Decimal points. Use 'em.

Seen in a hospital chart:

Thank you, Kim!

Stop!... Shovel time!

 While catching up on reading last weekend I came across this in a medical journal:


"The goal of the project is to supply an interactive system that translates vast amounts of data and scientific literature into insights that professionals can consult to inform their treatment decisions.

"A database, in this case big data, provides the foundation for the potential to use state-of-the-art analytics to generate truly actionable insights."


WTF does that mean?

This is the problem with modern buzzword bullshit. It is, like Macbeth said, "full of sound and fury, signifying nothing." Yet, medical journals are full of similar crap that tells you zilch.

EHR today is the same way. 5-page notes that automatically fill in what medications someone is on, what their allergies are, what their blood pressure is... yet only rarely do you find anything comprehensible telling you what the physician's impression and plan are- WHICH IS THE MOST IMPORTANT PART OF THE NOTE. Usually it's hidden in the ICD numeric codes, and oftentimes the "plan" says something like "see orders database." Which doesn't help me at all.

Quantity has replaced quality in medical writing, and the problem shows no sign of getting better.

The above collection of horseshit, BTW, was from an article about epilepsy treatment.

Rorschach

This is a neuron. It's the basic nerve cell that runs your brain, my brain, pretty much everything's brain:

Sometimes it's hard to leave my job at the office. Work is always on my mind.

One night, when I got home, I found my kids had spilled something in the kitchen. And it reminded me of...

Sigh.

June 6, 1944

"There have only been a handful of days since the beginning of time on which the direction the world was taking has been changed in one 24-hour period by an act of man. June 6, 1944, was one of them.

"No one can tell the whole story of D-Day. Each of the 60,000 men who waded ashore that day knew a little part of the story too well. To them the landing looked like a catastrophe. Each knew a friend shot through the throat, shot through the knee. Each knew the first names of five hanging dead on the barbed wire offshore, three who lay unattended on the beach as the blood drained from the holes in their bodies. They knew whole tank crews who drowned when their tanks were unloaded in 20 feet of water.

"There were heroes here no one will ever know because they're dead. The heroism of others is known only to themselves.

"What the Americans and the British and the Canadians were trying to do was get back a whole continent that had been taken from its rightful owners. It was one of the most monumentally unselfish things one group of people ever did for another.

"It's hard for anyone who's been in a war to describe the terror of it to anyone who hasn't. How would anyone know that John Lacey died in that clump of weeds by the wagon path as he looked to his left towards Simpson and caught a bullet behind the ear? And if there had been a picture of it - and there weren't any - it would've shown that Lacey was the only one who carried apples for the guys in his raincoat pocket.

"If you think the world is rotten, go to the cemetery at Saint-Laurent-sur-Mer on the hill overlooking the beach. See what one group of men did for another, D-Day, June 6, 1944."

- Andrew Rooney (1919-2011)

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.