Prestige

My regular readers know that I'm not a member of any organizations, nor do I have a particularly high opinion of them.

It was Groucho Marx who said "I don’t care to belong to any club that will have me as a member" and I'll agree with that.

So recently, my reader SMOD (who belongs to the American Academy of Neurology) showed me this survey they sent him:

 

 

To comment on a few:

"Ability to network with other neurology professionals."

This is DEFINITELY not an enticement. If I really wanted to do this I could go to drug-company sponsored dinners or hospital meetings. There's a reason I don't: neurologists are, in general, social freaks. You could write a textbook about all the personality pathology that occurs in this field. We fight over reflex hammers, FFS. You think I want to hang out with other members of this tribe? There's a reason I'm in solo practice.

"Free or reduced rates on AAN products, services, or conferences."

The last time I went to a conference was when my job paid for it, which was 1998. If I'm going to blow a mortgage payment (or two) on plane tickets and hotel rooms, I'd rather have it be something I can do for fun with my family, and not to drag my ass to a darkened conference room to hear about possible breakthroughs using chupacabra urine-derived proteins for the treatment of MS. In 1998 I went to a bunch of those sessions, many standing room only, and I don't think any of the research I heard actually bore fruit in the long run. I'll take a beach chair and umbrella drink, thanks.

As far as AAN products go... at my last meeting (admittedly, this was a long time ago, so maybe you don't do this now) there was a booth selling AAN-themed T-shirts, baseball caps, coffee mugs, and reflex hammers. I'll pass, even with a discount.

"Distinction, prestige, and/or added credibility of being an AAN member."

This is, far and away, my favorite item that you've asked people to rate. I'd be checking the box under "was not aware of." I mean, to me this is like saying you belong to the Gilligan's Island Fan Club for the effect it has on the general public. People either aren't aware there was such a thing or they pity you for being so proud that you belong to it. There are a lot of ways to earn respect, like being a good doctor, citizen, or parent. Giving back to your community. Helping the less fortunate. But hanging a sign in your office that says you're an AAN member is only going to matter to drug reps, who will use the info to cull favor for you to prescribe their latest and greatest.

One could also point out that being an AAN member isn't something that's visibly obvious, like some sort of aura, that makes people take notice so you get a better table or they clear a path as you come through. Perhaps that's why you might purchase an AAN T-shirt or baseball cap, but not sure that's going to help. Out in public people could take it to mean anything, like Anal Aficionados of Nebraska.

"Distinction, prestige, and/or added credibility" in medicine, as in life, are earned by actions, not by paying a $495 annual fee. If you think otherwise, then you probably wouldn't want me as a member, either.

- Thank you, SMOD!

I guess I won't send him a letter.

 Seen on a new patient information form:

Marriage

Dr. Grumpy: "Have you had any surgeries?"

Mr. Chole: "I had my gallbladder out."

Mrs. Chole: "Wait, I thought I was the one that had my gallbladder out?"

Mr. Chole: "No, it was definitely me. Remember? I had to miss your sister's wedding?"

Mrs. Chole: "Like you regretted that, anyway. But I thought that was for a business trip, and I had my gallbladder out at Christmas that year because your mother cooked that horribly greasy turkey and made me sick."

Mr. Chole: "At least she could cook. I'm pretty sure I'm the one that had it out, though."

Mrs. Chole: "No, it was me. I have the scar to prove it. See?"

(pulls up her shirt)

Mr. Chole: "Let's ask the doctor. Dr. Grumpy, which of us had our gallbladder out?" 

(pulls up his shirt)

Dr. Grumpy: "Uh, I'd say you both did. Can you please put your shirts down?"

(they both pull their shirts down)

Mr. Chole: "Anyway, besides that, I didn't have any other surgeries."

Mrs. Chole: "Your mother still couldn't cook."

Seen in a chart

 

Kindness

Hi, it's Frank, reporting from Local Grocery.

Since my dorm is closed and I'm doing college online, I've kept my job bagging groceries and collecting carts for the time being.

One of the things we do are the occasional grocery carry-outs, where we lug stuff out and load bags into cars. Generally the only people who need this are the older customers or those with disabilities, though we offer it to all.

It's not a hard part of the job, and certainly we don't ask for tips (in fact, there are signs telling customers not to tip us) but if the rare person hands us a dollar or two, we thank them.

I spent the Labor Day weekend working all 3 days, and Monday afternoon I was assigned to the parking lot. It was roughly 100 degrees, and Grumpyville's usual late-summer mosquito-laden humidity. While I was collecting carts from a corral in the back of the lot, some guy pulled up and asked me to help him swap out a few of the big white propane tanks.

He had 4 of them in his trunk, and as anyone who's had to carry them knows, they're heavy. It took me 2 trips, carrying a pair of them each time, to get them up to the exchange rack at the side of the store. He went inside and paid for 4 more, so I got the keys from the manager and rolled out 4 full ones for him. Then I carried those back to his car (which he had near the back of the lot for whatever reason). This took another 2 trips, and the full ones are, obviously, heavier.

After I put them in his trunk I asked if there was anything else I could help him with. He said no, so I wished him a good day and went back to the cart corral to pick up where I'd left off. A minute later he came over and said "Hey, kid, thank you for doing that, I know they're heavy" and handed me a folded $20 bill. I was gratefully surprised, and said "thank you" as I shoved it in my pocket.

I pushed a line of carts back into the store and the rest of my shift was uneventful. I wasn't expecting the extra money, but it would certainly come in handy since I need some new parts for my computer.

When I got home I went to transfer it to my wallet.

Upon unfolding it, it was a fake $20 bill, with a picture of Yogi Bear on it.

Civil servants

An NPI, for those of you unfamiliar with medical billing, is a government-issued magic number that registers doctors and practices with health insurers.

Occasionally my billing agency has to make a change in payment settings, which requires me to call Medicare to authorize it because only the actual NPI holder can do that. Fortunately, it's only every few years I have to deal with such because it usually involves long hold times. In fact, I plan it for when I have a lot of reading or writing to do, so I can work while listening to endless repeats of "your call is very important to us, please continue to hold" mixed with generic synth-pop music.

Last week was one of those times, so after being on hold for a while...

Music: "bee-bop-shooby-do" CLICK

Fred: "Thank you for calling Medicare. This is Fred. How can I help you?"

Dr. Grumpy: "Hi, this is Ibee Grumpy, I'm calling to verify my NPI for case number 8675309."

Fred: "What is your NPI number, please?"

Dr. Grumpy: "6EQUJ5."

Fred: "Thank you, one moment please... That number isn't in our system, can you repeat it?"

Dr. Grumpy: "6EQUJ5."

Fred: "Thank you... I'm still not able to find it. What state are you calling from?"

Dr. Grumpy: "I'm in Ohio."

Fred: "I'm sorry, you've called the wrong number. Ohio is in the Midwest region, and you've called the number for the Southeast region."

Dr. Grumpy: "Oh, are you able to transfer me?"

Fred: "No. You'll need to call 1-800-MID-WEST for Ohio practices."

Dr. Grumpy (sighs): "Okay, thank you."

Fred: "Thank you  for calling Medicare, have a nice day."


I get another Diet Coke to brace myself for more hold time, which this time was a surprisingly short 15 minutes.

Music: "bee-bop-shooby-do" CLICK

Fred: "Thank you for calling Medicare. This is Fred. How can I help you?"

Dr. Grumpy: "Hi, this is Ibee Grumpy, I'm calling to verify my NPI for case number 8675309."

Fred: "What is your NPI number, please?"

Dr. Grumpy: "Um, didn't I just talk to you about 15 minutes ago?"

Fred: "Yes. I'm answering phones for both Midwest and Southeast regions today."

Dr. Grumpy: "Then why didn't you check my number in the Midwest system when I called earlier?"

Fred: "Because you called in on the wrong line."

Thank you, I'll be here all week

Dr. Grumpy: "Have you had any problems walking?"

Mrs. Brady: "Well, a few months ago I felt like my feet were sticking to the floor, but that's better now."

Dr.  Grumpy: "Did it get better after you started Sinemet?"

Mrs. Brady: "No, it got better after I cleaned the floor."

Seen in a chart

 

Stupid mistakes are nothing new. But they've really increased in the world of EHR. It's funny... But at the same time it's not.

Random pictures

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

 

First, from the "Those are definitely changing looks, Billie" department we have this headline-photo mismatch:

 

Next, in the "this way, suckers" category we have a pool product that claims to - I swear - make water moister.

 

For novel methods of self-defense we have this brass knuckles - iPhone case combo.

 

 

From the "No wonder the bison was mad" file:

 

Here's the mysterious, yet oddly prevalent, use of quotation marks to make you wonder what's REALLY going to be served.

 

Of course, sometimes even without the quotation marks you know there's something wrong.

At other times you Just. Don't. Want. To. Know.

 

 

Sixteen Tons

Hi, this is Craig.

So, while Frank has been bagging groceries for the summer, I've been working for Tiffin Deliveries, picking up food from various restaurants and dropping it off at a variety of houses, businesses, apartments, and the occasional parked car (really!).

Basically, I'm the messenger. So I get blamed when things go wrong. Restaurant burned your food? Hey, I didn't cook it. You didn't get enough ketchup? Again, that's not me. During this viral summer restaurants are stapling delivery bags closed and leaving them on a table outside, so I can't eat your stuff, sneeze in it, or toss in the extra 3 packets of pickle relish you wanted - especially since many of you seem to think of the extra mustard needed AFTER I've left the restaurant.

To get this job I had to go through an extensive background check, which consisted of me emailing my name to a guy on the other side of the planet. He responded within 30 seconds that I'd been cleared, so I'm pretty sure all he did was type "Craig Grumpy mass murderer" into Google to see if it returned any hits.

Of course, this job has its highlights, which explains why Dad told me I should put it on his blog.

The best part of the company's app is for special instructions, where people get to type in pretty much whatever. This has included requests for me to pick up laundry while I'm getting your lunch, asking if I happen to know a good roofing service, and if Local Grocery has hand sanitizer in stock (I texted Frank for that one).

I think my favorite set of instructions so far was this:

Orders like that make me wonder if I'm on Candid Camera. Then I have to go to the place's counter and put in the order, knowing how ridiculous I'll look, since this specific dive won't accept them from the app. I felt like Jack Nicholson ordering toast.



Another great order was this one:

Fortunately, that order was pretty easy to fill, though I have to wonder where this lady previously got her tacos from.


I also got an order from a guy who lives across the street (literally) from a McDonald's to get him a Big Mac and fries (simple, huh?). BUT he wanted it from a specific McDonald's that was a 20 minute drive from his apartment.


Lastly, I got an order to run to Blazing Ketchup. They got the order right, and I made it to this guy's office within 10 minutes of picking it up. So I'd like to thank him for recognizing my effort:

Diary of an ER doctor

I have no idea who wrote this. I wish I could take credit for it, but I can't. But, since it's awesome, I'm sharing it. Thank you, Webhill, for sending it to me.


So guys, this is what my typical day at the hospital looks like now:

6am - Wake up. Roll off of my pile of money that Big Pharma gave me. Softly weep as it doesn’t put a dent in my medical school loans.

6:30am - Make breakfast, using only foods from the diet that gives me everlasting life by avoiding all fats, sugars, carbs, and proteins. For details buy my book and check out my shop.

7am - Get to work, load up my syringes with coronavirus before rounds.

8am - See my patients for the day. Administer the medications that the government tells me to. Covertly rub essential oils on the ones I want to get better. Flush down the toilet all the hydroxychloroquine tablets patients were to receive for the day. 

9:30am - Call Bill Gates to check how 5G tower construction is going, hoping for more coronavirus soon. He tells me they’re delayed due to repairs on the towers used to spread the Black Plague. Curse the fact that this is the most efficient way to spread infectious diseases.

10am - One patient tells me he knows “the truth” about coronavirus. I give him a Tdap booster. He becomes autistic in front of my eyes. He’ll never conspire against me again.

11am - Tend to the secret hospital garden of St. John’s wort and ginkgo leaves that we save for rich patients and donors. 

12:30pm - Pick up my briefcase of money from payroll, my gift from Pfizer for the incomprehensible profits we make off of the free influenza vaccine given every year. 

1pm - Conference call with Dr. Fauci and the lab in Wuhan responsible for manufacturing viruses. Tell them my idea about how an apocalypse-style zombie virus would be a cool one to try for the next batch.

2pm - A patient starts asking me about getting rid of toxins. I ask her if she has a liver and kidneys. She tells me she knows “the truth” about Big Anatomy and that the only way to detoxify herself is to eat nothing but lemon wedges and mayonnaise for weeks. I give her a Tdap booster.

2:45pm - Help the FBI, CIA, and CDC silence the masses. Lament the fact that I can only infringe on one or two of their rights. Oh well, there’s always tomorrow.

4pm - One of my rich patients begins to crash. I laugh as I realize I’ve mismatched her spirit animal and zodiac moon sign. I switch out the Purple Amethyst above her bed for a Tiger’s Eye geode. She stabilizes. I throw some ginkgo leaves on her for good measure.

6pm - Go onto YouTube and see coronavirus conspiracy videos everywhere. Curse my all-powerful government for how inept they are at keeping people from spreading “the truth”

6:10pm - Go onto Amazon and see that a book about “the truth” is the #1 seller this week. Question the power of my all powerful government. Make a reminder to myself to get more Tdap boosters from the Surgeon General next time we talk. 

7pm - Time to go home. Before I leave, sacrifice a goat to Dr. Fauci and say three Hippocratic Oaths.

9pm - Take a contented sigh as I snuggle under the covers made of the tinfoil hats of my enemies, realizing that my 4 years of medical school and 3 years of residency training have been put to good use today.

Seen in a chart

"I feel SO relaxed right now."

Social distancing

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

Mr. Zoom: "Hi, this is Mr. Zoom. My wife is a patient of Dr. Grumpy's. She's having all kinds of new neurological issues and needs a video appointment ASAP."

Mary: "Let me see... Your wife hasn't been here in over 3 years... You said she's having new problems?"

Mr. Zoom: "Yes! They just started a few days ago and..."

Mary: "I'm sorry, but after 3 years, and especially with her having new symptoms, she'll need to be seen in person."

Mr. Zoom: "Uh, there's a pandemic going on! It's not safe for us to leave our house!"

Mary puts him on hold, checks with me, I absolutely agree with her.

Mary: "I just double-checked with Dr. Grumpy. Because she's having new issues this really isn't something he's comfortable handling over the phone or on camera. He needs to be able to examine her in person, check reflexes, and all that other stuff he does, to get an idea of what's going on and what should be done. He wears a mask, and takes lots of precautions to minimize..."

Mr. Zoom: "This is criminal. It's unethical. Dr. Grumpy is needlessly endangering our lives by making us come to see him. We're both in our 80's and are a high risk group. He should be able to do this sort of thing over the phone. Can't he just order a bunch of tests and see what he finds?"

Mary: "He doesn't work that way, sir. You can certainly try to find another doctor to see her, or go to ER, or..."

Mr. Zoom: "No other doctor will be able to get her in before the weekend. She needs to be seen and have all the tests done before then."

Mary: "Why is this so urgent?"

Mr. Zoom: "We're flying to Miami on Friday night for a big family reunion."

Bliss

Dr. Grumpy: "Your MRI was entirely normal, which is very reassuring, so the next step..."

Mrs. Scan: "Oh, thank heavens. I was so worried I had a brain tumor."

Mr. Scan: "That is reassuring."

Mrs. Scan: "Isn't that wonderful news, Phil?"

Mr. Scan: "Yes."

Mrs. Scan: "What? You don't think it's good news?"

Mr. Scan: "I said I did. I said it was reassuring."

Mrs. Scan: "You could try to look a little more enthusiastic. Or happy. Or something."

Mr. Scan: "I am, what should I be doing?"

Mrs. Scan: "Why can't you ever be happy for me?"

Mr. Scan: "Why does this have to be a production?"

Mrs. Scan: "Dr. Grumpy, don't you think he should look happier about the news?"

Mr. Scan: "Dr. Grumpy, do you..."

Dr. Grumpy: "I'm staying out of this."