Don't ask

Dr. Grumpy: "What was your last hemoglobin A1c?"

Mr. Insulin: "7.1."

Lady Insulin: "Was it? I thought it was 8.2?"

Mr. Insulin: "No, Dr. Endocrine said it was 7.1 at my appointment last week."

Lady Insulin: "That was my appointment. Yours was in March."

Mr. Insulin: "I thought your A1c was 7.9 in March?"

Lady Insulin: "No, that was your appointment."

Mr. Insulin: "Mine was 7.1. You put it in your phone."

Lady Insulin: "I thought you put it in your phone?"

Mr. Insulin: "Why would I put yours in my phone?"

Lady Insulin: (takes out a phone) "Whose phone is this, anyway?"

Mr. Insulin: "I think the 8.2 was Sylvia's. She mentioned it at dinner last night."

Lady Insulin: "Dr. Grumpy, can you call Dr. Endocrine for us?"

We're gonna turn it on. We're gonna bring you the power.

Holy crap! Is that Morgan Freeman?

For those of you who absolutely can't bear to lose at videogames, you now have a new way to win.

For only $249 the company FOC.US is selling a headset that will run an electric current through your brain (specifically, the prefrontal cortex). Their website says it will "increase the plasticity of your brain. Make your synapses fire faster." They're marketing it as a way to improve your videogame skills for the "ultimate gaming experience."

Really.

It also comes with an iPhone app to control your jolts. And it's in your choice of red or black.

"Now I can kick my boyfriend's ass at Call of Duty."

Now, I'm not going to knock the uses of electrical brain stimulation. This is an area that's currently undergoing a lot of research as a way to treat disease and help people recover from strokes and other causes of brain damage.

But, on the other hand, let's keep a few things in mind:

1. This is electricity, for fuck's sake. It's dangerous.

2. We used to execute people with this.

3. If winning at Halo is that important, you need to get out more.

I'm sure people from FOC.US will point out that their gadget uses a low level of juice, which isn't going to hurt you (on the other hand, I have no idea if it will help. The last video game I mastered was Atari Adventure).

I have to be a bit skeptical about its benefits. I mean, the internet is full of people selling herbs, magnets, and who knows what else as ways to improve your performance at work, the gym, and in bed. Most have nothing more behind them than some half-assed data and anecdotal claims. While I think the jury is still out on cortical electricity, that doesn't make their claims true.

Another issue is that for many people, after you've plunked down a boatload of money for a game system, they don't have $249 to blow on this gadget. So what do they do?

Well, according to a recent editorial in Nature there's concern that people will start doing this as a do-it-yourself project. You could wire up with some batteries at home, or whatever you can find in the garage. There are even companies selling DIY kits for it online. This is where I think the editorial has its best line:

"That’s ‘could’ as in ‘you might be able to’, by the way; not ‘could’ as in ‘it’s a good idea’."

Granted, that's never stopped anyone from doing stupid stuff. Bigger, in the general perception, must be better. If a little battery can improve your score, then shouldn't plugging into your home's AC current be great? By the time you're playing an X-Box hopefully your parents have pulled those plastic things from the outlets that kept you from sticking a fork in them. The target audience here isn't known for being averse to risk.

What could possibly go wrong?

"Mario and Luigi, here I come!"

I also have to worry about how far this could go. What if electricity does clearly improve brain performance? Can't you just see pushy parents wanting to plug their kids in to get a better SAT score? Or a med school gunner wearing some shockware into a test, disguised as earplugs?

This could end up as the academic equivalent of athletic steroids. The next cheating scandal could be some guy tossed out of a math competition for illegal wiring.

Lance was stripped of his high school math letters when it came out he'd been "volting."

So, in closing, my point is this: low-level trans-cortical electrical may have medical utility (personally, I suspect it does). But if that "may" makes you want to shell out more money just to beat your brother at Grand Theft Auto V, then I've got some buildings in Rungholt to sell you.

"Superman warned me the electrodes would do this. Why didn't I listen?"

Thank you, SMOD!

Hazards of "V" and "C" being next to each other on the keyboard

Thank you, M!

"I'd like to buy a comma, Pat."

What are "heart joints?"

"I don't remember those from Netter."

Excuses

"Well, officer, I was in a hurry to get home and start waxing it."

Why I call him that

Drug rep: "Hi, Dr. Pissy. Lunch today is from Dave's Deli."

Dr. Pissy: "Dave's Deli? Why? What did I ever do to you?"

Ooooh! Fireworks!

Yesterday Mary had to take her kids to an early dentist appointment, and wasn't able to get here until 10:00. Annie was stuck in traffic, so I took over the front desk since the first patient, a new one, was scheduled for 9:00.

The patient showed up at 9:30, WAY too late (in my opinion) to try and see a new patient. So I told her she'd have to reschedule. She wasn't happy about it, and asked to see a different doctor, or a PA or NP. I told her we don't have anyone else, and so she finally rescheduled to next Tuesday.

Later in the afternoon:

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

Mrs. 9:30: "Yeah, I had an appointment this morning, and had to reschedule it to next week."

Mary: "Yes?"

Mrs. 9:30: "I just want to complain. The male receptionist who was working this morning wouldn't let me see the doctor. I didn't like that at all."

Mary: "Male receptionist... Oh, that was..."

Mrs. 9:30: "I don't care what his name was. The doctor needs to know his staff is turning patients away. Even if they show up late, it's still inappropriate. My time is valuable."

(long pause)

Mary: "The doctor is aware of what happened."

Mrs. 9:30: "Good. Because I want to be sure to tell him about that guy at my appointment."

Mary: "You'll definitely have the opportunity."

Looking forward to Tuesday!

The joy of Dragon

Seen in a hospital note while on-call this past weekend:

And no, I have absolutely NFC what they meant to say.

Never a dull moment

On Friday we had an unusually exciting afternoon.

A sweet octogenarian waiting for her appointment suddenly developed chest pain and shortness of breath in the lobby.

Mary, knowing how good Pissy and I are at handling REAL medical emergencies, immediately called 911. I'd run over to the hospital for a minute, and so the staff got him to check her blood pressure and hold her hand until paramedics arrived.

By the time I returned paramedics were loading her onto a stretcher to go to ER.

She immediately grabbed my hand and said "Dr. Grumpy, I'm so glad to see you. Before I leave could you get me more samples of Nomohurtz? It seems to be helping."

In days of yore...

Thank you, Ms. Donna!

Sigh

Local hospital decided last week to re-paint the "Reserved Doctor" parking spaces in the front lot.

Mary's desk

Mrs. Damadian: "Hello?"

Mary: "Hi, Mrs. Damadian. This is Mary, at Dr. Grumpy's office."

Mrs. Damadian: "Yes?"

Mary: "We got your MRI report in - the doctor says it's fine - so I'm calling to make an appointment for you guys to discuss your treatment plan."

Mrs. Damadian: "How did he get it?"

Mary: "Well, he said it was fine, but..."

Mrs. Damadian: "I don't care what it showed. I want to know how he got the report."

Mary: "What do you mean?"

Mrs. Damadian: "Did a courier bring it? Or was it faxed to him? Or mailed? Or e-mailed? Or did a radiologist call him? Or did he look it up online?"

Mary: "I believe he looks them up, but it depends on..."

Mrs. Damadian: "This is stupid. I can't believe you don't know. Why don't you find out, then you can call me back and we'll discuss me making an appointment."

(hangs up)

Once upon a time

Wirth-Liss Phramaceuticals makes a hideously expensive drug that has to be administered once a month at the doctor's office. The patient co-pay on most plans is anywhere from $50 a month and up (granted, that's cheap compared to what the insurance company is paying for the rest).

So Wirth-Liss came up with a patient assistance program, where the patient gets $600/year covered by the insurance company, to help lessen the cost burden. Their idea was that this way more patients could afford the drug, so more doctors would order it. I can see the logic.

But the implementation left much to be desired.

Some company genius, with apparently no grasp of reality or human nature, decided the best way to do this was to send every person who qualified for the plan a prepaid credit card with $600 on it. The idea was that Mr. Patient would hand it to the doctor's staff at each visit, it would be swiped for $50 each time, and at the end of the year the card would be empty.

Unfortunately, it didn't occur to them to lock-out the accounts so that they could only be used at a doctor's office...

Basically, they sent patients pre-paid giftcards with $600 on them.

Of course, given human nature, most patients saw this as a windfall, and went on spending sprees. They bought groceries, beer, clothes, toys, a tank of gas, whatever.

Then, when it was time to go to the doctor, they didn't have any money left for the drug. So they opted not to receive it. So the drug wasn't given, and Wirth-Liss Pharmaceuticals, Inc. wasn't able to bill an insurance company for it. And, in fact, they now had a new corporate loss of $600 per irresponsible patient.

Of course, the patients thought this was grossly unfair. They couldn't understand why they couldn't have the drug, when, after all, they'd qualified for the assistance program. The fact that they'd blown their co-pay was beside the point. They also didn't see why they now had to pay cash for the co-pay, since the program person told them they wouldn't have to.

And, of course, they wanted another card.

When the above was explained to them, suddenly they remembered they'd never received the $600 drug card, or it had been stolen, or they hadn't seen it since an alien abduction on the way home from Las Vegas.

The program has since been replaced with one where the card can only be used at a specific doctor's office.

The executive behind it, I hope, has been canned.

The drug reps have the difficult job of explaining the program changes, and why they were made, to doctors and their staffs. Who are laughing hysterically.

Moon river

Dr. Grumpy: "How did the medicine I prescribed work?"

Mrs. Solanaceae: "I never tried it. I looked it up on the internet, and found out it can cause liver problems."

Dr. Grumpy: "Okay... but that's pretty rare."

Mrs. Solanaceae: "I don't care! It's my body, and I'm not going to take a pill that might harm it."

Dr. Grumpy: "You told me you smoke 2 packs a day."

Mrs. Solanaceae: "That's different. It's not a pill."