'Murica

 1:00 patient called me a "Pinko Jew." What a country.

Hard at work

Your hero, Dr. Grumpy, is (along with a lot of other docs) certified by the American Board of Psychiatry and Neurology (ABPN).

You can be certified in either or both (I have no idea why anyone would want both).

All of us neurologists and psychiatrists pay the board a hefty amount to stay certified. It's a few hundred bucks a year, and every 10 years it's a few thousand more to prepare for and take a written test to maintain certification. This is in addition to all the continuing medical education required.

What the ABPN does with this money, besides writing new test questions and issuing certificates, I have no idea. But, in a recent newsletter I received, it was nice to see that the money is being put to good use:

Show and tell

My 11:00 brought a friend to the visit, who was silent for most of it.

Dr. Grumpy: "Okay, Annie will get your tests set up... do you have any questions?"

Ms. Patient: "No. It sounds like a good plan."

Ms. Friend: "I have a question, I, um , had surgery on my coochie last month, and am worried that the scars aren't going to heal..." she stands up, drops pants "do you think those will go away?"

My dementia patients at work

 

Thank you, Mike!

Cephalopoda

Seen in a chart:

 

Thank you, Mike!

Saturday morning voicemail

“Hi, I keep calling and getting a message that your office is closed, and am kind of confused because on Friday the message said it was open. Can someone please call me back and let me know if you’re closed or open?”

Fun with Google

My 10:30 came in because when she hears running water she has to pee, and she read online that this means she has a brain tumor.

Air time

Last week, for less-than-relaxing reasons, I had to do quite a bit of flying. So I read a lot of P.G. Wodehouse, which is my eternal go-to for travel reading, no matter how many times I've read it before.

On one flight we ran into a fair amount of turbulence and the pilot ordered everyone, including the flight attendants, to strap in, put all tray tables upright and locked, etc.

As we bounced around at 35,000 feet one of the flight attendants got on the microphone and said "Folks, please do not press your call button unless it is an emergency, as movement around the cabin is restricted at this time."

As soon as he said that the guy next to me in the window seat, IMMEDIATELY reached up and pressed his call button (no really, he did. Like he'd been waiting the whole flight for that moment).

Flight attendant unbuckles himself, runs back, and says "are you okay, sir?"

Guy next to me points out the window and says "What are those mountains over there called? They're really beautiful."

Brief pause

The flight attendant says "I have no idea, sir," then turns around and walks back to his seat.

As he's heading back the guy the next to me says "well, can you ask the captain? They're really beautiful."

Back after a few weeks

So going to just put up some random pics you guys sent in, and stuff I saw on my trip.

 This fan mail was posted at a local burger place:

 

From the "when I was your age" file is a pic of a 3 gigabyte external hard drive seen at a thrift store, I assume intended for a museum.

 

 

 

 

 

 

 

Next, in the "gross overuse of adjectives" category is this margarita sign, which needs to have "artisanal" added to really bring it home.

 

Then there's this Albert DeSalvo inspired car decal:

 

And this question on a survey to make sure you're paying attention:

Next!

Dr. Grumpy: "Hi, thank you for coming in today. I'm Dr. Grumpy. Have a seat."

Mr. Leon: "Hello."

Dr. Grumpy: "Let me get some notes ready... Okay, are you right or left handed?"

Mr. Leon: "Excuse me?"

Dr. Grumpy: "Are you right or left handed?"

Pause

Mr. Leon: "What kind of woke bullshit is that? Seriously, I am so sick of you people."

He got up and left

Surveys

As many of you know, occasionally I'll do online marketing surveys as a side job.

 

Sometimes they'll ask if I know another doc who might be interested:

Ones like this show that they either don't know who I am, or vastly overestimate my abilities, or both:

 

 

Sometimes they'll throw in a question just to see if I'm paying attention:

Other questions show that they're the ones who aren't paying attention:

 

 In this case I guess the computer wasn't paying attention:

 

When I get invitations like this I kind of wish I wasn't paying attention:

They often want to know how things progress if patients fail treatments (1st line therapy, 2nd line therapy, etc.). Sometimes the person writing the survey gets confused.

Then there are questions like this:

(For the record, there is absolutely NFW I am going to attempt to manage a patient's diabetes. I'm a neurologist. And any patient who would ask me to manage a non-neurological condition has a death wish).

 

 There are ones I have no clue about:

 

My favorites are when, after I've slogged through and completed a survey, it asks if I still want to get paid for it.

 

 

 

Life is a highway

So, although my academic goal of medicine was to get through my career unpublished (which didn't quite happen), I still occasionally get dragged into research peripherally.

Let me be clear here that I have nothing against research. It's very important. It's just not my thing.

But my call partner, Dr. Cortex, loves it. So when she's out of town I occasionally get dragged into seeing a research patient for her, or signing off on some papers, or whatever. It keeps peace in the local neurology community.

Currently she's on one of her far-flung skiing trips (I think to Hoth this time) so I got roped into doing a pre-study screening visit on a lady for one of her Alzheimer's drug trials.

I showed up at the research office and sat down to look over some papers. There were 2 older ladies in the lobby. The study coordinator told me the visit had become a doubleheader, because the one who'd come in for it had been joined by another lady who'd heard about the study from her and also wanted to participate. Not a big deal. We need volunteers to find out what works, so the more willing souls the merrier. This is where all medical breakthroughs come from.

So I saw the first woman and did her paperwork, then went into another room to meet the add-on.

Dr. Grumpy: "Hi, I'm Dr. Grumpy. Thank you for coming in today. So, I guess you heard about the study from Thelma and decided to join her?"

Louise: "Well, she and I were talking on the ride over and she was telling me about it. I've also been diagnosed with Alzheimer's disease by a neurologist, so I thought I should get involved, too."

Dr. Grumpy: "Are you a friend of hers?"

Louise: "No, I'm her Uber driver."

Weekend On Call

On Friday I admitted a lady who fainted at the store. After talking to her I wrote "seizure unlikely" in my impression and wanted cardiology to have a look at her.

I then turned her over to my call partner, Dr. Nerve, for the weekend.

He apparently agreed with me, but is under the impression her insurance pays by the word. He wrote:

 

For this we invented the internet

An email saying you are about to get more email.

Thank you, Mike!