Statistics

Saw this in a report:

The way it reads, I can't help but to interpret it (albeit erroneously) to mean that 99% of people taking aspirin for secondary prevention of CV (cardiovascular events) did experience a life-threatening GI bleed.

Stages of weekend call

Food

Stage 1: I'll get something healthy, maybe a salad, in the cafeteria.

Stage 2: Are there any bagels left in the doctors lounge?

Stage 3: There are Graham Crackers in the nurses station galley.

Stage 4: I see old Cheetos under the ICU fridge.



Transportation

Stage 1: I'll take the stairs up to 5. I need the exercise.

Stage 2: I'll only use the elevator if it's more than 2 floors up.

Stage 3: I'm taking the elevator to go down 1 floor.



Tests

Stage 1: Ordering an MRI and a few carefully selected labs to narrow the problem down.

Stage 2: Ordering an MRI, MRA, labs, and an echocardiogram to start by covering the bases

Stage 3: Ordering an MRI, MRA, CTA, echocardiogram, EEG, VNG, EMG/NCV, CT-myelo, pneumoencephalogram, and every lab in the book... figuring your call partner will sort it out on Monday.



New consults

Stage 1: I'll be right in to have a look at her.

Stage 2: Can I see her in the morning?

Stage 3: Call Dr. Brain after 7:00 a.m. tomorrow.




Signature line

Stage 1: Thank you for this interesting consult.

Stage 2: Thanks for this consult.

Stage 3: Scribbled name.



Handwritten chart note

Stage 1: A neatly written paragraph summarizing the key history, pertinent exam findings, and your impression and orders.

Stage 2: A brief note listing your impression and orders.

Stage 3: "Patient seen, note dictated."

Modern medicine

I was seeing Mrs. Hufnagel recently, and trying to get a hand on what medicine changes and labs she's had since her last visit (she's not the most precise historian).

After tearing some hair (actually, a lot of hair), out, I finally called her internist's office, and asked them to fax over her most recent chart note.

They sent this over:


Better yet, when I called them again, they verified that it's the entirety of her most recent note. After all, the Medicare quality measures are the only things of value anymore.

Thought for the day

"We have all these jokers running for President and the biggest news story any given day is whose ass looked better in a bikini. Then we have these heroes spend months in space for the greater good and hurtle back to Earth in a tin can and no one gives a shit. We don't need to make America great again. We need to make being intelligent great again."

- Geri

Great physical exams

Seen in a chart:

Thank you, H!

The buzz

Mary: "Hi, this is Mary, from Dr. Grumpy's office. I'm calling to remind you about your 2:45 appointment tomorrow."

Mr. Apoidea: "I'm not sure I'll be able to make it. I'm being stalked by bees."

Mary: "Excuse me?"

Mr. Apoidea: "There are bees following me, whenever I leave my house. I've been stung a few times this week. You'd think I'd bathed in honey or something."

Mary: "Okay, so would..."

Mr. Apoidea: "I'm hiding in my basement now, and they haven't found me yet. I'm going to stay here for a few days to see if they leave, and will call you when I'm ready to come in."

(click)

Skool nerse time

This is Mrs. Grumpy,

Dear Kids,

There are a lot of innovative ways to cut class and/or get sent home, and I think it's commendable that you guys work together so well.

Sometimes even I get fooled.

Last Thursday, for example.

Getting a bunch of kids in with stomach aches isn't that unusual, especially since I can't test for them. But when a second crop began showing up with skin irritations and rashes on their hands, faces, and mouths... it certainly got my attention. I even called the state and poison control to see if there were reports coming from other schools along those lines (there weren't).

Until someone came in with bad eye pain, which I had to flush out with water... and they spilled the beans. Before that I really had no clue what you were all up to.

Apparently one of you cute tykes smuggled in several Carolina Reapers with your lunch. Some bravely tried to show off by eating them, while others just vigorously rubbed pieces on their skin to induce redness and swelling. And a few accidentally ended up getting it in their eyes, nasal tissues, and (in one horrifying case) rear end. ("It was an accident, Nurse Grumpy!" Uh-huh, sure.)

Fortunately, no students were permanently harmed in this debacle, though many parents were quite inconvenienced by me having to call them about what was going on. And the majority of them began laughing hysterically.

To recap:

1. Mrs. Decimal says you still have to make up the math test.

2. Your parents think you are idiots.

3. Scoville units are not to be taken lightly.

Have a nice day.

Why don't you just ask?

Seen in a hospital chart:

Random pictures

Okay, time to hit the mail bag for stuff you guys have sent in.


First is this Engrish sign:

Next up is this school job opening for, um, not sure:

Then there's a fortune cookie...

"Confucious say, when alone, use the self-service pumps."

Then there's this sign. "Lobster Happy Hour" apparently doesn't apply to the lobster:

Here's a vintage drug company promo piece. You'd think Viagra would have been a better choice:

Speaking of Viagra, here's a great pharmacy sign. Love the stick figure.

 

And, lastly, is this page from a telephone directory:

One of these things is not like the others

Source: Alaska Airlines

Thank you, Laurie!

Max and Min

A bit of background explanation for my non-medical readers is required.

In pharmacology, the points at which a drug reaches the highest and lowest concentrations in the body are called Cmax and Cmin, respectively.


Last week I was at a meeting where the speaker kept pointing to graphs and saying things like "we obtained Cmin from testing healthy volunteers," "Cmin samples were analyzed by Whatzefukk chromatography," and "Overall, we were surprised by the Cmin values that were obtained."

And through it all... She didn't seem to realize what Cmin sounded like phonetically.

Immature as I am, it was hard not to snicker.

My readers write

Dear Dr. Grumpy,

I teach psychology courses at a community college.

I was teaching Intro Psych one quarter, and we were at the neuroscience portion of the course. One student spent every class either snapping her gum, texting, or staring off vacantly with ear buds in.

On exam day students were required to list the 4 lobes of the cerebral cortex and to write just one function of each lobe.  It's an easy section of the test for most students. This one, however, could only come up with 1 lobe and its function.

Her answer:   "Ear lobe - hearing."


Thank you, J!

The front line

Me and Pissy's office building has been remodeling the public bathrooms on each floor. This involves closing one and making the other a unisex john for a few days, then switching them off, then moving to the next floor.

This week they got to our floor and taped up their little "Unisex Restroom" and "Under construction" signs while they tore out old tile and fixtures. Honestly, I don't understand this. As long as a public bathroom is reasonably clean, most people don't care about the tiles or paintings. This is a medical office building, not the Waldorf-Astoria. Besides, each one just has a toilet and a sink, and the door locks. They're freakin' identical.

Anyway. Cut to day 3 of our floor's construction project:


Guy walks in, stands at counter.

Mary: "Can I help you sir? Do you have an appointment?"

Guy: "What is wrong with you people?"

Mary: "Uh, is there a problem?"

Guy: "YES! I'm tired of people like you, trying to make me think men and women are the same!"

Mary: "What are you talking about? This is a doctor's office."

Guy: "Instead of having separate men's and women's restroom's, you liberal PC types are trying to cram unisex bathrooms down my throat. I'm sick of this trend."

Mary: "Okay, that's not even our bathroom out there. And the sign is just temporary, while they're remodeling them."

Guy: "Oh... "

Mary: "Do you have an appointment with Dr. Grumpy or Dr. Pissy?"

Guy: "No, I just need to use the bathroom."

Leaves

Seen in a chart

Thank you, B!