Wednesday night, 10:27 p.m.

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

Mr. Molosser: "YEAH! You saw my daughter last week, she's in college up there, and I CAN'T BELIEVE WHAT YOU PRESCRIBED FOR HER MIGRAINES!!!"

Dr. Grumpy: "Um, sir, Migragone is a common treatment for migraines. It's been around for almost 20 years, and is pretty standard."

Mr. Molosser: "DON'T TELL ME THAT! I know medications! It's dangerous! It's experimental! I told her not to take it!"

Dr. Grumpy: "Are you a doctor?"

Mr. Molosser: "No, I manage a White Castle. And I'm having her find another neurologist. NOBODY treats my beautiful daughter like a guinea pig!"

Click

Parental abuse

My mom recently updated her phone to iOS 8, and texted to let me know.

"Those better be some damn fine scrubs!"

Seen on Amazon:

"Not just polyester and rayon, they're ARTISANAL polyester and rayon."

Thank you, Helle!

Family

I'm seeing the elderly Mrs. Cuticle, who's accompanied by her 2 adult daughters. We stopped talking for a few minutes so I could review records they'd brought, and...


Daughter 1: "When are you getting your nails done?"

Daughter 2: "I don't get my nails done. I've never liked it."

Daughter 1: "Well, you should. I mean, it's Autumn. I bet they could do them in some pretty seasonal colors."

Daughter 2: "I don't care, I don't want to get them done."

Daughter 1: "It helps them grow better."

Daughter 2: "It does not."

Daughter 1: "You'll look much nicer in church. It would really improve your appearance."

Daughter 2: "Are you calling me ugly?"

Daughter 1: "No, but you never..."

Daughter 2: "Zip it."

Daughter 1: "Mom, don't you think..."

Mrs. Cuticle: "Shut up. Why can't you ever NOT cause trouble?"

Daughter 1: "You always take her side."

Daughter 2: "Can you blame her?"

Mrs. Cuticle (whips out phone): "I'm calling Michael to give me a ride home. Both of you get out."

Daughter 1: "But Mom..."

Mrs. Cuticle: "Get out or you're grounded!"

Thursday afternoon whatever

Mrs. Dermtag: "There's a weird piece of skin on the back of my neck, so I'm having an autopsy tomorrow."

Dr. Grumpy: "You mean biopsy."

Mrs. Dermtag: "Whatever."

Reputation

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

Mr. Neuron: "Hi, I need to find out if I have brain atrophy. A friend said she saw something on TV about it."

Mary: "Okay, let me see... We have an appointment tomorrow afternoon at 4:00, or on Tuesday morning at 8:30, or..."

Mr. Neuron: "Can I just talk to the doc? Right now? On the phone?"

Mary: "You're not an established patient, sir, and he doesn't do that. I can certainly put you on the schedule, though."

Mr. Neuron: "But I don't need to come in. Can't he tell just from talking to me for a few minutes? Isn't checking for brain atrophy part of what neurologists do? It'll just take a few minutes, and I have time right now."

Mary: "I'm sorry, but you'll need to make an appointment to see the doctor. He doesn't do phone appointments, especially when he's never see you before."

(long pause)

Mr. Neuron: "You know, from seeing his name on the "Best Docs" list in Grumpyville Today magazine, I thought he'd be better than this."

(click)

Doctors behaving badly

I'm with a patient when Mary knocks on my door.


Mary: "Dr. Tanned is on the phone, says he needs to talk to you."

Dr. Grumpy: "Okay. Sorry, Mrs. Patient, let me take this call..." (picks up phone) "This is Ibee Grumpy."

Dr. Tanned: "Hi, Ibee. Sorry to interrupt you, but I just wanted you to know my wife works in home mortgages, and would like your business. Have you considered refinancing? She can get you a great APR."

Dr. Grumpy: "Are you kidding me?"

Dr. Tanned: "Not at all. She's saved a lot of people money on their house payments, and..."

Dr. Grumpy: "I'm with a patient. I have to go."

Dr. Tanned: "I'll fax you..."

I hung up.

Dear Medscape and Duke University,

Thank you for your recent invitation to take my practice "to the next level":

Your five courses sound enticing, exciting, and insomnia-curing. I'm sure they're ideal for doctors who wear suits every day and use phrases like "reaching out," "think outside the box," "patient empowerment," "corporate values" (an oxymoron if I've ever heard one), and "evidence-based paradigm." They probably make more money than I ever will.

I like how the price is down at the bottom in the smallest print. $899, with "per course" intentionally faded, hoping no one realizes this ads up to $4495.

Once upon a time, like many other doctors, I incurred a large educational debt. I don't want to do that again.

I like what I do, and have no interest in learning how to be a boardroom doctor who watches Powerpoint presentations, argues about what payment models are best for the shareholders, and denies medical coverage that might cut into his year-end bonus. I'd rather make less money and sit at the bedside of someone who needs my help.

Actually, the ad gives me the impression that the best way to make money in medicine these days... is to sell educational courses to doctors on how to make money. It reminds me of an old SCTV piece featuring the awesome Joe Flaherty as a huckster. He said something along the lines of "I came up with a great idea to get rich. I'm not going to tell you what it is, but if you send me $100, I'll mail you a pamphlet with some other ideas I had." (I couldn't find it on YouTube. If anyone knows where it is, send me the link and I'll embed it in here. No "Doctor Tongue's 3-D House of Stewardesses," please).

I've sat in enough classrooms in my time. I'll stay where I'm needed - with patients.

But, I have to thank you. Because after reading your ad I've already figured out a way I can save $4495.

See you next Tuesday... at the lab

Thank you, Webhill! 

Placement

"We still need to run that ad for the funeral home. How about next to the funny pages?"




Thank you, Michelle!

I should hope so

Seen in a hospital chart:

Yes, that's all it said. I didn't cut anything out.

Support the staff cardiologists

Seen in a reader's doctors lounge:

Thank you, Bill!

Memories...

One of my favorite drug reps asked me to share a story from the early days of her career.


I was calling on a cardiologist's office. They said the doctor needed samples, and would be out in a few minutes to sign for them.

Being a rep is a LOT of waiting in lobbies, and I'm used to it. There was a sweet looking elderly lady in a chair, who'd been asleep when I came in. When I was talking to the front desk she woke up, and when I stepped away said "that's a beautiful necklace."

It's my grandmother's necklace, and is an unusual piece. I'm quite proud of it. She asked me the story behind it, so I sat down  and chatted with her for a few minutes. Then I had to take a call from my partner. She picked up a magazine, but quickly dozed off again.

A few minutes went by, a patient left, and the doctor came up front. He signed for my samples, then cheerily called "Mrs. Dozer, come on back!"

Mrs. Dozer, however, was still asleep. The good doctor said "Can you give her a gentle tap? She's quite hard of hearing."

So I went over and softly shook her shoulder. "Mrs. Dozer, time for your appointment."

She fell, limply, out of the chair.

The doctor leaped over the front desk into the lobby and yelled for his nurse to call 911. In spite of his heroic efforts, however, Mrs. Dozer was gone.

I called my boss and told her I was going home. I didn't go back to work the next day, either. And I still have a visceral reaction when an elderly patient asks about my necklace.

Dear Kids,

While mom and I appreciate your efforts to save money, judging from your homework table I think things have gone a little too far:

Quarter added for scale

 We can, I assure you, afford to buy new pencils.