Medicine by committee

I'm with a new patient.


Dr. Grumpy: "What did the MRI show?"

Mr. Triad: "I'm not sure, my other neurologist said..."

Dr. Grumpy: "Wait, you have another neurologist?"

Mr. Triad: "Actually, I have 2 others. I saw both of them earlier this week."

Dr. Grumpy: "Why are you seeing 3 different neurologists?"

Mr. Triad: "Well, it seems like a good idea. I mean, this way if I disagree with something one does I can call the other two, and see what the majority opinion is."

Dr. Grumpy: "Who are the other 2 neurologists?"

Mr. Triad: "I don't want any of you to know who the others are. I think that will help keep all of you impartial."

Long pause.

Dr. Grumpy: "Honestly, I'm really not comfortable with this situation. I can understand someone wanting a 2nd opinion, or even a 3rd, but to have 3 different neurologists trying to manage the same condition, ordering tests, and prescribing medications at the same time... I'm going to have to end this appointment. I won't charge you for it, but I just don't think this is a good idea, and don't want to be a part of it."

Mr. Triad: "You know, that's funny. My 5th cardiologist said the same thing yesterday."

Great deals on prions! This week only!

Dear Major Chrysler, Jeep, & Dodge,

A reader sent me your flyer about the recent Memorial Day car & truck sale.

I can only assume you don't have a lot of customers who are neurologists...

Methinks I smell a rat

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

Mr. Gad: "Hi, I saw Dr. Grumpy a few years ago, and am worried about my records there."

Annie: "What's the problem?"

Mr. Gad: "Well, I'm concerned they might affect a legal action I'm in, and would like to change them."

Annie: "We can't change records, sir. If you feel something is incorrect you can send us a letter and we'll note it in your chart, or you can make an appointment to discuss it further with the doctor."

Mr. Gad: "That won't do. I need you to change my diagnosis."

Annie: "We can't do that."

Mr. Gad: "Okay... How about if you shred my chart and destroy any scheduling records, bills, and whatever that says I was there? I'll pay you, in cash, for your time."

Annie: "I'm sorry, sir, but that's illegal, and we can't do that."

Mr. Gad: "Don't you believe in 'the customer is always right'?"

Annie: "That's not the issue here."

Mr. Gad: "Thanks for nothing." (hangs up)

Numbers

How much did your employer give to charity last year?

Contrary to popular belief, American doctors and hospitals give away free care quite often, to the tune of $74.9 billion for 2013. That, in case you don't understand numbers, is a fuck-ton of money. Let's look at the zeros: $74,900,000,000.

Of course, most of it isn't voluntary. There are a lot of uninsured people in America, and, whether you like it or not, you're still paying for them (and always have been, long before the current health policies). Even though they don't have insurance, that doesn't mean they won't get sick or injured and land in the hospital. There they'll likely need labs, tests, medications, supplies, and (of course) doctors and nurses. Since the amount of money charged for medical services are realistically beyond what most can pay, the doctors and hospitals have no choice but to write them off as losses. So you pay for them by higher insurance rates (I've addressed this before).

But the office is a different matter. Most doctors, including me, collect payment up front. Maybe not the full amount, but we copy your insurance card and charge your $50 co-pay (or whatever) before seeing you. The rest we'll bill to your insurance company. For the record, I don't like billing people before their appointment, but it's amazing how many people have "forgotten" their wallet if you try to collect after the visit. Me and my staff have families to support, too.

My point here is that office care generally isn't free, unless previously arranged. To make an appointment you have to have insurance (or agree with our cash prices). Before you even get seen we copy your insurance card and charge you for your share.

Like most doctors, though, I still see the occasional uninsured patient for free. Sometimes as a courtesy to someone else, sometimes because I genuinely feel bad for someone and am trying to help. Most doctors do.

So how much free office care are U.S. doctors voluntarily giving up? Well, for 2013 it was $10.5 billion. $10,500,000,000. I'd still call that a shitload of money (shitload < fuck-ton).

For comparison, let's look at America's biggest retail company: Walmart. According to their own website, last year they gave away roughly $1 billion in cash and merchandise to various charities.

That's a lot, but it's not even 10% of the amount that doctors like me provided. Sam, you're a cheap-wad compared to us (but I love the way your shoppers dress).

Keep that in mind next time you hear some politician or "patient activist" talking about how doctors are all greedy bastards who don't really care about people. Maybe you should ask that person what they gave up to help others.

Odds are they don't have a 6-figure educational loan hanging over their fat heads, either.

Random weekend pictures

Okay, time to hit the mailbag for images you guys have sent in.


First, we have this delectable name for an alcoholic beverage:

If you can't make out the back bumper, it looks like "Drink Responsibly. Don't be an ass."



Next we have this name for a WiFi network:

The person who sent it in says she was on a street between a hardware store a nursing home. I'm not going to even try to guess.



Then there's this ad. Given the common slang definition of "dump" it doesn't sound like ANYTHING I'd ever want to eat, no matter what's really in it.

"I am NOT baking anything I just dumped."

Next, we have this strange command seen at a retail store:

"I'm tired of all this sex on TV. I keep falling off."

Mrs. Grumpy had me stop at Chipotle recently to pick up dinner, and I got this receipt:

Unfortunately, being a medical person, I erroneously read it as "Our guaiac rocks" and was (briefly) pretty horrified wondering what they're doing with guaiac in a restaurant.

Great reasons for referring a patient

"I get blurry vision when I watch TV. But only channel 7."

Head job

Recently, the Cefaly gadget was introduced. It's an electrical headband being promoted to treat migraines.

I'm not here to knock or praise it. I think the jury is still out, and have previously given my thoughts on the various electrical gadgets coming to market.

However, I can't help but notice there are a lot of promotional pics out there showing women (none of whom look anything like my patients) using this product:

"Do I look blissful enough? Is the Dalai Lama here yet?"

"The card you're holding is the 3 of hearts"

"Isn't this more artistic than touching my temples?"

OR

"The bells! The bells! They torment me!"

"Mine is blue. It matches my shoes. And that's all I'm wearing."

 

Anyway, after looking at these, I think they missed a chance to REALLY boost sales by putting a star in the middle. You know, something like this...

"The batteries are in the bracelets. They also deflect bullets."

Tangled

Annie: "Hey, Mr. Memory just called. Says he's still waiting for his Aricept refill?"

Dr. Grumpy: "Really? I thought I called it to DrugMart a few days ago."

Annie: "He says they never got it."

Dr. Grumpy: "Hang on... Here it is. Yeah, I called it in on Thursday."

Annie: "Let me call DrugMart."

(5 minutes later)

Dr. Grumpy: "What did DrugMart say?"

Annie: (sighs) "He picked it up yesterday."

The buzz

Eric

Last week Mrs. Grumpy bought a big jar of honey.

Yesterday morning we discovered one of the kids had put it in the freezer for no clear reason (and of course, no one admitted to it).

It had crystallized, so wouldn't go back to being a liquid easily. Since she didn't want to toss the whole thing, she scooped it into a pot and set it on the stove to liquify.

Then she got distracted with fighting kids, and forgot about it. So it boiled and went all over the stove and gave off a shitload of smoke. Which set off the smoke detectors, and then the fire alarm.

While the kids panicked like it was the apocalypse, I turned off the alarm, and she began cleaning the stove. The kitchen was filled with the sickeningly sweet smell of burning honey, so I sent the tribe to open the doors and windows and turn on ceiling fans.

Then suddenly the twins began screaming and running down the hall as, attracted by the smell, a bunch of bees came flying in. So I began killing them, and sent Frank to go close the doors.

He ran to get the front door, then yelled for me to come there. So I went up front and watched as a fire truck pulled into our driveway. Our alarm company had called them without even dialing the house to check.

I apologized to the guys, and explained what happened. I told them to ignore the twins, who by now had locked themselves in a bedroom and stuffed towels under the door to keep bees out, and were yelling out the window for the firemen to come help kill the bees. They laughed and drove off.

It took about 30 minutes to get rid of all the bees inside, but the smell was so strong we had to leave the windows open the rest of the day, during which time a bunch of them hovered menacingly outside the screens.

How was your weekend?

Memorial Day, 2014

Doris Miller was born in Waco, Texas, the 3rd of 4 boys. He worked on his father's farm until he was 19, when he joined the navy.

He signed up as a mess attendant, one of the few navy positions open to black men at the time, serving meals, cleaning, and doing other jobs. In January, 1940 he was assigned to the battleship West Virginia, where over the next year he was promoted to cook.

On the morning of December 7, 1941, The West Virginia was in Pearl Harbor. Miller had just finished serving breakfast and was starting to collect the officers' laundry for the day's washing. At 0757 the ship was struck by a torpedo from attacking Japanese planes.

Miller immediately ran to his battle station in the mid-ship anti-aircraft guns - only to find they'd been destroyed by a bomb. He took the initiative of going to the ship's central passageway, where he told any officer he could find that he was available for duty. The communications officer was looking for someone to help carry wounded men, and the 6'3", 200 pound Miller fit the bill.

They went to the bridge, where West Virginia's captain, Mervyn Bennion, lay dying outside from a large shrapnel wound. They carried him to a sheltered position. He refused to leave the bridge, continuing to give orders until he died.

Next, he was grabbed by 2 officers he routinely served meals to, and the 3 ran to an unmanned machine gun position. Miller had never operated the gun before, but learned quickly. Initially the officers planned to have him feed the ammunition belts to them, but while they were setting up he loaded a gun himself and started firing at planes.

The Japanese planes eventually left, with the West Virginia sinking to the bottom of the harbor 40 feet below. Parts of the ship were flooded, and Miller now set off to help the wounded. With portions of the deck covered in water and oil, he saved many lives by repeatedly carrying wounded men through the flooded areas to the dry quarterdeck, from where they could be taken ashore. When there was no more to do, he and the others finally left the ship.

A week later Miller was back at his usual mess job, this time on a heavy cruiser.

The initial roll of men who'd received commendations for their actions on December 7 didn't even have his name on it - just listing "an unnamed negro." It wasn't until March 12, 1942 that his identity became publicly known. In April, 1942 he was personally awarded the Navy Cross - the first African-American to be so decorated - by Admiral Nimitz himself. Nimitz wrote "this marks the first time in this conflict that such high tribute has been made in the Pacific Fleet to a member of his race, and I'm sure that the future will see others similarly honored for brave acts."

Miller's next assignment was the escort carrier Liscome Bay. On November 24, 1943 she was at the Battle of Makin Island. A Japanese torpedo detonated the ship's magazine, sinking her within minutes. Out of a crew of 916, only 262 men survived. Miller wasn't among them, and rests with his shipmates at the bottom of the Pacific.

He was 24 years old.

Thursday afternoon

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

Mrs. Time: "I need to make an appointment for Monday, May 26th."

Mary: "I'm sorry, but we're closed that day for Memorial Day. He can see you on Tuesday at..."

Mrs. Time: "That's not acceptable. Monday is the only day I can come in."

Mary: "I'm sorry, but we're going to be closed. It's a holiday."

Mrs. Time: "Well, then I'll meet him there. 10:00 in the morning should be okay. Tell him I'll be outside the building's western entrance."

Mary: "Ma'am, he's not going to come see you on a holiday. Do you have an emergency?"

Mrs. Time: "That's irrelevant. This is nonsense. Are you aware that it's violation of both state and federal law? Any doctor is legally obligated to see any patient whenever requested to do so."

Mary: "That's not true."

Mrs. Time: "I read it on the internet!"

Mary: "I'm not going to argue with you, ma'am."

Mrs. Time: "That's not acceptable, either."

Skool Nerse time

This is Mrs. Grumpy.

Now, I want to start by saying I'm glad no one was even slightly injured during yesterday's events, but I think this is a good time to review what happened, and how parents at Douglas C. Kenney Elementary School can learn from it. Even though there's only 2 weeks left in the school year, it's always important to go over basic safety.

As you all know by now, Mr. Ima Scumball robbed the convenience store across the street from the school yesterday morning, then (due to poor planning in not having a getaway car), unsuccessfully attempted to carjack a driver at gunpoint, then gave up and tried to escape on foot into the neighborhood. This all happened at about the same time classes were starting.

Obviously, this sort of activity is frowned upon by the Grumpyville Police, and so the area was quickly swarming with policemen, police cars, and a helicopter looking for Mr. Scumball.

Since there was a chance he'd try to get into the school to hide or take hostages, we were ordered to put the school on lockdown. So all gates were closed and locked, with no one allowed in or out. We even woke-up Elmer, our octogenarian security guard, from his morning nap.

Unfortunately, as always, the beginning of the school day is followed by stragglers who show up 10-15 minutes late, drop off their kids in front, and head to work. By the time they did yesterday, the gates were locked, and under lockdown protocol we aren't allowed to open them again until the all clear is sounded.

So, with policemen everywhere, more police cars arriving every moment to try and cordon off the area, and a helicopter hovering loudly overhead, it was reassuring to see so many parents doing the right thing: Dropping their kids off outside the locked gate and going to work.

Now, I personally don't leave my kids alone in an area where people with drawn firearms are chasing each other. Maybe I'm just overprotective that way. But it still seemed odd to me.

So, with your kids out there in the potential firing line, we can't let them in, either. Because that's the rule. We can't do anything to jeopardize the safety of the kids already inside the school. Calling on your cell phone as you drive away to say "Hi, the gate was locked and blocked off by a police car for some reason, please let Billy in." Isn't going to change anything.

I was particularly touched by some of the responses we got, when parents were told WHY the gate was locked:


"Really? Well, I still have to get to work."

"Wow. I hadn't heard it on the news. I'll go check again."

"I figured he was safe because there were cops everywhere."

 "Huh. Okay, call me if there's a problem."

"How long will he be out there? He had to pee when he got out of the car."

"Why can't you let him in? It's not like he's the robber. I can vouch for him."

"Oh, cool! Michael loves to play policeman! Will they let him help?"


Fortunately, Mr. Scumball was quickly caught hiding in someone's backyard, and we were able to let your kids in. However, I'd like to stress the key points here:

1. On the rare occasion the school gates are locked during the day, DON'T let your kid out of the car. It means something bad is happening.

2. Armed police everywhere is NOT a sign that the area is a good place for your kids.

3. The police are here to catch bad guys, not babysit your kids so you can go to work.

Thank you, and have a great summer.

You VILL have foot pain!

Hazards of misspelling "fasciitis:"

Making a point

Dr. Grumpy: "What's the pain like?"

Mrs. Bun: "It's stabbing, aching, burning, stabbing, throbbing, stabbing, itching, dull, stabbing, sore, stabbing, sharp... Did I mention stabbing?"

"Spam, spam, baked beans, spam, eggs, spam..."