Guidance

So today, me, and pretty much every doctor, veterinarian, nurse practitioner, and pharmacist in the country got this email:

Apparently the folks at the DEA (Drug Enforcement Administration) decided that people reading the rules about guidance didn't have enough guidance, and so needed some guidance. Or they just made a bet over the weekend on who could use the word "guidance" in an email the most:

 

 

Isn't that impressive? Okay, so what does the guidance in this remarkable document on guidance say? I'm glad you asked!

Here's page 1 (page 2 is more of the same, so I'm not going to bother with it).

 

 

For those of you who went to college in the same era that I did, I keep thinking of the word "guidance" now in the same way I used to think of the phrase, "Hi, Bob."

 

You're in luck

I take my 11:30 patient back to my office.

Dr. Grumpy: "Hi, Don, have a seat. How are you doing?"

Mr. Epazil: "Sorry if I'm in a rush, doc."

Dr. Grumpy: "Everything okay?"

Mr. Epazil: "Yeah, but I  have an appointment with Dr. Grumpy at 11:30. I think he's also in this building, but I can't remember where."

Pissy. Must. Die.

Me, Dr. Pissy, and our combined office staffs are having lunch with a drug rep.

 

Ms. Pharma: “That covers all the new info about Nomoshakin, so next time either of you sees a patient with refractory seizures, please keep Nomoshakin in mind. Any questions?” 

Dr. Grumpy: “No, thank you.” 

Ms: Rep: “Okay. Looks like we still have a few minutes, so let me tell you about Gramzap. This is our new, highly potent, highly absorbed, once-daily oral antibiotic. It has excellent coverage against many commonly encountered infections and…” 

Dr. Pissy: “Do you have samples?” 

Ms. Pharma: “Of course! Let me…” 

Dr. Pissy: “Please leave them for Dr. Grumpy. Gramzap sounds better than the weekly shots he gets at the free clinic."

Quote of the day

"I was in the ER last weekend for a seizure. They said my Kepdepatrol level was 4. Or maybe it was 8, actually, it could have been 14, or maybe 28. Whatever it was, it had either a 4 or an 8 in it, I'm not sure which. Does that help?"

Things seen in charts

 Here's this one, showing the hazards of cut & paste:

 

Next we have this bit of bullshit, which was, sadly, the entirety of the chart note and which told me nothing:

 

Apparently someone is hoping there's a CPT billing code for "vice versa:"

Next is another piece of crap someone pasted in. I'm willing to bet that the physician involved pastes this in at the end of pretty much every single note they write.

 

 

 

 

And, lastly:

Translation: just because I'm billing your insurance for treating a disease, doesn't mean you have that disease.

There are 11,000 neurologists in the U.S.

And a few weekends ago, due to a computer glitch, every one of them had an inbox that looked like this:

Voicemail theater

Message left at  6:55 a.m.

"Hi, thith ith Mike Thmith. I haf to canthel my appointment wif Dr. Grumpy for thith morning. I wath in a barfight lath night and loth thome teeth and have an emergenthy dental appointment. Thorry."

Message left at 7:00 a.m.

"Good morning, this is Dr. Perry O'Dontis. I'm sorry, but I'm going to have to cancel and reschedule my appointment with Dr. Grumpy for this morning. My partner is out of town, and one of his patients got into a barfight last night and had his teeth knocked out, so I need to work him in this morning."

Weekend on call

I've been called down to ER to see a fellow who suffered a stroke while at the local casino. His wife has just arrived.

Dr. Grumpy: "I'm glad you're here... his face is kind of drooping on this side. Is that normal for him?"

Mrs. Alteplase: "Let me see... He always has that."

Dr. Grumpy: "Okay. Do you know what medications he's on?"

Mrs. Alteplase: "No, but check his wallet. He always has that."

Dr. Grumpy: "Okay" (I start searching through the guy's pockets). "You know where he keeps it?"

Mrs. Alteplase: "No, but he always has that."

As I find and pull out the wallet a handgun - with the safety off - falls out of another pocket and lands on the floor with a loud THUNK. Me and 2 nurses freeze for a second, afraid it might go off.

Mrs. Alteplase: "He always has that."

Bathroom humor

A reader sent in this picture, where apparently an "out of order" sign just wasn't enough:

 

Of course, art imitates life, and vice versa:

Review of Systems

Dr. Grumpy: "Do you have any other health issues?"

Mr. Toss: "On January 14, 1999, I threw up in a Taco Bell bathroom, but other than that I've been fine."

Accuracy

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

Mr. Plumbum: "Yeah, I got shot, and they had to take out the bullet."

Dr. Grumpy: "Where did you got shot?"

Mr. Plumbum: "Korea."

Breaking the fourth wall

Actual CT scan report:

Thank you, M!

Abracadabra

Dr. Grumpy: "Have a seat, what can I do for you?"

Mrs. Anatidae: "My homeopath says his exam showed I have taurine in my brain, and referred me to you to take it out."

 

Pause

  

Dr. Grumpy: "Ma'am, everyone has taurine in their brain. It's critical for nerve function. It's in most organ systems."

 

Pause

 

Mrs. Anatidae: "So... you're telling me there isn't a surgery or something to take it out? He said there was."

Dr. Grumpy: "No. It's normal to have taurine in your brain. You need it to stay alive."

 

Pause

 

Mrs. Anatidae: "I'm sick of all the lies you regular doctors tell people like me to keep us sick so you can make money off our suffering!!!"

 

She stormed out and slammed the door.

 

Change

Since the twins are both at the same university, we bought them a car to share a few months back.

Yesterday we received a letter from the dealer's accounting department, saying they overcharged us in error, along with a check for the amount.

 

I am not making this up.