It's fun to stay at the A.N.Z.C.A!

Next month, for those of you who don't follow meetings outside your own hemisphere, is the annual Australian & New Zealand College of Anaesthetists convention. This year it's being held in Melbourne.

Normally I don't pay attention to ANY meetings. Not even the ones in my own specialty, let alone someone elses' on the other side of the International Date Line. But my reader Rebecca (thank you, Rebecca!) brought this one to my attention.

All these meetings are composed of various lectures and workshops you sign up for, and this one is no different. Here's a sampling of the exciting courses available:

  

If anything sounds more stimulating than a course on coagulation management, I don't know what it is. Oh wait, I do. A can of Diet Coke.

But if you scroll farther down the list, there IS a stimulating course:

Of course, caffeine isn't the only thing you can learn about at the meeting. If your anaesthesia machine (the one that goes "ping!") is all tuned up, why not work on...

After that course, a few cups of coffee, and a bathroom break you'll be ready to move on to...

After a long day of such interesting meetings you've done all sorts of things, but on the way out of the building you discover the elevator has no windows and no doors, which offers you this chilling challenge: to find a way out!

Of course, there's always my way...

Annie's Desk

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

Mr. Lombardi: "Hi, I see Dr. Grumpy for my seizures, and he increased my Nomoshakin dose last week."

Annie: "Okay, let me look up your note."

Mr. Lombardi: "Anyway, yesterday I was playing football with my buddies, and one of them stepped on my left hand, really hard. Today that wrist hurts and is all swollen."

Annie: "Did you have a seizure?"

Mr. Lombardi: "No, but do you think the wrist problem is from the medication increase? Because I didn't have it on lower doses."

Patient quote of the day

"I understand, but I don't understand. Do you understand?"

Mary's desk, March 27, 2013

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

Mrs. Khwarizmi: "Yeah, I'm driving all over, and can't find your office."

Mary: "Okay, we're in Medical Office Tower 6."

Mrs. Khwarizmi: "Yes! That's where I am! But there isn't one marked 6!"

Mary: "We're the building farthest to the east. There's a sign in front that says 'MOT 6'."

Mrs. Khwarizmi: "I must be in the wrong place. The only sign I see just says 'motvi'."

Mary: "Motvi? Wait... Okay, you ARE in the right place. The 'MOT' sign uses Roman numerals."

Mrs. Khwarizmi: "Roman numerals? Damnit, doesn't anyone speak English anymore?"

WTF?

Doing a survey last night, one allegedly for neurologists, and this question came up:

Beyond shingles I really had no comment.

Memories...

My former call partner, Dr. Darth, had an office manager (Suzee). He eventually fired her and promoted his secretary (Floozee, who he was banging on the side) to office manager.

So when Suzee needed to see a neurologist a few months later, she made an appointment with me.

Unfortunately, she came in on a week when Dr. Darth was out of town, and I was covering for him.

So as Suzee sat in my lobby, leafing through "So You're Trapped in a Doctor's Waiting Room" magazine, Floozee came in with a bunch of MRI reports for me to review in Dr. Darth's absence.

The magazine and MRI reports were quickly forgotten.

They both had pepper spray. Mary had to call hospital security to get them out before anyone got hurt.

Perseveration

Mrs. Map: "Sorry I'm late, I had trouble finding your office. My iPhone gave me weird directions."

Dr. Grumpy: "That's okay. What bring you in to see me?"

Mrs. Map: "Well I..."

Siri: "Please turn right on 24th street, then continue west."

Dr. Grumpy: "Was that your phone?"

Mrs. Map: "Um, yeah, I guess she's still trying to get me to your office."

Siri: "Please turn right on 24th street, then continue west."

Dr. Grumpy: "Siri! She found it!"

Mrs. Map: "I don't know how to turn it off."

Siri: "Please turn right on 24th street, then continue west."

I reached over and turned off the phone.

Mrs. Map: "Wow! That bitch drives me nuts!"

Weekend reruns

It's been 3 years since I ran this post. And I still believe every word.


Nurses...

Are AWESOME.

I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.

I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Us doctors will see you from 5-30 minutes a day (30 is A LOT), depending on how sick you are. And the rest is the nurses.

They come in all shapes, colors, and sexes. Yes, there are a few idiots out there, that I take shots at in this blog. And there are idiot doctors, too. Idiots are in all fields, but the majority of nurses are damn good.

They're the ones making sure you get your pills, checking that your vital signs aren't dropping (and doing what they can to save your ass initially if they are, of which calling a doctor is only one part). They make sure you don't fall down and break something. If you start barfing, us doctors will run out of the room and the nurses will rush in. They change your wound dressings and start your IV line. They'll bring you a warm blanket. And clean disgusting things off you. Even if you're drunk. Or delerious. Or mean. And through all of this they try be friendly and positive. Even though you aren't their only sick patient.

I respect nurses A LOT. I learned early on that they're key to being a good doctor. You piss off the nursing staff, and you'll have a miserable career at that hospital. Respect and treat them well, and you'll never regret it. They're as important to being a good doctor as your medical degree. Maybe more.

If you come out of medical school with a chip on your shoulder against nurses, you better lose it fast. Because they will make or break your training, and often know more than you do. Be nice and they'll teach you. A good neuro nurse is often a better inpatient neurologist than some doctors I've met.

I remember a guy named Steve, who was an intern with me a long time ago. He had his head up his ass about being a doctor, and saw nurses as lesser scum. We were only a few months out of med school, and as we were writing chart notes one morning a nurse came over and asked if he'd go listen to his patient's heart. With icy contempt, and not even looking up from the chart, he said "I don't have to listen to his heart, because I looked at his EKG." They ain't the same thing, dude. If he'd listened he might have noticed that the patient had developed a loud murmer in the last 24 hours. When the attending caught it a few hours later, Steve got his ass chewed out. If he'd taken the nurse's advice, and listened, he wouldn't have gotten reprimanded by the residency board.

I talk about my Bible a great deal in this blog. Here's a quote from it: "Working with a good nurse is one of the great joys of being a doctor. I cannot understand physicians who adopt an adversarial relationship with nurses. They are depriving themselves of an education in hospital wisdom."

Those doctors are also depriving themselves of friends. On a shitty day on call, sometimes all it takes is a sympathetic nurse to temporarily add you to her patient list, steal you a Diet Coke from the fridge, and let you cry on her shoulder for 5 minutes. It doesn't make the day any less busy, but helps you absorb the punishment better.

What got me started on this?

While I was rounding this weekend, a grateful patient's family brought the ICU nurses a box of donuts, and so the staff was picking through them. One said "Oh, this kind is my favorite, it has cream filling."

And some pig in one of the rooms yelled "Hey, babe, I got my own kind of cream-filled dessert in here! Come have a taste!"

You say that to a waitress, and you'd likely get your ass kicked out of the restaurant.

You say that to a co-worker, and you'd be fired and/or sued for harassment.

You say that to a lady in a bar, and you'll likely get a black eye.

And what did the nurse do? In spite of the fact that the guy was obviously a detestable jackass, she went in his room, turned off his beeping IV pump, and calmly told him that he would not talk to her that way.

And I admire the hell out of that.

Nursing is a damn tough job. And the people who do it are tougher. And somehow still remain saints.

While this post isn't about them, there are a lot of other unsung heroes who are part of the hospital team- pharmacists, social workers, nursing assistants, EMT's, respiratory therapists, X-ray techs, lab techs, physical/occupational/speech therapists, housekeeping staff. And many more.

Hospital rounds, Thursday night, 7:10 p.m.

Dr. Grumpy: "What were you doing just before you blacked out?"

Mrs. Climax: "Having a MAJOR orgasm."

Reasons Mary drinks

Lady walks into office, signs in

Mary: "Hi... ma'am, your appointment was yesterday. We have you marked down as a no-show."

Mrs. Hansen: "I'm sorry, I had a family emergency. Can't you just see me today?"

Mary: "No, we're completely booked up."

Mrs. Hansen: "But I had an emergency!"

Mary: "I understand, that can happen. We can see you this Friday at 1:00 or..."

Mrs. Hansen: "Why are you doing this to me?"

Mary: "Excuse me?"

Mrs. Hansen: "I don't appreciate that you're treating me like a leper."

Mary: "Ma'am, I'm not..."

Mrs. Hansen: "This is so unfair! I had an emergency that wasn't my fault, and for that you're punishing me."

(pause)

Mary: "Do you want the appointment on Friday afternoon or not?"

Mrs. Hansen (scrolls through phone): "No, I'm meeting a friend at the casino."

Advice for grads (new and old)

A few years ago I signed up for an account with one of those "suggest-a-doctor" sites as a way to get business.

Shortly afterwards I began getting emails that "a patient has sent you an appointment request." Figuring it was a prospective patient, I checked them. My plan was that I'd forward the info to Mary to call and schedule them.

To my horror (I guess I'm naive) people who used the site had absolutely no interest in actually coming to the office. They just wanted medical questions answered online. For free (of course).

Examples of typical questions I received included:


"I've been dizzy on and off for years. I've had lots of tests and seen many doctors, but none of them can find the cause. Can you tell me what's wrong?"

"I can't afford my medications. Can you please put samples with my name on them out in your front office? 3 months worth would be good."

"I don't have time to go to a surgeon, so can you tell me if I need back surgery? MRI images attached."

"I live in Farfaraway, but am willing to travel to Grumpyville if you can cure me. I'll do this only if you offer a money-back guarantee, and cover my plane fare."

"I think my husband is more sick from taking his pills than he is without them, but he will only stop if a doctor tells him too. Can you call him and tell him to stop?"


NONE of these people were established patients of mine. As best I can tell, of the 200+ messages I received over time, fewer than 5% were within 100 miles of my office. Some were from overseas.

Besides the obvious money issues here (I have a family to support. I am not free.) is the legal one. This basically amounts to treating a patient without actually seeing or examining them. I worry enough about getting sued by patients that I do see, and don't want to add ones I don't to the list.

I finally deleted the account last year.

So here's today's advice from Dr. Grumpy: Don't even bother with these sites. Unless the idea of practicing free, legally dangerous, medicine appeals to you.

Ouch

My 2:00 patient had a large, straight, red mark on her forehead.

Mrs. Amana: "Sorry I'm a little late. I burned my forehead."

Dr. Grumpy: "I see that. What happened?"

Mrs. Amana: "Well, I was ironing some shirts, and needed to do my hair. So to save time I put my head on the ironing board, and started doing my hair, too. Then my phone rang, and I turned my head to answer it and..."

Why do I bother?

Dr. Test is down the street from me. He sends me infrequent referrals.

I consistently send him notes about visits, listing what, if any, tests I'm ordering. Within an hour of one being faxed I always get a return fax from his office, listing the tests that I just said I'm ordering, and asking me to send the results to him when they become available.

I don't know why, but I find this thoroughly irritating. I'm actually quite obsessive about sending letters and tests to referring physicians, and after years of doing so it annoys me that this one still asks. Of course, there's also the (likely) possibility that the letters go to a trained chimpanzee who reads the last paragraph, fills out the results-request form, and faxes it back without the doctor ever seeing it.

Last week, on a quiet morning due to some last-minute cancellations, I sent his office a fax on a non-existent patient saying I was ordering a "serum profactor 7-CoA." To the best of my knowledge there is no such test.

Within 15 minutes we got a note back saying "Mr. Non Existent isn't a patient in our practice. Please send us a copy of his serum profactor 7-CoA result as soon as it becomes available."

I amuse myself.

Patient quote of the day

"I'm looking through a fishbowl, but without fish. This is because my left toenails are all pale, which explains my neck problems."

(no, folks, the patient doesn't have a left cortical lesion. Or dementia)