, I volunteered. I figured "How hard can it be? Hell, it's just some pencils and a bottle of glue". DUMBASS!!! The list is HUGE, and features items from the mundane (No. 2 pencils), to the specific (Expo dry erase markers, wide tip, in blue, green, yellow, and black) to the odd (1 Pringles can with lid, original flavor, empty). It took me 2 freakin' hours!

2. Be prepared. Normally there are 5-10 other quiet business-type people in there. NOT THIS WEEK! Holy Crap! An African street bazaar is an orderly affair compared to this! Deranged parents running on caffeine! Kids running amok! Store clerks running for their lives! And all the crazed parents are trying to read off a list, push a cart, yell at kids, text, and scream into a cell phone at the same time. Bring a water bottle, food, a map, a cattle prod, and a flashlight. A card with your blood type, hospital preference, and next of kin is also a good idea.

3. Do not leave your cart unattended. People will steal your shit out of it. I AM NOT MAKING THIS UP! I had my cart 2/3 full with the crap on my list, when I left it at the end of an aisle to go find notebooks (spiral, wide-ruled, 100 pages each, single subject, 1 red, 1 blue, 1 green). When I returned 3 minutes later about half the stuff I'd already put in it was GONE! I watched a few minutes later as it happened to others. Apparently, when you walk away from your cart, people think it means they can raid it for supplies they haven't had a chance to pick up yet. "Hey, this guy has those index cards (2 sizes, lined and unlined, 100 each) that my kid needs. Cool. I'll scratch that off my list".

If another parent asks you what school your kid goes to, or who their teacher is, DO NOT ANSWER. Ignore them. Pretend you're deaf, or that you don't speak English. They are not making conversation. They are casing your cart, and if they find out your kid is in the same class as their kid, they'll wait until you aren't looking to take your stuff (or just switch carts).

Best part was when I went to ask an employee for help finding something (Flair Correction Pens, in 4 colors). When I got back to my cart the box of 12 ultra-fine tip Sharpies I left in it had been opened, and someone had taken one of them. They'd even doodled on the shopping list I left in my cart to make sure they were taking a pen that worked.

Oddly, you can leave valuables in your cart. Your wallet, purse, and gold jewelry will be perfectly safe if left unattended, but the $2.69 box of high-lighters (12 markers, large tip, in 3 colors) will vanish.

My recommendation: bring a child to guard your cart, preferably one with an iron bladder and who's old enough to use a Taser or firearm if needed. If your kids don't meet this requirement, stop by Home Depot and hire one of the day laborers who hangs out in front looking for work.

4. Do not look for certain numbers of things. The people who make these lists have no idea how things are sold, so it lists things as "1 Expo dry erase marker, chisel-tip, red). Great. They don't sell red ones individually, just in boxes of 4. Or the Flair Correction Pens don't come in only 4 colors, but they do come in 8. Just buy it. If you aren't certain what item the teacher wants, just buy everything in sight and return the rejects later.

Alternatively, if the teacher only wants 1 of an item, such as, say, an ultra-fine tip Sharpie (which only come in boxes of 12), you can always look for an unattended cart with a box of them in it, and take one. If paper is handy, try doodling on it to make sure you are stealing one that works.

5. Hold your place in the check-out line AT ALL COSTS. Reserve it as soon as you walk in the store BEFORE shopping. Use a child (preferably your own) if possible. Other options include day laborers from Home Depot, mannequins, dogs, and aggressive Venus Fly Traps.

6. When in doubt, ask the bleary-eyed, terrified employees for help. If nothing else, it's fun to watch them try to convince you that they don't speak English as they run outside for a cigarette.

Good luck!