In memoriam

This is the launching of the aircraft carrier HMS Queen Elizabeth, July, 2014.

Photo credit AP

 

This is the launching of the battleship HMS Prince of Wales in May, 1939.

 

 

If you look carefully, the same lady is in both pictures:

 

 

 

Seen in a chart

 

Friday afternoon

Dr. Grumpy: "This is Dr. Grumpy, returning a call."

Debbie: "Hi, it's Debbie, Dr. Nerve's office manager. Are you going to be covering his new partner, Dr. Axon's, hospital patients this weekend?"

Dr. Grumpy: "Does he have any hospital patients?"

Debbie: "No. He doesn't even have hospital privileges yet, so he won't have any hospital patients."

Pause

Dr. Grumpy: "Then why are you asking?"

Debbie: "Because Dr. Nerve told me to."

Undercover Angel

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

Mr. Bedsheet: "My wife says I kick in my sleep."

Lady Bedsheet: "He does! About an hour after he dozes off his legs start thrashing around, and it keeps me up."

Dr. Grumpy: "Do they..."

Lady Bedsheet: "Actually, I took a video of him doing it last night. Would that help?"

Dr. Grumpy: "Sure, why don't you put it on and I'll have a look."

Lady Bedsheet: "Let me get my phone." (rummages in her purse)

Mr. Bedsheet: "Doc, do you mind if I come around to that side of your desk? I want to see what it looks like myself."

Dr. Grumpy: "That's fine, why don't you stand right there." (I took a swig of Diet Coke)

Lady Bedsheet: "Okay, this woke me up just after midnight last night, you can see them kicking here..."

(I suddenly tried desperately not to blow Diet Coke all over her phone)

Mr. Bedsheet: "WHAT THE FUCK, HARRIET? WHY IS THAT IN THERE?"

Lady Bedsheet: "What was I supposed to do? You always sleep in the buff."

(I managed - barely - to get the Diet Coke down) 

Mr. Bedsheet: "YOU COULDN'T HAVE TAKEN IT FROM A DIFFERENT ANGLE?!!!"

Lady Bedsheet: "A different angle? Who am I, Spielberg?"

Mr. Bedsheet: "WHY DIDN'T YOU PUT A SHEET OVER MY CROTCH OR SOMETHING?"

Lady Bedsheet: "Look, Dr. Grumpy is a doctor. I'm sure he looks at schlongs all day in his job."

Mr. Bedsheet: "He's a brain doctor! They don't look at schlongs!"

Lady Bedsheet: "Dr. Grumpy, is this true? Do brain doctors look at schlongs at work or don't they?"

Dr. Grumpy: (desperately trying to regain control of the appointment) "Um, how many nights a week does this happen?"

Mr. Bedsheet: "What? That she films my schlong? Apparently at least once."

Lady Bedsheet: "Harold, can you stop saying 'schlong'? I'm sure the doctor would prefer a more medical term."

Mr. Bedsheet: "I think he'd prefer you go sit in the waiting room."

Lady Bedsheet: "Fine. Dr. Grumpy, did you see enough of the video to understand what's going on?"

Dr. Grumpy: "Most definitely."

Mary's desk

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

Ms. Cricetinae: "Hi, um, can Dr. Grumpy work me up for fur, I mean hair, loss, and weight changes?"

Mary: "No, you'll need to call your family doctor for that."

Ms. Cricetinae: "Well they won't see me for it."

Mary: "Well, I don't know what to tell you there, but Dr. Grumpy doesn't..."

Ms. Cricetinae: "Okay, the truth is that it's my hamster, Tulip. He's been losing weight, and fur, and I think he needs his thyroid checked and other stuff, but I don't want to pay for a vet. Can't Dr. Grumpy just draw the labs and bill them under my name to my insurance and say they were for me?"

Mary: "No, we can't do that. It's fraud. And Dr. Grumpy doesn't see hamsters, or know much about them."

Ms. Cricetinae: "But what about Tulip?

Mary: "Take him to the vet."

Ms. Cricetinae: "Thanks for being totally useless."

Click

Saturday night, 8:24 p.m.

Dr. Grumpy: "This is Dr. Grumpy, returning a call."

Mrs. Cartography: "Hi, I'm sorry to bother you on a weekend, but I'm on vacation and I guess I forget to bring my Fukitol pills."

Dr. Grumpy: "Okay, do you have a pharmacy you want me to call it to? Where are you?"

Mrs. Cartography: "I'm in Hawaii, in... hang on. It says this is Lahaina. Do you know a pharmacy here?"

Dr. Grumpy: "No but let me..."

Mrs. Cartography: "My phone says there's a Dumpster Drug in Honolulu. Can you send it there?"

Dr. Grumpy: "Yes, are you going there soon?"

Mrs. Cartography: "It wasn't planned, but I can if I need to. We have a rental car."

Dr. Grumpy: "Honolulu is on another island. You're on Maui."

Mrs. Cartography: "I know Hawaii is an island. I'm not stupid."

Dr. Grumpy: "It's several islands, and Lahaina and Honolulu aren't on the same one. Let me look up a pharmacy in Lahaina for you, hang on..."

Mrs. Cartography: "Well, I'd rather go to Dumpster Drugs, because I use them back home. Why don't you just call it in and we'll drive there tomorrow?"

Dr. Grumpy: "You can't drive from Lahaina to Honolulu."

Mrs. Cartography: "I'm sure you can, there must be bridge or something. I mean, that's what I do when I'm going to Brooklyn."

Dr. Grumpy: "It's not quite the same. Let me..."

Mrs. Cartography: "Oh, never mind. My husband found the Fukitol bottle in my purse. Have a good weekend, doctor."

Memories

Going through some old emails over the weekend, I found this one to my office staff. I wrote it roughly 10 years ago, during a family trip to Disneyland.

While waiting to get in this morning we passed a lady yelling at a park employee outside a ticket booth. She was quite upset that the "special Disneyland admissions" she'd bought for a few $100 bills wasn't going to get her into the park. Or anywhere.

Lady: "I demand you honor these tickets! They say they're official tickets, and I paid good money for them."

Employee: "Ma'am, I'm sorry, but these aren't tickets. Did you get them at your hotel desk?"

Lady: "NO! The desk was ridiculously expensive. These were much cheaper. I got them from a man selling them at the bus stop in front of my hotel."

Employee: "I think you've been scammed. I can call the police if you wish. He wasn't a Disney employee, and these aren't real tickets."

Lady: "Of course they're real! They have a picture of Mickey Mouse on them."

Employee: "Yes, but that doesn't make them real tickets. In fact, that's a decal of Mickey stuck to them. It looks like they were made on a home computer."

Lady: "Well, he SAID he was an authorized Disney ticket sales person, and was wearing a hat with Goofy on it. Why would he lie about that?"

Beware of the dragon

 Seen in a chart:

Wait, what?

Pissy and I are talking to a drug rep.

"So, doctors, this nasal spray contains batsonshazam, that can be used emergently to stop a seizure, or attack of seizures. It comes 2 units in a box, which is convenient, as it allows patients to keep one at home and one at work, or one in the car, so they can even use it if they have a seizure and lose consciousness while driving."

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.

Write your own caption

This picture, I swear, is taken from the Disney website, showing a family enjoying the all-new MCU Avengers Campus at Disneyland.

If they're having fun, I can't imagine what the families who aren't enjoying it look like.

 

Meanwhile, up front

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

Ms. Young: "Hi, I was referred by Dr. Neverheardofhim, and he says you need to work me in RIGHT AWAY. Like, today. Now."

Mary: "We have nothing open today... I can do next Wednesday, at 2:30, or..."

Ms. Young: "I looked it up! On the internet it says you are legally obligated to get me in, since my doctor referred me urgently!"

Mary: "Uh, no. If you have an emergency you'll need to go to ER. We don't have any kind of relationship with Dr. Neverheardofhim. The soonest I get you in is Wednesday, though I can put you on a waiting list for..."

Ms. Young: "This is terrible that you're breaking the law like this! I'm going to call my cousin, who's a lawyer!"

She hung up

2 hours later

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

Ms. Young: "Hi, um, I was referred by Dr. Neverheardofhim, I called earlier, and I decided I'll take the Wednesday appointment."

Mary: "I'm sorry, but it's no longer available. We can see you Friday morning, at 8:00, or..."

Ms. Young: "You gave away my appointment? You can't do that!"

Mary: "You never made an appointment."

Ms. Young: "You offered it to me! That's the same thing! I looked it up! On the internet it says you are legally obligated to hold it for me."

Mary: "I'm not going to argue with you. Would you like the Friday morning slot?"

Ms. Young: "This is terrible that you're breaking the law like this! I'm going to call my cousin, who's a lawyer!"

She hung up 

 

1 hour later. 

 

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

Ms. Young: "Hi, um, I called earlier, I was referred by Dr. Neverheardofhim, can I take the Friday morning appointment? Is it still available?"

Mary: "It is, that's Friday morning at 8:00. Okay, what insurance do you have?"

Ms. Young: "Federal United Healthcare."

Mary: "Oh... I'm sorry, Dr. Grumpy isn't contracted with F-U Healthcare."

Ms. Young: "Dr. Neverheardofhim referred me! So you have to take it! I looked it up on the internet!"

Mary: "We don't take that plan, so you'll have to try their website to find a neurologist who does."

Ms. Young: "No, that's YOUR job! You need to find someone who takes my insurance, and have them work me in! It's the law! I looked it up on the internet! I'm going to call my cousin, who's a lawyer!"

Mary hung up

Deep thoughts

Mrs. Seegarp: "My headaches have been terrible the last few months, and I don't know why."

Dr. Grumpy: "Have you had more stress? Or does it seem the Perflukin has stopped working?"

Mrs. Seegarp: "I stopped Perflukin 3 months ago when the copay coupon expired."