Free

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

Mr. Gratis: "Hi, I need to see the doctor."

Mary: "Okay... We have an opening tomorrow at 2:30. What insurance do you have?"

Mr. Gratis: "I don't have insurance."

Mary: "All right, our cash prices are..."

Mr. Gratis: "Oh, there's no charge for the visit. I was referred by Boondock Hospital."

Mary: "What?"

Mr. Gratis: "I was seen in the ER at Boondock Hospital last week, and they told me I should see a neurologist. Your name was on the list they gave me."

Mary: "Yes, but we still charge for the visit."

Mr. Gratis: "It's supposed to be free. A hospital referred me!"

Mary: "I understand that, but it doesn't mean we don't bill for our services."

Mr. Gratis: "I can give you the name of the doctor there. Can you bill her? Or the hospital?"

Wonder powers activate!

Medikidz is a company that sells medical comic books for kids.

I get it. I was a kid once, and loved comic books. In fact, I think there were educational ones at my pediatrician's cave office then, so I'm glad they're still using them today. (I just wish there'd been a good one for biochemistry during med school).

These are the Medikidz superheroes:

I haven't read the comics, but it looks like they fly around on a giant red corpuscle. Being a neurologist I kind of like the knobby-kneed brain in the background. I'm not sure what to make of the guy in front, as generally I prefer my superheroes to wear pants. There's also the guy behind him on the left, who's carrying eating utensils in his belt. This is not standard JLA equipment.

Anyway, the reason I'm even on this subject is that recently the annual Neurology meetings were held in Philadelphia, and my top field agent, SMOD, was there.

Like many companies, Medikidz had a booth on the exhibit floor. I've seen my share of these. Pleasant sales reps in professional attire extolling the virtues of whatever they're selling.

But not Medikidz. To SMOD's horror, their reps were wearing the superhero outfits:

"For this I got a college degree."

They look kind of lonely. It's good to have a job, but still pretty humiliating to have to be at an adult medical convention wearing spandex and a cape. Normally you only see this kind of outfit on Halloween, when shopping at Walmart, or in the personals section of Craigslist.

Dear Medikidz: if you want to attract neurologists, you should wear Star Trek costumes.

Relevance

On the fax machine yesterday morning was a note from Dr. Intern's office, about a lady who has an appointment tomorrow.

It said: "Please evaluate Flora Betapir for Alzheimer's disease. Records attached."

The attached records were:

Right hand x-rays from 1999

A mammogram report from 2002

and a Pap smear report from 2005

Sigh.

True colors

Last week, for those of you who missed it, Los Angeles Clippers owner Donald Sterling temporarily became the most hated man in America. This is actually pretty impressive, as it involves leapfrogging over politicians, television pundits, lawyers, doctors, and the barista who can never get your order right.

Mr. Sterling's downfall came because of overtly racist statements. This rapidly brought him condemnation from politicians, celebrities, and pretty much anyone with a microphone or Twitter account. People lined up around the block to announce they would boycott Clippers games if he wasn't removed, and team sponsors jumped ship fast.

So, guess who can't boycott Mr. Sterling? I can't. Or anyone in the healthcare field.

Sure, I can refuse to go to his games, or live in one of his buildings. But if he shows up in my office or hospital, I wouldn't turn him away. And neither should any doctor or nurse.

This is one of the hardest things in medicine. Regardless of how we may feel about a person, or disagree with their beliefs, we still have to do our best to help them when they need us. I've taken care of neo-nazi white supremacists, militant black supremacists, dirtballs who shoot police or kill innocent people just because they don't like them... the list goes on. Sterling's condescending boardroom racism is minor league compared to these guys.

It's part of the job. Whether they come to you in the office, or you're seeing them in the hospital, you have to set aside your personal feelings and do your best to help. Dr. Samuel Mudd spent 4 years in prison for providing medical care to John Wilkes Booth - a conviction yet to be overturned.

I never discuss politics with patients, as it's bad for the relationship. But that doesn't stop some from bringing it up, sometimes expressing blatantly racist or antisemitic views. I've had people tell me all blacks should be shipped to Africa, or Jews or homosexuals killed. Do I agree with this? Hell no. But I also believe that part of being a doctor is caring for anyone who seeks my help, regardless of personal feelings for them.

In hospitals they have it even worse. Nurses and doctors there have to deal with people who are drunk, high, verbally abusive, and sometimes violent. And, again, they do their best to help those no one would want to. As professionally as possible.

Like most people these days I don't support or like Mr. Sterling. But that wouldn't stop me, or any number of doctors, nurses, or paramedics from doing our best to help him if he needed us. Because that's what we do.

Overheard in ER

Dr. Urgent: "What brings you to ER today?"

Mr. Couth: "I got a big, huge, ball of shit in my ass and it fucking hurts."


Attention medical students: we at Dr. Grumpy, Inc., will not be held responsible for your grades if you use the above quote when presenting a case to your attending.

Wednesday afternoon

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

Dr. Equine: "Hi, thanks for calling me back. I'm a horse veterinarian at Grumpyville Racetrack. Do you have a patient named Mr. Adipose?"

Dr. Grumpy: "Uh, yeah... I just saw him this morning."

Dr. Equine: "You ordered an MRI on him?"

Dr. Grumpy: "Um... What does this have to do with the racetrack?"

Dr. Equine: "I'm going to guess he's a large fellow."

Dr. Grumpy: "Why..."

Dr. Equine: "He just called my office to see if we had an MRI for horses he could use."

Hey, it's for a good cause

Previously I've featured such tasteful fundraisers as:

The Alzheimer's Association "Night to Remember" ball

and

A Parkinson's support group's "Shaken, not Stirred" happy hour.


Now, thanks to a reader submission, I've found:

Thank you, M!

Fly me to the moon

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

Ms. Pisces: "Hi, I need to get in to see Dr. Grumpy right away!"

Mary: "Well, you're in luck. We just had a cancellation, and he can see you this afternoon..."

Ms. Pisces: "Oh, no. It will have to be next week. My astrologer says the horoscope doesn't favor an appointment this week."

Groundhog Day

A few weeks ago I wrote about the recent disclosure of Medicare payment data to the public. I finally got around to running my own numbers from it, and found my total take was around $70,000.

Now, normally I don't care how much other docs are getting. I try not to pay attention to those things, as it's none of my business. But, due to a recent news story, I decided to look up the stats on another doctor.

The doctor in question is an interventional cardiologist, practicing in the northeast. His father is also a cardiologist, and they work together. Sounds nice huh? A family-run medical group.

Anyway, per the 2012 Medicare data, that year Uncle Sam paid this gentleman $313,375.23. DISCLOSURE: I suck at math. Really. So this number could be completely wrong since I had trouble making sense of which column was which, and then I had to multiply across, then add.

Now, like I previously pointed out this is gross, not net. Like all of us out there, I'm sure the good doctor has insane office overhead to cover. This guy is in a field, unlike mine, where you truly are saving lives, and you can't put a price on that. And I'm also not in the business of telling other people how to spend their money. After all, I blow most of my immense fortune on a Diet Coke habit.

So what does this successful cardiologist spend it on? Well, he supports local businesses by spending $135,000 at a strip bar.

I am not making this up.

"I need it all in singles. Don't ask why."

Granted, this wasn't all at once. It took him 4 visits over 10 days last November at Scores Gentlemans Club to reach that amount, averaging $33,750 per visit. It was a cold winter, and I think we all needed to warm up (at the Grumpy household we cranked the heater up and got out extra blankets). Perhaps it was national "Support your local strip bar week" (if it was, I missed the memo).

I haven't been to a strip bar since a bachelor party in residency, but don't think I could spend that much on drinks, tips, and lap dances if I tried (although I haven't tried, either). Maybe I wasn't going to the right bars.

But it gets better. The good doctor (Zyad Younan, M.D.) put the charges on he & his dad's business credit card. Can you imagine how proud the elder doctor Younan felt when the AMEX statement came in? "EKG supplies, ultrasound gel...  $135,000 at The Boob Palace? ZYAD!!!"

Regrettably, daddy's reaction to his prodigy's spending habits hasn't been in the news. He probably grounded him and took away the car. These things don't look very good on IRS audits.

I'm really not sure how Dr. Younan, Jr. was planning to claim this as a business expense. Granted, he's a heart doctor, and the heart is located in the chest, and I'm sure there are a lot of chests displayed at Scores. Perhaps it was a research project he was working on ("I want to put my stent in your vessel"). He could also have been recruiting a new partner, though not necessarily for the practice.

"You say it's a study to repeatedly check my femoral artery pulse?"

So, to recap thus far: a successful cardiologist blew $135,000 in 4 visits at a strip bar, using his business AMEX.

But wait, that's not all!

As anyone who owns a credit card knows, sooner or later the card company wants to get paid (they're funny like that) and sent a bill to Dr. Younan. Like any honest, law-abiding, boob-ogling, dad-fearing cardiologist, he should pay it, right? And, if he had, none of this would even have made the newspapers.

But he didn't.

Instead, he claimed that he didn't have to pay because he was drugged. EACH TIME (I assume he means something beyond alcohol) and therefore has no recollection of being there.

Now, this, in my opinion, is pretty far-fetched. Okay, maybe once is semi-believable. I mean, stranger things have happened. One minute you're walking out to the doctor's lot, the next you're waking up and finding out you spent a fortune at a strip club. Maybe it was aliens. Or terrorists. Or your ex.

BUT 4 TIMES? I mean, that's one seriously good drugging job. If I'd blown that kind of money in a strip bar, I'd at least like to remember what I got for it. But not this unfortunate fellow. Whatever they used to drug him must have been pretty strong to make him not only forget, but to return to the same place 3 more times. Holy déjà vu, Batman!

"It's February 2nd, and I've been drugged by a stripper. Again."

The good doctor's refusal to pay is so steadfast that Scores has filed suit against him for the amount. They claim to have video of him in their fine establishment, acting, I assume, somewhat coherently. To date I haven't seen it listed on Youtube.

So, in summary:

1. No matter what Medicare actually pays your doctor, IT'S NOT WHAT THEY'RE TAKING HOME. The overhead for a medical practice is higher than you think. Probably much higher.

2. Don't let that hair-netted lady who puts out the bagels in the doctors lounge slip something into your coffee. You never know where you'll end up, sometimes repeatedly.

3. If you want to go to a strip bar, more power to you. But trying to charge it to your dad's business AMEX card may not be a good idea.

4. What you do with your hard-earned money is up to you, but remember to pay the bill. Because if you do, they won't sue you to get their money, and this sort of thing won't end up in the news.

5. $135,000 is a helluva lot of money to blow at a strip bar. I think my record was $50 for my share of the bachelor party.

Weekend reruns

From 2009:


Today ended with me doing a telephone and internet conference with 15 other neurologists across the country to review data on a drug that's in development.

The meeting took place after we were all home. So you'd hear the occasional sounds of home life. A kid yelling, a dog barking, somebody laughing in the background, etc.

Usually these things go fairly smoothly. Tonight's, however, had 2 noteworthy interruptions:

Interruption #1:

The "click" of a receiver being picked up, and suddenly a young female voice cuts off the moderator:

Young female: "Daddy! My boyfriend is supposed to call tonight! Why are you on the phone?"

Neurologist X: "Britney! Get off the phone NOW! I'm in a meeting!"

Young female: "Daddy! This isn't just any boy! This is TREVOR!!!!!!!!!!!!" (click)



Interruption #2

The moderator was asking a few questions. He was interrupted when a neurologist with a New York accent apparently had an interruption at home, and loudly said:

"What? Tell him to fuck off! I'm on the phone!"

Seen in a hospital chart.

No. I have no idea what #4 means.

Striptease

Mr. Larsson is sitting in the lobby, reading old issues of People, during his wife's appointment. Suddenly he walks up to Mary's desk, holding a small plastic box.

Mary: "Can I help you, sir?"

Mr. Larsson: "Do you have a land-line?"

Mary: "Yes."

Mr. Larsson: "I need to make a call, and can't use a cell phone."

Mary: "Okay, that's fine, just come around the counter there."

He sets the plastic box on the counter, comes over to the desk, and starts unbuttoning his shirt.

Mary: "What are you doing?"

Mr. Larsson: "I need to send a pacemaker report to my cardiologist's office, and we don't have a land-line at home."

He tosses his shirt on a chair and starts attaching clips from the box to his chest. 

"Wanna see the scar?"

Mary: "Um, I don't know how to send a pacemaker report..."

Mr. Larsson: "Can you unplug one of your phone lines and hand me the cord?"

Mrs. Larsson and I finish her appointment. She opens my office door and walks up front.

Mrs. Larsson: "ARNE! PUT YOUR SHIRT ON!"

Mr. Larsson: "But I need to..."

Mrs. Larsson: "NO! I told you, we'll stop at Dr. Senning's office tomorrow, and you can do it directly. You don't need to do this today!"

Mr. Larsson: "But Dr. Grumpy has a land-line!"

Mrs. Larsson: "So does Dr. Senning! Here's your shirt! I'm sorry, Mary, he's just very obsessive about this."

They leave. The door closes. Mary and I stare blankly at each other for about 10 seconds. Then collapse in hysterics.

Monday afternoon

I had a nice elderly couple in. She had mild-moderate dementia, and I was looking over her previous test results.


Dr. Grumpy: "It looks like your internist did a pretty decent work-up. Unfortunately, I have to agree with him that she has Alzheimer's disease."

Mr. Amyloid: "Yeah, that's what her daughter and I both figured. What about..."

Lady Amyloid: "We just got married!"

Dr. Grumpy: "Really?"

Mr. Amyloid: "Yep. We've been together for 10 years, but got married last week."

Dr. Grumpy: "Congratulations!"

Mr. Amyloid: "We weren't ever planning on it, but after Dr. Intern told us the news I decided we should while she still knew how much I love her."


After 15 years in this job, it takes a lot to get to me. That did.

Think

For those of you who haven't seen it, this excellent piece was on KevinMD today.

For those of you who don't believe this is what American medicine has come to... you should. I've felt the same things other docs have more times than I can count.

For those of you looking to a career in medicine... I repeat what I said last Thursday: GET OUT NOW.