Crossing over

 

A friend of mine, while traveling, recently took her son to a doctor in an unfamiliar area for a semi-urgent issue. While there the staff tried to sell her weight loss supplements (and she's slim), asked her (and she wasn't the patient) if she had foot numbness (giving her a brochure about a pseudo-NCV procedure they do), and tried to talk her into a sleep study. She hadn't raised any of these issues, but they were repeatedly brought up by the physician and his staff while treating her daughter.

Pissy and I call this "The Dark Side." And, unfortunately, it's a growing trend in medicine.

Insurance reimbursements dwindle, and so doctors try to find "alternative revenue" streams. Sometime they aren't a bad idea, but other times they're simply unnecessary tests and/or ineffective treatments done solely to increase profits. The worst are where they involve an invasive, potentially hazardous, procedure that has no proven benefit. Pointless biopsies that won't change a treatment plan, gadgets to relieve pain that aren't statistically superior to placebo, supplements sold at the front counter with extravagant claims to cure Alzheimer's, and other horseshit.

Doctors who do this likely start out as well-intentioned, and end up on a slippery slope. As the revenue stream increases they get greedy, adding more and more bells and whistles to the practice- at the cost of patient care. Like Anakin Skywalker, they become seduced by the Dark Side, needing to keep expanding their practice away from what's best for the patient.

Of course, they won't admit that. To them the new laser-magneto-hydrological thingamajig they put in to cure chronic halitosis at $100 a pop is medically necessary. It's not covered by any insurance, or even mentioned in any reputable publications, but the company that sells it has infomercials on TV and glossy booklets for the waiting room. Likewise, there are some procedures that are covered by insurance but have no real medical evidence to support them. And they're also done purely for profit.

Years of moving in that direction have convinced the doctors involved that these things are the standard of care. Like Darth Vader, once you cross the line there's no going back.

I get calls from companies selling this stuff, too. Usually Mary filters them out, but occasionally they reach me. Or fly in under the radar by claiming to be a drug rep. They show me graphs of start-up costs and how much money I can make (usually insane amounts, like $100K per month, with an asterisk noting that's only if you see patients 24/7).

I try to be polite, but in my mind I hear them speaking in a deep voice through slow, heavy, respirations, asking me to join them on the Dark Side,

Luke tossed his lightsaber aside and walked away. I just thank them and head back to my desk. I may not be getting rich, but at least after 15 years of this I can still face myself in the mirror and believe I'm doing what's right for my patients.

Crime in America

Thank you, Don!

Mary's desk, Tuesday afternoon

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

Mrs. Bland: "Hi, this is Katie Bland. Our daughters are in kindergarten together, and had a playdate last weekend at Local Park."

Mary: "Yes, she had a good time. I remember, you and I talked about the school's fundraisers."

Mrs. Bland: "Yeah. Anyway, my husband and I were wondering if you and your fiancé are interested in swinging with us at the Daisy Chain Club this weekend?"

I'd say you're doing pretty well

Dr. Grumpy: "Do you have any other health problems?"

Mrs. Octogenarian: "I have Hufnagel's disease."

Dr. Grumpy: "If I remember correctly, that's a pretty serious illness."

Mrs. Octogenarian: "It's fatal. I'm terminally ill."

Dr. Grumpy: "How long have you been terminally ill?"

Mrs. Octogenarian: "57 years."

Quiz time

A friend of mine was recently taking a practice test for the Emergency Medicine boards, and came across this question:

A day at my office

Thank you, Elmo!

Thursday afternoon

A touching mother-daughter moment in my office:

"Mom, when I get to heaven I'm going to kick Dad's ass for leaving me alone with you."

Uh, Dan... on the screen behind you, Dan...

From Huffpost.

Medical science marches on

This spring Local Hospital installed a new hand washing system. Apparently the old system of soap and water wasn't doing what they wanted (what they wanted I'm not sure, because we were using it to wash our hands).

The new system they installed involves, okay, soap and water (revolutionary, huh)? But it also involves a new technology- the hand-washing entertainment system. REALLY.

Studies have recommended that you wash them for 15 seconds to kill/drown the majority of germs, and most people don't do the full quarter-minute. So, in order to keep you washing, it tries to keep you entertained. And what better way to do that than with a screen? After all, in the 4 million years since we split off from the rest of the primates, staring at screens is what our species truly excels at.

As soon as you pump soap onto your hands, the show begins. Almost always there's a timer on it, counting backwards from 15, to make sure you scrub for your allotted time.

Usually it also involves telling you the weather outside. Which is, if you think about it, a real "fuck you." If you're washing your hands at the nursing station it means you're working, and there's no way you're getting outside to enjoy the day no matter how nice it is.

It also features all kinds of other stuff. Here's some examples.

If you like sports, it keeps you updated on scores while you think about your buddies with the day off having a tailgate at the game:

Sometimes you get a bit of semi-wisdom fortune-cookie-ish sayings. Like you really need that while trying to get an unhelmeted motorcyclist's shit out from under your fingernails.

 

Cute sayings are also common fodder. Who needs a self-help book when you can just get a daily dose of happy-happy joy-joy by washing your hands?

 

Ever find yourself suddenly struck by a panic attack that you'll be on a quiz show and not know the answers (or, if it's Jeopardy!, the questions)? Fear not! The magic handwashing gadget is happy to share pointless trivia.

For those at other hospitals using this system, feel free to send me shots of your hand-washing entertainment. I'll edit out any identifying info if needed, and perhaps make this a regular feature if popular enough.

NOTE - Dr. Grumpy, Inc. will not be responsible for any water damage your phone may suffer in the mad rush to scrub poop & blood off your hands and get your phone out during the allotted 15 seconds.

Still a few bugs in the system

Last night I was doing a survey about a new medication, and encountered this question:

The Long and Winding Road

 

Guy walks in, stands at counter.

Mary: "Hi, can I help you?"

Mr. Far: "Yeah, I have a new-patient appointment with Dr. Grumpy for 2:00."

Mary: "Oh! You must be Mr. Far. It's 1:30 now, but that gives you time to get started on your paperwork..." (hands over a clipboard) "and can I get a copy of your insurance card?"

Mr. Far: "Sure..." (take clipboard, rummages through wallet, hands card to Mary) "I left my house early to make sure I had plenty of time to get here."

Mary: "That's fine. If he's done with his current one early, he'll usually start with you."

Mr. Far: "I had no idea how far you were from my house."

Mary: "I'm sorry. I thought you lived in South Grumpyville?"

Mr. Far: "I do... It was a 30 minute drive here."

Mary: "Isn't that what I told you it would probably be?"

Mr. Far: "Yes... You were right. I just hadn't realized it was that far."

Mary: "Well, you made it here early, which is better than late. Here's your insurance card back, thank you."

Mr. Far: (puts card back in wallet) "My GPS even said it would be this far, so I left early to make sure I had enough time. Still... it seemed like a long drive."

Mary: "I'm sorry. Did you have a question about the forms? Or need a new pen? Let me get you another one..."

Mr. Far: "No, let me give this back to you" (hands clipboard and pen back) "I... I think this is too far for me. I'm just going to leave and try to find a neurologist closer to my house."

Mary: "Are you sure? I mean, you're already here, and have an appointment in a short while?"

Mr. Far: "Yeah, this is just too far for me to drive. Thank you, anyway." (leaves)

Sunday afternoon

So, as hunter-gatherer tribes have done for the past several million years, Craig and I went on our weekly hunting & gathering expedition to Costco yesterday.

One of the items I needed for our cave was a chair mat. I'm notoriously rough on these things, and 6-12 months is about average for me. So I grabbed one off the pile, and was carrying it by the handles

When I got to check-out, the guy took it from me and set it upright in the cart, saying this would make it easier to transport. So it looked like this:

Side view

Front view

Seemed like a good idea. This way, if I was attacked by stone-throwing members of the rival Samsclub tribe, I'd have a shield.

Until I tried to push the cart. When I discovered I had this view:

Yes, that's Craig in front of the cart, trying to help me navigate my way out without killing anyone or denting another family's dinomobile.

After a few minutes of struggling with this, some 10 year-old walked by and said, "Mister, why don't you just pull the cart instead?"

Craig still hasn't stopped making fun of me (though it's not like he thought of it, either).

Patient quote of the day

"My mom and I are the same age, but my Dad is younger than me."

Dear Job Recruiter,

Thank you for this ad I received in the mail yesterday.

Let me give you a few pointers:

1. Neuro-Hospitalists are just neurologists, like me. The only difference is that they only work in hospitals. Granted, I don't call myself a Neuro-Officist. Probably because some idiot would pronounce it as "Neuro-Orifice."And calling myself (more accurately) a Neuro-Hospital-Officist just sounds silly.

My point here is that we don't wear surgical hairnets. Or gowns. Or gloves. I suppose if you worked in a hospital you could wear scrubs all the time, but there's no point to the other surgical accoutrements. I do know one Neuro-Hospitalist (I'm not sure it needs to be capitalized either, but you started it) who didn't match into neurosurgery, but 15 years later still plays make-believe by rounding in scrubs with a surgical hat & booties. But that's not normal.

Also, if you're going out of the way to wear sterile surgical gear and look official, you just contaminated your gloves by touching the film.

2. Holding up X-ray films is so 1990's. It's all on a computer monitor now. If the hospital you represent is still using films, that's not a good selling point.

3. It's a freakin' X-ray of a skull. Now, I know you're just a job recruiter, and likely grabbed some stock footage, but this isn't what neurologists look at. We look at MRI's and CT's, NOT PLAIN X-RAYS!!! Especially of a skull. While the skull is of relevance to neurosurgeons and ENT's, my tribe is more concerned with what's inside it. Unless this hospital is still using pneumoencephalograms as a diagnostic tool, a neurologist won't be looking at skull films.

4. If a plain X-ray of a skull is the best neuroimaging this hospital can do, they need a lot of things more than they need a Neuro-Hospitalist.

Yours truly,

Ibee Grumpy, M.D.