Personalized medicine

Monday

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

Dr. Cowboy: "Hi, this is Dr. Cowboy down the street. I have a guy, a really great guy here. I'd like to set him up to see Dr. Grumpy. He has good insurance."

Mary: "Okay, how do you spell his name?"

Dr. Cowboy: "Shit, I have no idea. Let me call you back when I have the chart."


Wednesday:


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

Dr. Cowboy: "Hi, this is Dr. Cowboy again. I have a great guy here, I talked to you about him the other day. Anyway, I've got his name here, so I can set that up now. He has good insurance."

Mary: "Okay. What insurance is it? I just want to make sure it's one we take."

Dr. Cowboy: "Sure, I agree, it's... Shit, I don't have that here, just his name. It's one of the big companies, let me call you back when I have that in front of me."


Friday:


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

Dr. Cowboy: "Hi, this is Dr. Cowboy. I talked to you about this guy. He's a great guy, and his insurance, which is good insurance, is Major Illness, Inc."

Mary: "Great! We take that. And what day would he like to come in? We have openings on..."

Dr. Cowboy: "Shit, I'm not sure. I better ask him first. I'll call him later today and get back to you, or have him call you, and we'll get something set-up."



Monday (again):


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

Dr. Cowboy: "Hey, it's Dr. Cowboy. Okay, I spoke to him late of Friday, and he says he can come in on Tuesday or Wednesday, preferably in the..." (mumbling in background) "Really?"

Pause

Mary: "Hello?"

Dr. Cowboy: "Shit, never mind. My nurse just said he died over the weekend. He was a good guy, too. Had great insurance."

Weekend on call

Seen in a chart:

Rimshot

Dr. Grumpy: "How are you doing? That was a pretty bad concussion."

Mr. Cantu: "I'm not myself at all."

Dr. Grumpy: "What do you mean?"

Mr. Cantu: "I have to ask my wife for help with everything."

Mrs. Cantu: "If that's the main issue, then you've had a concussion since we got married."

Let's hear it!

Turing test

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

Voice: "Hello, I'm calling from Major Illness Insurance to verify your office information."

Mary: "Okay."

Voice: "Is this Dr. Grumpy's office?"

Mary: "Yes."

Voice: "And is this the correct phone number to call Dr. Grumpy at?"

Mary: "Yes."

Voice: "What is the correct number for your office?"

Mary: "Uh, this one. You just called me on it."

Voice: "Please verify."

Mary: "867-5309"

Voice: "Correct, thank you. Do the doctor and staff speak English?"

Mary: "Yes."

Voice: " Any other languages?"

Mary: "No."

Voice: "Does Dr. Grumpy see patients?"

Mary: "Of course."

Voice: "Is that yes or no?"

Mary: "Yes."

Voice: "What kind of doctor is Dr. Grumpy."

Mary: "He's a neurologist."

Voice: "Does he specialize in neurology?"

Mary: "Yes."

Voice: "Does he see neurology patients?"


This went on for another 10 minutes.

Relax

Seen in a chart:

The power of zero

To give you some background, Duchenne's Disease is a form of muscular dystrophy. I don't see it at all because there's an MDA clinic across the street from my office, so I refer cases there.

Anyway, last night I was doing an online study, and it asked me how many Duchenne's patients I've seen in the last year. I said zero.

So the next question...

Wait a minute...

Keep in mind that the Grumpy/Pissy Medical Emporium is on the 6th floor of our office building.


Mary: "If you could just fill out these forms... And let me copy your insurance card..."

Mrs. Parker: "Where's the restroom? I need to use that first."

Mary: "Sure. If you go back past the elevators it's on your right."

Mrs. Parker: "I didn't take the elevator."

Mary: "Oh, okay, then the bathroom is across the hall from the staircase."

Mrs. Parker: "I didn't take the stairs, either. I just walked here."

Mary: "Okay... then... uh..."

Mrs. Parker: "I'll go look for it, and be right back."

Spell check

Nortriptyline is an old antidepressant, now used primarily for pain and migraines.

I recently put it in a note, and the spell-check feature kept trying to change it:

I have no idea.

Laces

I get a fair number of emails from people asking me for advice on careers in medicine. I don't answer them often, because realistically I can't make those decisions for someone else. A career in this insane field, not to mention all its different branches, is a pretty personal choice.

A medical student, though, recently wrote and asked what one piece of advice I'd give anyone already in med school (besides "cut your losses and get the hell out"), so I thought about it.

Here it is:

Learn to tie shoes.

Yes, you read that correctly. That's my sage advice, for whatever it's worth, to all of you in training.

Now, I figure you already know how to tie your own shoes (although in the age of Velcro straps I could be wrong). What I'm talking about is tying someone elses shoes. This is a 180° reversed perspective of tying your own, and takes a little bit of getting used to, and not making them too tight.

During my 4th year of medical school I had a rotation where I was assigned to a family practice doc, just for his morning rounds at the hospital. I don't remember his name. He was in his mid-50's, and was always neatly dressed with a tan blazer. I'd meet him outside the doctor's lounge every morning and we'd see his hospital patients.

What always impressed me is how he knew his patients. Not just their medical stuff, but he'd often make comments like "she bakes the best sweet potato pie" or "he paints great landscapes." And his patients clearly adored him, too.

Anyway, the time we rounded was usually when breakfast was being brought around. Most docs I'd met would just ignore it, and have the food set aside until they were done talking to them.

But not this guy. He'd take the trays and help sit the patient up to have them. He'd ask what they liked in their coffee (though usually he already knew!). He'd open those little cardboard milk cartons (they can be tricky) and pour it in cups or on cereal. He peeled and cut up bananas for them.

And, if we happened to go in while they were getting ready to go home, he'd help them tie their shoes.

Although some may find this silly, I found it was a pretty important lesson. Letting your patients know you care about them goes beyond looking in ears and reviewing labs. It wasn't an act, this guy obviously just wanted to help them.

I typically don't round during meals, but I do tie shoes. Checking feet for atrophy, sensation, and reflexes are a big part of being a neurologist, so you end up with barefoot patients sitting on your exam table.

Younger people generally don't want help, but older people or those with physical limitations appreciate it. Helping them put on socks and tie their shoes may not seem like a lot... But it is. It's letting someone know you care about them, no matter how grody their toenails are.

Pro tip: always keep a shoe-horn handy.

No matter how far you go in medicine and life, never think that you're above helping another person put their shoes and socks on. You aren’t. And someday you may be in their position.

Ding!

 

Dr. Grumpy: "Okay, so at the last visit..."

Mrs. Bickerson: "Doc, what's with the box of clothes by your briefcase?"

Dr. Grumpy: "Oh, my kids cleaned out clothes that don't fit them anymore, so I'm dropping those off at the charity store on the way home."

Mrs. Bickerson: "That's a good idea. We have some old chairs I've been meaning to donate."

Mr. Bickerson: "No, we're not getting rid of them. I can use them. They just need to be re-done. Why can't we donate the old vacuum in the back closet?"

Mrs. Bickerson: "What do you mean? It still works."

Mr. Bickerson: "It's not like you ever use it. It's taking up space."

Mrs. Bickerson: "What, like one square foot in a room you never go in?"

Mr. Bickerson: "We don't need it."

Mrs. Bickerson: 'What about that fucking dune buggy you got on Craig's List that takes up the whole shed and that you've never driven? It's bigger than a tank."

Mr. Bickerson: "Really? How about the stupid exercise machine you don't use? Let's get rid of that."

Mrs. Bickerson: "Oh, it is SO on now. Let's talk about that collection of racing photos piled behind the couch..."

The calls

Actual message left on Mary's voicemail at 3:43 p.m. yesterday:


“Hi, I saw Dr. Grumpy about 10 years ago for something or another. Anyway, my wife may have had a stroke, or migraine, one of those things, this morning. I’d like him to order an MRI on her for today. We’re flying out tonight to Europe, so need it before then."

Futility

Monday afternoon, 4:35 p.m.


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

Ms. Daughter: "Hi, this is Mrs. Substantia's daughter, and her Parkinson's disease is really bad this afternoon!"

Annie: "What's going on?"

Ms. Daughter: "Her tremor is out of control! She's shaking everywhere, and can barely walk!"

Annie: "Has she missed any medication doses?"

Ms. Daughter: "No! She got her morning pills right on time!"

Annie: "What about her 2:00 p.m. afternoon pills?"

Ms. Daughter: "I haven't given her those yet. Should I?"

Holiday reruns

Here's this memory from 2010:


The twins (Craig and Marie) routinely beat the crap out of each other. This is such a normal occurrence at our house that we just ignore it unless at least one liter of blood is spilled.

So after I got home from work today, the phone rang.

Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Marie Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Marie was involved in a playground fight today, with a boy at school."

Dr. Grumpy (glancing out the window at the twins gouging each others eyes out on the trampoline): "Is she in trouble?"

Mrs. Playground: "Yes, she has to miss recess tomorrow. She and the boy suffered some minor scrapes, so I need to notify the parents of both children."

Dr. Grumpy: "Okay, thank you."


I hung up the phone, looked at Mrs. Grumpy, and began counting. "5-4-3-2..." As soon as I got to "1", the phone rang. I bit my tongue, hard.


Dr. Grumpy: "Hello?"

Mrs. Playground: "Is this the father of Craig Grumpy?"

Dr. Grumpy: "Yes."

Mrs. Playground: "I'm the playground supervisor at Wingnut Elementary School, and I have to notify you that Craig was involved in a playground fight today, with a girl at school..."

Patient quote of the day

"Barfing is much worse than diarrhea, though I think the caveat depends on the exit velocity."