Ockham must be horrified

Seen in a chart, from the "throw stuff at the wall and see what sticks" school of differential diagnosis:

Dragon gone bad

On rounds yesterday I encountered a urologist in the doctor's lounge, laughing hysterically as he proofed his dictations (done by the hospital's Dragon system).

His sentence “due to ejaculatory problems he runs into issues during intercourse.”

Had been changed to  “due to ejaculatory problems he runs into her shoes during intercourse.”

I cracked up, too.

Another round for my staff

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

Mrs. Lost: "Hi, I'm here at the pharmacy, and my prescription isn't ready."

Annie: "Really? I called it in last night. You're at the Walgreen's, at 5th & Hamilton?"

Mrs. Lost: "I think so."


In background:

Mrs. Lost: "Hey, is this the Walgreen's on 5th and Hamilton?"

Male voice: "No, this is the CVS at 5th & Hamilton. The Walgreen's is across the street."


Mrs. Lost: "No, it's not here."

Annie: "Well, didn't I just hear someone tell you it's at the store across the street? You're in the wrong drugstore."

Mrs. Lost: "I guess so. Can you call and tell them to have someone carry it over here?"

Annie: "No. You'll need to go get it. You're in the wrong store."

Mrs. Lost: "But it might start snowing any minute now. I saw that on the weather."

Annie: "You can drive across the street."

Mrs. Lost: "But then I have to walk to my car."

Annie: "How far away is your car?"

Mrs. Lost: "It's at the Walgreen's across the street. The CVS didn't have any open parking spaces."

"Wadda ya want, I'm tired."

Seen in a hospital room:

"It's not like anyone actually reads them."

Thank you, W!

Monday reruns

I've always liked the Muppets. One of my favorite songs is "Rainbow Connection," as performed by Kermit at the beginning of their first movie.

For those of you who don't know it:





Anyway, it may be corny, but the song got me through some shitty times. After I failed the first anatomy test in medical school (big time, too- I was the class low out of 120 people) I went to a used record store and bought the Muppet Movie soundtrack just to listen to that song. In a sappy sort of way it reminded me of why I was there in the first place, and I pulled my shit together, didn't drop out of school, and forged ahead.

Life goes on. Medicine is still fun. I mean, I like what I do. I have to earn a living, so I might as well be doing something I like.

And then, one day a few years back, I was having an ordinary day at the office. And toward the end of it was served with my first malpractice suit.

Nothing will kick the shit out of you faster than that moment. Yes medical students and residents, you WILL get sued. Get used to it. Someone on Sermo recently wrote "I have believed for a long time that unless you are practicing grossly negligent medicine your probability of getting sued is small." This is a remarkably ignorant statement.

Getting sued is like cancer- something that happens to other people. I think all doctors, on a superficial level, know it will likely happen. But you're still blindsided when it happens to you.

Obviously, I'm not going to go into legal details of the case, or who won, or even if it was dismissed. Because none of those are relevant to this post.

And I'm sure there are plenty of patients out there who can write how horrible Dr. Butcher maimed you. I'm sure some of you have legitimate claims. But I'm not writing about you.

Malpractice isn't black or white. It's really mostly shades of gray. I'm not biased against lawyers, in fact- my Dad is one, and sued several doctors for malpractice. But I'm not going to get involved in arguments about lawyers vs. doctors, either.

My point is just my own experience.

People portray doctors as being arrogant or uncaring. And I'm sure some are. But anytime a case goes bad, it's personally devastating for most of us. Even if you did nothing wrong. Sometimes shit happens despite your best efforts.

It hurts. A lot. You do your best day in and day out, and feel awful when things go wrong. And now someone is accusing you of having committed malpractice in your efforts. They tell you not to take it personally, but how can you not? Hell, they even name your spouse in the suit (really, they do).

You may be absolutely right. The literature may back you up completely. But that often doesn't matter.

You see, there is always another doctor out there willing to testify in court (for a nice fee, of course) that what you did wasn't appropriate. He's Dr. Jukebox. You put in money and he'll play whatever tune they want him to (it pays a lot better than seeing patients). The statements from these whores will make you feel like shit, and the legal language used makes you sound on a par with Dr. Mengele.

No amount of medical competence can prevent someone from filing a lawsuit against you. Even if you did nothing wrong, there's always a hungry lawyer willing to take the case. After all, it only costs about $100 to file a suit, the potential payoff is 1/3 of the winnings, and he knows a Dr. Jukebox who will gladly testify that you're incompetent.

Your medical school teachers won't tell you what it's like to be sued, but I will.

It's devastating.

It kicks the shit out of you. You lie awake at night wondering if you're going to lose everything you ever worked for. You cry. You think about suicide, but have to go on for your family. With this sword of Damocles hanging over your head, you still have to go to work every day, and do your best for the patients who still depend on you. Some days it's pretty damn hard NOT to start drinking.

And, deep down, you wonder: Am I really incompetent? You question your own judgment. Suddenly every headache patient needs a brain MRI. Every person you see is a time bomb. You start to view them as the enemy.

People use the phrase "defensive medicine" in a derogatory fashion, meaning unnecessary testing doctors order to prevent themselves from being sued. But after it's happened to you, hell, you don't give a fuck how much money the "unnecessary" tests cost. You'll order anything to cover your ass.

And no matter what you did, Dr. Jukebox will testify that it wasn't the right thing. And no amount of literature in your favor will change his "expert" (i.e. well-paid) opinion. The people on the jury deciding your fate aren't medical people.

Even if you win, it still doesn't take away the living hell you and your family are put through for the 3-5 years (yes, years) it takes the case to play out. The sleepless nights, the gray hairs, the stress eating that shortens your time on Earth, and the spouse and kids who worry about you.

And, regardless of the case's outcome, it will forever destroy your Rainbow Connection, and the beliefs that once drove you to dream of being a doctor.

It's complicated

Dr. Grumpy: "How are you doing? It's been about a year since your last appointment."

Mr. Optimist: "Going okay. I've met a great girl, and this could be the one. I mean, she threw me and my stuff out of her apartment and called the police on me last week, and I had to live in my car for a few days until I could find a new place, but I think this is part of the road to a stronger relationship."

Huh?

My iPhone rings. It's a hospital extension, so I pick it up. It turns out it's one of my call partners.



Dr. Grumpy: "This is Dr. Grumpy."

Dr. Nerve: "Hi, Ibee. I'm over at the hospital."

Dr. Grumpy: "What's up?"

Dr. Nerve: "Will you have time in the next week or two to talk about something on the phone?"

Dr. Grumpy: "I have time now. What's up?"

Dr. Nerve: "I'm busy. I'll call you back when I have time. Thanks."


He hung up.

Tinea

Dear Mr. Floccosum,

There is a time a place for everything. When I am ready to examine you, believe me, I will.

I sent you back to my office so we can start just by talking.

I did not ask you to, right off the bat, remove your shoes and socks. Nor did I know that you hadn't trimmed your toenails or washed your feet since the Ford administration.

And for the love of all that is good and holy, you did not need to prop them both up on my desk.

Thank you.

Goodbye, David Bowie

You were awesome. Good luck out there on your way home.

"If you're ever sad, just remember the world is 4.543 billion years old, and you somehow managed to exist at the same time as David Bowie."

- Another Bowie fan.

 

 Picture from APOD.

Patient quote of the day

"I think the real issue causing the stress is that she thinks that I think that she thinks that I think that she's under stress. And I'm not under stress. And neither is she. So I don't understand why she thinks I'd think she'd think that I'm under stress, or why I'd think that she'd think that I'd think that she's under stress. I mean, the whole thing is really stressful."

Goodbyes

Mike is a great guy. Doing remarkably well even into his late 80's. He's had epilepsy since childhood, which is controlled very well with medications. I've been seeing him since he moved here 15 years ago. He comes in once a year for me to refill his medication. Because he's so stable it's really more of a social visit. We talk about families, baseball, and (his favorite topic) horse racing.

He came in for his annual visit yesterday, and looked awful. He's been diagnosed with metastatic esophageal cancer, way too extensive to operate, so he's just getting palliative treatment.

There was really nothing, from a neurological view, for me to do. We talked about the usual things, especially his excitement at 2015 having brought the first Triple-Crown winner since 1978. I refilled his medication and sent him out with a handshake, like I always do.

I know I won't see him again. He probably does, too. On the "next appointment" line I just scribbled "will call" because it seemed cruel to write the usual "1 year."

Even the easy patients aren't always easy. It's part of the job, but that doesn't mean I like it.

Thursday afternoon

Lady comes in, walks up to counter.


Mary: "Hi, can I help you?"

Mrs. Dayoff: "Hi, I'm Ada Dayoff. I'm here for my 3:00 appointment."

Mary: "I'm sorry... Actually your appointment was for yesterday, Wednesday, at 3:00. But I can reschedule you for..."

Mrs. Dayoff: "But you're the one who told me it was for Thursday!"

Mary: "I called you on Tuesday afternoon, with the rest of my reminders. The notes say I spoke to you directly."

Mrs. Dayoff: "EXACTLY! You said "your appointment is tomorrow!' I remember quite clearly."

Mary: "Yes... And since it was on Tuesday, that would have been for your Wednesday appointment."

Mrs. Dayoff: "But you called me at 4:18 p.m. See? Here's the call time on my phone!"

Mary: "Okay, that's my call, but it says 4:18 p.m. on Tuesday. Your appointment was Wednesday.  Today is Thursday."

Mrs: Dayoff: "Look! Everyone knows that if you say tomorrow BEFORE 4:00 p.m. you mean the next day, and if you say tomorrow AFTER 4:00 p.m. you mean the day after tomorrow."

Mary: "Uh..."

Pause.

Mrs. Dayoff: "Anyway, I'll reschedule. Do you have anything for tomorrow?"

That clears things up

Seen in a chart:

Crustaceans

I'm in line at the meat & seafood counter at Local Grocery, waiting to buy something other than tomatoes. Ahead of me is a couple in their late-20's, who are fascinated with the live lobster tank next to the counter.

Counter Guy in his white apron wanders over.


Counter Guy: "Hi, can I help you?"

Mr. Clueless: "Um, we have some questions about the lobsters."

Counter Guy: "Sure. What's up?"

Mrs. Clueless: "How long do they live?"

Counter Guy: "Well, until you're ready to..."

Mr. Clueless: "What do you feed them?"

Counter Guy: "Uh, not sure. The night shift handles that."

Mrs. Clueless: "Can you keep them in a regular tank? We have Tetras already, is that okay?"

Counter Guy: "Um... Not sure. Most people don't keep them alive..."


Pause.

Mr. & Mrs. Clueless are staring at Counter Guy like he's balancing a Buick on his winkie.


Mr. Clueless: "Why... would you keep a dead pet?"*

Counter Guy: "They're to eat... not for pets."


Pause.

After 10 seconds or so of silence Mr. & Mrs. Clueless walk away.


Counter Guy: "Uh..."

Dr. Grumpy: "Yeah... I know... I'd like a 1/2 pound of roast beef and a large container of cole slaw."


*How many others out there imagined John Cleese asking that question?