Seen in a chart

Wednesday morning

Dr. Grumpy: "The next step will be..."

(Mrs. Paper digs through her purse and hands me a post-it note with a name and phone number on it).

Mrs. Paper: "I'd like you to call that doctor to update them on my case."

Dr. Grumpy: "Um... is this your internist?"

Mrs. Paper: "No, she's a specialist in the condition I think I have. I want you to coordinate my care with her."

Dr. Grumpy: "Okay. I've just never heard the name."

Mrs. Paper: "She doesn't practice here. She's the chair of neurology at Ivory Tower Hospital in Farfaraway."

Dr. Grumpy: "Does she know you? Have you seen her as a patient?"

Mrs. Paper: "No, but I saw her interviewed on TV this morning and she seemed to be pretty smart."

Dr. Grumpy: "I..."

Mrs. Paper: "Why aren't you calling? I think you should have her on speaker phone for my visit today."

Dr. Grumpy: "Look, in all fairness, I'm not going to call a doctor who's never seen you, who doesn't know me, who's in another state, at the drop of a hat. This person is likely very busy. If you want to set up a second opinion appointment with them and have me send records, that's different."

Long pause

Mrs. Paper: "You realize I'm going to have to mention your unhelpful attitude in a Yelp review."

Department of Redundancy Department

Seen in a chart, in a section about a patient's fluid intake:

Breaking news!

From around the globe, Dr. Grumpy's crack team of reporters bring you the stories that shape your world.

DATELINE: Scotland

Matthew Davies, age 47, failed in his attempt to rob a Bank of Scotland office in Dunfermline.

Armed with a meat cleaver (which he'd hidden inside a pillow case) Mr. Davies approached the counter, pulled out the meat clever, and demanded money.

At that point he cleverly tried to conceal his identity by pulling the pillow case over his head.

Unfortunately, Mr. Davies had forgotten to cut eye holes in his disguise, and therefore now he couldn't see. So he removed the pillow case allowing the teller, and cameras, to get a good look at him as he brandished the cleaver.

He escaped with almost £2,000, then walked home, followed by a witness. On the way he stopped to briefly play with someone's dog before going upstairs to his apartment. Which is where police arrested him a short time later.

In a moment of understatement, his defense attorney said his robbery plan was "one that, when looked at objectively, was unlikely ever to go successfully."

Mr. Davies pleaded guilty and has been sentenced to 4 and 1/2 years behind bars.

It's unknown if the dog will be allowed to visit him.

Quote of the day

"I am not a hypochondriac. I am being proactive about my health. Back to my list, item 27..."

Mary's desk

Ms. School: "Hello?"

Mary: "Hi, this is Mary, at Dr. Grumpy's office. We need to reschedule your appointment."

Ms. School: "When is it?"

Mary: "July 16, at 2:30. Dr. Grumpy was notified today he has to spend that afternoon at a research department meeting."

Ms. School: "Well, this is inconvenient."

Mary: "I'm sorry, but fortunately it's scheduled for July, so we have plenty of slots still available then. We can see you that morning, pretty much anytime between 8:00 and noon. If mornings don't work I have every other afternoon that week open right now, too."

Ms. School: "I really don't like you calling me at the last minute to reschedule this. I have a life and plans, too."

Mary: "That's why I'm calling you now, not at the last minute. It's February 7th. The appointment is over 5 months away, so there are plenty of other open slots around it. You can also move it up to next week if you prefer."

Ms. School: "I'm not happy about this... I think I need a more reliable neurologist. I can't do last-minute changes. Just cancel the appointment all together. I'll send you a release when I find a more considerate doctor. I have a life, too, you know."

Hmmmm.......

I was doing a marketing survey last night.

This is a treatment for depression that hadn't occurred to me...

Annie's desk

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

Mrs. Shaking: "I saw Dr. Grumpy last week, and he sent my refill to my mail order pharmacy, and IT STILL HASN'T GOTTEN HERE! They say they deliver within 3 days. This is unacceptable."

Annie: "Have you called them?"

Mrs. Shaking: "Yes! They said they're still waiting for you to give them more information! This is very upsetting that your office has dropped the ball like this. I demand you call them right now and fix this! I need my medication!"

Annie: "Let me put you on hold while I call them."


Annie puts her on hold, dials the doctors-office line to the mail-order pharmacy.


Phone person: "Thank you for calling BigAzz Pharmacy physician's line."

Annie: "I'm calling from Dr. Grumpy's office. We sent you a script last week for Mrs. Shaking? She's called here and says she hasn't received it yet."

Phone person: "Let me see... It looks like we haven't shipped it yet because she's refusing to give us any payment information."

Annie: "WHAT?"

Phone person: "Yes... She's called 3 times in the last 2 days, each time demanding we send it, but then refuses to give us a credit card number so we can bill her the copay of $40."

Annie: "Sorry, I had no idea."

Phone person: "In fact, it looks like yesterday she told us to bill your office for it, and we refused."

Artisanal overload

Okay, time to hit the mailbag for more examples of "artisanal" crap you guys have sent in.


First we have this flour, which is so uniquely handcrafted that it was being dumped off sold at the dollar store:









Next, for the health conscious, we have these "nourishing" pork rinds. They're apparently not only artisanal, but "epic," too:

Being antibiotic-free didn't do the pig much good, I guess

 If you're into artisanal junk and buy a lot of it, what better place to store it in than this:

Here's this sandwich, whose description ominously ends without telling you what, specifically, is artisan, making you wonder if the prosciutto is from the classic 1980 horror-movie Motel Hell.

 

Lastly, to my disgust, is this: A neurology hammer (a Trömner, no less) being advertised as artisanal:

Let's keep in mind that, no matter what it is, if it's made from "high density plastic" the odd are that it isn't really artisanal.

Dr. Grumpy's personal Trömner, for the record, was bestowed upon him by a drug rep pushing brand-name Naprosyn. Which dates me more than I want to think about.

Marketing

There's a new drug on the market in my field (hell, I could say that every month), so my partner Pissy and I are getting the usual drug rep visits, lunches, glossy brochures, and samples.

I tend to be more sympathetic than most to reps. I understand they have their job, like I have mine. They're just trying to support a family and pay the mortgage like any of us. So, if I have time, I listen politely and sign for samples, and try to give them a few extra minutes if their boss is shadowing them that day.

But this time there's a new tactic me and Pissy haven't encountered before. The reps for this product have all pushed this idea:

"When you send a prescription online, or hand one to a patient, call me with the patient's name and their pharmacy. I will personally go to that pharmacy and demand they order it, so it's in stock when the patient needs to fill it."

So far I've been called on by 3 separate reps for the drug, and all have given me the same spiel. So it's a pretty safe bet to assume the idea is coming from their corporate masters in training sessions.

And no, I ain't doing that.

To me, this is wrong on a couple of levels.

1. Privacy.

Mrs. Patient comes to me hoping I'll keep her health issues a secret. Granted, that also includes my staff, like Mary and Annie, because they have to know what's up.

Her pharmacist is also, at least partially, in the know. They don't have access to my charts, but they know private things about her health from the medications she takes and what she tells them. Which is fine. They're as much involved in her health care as I am. They need to be able to advise her properly about her medications and protect her from any multitude of errors I might make in prescribing stuff (and, for the record, I'm eternally grateful for you guys bailing me out on one in particular last week).

But the drug rep? No. Their job is to make me aware of, educate me about, and convince me to prescribe, their product. Which is fine. But they aren't part of the medical chain between me, Mrs. Patient, and her pharmacist. To give them her name to bandy around Local Pharmacy is, at least to me, a pretty serious breach of her privacy.

Not only that, but my loyalty, and my staff's, and the pharmacist's, are on her side of the equation. We are working for her benefit. The drug rep may claim to be doing so, and some may even believe they are. But at the end of the day, they work for a large publicly-traded pharmaceutical company. Once I give them her info, they have a snippet of personal data on her. Who's to say it won't be used to send her mail about great offers on their other products, and/or sold to clothing companies and banks that want to mail her ads for underwear, new low-fee once-in-a-lifetime credit card offers, or robocall her with great deals on trips to Bermuda?

Obviously, if she gives them this information herself as part of an assistance program or freebie offer, that's different. Then it's her call and informed consent. But I'm not going to.


2. Have you ever watched a pharmacy staff at work?

You don't have to stand there in a creepy I'm-casing-the-joint way, but next time you're at the supermarket, just look over and see what's going on in the pharmacy. Odds are there's 1 pharmacist and 1-2 techs working. At least one of them will be on the phone, the other will be at the patient window or getting something off a shelf, the phone is ringing, there will be lines at both the drop-off and pick-up windows, and some random guy at the counter interrupting them to ask where ketchup is.

They're swamped.

So pretty much the last thing they need in their daily shit storm is for a well-coiffed drug rep to wander in and demand they order & stock their latest and greatest drug (currently $95 a pill per Epocrates), when there's a reasonable chance the patient may never even show up for it. Mrs. Patient could wind up going to a different pharmacy, or find the sample didn't work and she doesn't want to pick up the script, or suffer a nervous breakdown when she hears the price and calms down by strangling the ketchup guy.

In summary, I'm pretty sure the pharmacy doesn't have time for this idea.


I know there are drug reps reading this. Don't take it as an insult. I know you're just doing your job, and that's why I meet with you. I really do appreciate the samples for the product so my patients can try them and see if they're worth fighting with insurance over. Me and Pissy and our staff enjoy the lunches (although if you go to that vegan wrap place again we'll put a restraining order on you).

But don't expect me to betray my patients' confidence to you. You can ask me, if that's what your company requires you to do. I understand that. But don't be too upset when I don't. At the end of the day, I work for their best interests, not yours.

I wish it was that simple

Seen in a chart section on improving patient medication compliance. The spelling error and bad grammar only make it worse.

On call

Mr. Angry: "I demand you order an MRI of my abdomen."

Dr. Grumpy: "Sir, we've been through this before. I'm not the doctor seeing you for those issues. I was consulted because of your headaches. The GI doctor saw you yesterday, and has ordered a work-up for those issues."

Mr. Angry: "She didn't order an MRI of the area, and I want one. She ordered other stuff."

Dr. Grumpy: "I'm going to have to defer that work-up to her. It's not my specialty."

Mr. Angry: "This is ridiculous."


I left the room, wrote a note in the chart, and moved on to the next patient. As I scrolled though some test results my cell phone rang.


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

Officer: "Hi, doctor. This is Officer Badge of the Grumpyville Police Department."

Dr. Grumpy: "What can I do for you?"

Officer: "I'm sorry to bother you with this. Our 911 desk just got a call from a Mr. Angry. He says you're refusing to order tests on him, and called the emergency line to ask that we arrest you."

Dr. Grumpy: "I..." (I started giggling)

Officer: "Yeah, I know... But we have to address each call."

Dr. Grumpy: "I understand..."

Officer: "I'm just going to note that I spoke to you and nothing further was indicated. Have a good Sunday."

Seen in a chart

On a patient with a heart attack.

Time to light up, apparently.

Mary's desk

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

Mrs. Call: "Hello, I was referred by Dr. Unka to see Dr. Grumpy."

Mary: "Sure. What insurance do you have?"

Mrs. Call: "Sikazchit PPO."

Mary: "Oh... I'm sorry. We don't take that insurance. Let me give you the names of some other neurologists you can try..."

Mrs. Call: "Dr. Unka wanted me to see Dr. Grumpy."

Mary: "He probably doesn't know we're not contracted with Sikazchit PPO. There's Dr. Brain, who..."

Mrs. Call: "I. Don't. Think. You. Understand. This is Dr. Unka who referred me. He wants me to see Dr. Grumpy. So make me an appointment."

Mary: "But we don't take your insurance. Do you mean you want to do this as cash pay?"

Mrs. Call: "Don't be ridiculous. Since Dr. Unka referred me you should be seeing me as a courtesy to him."