Patient quote of the day

"It was dark. I mean, pitch black. I was afraid I'd completely lost my vision and was blind. But then I found the light switch, and flipped it. That made everything fine, and I could see again."

Money changes everything

Dear Dr. Cashpay,

I know you don't remember what it was like to be a peon. It's been several years since you last saw an average patient. Nowadays people pay you $5000/year to "belong" to your practice, and then another $400/hour if they actually have to see/speak/text/stand in your radiant aura.

And you normally don't refer to me, anyway. Since I take insurance, I get paid the same amount of money to see one of your self-important assholes as I do for a decent, but non-wealthy person. So I don't give your patients the priority attention you feel they deserve. But, occasionally, one of them will show up on my doorstep and I'll see them. As did Mr. Rich last week. Unlike most of your peeps, he was quite pleasant.


3 days later:


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

Lacey: "Hello, this is Lacey, calling from Dr. Cashpay's office. He wishes to discuss Mr. Rich's case with Dr. Grumpy."

Mary: "Hang on, he's between patients, so let me get him."

Lacey: "No, we don't work that way. He'd like to schedule a 15-30 minute appointment to discuss Mr. Rich by phone."

Mary: "Wait... You're actually trying to schedule a phone call for the doctors to talk?"

Lacey: "That's what we do here."


This was a first for my office. Mary grabbed me, and I got on the phone.


Dr. Grumpy: "Hi, this is Dr. Grumpy."

Lacey: "Dr. Cashpay would like to schedule a 15-30 minute phone appointment to discuss a mutual patient."

Dr. Grumpy: "That's a lot of time. Is Dr. Cashpay going to pay me for this phone call?"

Lacey: "Certainly not. He works for his patients."

Dr. Grumpy: "But he'll charge Mr. Rich for the time he spent on the phone on his behalf, right?"

Lacey: "Of course. And rightfully so."

Dr. Grumpy: "Look. I've get about 5 minutes on the phone between patients right now. So Dr. Cashpay can talk to me now, at no charge. But I really don't have time to set up phone appointments for this sort of thing."

Lacey: "He's with a patient, and doesn't allow interruptions."

Dr. Grumpy: "Then he can try later, and see if I'm available. Show him how to dial. Goodbye."

Overheard at the Nurses Station

It's shift change:


Nurse 1: "Beware of when she coughs."

Nurse 2: "Why? She really sick?"

Nurse 1: "No. When she coughs, she farts. And sometimes more."

Wrong Way Wooten

Dear Dr. Lazar,

One of my readers noticed an ad for your recently published book:

I'd like to make 2 points (so to speak).

1. While your book is on stomach cancer, and I understand anatomy is important, the breasts seem unusually voluptuous detailed for a book that focuses on an entirely different organ system.

2. In a book about stomach cancer, some details are more important than others. The anatomy of the stomach, for example, is pretty critical. And in this case, your cover art has it backwards. So, unless you've got an exceedingly rare patient born with reversal of the internal organs, or a previously undescribed form of malignancy that causes them to rotate a perfect 180°... I'd break out your Netter.

Thank you, Robyn!

Hmmmmm...

Dr. Grumpy: "Are you married or single?"

Mr. Shakes: "Um, do you think the girl who drove me can hear us? She's out in your lobby."

Dr. Grumpy: "No, not through these doors."

Mr. Shakes: "Then I'm single."

Correct!

Dr. Grumpy: "Have you had any surgeries?"

Mr. Cecum: "I've had a unilateral appendectomy."

Mary's desk

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

Mr. Sativa: "I need to make an appointment."

Mary: "Okay, what will you be seeing the doctor for?"

Mr. Sativa: "I need my transmitters or transistors checked in a test."

Mary: "I'm not sure what you're talking about. What symptoms are you having?"

Mr. Sativa: "I don't know if I'm having symptoms or not. See, I've been smoking weed for years, and 3 days ago I stopped cold turkey because I needed the money to get my car fixed, and I need that test to see if my brain is, like, really fried."

Mary: "And what test did you say it was?'

Mr. Sativa: "I want my transistors, or transmitters, or whatever those things are that radios and TV's and power stations have, you know, except they're in your brain. I read about it on the internet."

Mary: "I'm not sure..."

Mr. Sativa: "Also, I need to know how much it costs, too, because now that I'm not smoking weed I'm trying to save money, in case I need more tests, or go back on weed, or get my car repaired again because it still isn't working right. It makes this weird noise, like a rabbit is trapped in the glove compartment, and I looked and there's no rabbit there, or bird, or anything. Do you know what can make a noise like that? Or can you ask the doctor?'

Mary: "Why don't you call Dr. Hehatesusandwehatehim, down the street. He does this test."

Mr. Sativa: "Oh, cool. Does he know anything about cars, too?'

Texting with Frank

Frank and I are usually texting back and forth in the afternoon, as I have to pick him up and take him to Kumon, or home, or heaven knows where.

Unfortunately, this isn't nearly as easy as it sounds. For example, here's one where I wanted to know if he was going to stay at a friend's house, or was ready for me to come get him.

 

Another issue is the somewhat unusual messages he sends:

 Or his attempts to get out of going to Kumon:

Or the ones that warn me there's a mess waiting at the house:

And yes, he did use the SodaStream CO2 cartridge. A brand-new, sealed, one, completely emptied in Frank's attempt to build an anti-zombie weapon. You have no idea of the looks you get at Target when trying to exchange an empty SodaStream cartridge that has "DESTROY ZOMBIES!" painted on the side.

Monday night, 8:45 p.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mr. Quattro: "Hi, I'm a patient of Dr. Brain, and ran out of my pills. Can you call them in for me?"

Dr. Grumpy: "What pill is it?"

Mr. Quattro: "The tan one. It's from Dr. Brain."

Dr. Grumpy: "Do you know its name?"

Mr. Quattro: "It's on the Walmart $4 list. Does that help?"

Weekend on call

Early morning Sunday, I go in to see a new hospital consult.

I walk into the nurse's station, looking for the chart. One of the nurses is on the phone, looks up at me, and says, "Doctor, it's for you."

She shoves the receiver into my ear and disappears into a room with a blinking call light.

Dr. Grumpy: "Uh, hello?"

Voice: "What do you think of her?"

Dr. Grumpy: "Who is this?"

Voice: "This is Mr. Smith. Are you the neurologist seeing my wife?"

Dr. Grumpy: "Yes, but I literally just got here. I haven't been in the room, or even seen the chart yet."

Voice: "Well, what's going on with her?"

Dr. Grumpy: "Sir, I just got here. I have no idea yet. I can call you back..."

Voice: "Okay, what do you think is going on with her?"

Dr. Grumpy: "I haven't had a chance to..."

Voice: "Okay, you obviously don't have the answers we need. Don't bother seeing her, I'll have them call another neurologist."

(Hangs up)

Today's lesson from Snowball

Never knock over a trash can and walk in. Someone might stand it back up.

Truth or Consequences

Last night, trying to be a nice guy and participate in the hospital's community outreach program, I gave a talk to a roomful of senior citizens about Alzheimer's disease.

One guy interrupted me 3 times to ask what a neurologist does.

I'm still not sure if this was real, or if he was intentionally fucking with me.

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!