Annie's desk

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

Mr. Valproate: "I want to know why the doctor won't refill my seizure meds!"

Annie: "Let me see... I don't show that we have a request for that. Did you call your pharmacy?"

Mr. Valproate: "Yes! They told me they've sent it to Dr. Intern 3 times, and all she does is say that she doesn't prescribe my seizure meds. So why won't Dr. Grumpy refill it?"

Annie: "Why are they sending it to Dr. Intern? Did you ask them to fax it to Dr. Grumpy?"

Mr. Valproate: "No. Am I supposed to?"

Memories...

As readers know, my roommate for all 4 years of medical school was a guy named Enzyme.

Enzyme was about 6'3" and maybe 190 lbs. He was calm, cool, and confident, the perfect model of the U.S. Navy officer that he is today. Handsome and a ladies man. He knew how splendid he looked in his uniform. He loved the military, and didn't let anything alarm him.

Until one night.

It was, maybe, around 2:00 a.m. I'd gone to bed at midnight after giving up on studying for the day, and was in a deep sleep.

While I slumbered, deeply napping, suddenly there came a tapping, as of someone gently rapping, rapping at my bedroom door.

Med student Grumpy: "Hello?"

Enzyme: "Ibee, are you awake?"

Grumpy: "I am NOW. What's up?"

(silence)

Grumpy: "Are you okay?"

Enzyme: "I... Need your help."

Grumpy: "It's 2:00 a.m. What's going on?"

(silence)

Grumpy: "Enzyme?"

Enzyme: "There's a spider in my room."

Grumpy: "What?!!!"

Enzyme: "I said there's a spider in my room."

Grumpy: "What the hell? So squash it and let me sleep."

(silence)

Grumpy: "Hello?"

Enzyme: "I'm scared of spiders."

It wasn't even that big, FFS.

"Are you shitting me?"

Awesomeness

For those of you who don't follow Twitter, I'm going to have to put this up.

My random observation was good. But WhiteCoat's response made it great:

Senior citizens behaving badly

A "Neurology Update" sent out recently by MDlinx. Hazards of leaving the "T" out...

Thank you, Gene!

Postage stamps

While waiting in line at the post office yesterday, I saw this stamp in a machine:

I had a brief thought about trying trying to ask for one at the counter:

"I need a great sparkled fraternity. I mean, a freight spanked fickle lilly. No, wait, a crate mangled fritterfrilly. No? A great teutonic titterwilly? Trait-specific hereditary? Um... fate frazzled hillbilly? Razzle-dazzled pickled lorrie?

"Fuck it. I need a 70-cent stamp."

How not to get an appointment

Mary: "Okay, Mr. Suidae. Now, let me give you some forms... here's a clipboard, and a pen... I'll need to get a copy of your insurance card. Any questions?"

Mr. Suidae: "Yeah, will you go down on me?"


And no, folks, he had no neurological reason to act like that.

Beware of the Dragon

Seen in a vascular ultrasound:

"We're gonna need a really big ultrasound machine."

For non-medical readers: It should have said "left lower extremity."

Thank you, Homebru!

12:07 a.m.

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

Miss Myelin: "Hi, I'm a Multiple Sclerosis patient of yours, and I wanted you to know I'm in the emergency room. The doctor here is probably going to call you."

Dr. Grumpy: "Okay... Why did you go to ER?"

Miss Myelin: "I lost vision in my left eye. I didn't want to bother you, so I came right in. I was worried that I should get it checked out."

Dr. Grumpy: "Sounds like you did the right thing. Has the doctor seen you yet?"

Miss Myelin: "No, but they just got me back here."

Dr. Grumpy: "When did you lose vision in your eye?"

Miss Myelin: "About a month ago."

Dr. Grumpy: "A MONTH AGO? Why didn't you call me?!!!"

Miss Myelin: "Like I said, I didn't want to bother you."

Dr. Grumpy: "Did you start the MS medication, the Tyglatfiderexa, that I prescribed 2 months ago?"

Miss Myelin: "No. I don't know why you gave me that. I informed you at the first visit that I won't take narcotics."

Dr. Grumpy: "It's not a narcotic! I told you that. It's for your immune system. Who said it was a narcotic?"

Miss Myelin: "This lady I met."

Dr. Grumpy: "Is she a doctor?"

Miss Myelin: "No, she's the cashier at Qwik-Mart. But I think her boyfriend's dad is."

Back from the trenches

Frank and Craig returned yesterday from 10 days at Camp Befouled, where they did outdoors type stuff with other guys in the forests of northstate.

To the horror of all (except the boys) we discovered they were wearing the same clothes they'd left our home in 10 days earlier. And, on looking through their bags, we discovered no dirty clothes at all. Just neatly folded shirts, underwear, socks, etc. So they'd been wearing the same outfits, day and night, for 10 days.

They didn't seem to have a problem with this, but on the drive home Mrs. Grumpy and I sure did. In the high humidity of a hot day we had no choice but to keep the windows down so we wouldn't die. If I'd thought to bring some twine I might have just put them on the roof rack for the ride.

Upon getting home, even the dogs didn't want to get close to them. When you smell so awful your dog isn't interested... That's really bad.

We immediately directed them to the shower closest to the garage.

Weekend reruns

Dr. Unka is in my office building. When he refers a patient to me, he often walks them upstairs to my office and waits with them up front (while his own waiting room backs up) until Mary has scheduled the patient. He often asks that I drop everything I'm doing to come meet his new referral, instead of just, say, having them call us to make an appointment.

So today Mary grabbed me to say Dr. Unka was up front, and wanted me to come meet a new patient. So I excused myself from my current patient and went up front, to see him standing there with a familiar, somewhat irritated-looking, older lady.


Dr. Unka: "Ibee, I'd like you to meet Mrs. Ancient. I'm referring her for memory loss."

Dr. Grumpy: "Uh, I saw Mrs. Ancient 3 weeks ago for that."

Mrs. Ancient (glaring at Dr. Unka): "I told you! Why didn't you listen to me?"

Dr. Unka: "She did?"

Mrs. Ancient: "Yes!"

Dr. Grumpy: "Yes, I sent you a note."

Dr. Unka: "You did?"

Mrs. Ancient: "Yes! He did! It was even in my chart at your office! I pointed it out to you!"

Dr. Unka: "You did? Um, I mean, then have her make a follow-up." (leaves my office).


So, in this situation, who REALLY needs to be seeing the neurologist?

Thursday afternoon

Dr. Grumpy: "Hello, sir, I'm Dr. Grumpy. Have a seat... so what can I do for you?"

Mr. Thebaine: "My life is a never-ending orgy of pain and misery."

Ma-Ma-Ma Bell

 Mrs. Dementia lives with her daughter. She's on the ball enough to remember that she doesn't like me because I took away her driver's license, but that's about it. Anyway...


Mrs. Dementia: "Hello?"

Mary: "Hi, Mrs. Dementia. This is Mary, from Dr. Grumpy's office."

Mrs. Dementia: "Hi, Mary. You have the wrong number. I don't live here anymore."

Mary: "Okay, well, I'm calling to remind you about your appointment tomorrow."

Mrs. Dementia: "I won't be able to go. My daughter's car isn't working, and can't be fixed. I can't go to doctor appointments anymore."

Mary: "Is your daughter there?"

Mrs Dementia: "No, she drove to the grocery store because we're out of bread."

Mary: "Can you have her call me when she gets home?"

Mrs. Dementia: "She doesn't live here anymore, either. I don't know when she'll be home."

Mary: "Okay, I'll just call back later, thank you."

Mrs. Dementia: "You can't. Our phone is broken, and no one has been able to reach us for days."

Mary: "Does your daughter have her cell phone with her?"

Mrs. Dementia: "That's broken, too. I think you have a wrong number."

Mary: "Okay. Thank you. I'll try..."

Mrs. Dementia: "Our phone is broken, so don't try to call back. The grocery man told us it can't be fixed."

Daughter (picks up extension): "Hello? This is Sue. Mom, who are you talking to?"

Mrs. Dementia: "I'm sorry Sue, I think you also have a wrong number."

Mary: "This is Mary, at Dr. Grumpy's office."

Mrs. Dementia: "Our phone is broken, and we can't hear you."

Sue: "Hi, Mary. Is this about tomorrow?"

Mary: "Yes, at 2:45.

Sue: "We'll be there."

Mrs. Dementia: "You both have a wrong number because the phone is broken. I didn't hear it ring."

Mary: "Thank you. See you then."

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.