Sunday, 3:47 p.m. voicemail

"Hi, this is Mr. Foggy. I need to cancel my appointment with Dr. Grumpy for this week. It's, uh, one of the days this week. Actually, maybe it's next week, or the week after that... I'm sure it's sometime this month. Anyway, can someone please call me back and tell me when my appointment is so I can cancel it?"

It's been such a long time

One of my longstanding patients, Mrs. Laugh, came in this week.
 

Dr. Grumpy: "How are you doing?"

Mrs. Laugh: "Fine. You know, I've been meaning to tell you how great you look for your age!"

Dr. Grumpy: "Thanks. I had no idea that looking great in middle-aged now meant pudgy and balding."

Mrs. Laugh: "Oh, I think you're beyond middle-age!"

Dr. Grumpy: "All right... Where are you going with this?"

Mrs. Laugh: "Well, I was looking up your profile on shittydocratings.com and found this:" (holds up iPhone)

 

Skool Nerse Tyme

This is Mrs. Grumpy.

So many of you have returned to Douglas C. Kenney Elementary School these days. It certainly keeps me busier, as your friends who are taking Zoom classes don't get sent to the nurse for itches, life-threatening pencil pokes, and sundry ailments that just happen to coincide with a math test.

I'd like to thank all the parents who filled out your information cards with such helpful items as "he's allergic to something, don't let him have any," a reminder not to give your child "stuff that might not be organic," and (my favorite) "do NOT allow her to get COVID!!!" Please keep in mind that I'm not the one who voluntarily sent your kid back to what is basically a 95,000 square foot fomite.

I'd also like to make a public service announcement: As you know, me and a handful of teachers have been assigned to screen you little darlings for fevers each morning, pointing that laser scanner at your forehead before you go inside.

It certainly alarmed us when we found large numbers of you were running fevers when you got off the bus. Not just fevers, actually, but temperatures in the 120 degree range. Which are, quite frankly, incompatible with human life.

Fortunately, Maxine, the lady who's been driving school buses since they were pulled by horses, called me onto the bus to see the discarded hand warmers from the camping supply store, which you frauds adorable children had been pressing to your foreheads and passing around.

As always, nice try. Now go to class.

 

Medical news

Journal headline writers apparently are now paid by the word:

Tech

 Logging into the pharmacy prescription portal to do refills this morning, I was greeted by this:

 

 

 

So, being the kind of doctor (I hope) who wants to make sure his patients are getting their medications, I click on the warning. It immediately brought up this helpful box:

 

 

That's all folks. No name, birthday, medication, anything.

Language

I recently didst endorse myself for an online continueth education lecture series, and amongst the linguistic choices there wast thine following:

 

 

 

Verily, I wouldst be most delighted to conduct such endeavor in the tongue of Geoffrey Chaucer, as I still have a copy of The Canterbury Tales from my salad days stored in the dusty lofts of my dwelling.

 

Though, if it would suit Ra and Anubis, I could also attempt to do it in Ancient Egyptian, provided I could find an appropriate app.

Forsooth.

Memories...

 

 

Back in the old days, before every phone had a GPS system and Siri to boss you around, we used an aging GPS gadget we named Bib (for "bitch in the box") that we'd bought secondhand.

Bib at the time was about 7 years old. She had an electrical short in her end of the connection that plugged into the car. For a few months we got her to work by (I swear) licking the leads before plugging them into her. Doing these steps in order was critical, as getting them reversed once caused me to take the charge from the car battery through my tongue. Which hurt.

Anyway, as it worsened, any bump we'd hit would turn her off and then she'd have to reboot, and find satellites, and we'd have to re-enter directions... you get the idea.

Of course, this happened once in a city we were entirely unfamiliar with, and were already having trouble finding our way around.

Bib, however, wasn't going to reboot this time. We pulled into a Target lot, and futzed around. But Bib was gone. Putting water, saliva, Diet Coke, whatever, on the contacts worked for about 10 seconds before she shut down again.

Since we were outside the store I figured I'd go in and see what they had for new GPS systems, when I had an idea.

I bought a small tube of K-Y jelly, and went back. Mrs. Grumpy was laughing hysterically at me, but I put a glop of it on Bib's electrical connection AND IT WORKED. Bib got us back to the hotel, and worked fine for the rest of the trip.

So, for the rest of the time we had her we kept a little tube of K-Y in the GPS gadget's bag, carefully applying some before attaching the cord.

At some point we left Bib, in her bag, with the K-Y, either at a Goodwill or E-waste collection. Someone out there opened the bag and is probably still wondering about it.

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."