To err is human

Dear American public,

I apologize.

I accidentally cost you $470 last month, and so I owe each of you a $0.000000076.

I actually feel quite bad about this, but more in terms of the money lost and the inconvenience to the patient.

What happened, you ask? Well, I meant to order a lumbar spine CT scan. But due to a busy day and multitasking, accidentally wrote an order for a cervical spine CT. No one questioned it, and so it got done. I didn't realize the error until the report showed up on my desk. I apologized to the patient, and ordered the correct study.

The whole thing is overall harmless. The patient is elderly, and a few additional units of radiation are inconsequential. The 1 week delay in getting the proper test didn't have an adverse impact on his condition.

But still, I feel bad. I'm certainly not out to rip anyone off, especially other taxpayers.

This is, as far as I know, only the second error I've made in ordering the wrong imaging study in the last 10 years. I assume I have the same error rate as other docs for this sort of thing, and the total for mine is around $1100. Given that there are roughly 900,000 practitioners in the U.S., that comes out to $990 million dollars wasted every 10 years. That's enough to pay 20,000 school teachers for a year, or buy the Air Force eight F-35 fighters. Even by government standards it's still a decent chunk of change.

I don't have an easy answer for this. Should I be responsible? If a doc orders the wrong test, should he have to eat that cost? I guess that makes some sense, but someone is going to argue at some point that a test shouldn't be ordered. What happens if I did order a correct test, but then an insurance company claims it wasn't necessary - so should I pay for it?

Or what if the patient (after getting a test bill, of course) claims that I shouldn't have ordered a test, and wants me to pay for it? I've had that happen (I refused) and have learned it's common. I know another doctor who was threatened with a malpractice lawsuit to get her to pay for a study (she stood her ground, and they backed down).

So, I guess the only easy answer is to leave it as it is, and accept the fallible nature of humans. If ordering the wrong CT scan (at no harm to the patient) is the worst mistake I ever make in this business, I'll take it.

Doctors behaving badly

I'm with a patient, when Mary knocks on my office door.

Dr. Grumpy: "What's up?"

Mary: "Sorry, it's Dr. Promissory. He says he needs to speak to you urgently."

Dr. Grumpy: "Okay." (picks up phone) "This is Dr. Grumpy."

Dr. Promissory: "Hi, sorry to interrupt you."

Dr. Grumpy: "What's going on?"

Dr. Promissory: "My wife recently started her own business as a mortgage agent, and I was wondering if you'd considered refinancing your home?"

Mary's desk, June 3, 2013

Guy walks in, stands at counter.

Mary: "Can I help you, sir?"

Counter Guy: "Yeah, um, is this Dr. Grumpy's office?"

Mary: "Yes, sir. Do you have an appointment?"

Counter Guy: "No, I'm looking for another office. Thanks."

(leaves)

Maaaaaaaaaarrrrrrrrrrrrryyyyyyyyyyyyyyy!

Dr. Grumpy: "Can you smile for me?"

Mr. Poligrip smiles a little.

Dr. Grumpy: "Smile wider. Can you show me your teeth?"

Mr. Poligrip takes out his teeth and holds them up.

Those were the days

I just can't take it

Patient quote of the day:

"I don't want to take a pill just to take it. Because I'll be "taking it" taking it, when I'm not sure I need to take it. But if I have to "take it" take it, then I'll have to take it and will take it. But only if I really have to "take it" take it.

Things that make me grumpy

Times are tough for doctors these days. No one gives a shit, so I'm not elaborating further.

But even big institutions are affected. Take, for example, the venerable MD Anderson Cancer Center in Texas. This giant of oncology has recently been having financial issues, so much so that its president, Ronald DePinho, sent out this e-mail to employees 2 weeks ago:

"For most of fiscal year 2013 our operating expense has exceeded our operating revenue - meaning that we've spent more than we've made from providing patient care services."

He went on to say that because of this shortfall MD Anderson is suspending merit raises and slowing its hiring rate. This is what they call "austerity measures."

Now, every concerned CEO in America has been saying stuff like this, so why am I singling out Dr. DePinho?

Because.

At the same time Dr. DePinho is preaching financial restraint for his cash-strapped institution, he's used $1.5 million of its capital funds (which come from investment income, donations, and patient revenue) to build a 25,000 square-foot (2,322 square meter) office suite for Dr. Lynda Chin at the institution.

Who just happens to be his wife.

Really. I am not making this up.

Dr. Chin is the scientific director of MD Anderson's Institute for Applied Cancer Science. How this justifies her having an office suite that is 10 x larger than the average American home is beyond me. According to the institute it's to "provide an appropriate meeting space with high-level industry decision makers and support a new suite in computational biology." Translation: By using a lot of syllables we're hoping you'll ignore what's really going on here.

And no, I have no idea what "computational biology" is. Maybe that's why my entire office is 1,250 square feet, including the john.

According to an itemized expense report (obtained by The Cancer Letter under the Texas Public Information Act) this ginormous office has $28,000 worth of chairs, sofas, and tables. They also spent $210,000 on fancy translucent glass walls, which required them to get a special permit from the University of Texas. By comparison, the Grumpy Neurological Emporium has used furniture (valued at $948 total), and plain old painted drywall.

So, if you donated money in a loved one's memory to MD Anderson hoping they'll find a cure for whatever cancer killed grandma, there's a reasonable chance your hard-earned dollars went to pay for... upscale furniture and fancy glass walls in an office bigger than your house.

I'm going to close with another quote from Dr. DePinho, found in the same e-mail I quoted earlier about the austerity measures MD Anderson will have to take to survive:

"If we don't make changes now, we potentially will find ourselves in a crisis that will force us to take drastic measures that could hurt our ability to meet our mission... [all will] have to share sacrifices."

Well, almost all.


Thank you, SMOD!

History reruns

May 29, 1914

If you read the popular stuff, you'd think there were only 3 major shipwrecks of the 20th century: Titanic, Lusitania, and Andrea Doria. Obviously, there are many more, even if you exclude 2 worldwide conflicts in the last 100 years. The worst peacetime shipwreck in history, the Dona Paz (Philippines), took 4,375 lives as recently as 1987. And I bet you've never heard of it.

Trans-Atlantic crossings have always been critical to both sides of the Atlantic (look at the chaos caused by the recent Icelandic volcanic eruption). Although the giant liners of Cunard and White Star are best remembered, they were by no means alone. Ships were constantly coming and going, carrying passengers and freight, both ways across The Pond.

Although less glamorous than the liners that sailed in & out of New York, there were many busy ships that called on the Canadian ports. One was the Empress of Ireland, which in 1914 was serving the Quebec City to Liverpool route.

Early this morning, 96 years ago, the Empress was outbound from Canada. She was heading northeast on the St. Lawrence River. It was 2:00 a.m., and most of the passengers were sleeping.

In a thick fog, the Norwegian coal-carrier Storstad struck the Empress on the starboard side. The damage was extensive. There was only limited time to sound an alarm, and electricity failed quickly, plunging the ship into darkness. The Empress was gone in 14 minutes.

The survivors were picked up by the few lifeboats that had been launched, and were carried back and forth to the Storstad, which had stayed afloat. Captain Henry Kendall, who was thrown into the water as the ship rolled over, supervised the rescue efforts and likely saved many lives by organizing the lifeboats.

All together the Empress took 1,024 people with her. It remains the deadliest maritime disaster in Canadian history. In spite of this, the ship is mostly forgotten today. The St. Lawrence Seaway is a very busy channel. Hundreds of ships steam over the Empress every day, very few knowing of the tragedy beneath them.

The Salvation Army remembers. A large contingent of members (167) were lost on the ship, traveling to a conference in London. There is a monument to them at Mount Pleasant Cemetery, in Toronto.

The Empress of Ireland is in 130 feet of water, well within the range of scuba equipment, but the currents and poor visibility limit diving

Marketing FAIL

How impressed can you be with a medical practice management company that obscures their own contact information on a fax advertising their services?

Thank you, Lee!

Memorial Day

Capt. John P. Cromwell, USN, 1901-1943

John Cromwell was born in Illinois, but his heart took him from the midwest to the ocean. He graduated from Annapolis in 1924.

His initial sea service was on the battleship Maryland, but his abilities led to him being picked for the fledgling American submarine force. He served aboard, and commanded, some of the United States Navy's first large submarines.

After several tours at sea, Cromwell was selected for further training in the complex diesel engines that were critical to submarines of the pre-nuclear era. He rose through the ranks, eventually becoming a division commander.

WWII found now-Captain Cromwell in the Pacific, commanding submarine divisions 203, 43, and 44. His flagship was the U.S.S. Sculpin.

In November, 1943 Sculpin (commanded by Lt. Cmdr. Fred Connaway) put to sea with orders to rendezvous with the submarines Searaven and Spearfish to attack Japanese shipping. Upon arrival Cromwell would take command of the group.

The Americans were preparing to invade Tarawa island later that month. It would be a critical (and bloody) fight to wrest control of the central Pacific from Japanese forces. Cromwell was aware of the operation's details, and was also familiar with the top-secret American ability to read Japanese military codes.

On November 18, 1943, while en route to the rendezvous, Sculpin was preparing to attack a Japanese convoy. A damaged depth gauge, however, caused her to surface rather than go to periscope depth, and she came up directly in front of the Japanese destroyer Yamagumo. Although Connaway quickly dived again, it was too late. Yamagumo pounded Sculpin with a series of depth charges, causing severe damage.

With no way to escape, and more destroyers coming, Connaway decided to surface again and try to fight it out. The destroyer was ready. As the Sculpin came up, Yamagumo's first salvo killed her entire bridge crew (including Connaway) and those running to man the weapons.

Sculpin's surviving senior officer ordered the submarine scuttled, and the crew to abandon ship.

Captain Cromwell realized the secrets he knew could seriously jeopardize the American war effort. The Japanese couldn't be allowed to learn the invasion plans for Tarawa, or that the Americans had broken their codes. While he wouldn't voluntarily talk, there was no guaranteeing he might not break under torture or the influence of interrogation drugs.

He therefore decided to stay with Sculpin forever. He helped the crew abandon her, but made no move to leave himself. He was last seen standing in the control room, watching it fill with water.

His Congressional Medal of Honor was presented to his widow.

Sunday reruns

Ms. Crappystaff: "Dr. Imed's office."

Dr. Grumpy: "Hi, it's Dr. Grumpy. You guys referred Mrs. Brain to me for an abnormal MRI, and I don't have the report. She's here now. Can you please fax that over, ASAP?"

Ms. Crappystaff: "Hang on... Sorry, the doctor just went into a room with a patient, and doesn't like to be disturbed. I can have him call you back later."

Dr. Grumpy: "I don't need to talk to him. I just want you to fax over the MRI report."

Ms. Crappystaff: "I'm not comfortable doing that. I don't know what the report means."

Dr. Grumpy: "I'm not asking you to know what it means. All you have to do is fax it to me."

Ms. Crappystaff: "Don't patronize me. I don't even know who you are."

Dr. Grumpy: "I'm Dr. Grumpy. You faxed over an insurance authorization on this patient an hour ago. I just need the MRI report, so I know what to tell her."

Ms. Crappystaff: "I told you, I'll have Dr. Imed call you to discuss this."

Dr. Grumpy: "The patient is here now. I just need the MRI report. Please fax it over. It's why you guys sent her to me."

Ms. Crappystaff: "You obviously don't understand the importance of patient privacy."

And she hung up.

Uh... What kind of work do you do?

This is from a form on a patient's ability to do the following at work. It was the last one that caught my attention.

Jawohl!

Dr. Grumpy: "What brings you in today?"

Mrs. Mom: "I'm worried about my son. I think he drinks too much, and I know it's bad for him."

Dr. Grumpy: "I'm sorry to hear that."

Mrs. Mom: "The only person he'll listen to is Dr. Intern, but he refuses to go back to see him about this."

Dr. Grumpy: "How are you..."

Mrs. Mom: "Anyway, here's my son's phone number. Can you please call him tonight, and pretend to be Dr. Intern to talk to him about the drinking? The doctor is from Germany, so you'll have to fake an accent, and..."

Not Helpful

Mrs. Papers: "Here's my background information."

Dr. Grumpy: (looking it over): "Okay... What's this say about your sister?"

Mrs. Papers: (leans over desk) "Let me see. Looks like it says 'Sister in NH'."

Dr. Grumpy: "What does 'NH' mean? Nursing home? New Hampshire?"

Mrs. Papers: "I don't remember. Could be either, or both. It's been years since I typed that up."