Department of Redundancy Department

Seen in a chart, in a section about a patient's fluid intake:

Breaking news!

From around the globe, Dr. Grumpy's crack team of reporters bring you the stories that shape your world.

DATELINE: Scotland

Matthew Davies, age 47, failed in his attempt to rob a Bank of Scotland office in Dunfermline.

Armed with a meat cleaver (which he'd hidden inside a pillow case) Mr. Davies approached the counter, pulled out the meat clever, and demanded money.

At that point he cleverly tried to conceal his identity by pulling the pillow case over his head.

Unfortunately, Mr. Davies had forgotten to cut eye holes in his disguise, and therefore now he couldn't see. So he removed the pillow case allowing the teller, and cameras, to get a good look at him as he brandished the cleaver.

He escaped with almost £2,000, then walked home, followed by a witness. On the way he stopped to briefly play with someone's dog before going upstairs to his apartment. Which is where police arrested him a short time later.

In a moment of understatement, his defense attorney said his robbery plan was "one that, when looked at objectively, was unlikely ever to go successfully."

Mr. Davies pleaded guilty and has been sentenced to 4 and 1/2 years behind bars.

It's unknown if the dog will be allowed to visit him.

Quote of the day

"I am not a hypochondriac. I am being proactive about my health. Back to my list, item 27..."

Mary's desk

Ms. School: "Hello?"

Mary: "Hi, this is Mary, at Dr. Grumpy's office. We need to reschedule your appointment."

Ms. School: "When is it?"

Mary: "July 16, at 2:30. Dr. Grumpy was notified today he has to spend that afternoon at a research department meeting."

Ms. School: "Well, this is inconvenient."

Mary: "I'm sorry, but fortunately it's scheduled for July, so we have plenty of slots still available then. We can see you that morning, pretty much anytime between 8:00 and noon. If mornings don't work I have every other afternoon that week open right now, too."

Ms. School: "I really don't like you calling me at the last minute to reschedule this. I have a life and plans, too."

Mary: "That's why I'm calling you now, not at the last minute. It's February 7th. The appointment is over 5 months away, so there are plenty of other open slots around it. You can also move it up to next week if you prefer."

Ms. School: "I'm not happy about this... I think I need a more reliable neurologist. I can't do last-minute changes. Just cancel the appointment all together. I'll send you a release when I find a more considerate doctor. I have a life, too, you know."

Hmmmm.......

I was doing a marketing survey last night.

This is a treatment for depression that hadn't occurred to me...

Annie's desk

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

Mrs. Shaking: "I saw Dr. Grumpy last week, and he sent my refill to my mail order pharmacy, and IT STILL HASN'T GOTTEN HERE! They say they deliver within 3 days. This is unacceptable."

Annie: "Have you called them?"

Mrs. Shaking: "Yes! They said they're still waiting for you to give them more information! This is very upsetting that your office has dropped the ball like this. I demand you call them right now and fix this! I need my medication!"

Annie: "Let me put you on hold while I call them."


Annie puts her on hold, dials the doctors-office line to the mail-order pharmacy.


Phone person: "Thank you for calling BigAzz Pharmacy physician's line."

Annie: "I'm calling from Dr. Grumpy's office. We sent you a script last week for Mrs. Shaking? She's called here and says she hasn't received it yet."

Phone person: "Let me see... It looks like we haven't shipped it yet because she's refusing to give us any payment information."

Annie: "WHAT?"

Phone person: "Yes... She's called 3 times in the last 2 days, each time demanding we send it, but then refuses to give us a credit card number so we can bill her the copay of $40."

Annie: "Sorry, I had no idea."

Phone person: "In fact, it looks like yesterday she told us to bill your office for it, and we refused."

Artisanal overload

Okay, time to hit the mailbag for more examples of "artisanal" crap you guys have sent in.


First we have this flour, which is so uniquely handcrafted that it was being dumped off sold at the dollar store:









Next, for the health conscious, we have these "nourishing" pork rinds. They're apparently not only artisanal, but "epic," too:

Being antibiotic-free didn't do the pig much good, I guess

 If you're into artisanal junk and buy a lot of it, what better place to store it in than this:

Here's this sandwich, whose description ominously ends without telling you what, specifically, is artisan, making you wonder if the prosciutto is from the classic 1980 horror-movie Motel Hell.

 

Lastly, to my disgust, is this: A neurology hammer (a Trömner, no less) being advertised as artisanal:

Let's keep in mind that, no matter what it is, if it's made from "high density plastic" the odd are that it isn't really artisanal.

Dr. Grumpy's personal Trömner, for the record, was bestowed upon him by a drug rep pushing brand-name Naprosyn. Which dates me more than I want to think about.

Marketing

There's a new drug on the market in my field (hell, I could say that every month), so my partner Pissy and I are getting the usual drug rep visits, lunches, glossy brochures, and samples.

I tend to be more sympathetic than most to reps. I understand they have their job, like I have mine. They're just trying to support a family and pay the mortgage like any of us. So, if I have time, I listen politely and sign for samples, and try to give them a few extra minutes if their boss is shadowing them that day.

But this time there's a new tactic me and Pissy haven't encountered before. The reps for this product have all pushed this idea:

"When you send a prescription online, or hand one to a patient, call me with the patient's name and their pharmacy. I will personally go to that pharmacy and demand they order it, so it's in stock when the patient needs to fill it."

So far I've been called on by 3 separate reps for the drug, and all have given me the same spiel. So it's a pretty safe bet to assume the idea is coming from their corporate masters in training sessions.

And no, I ain't doing that.

To me, this is wrong on a couple of levels.

1. Privacy.

Mrs. Patient comes to me hoping I'll keep her health issues a secret. Granted, that also includes my staff, like Mary and Annie, because they have to know what's up.

Her pharmacist is also, at least partially, in the know. They don't have access to my charts, but they know private things about her health from the medications she takes and what she tells them. Which is fine. They're as much involved in her health care as I am. They need to be able to advise her properly about her medications and protect her from any multitude of errors I might make in prescribing stuff (and, for the record, I'm eternally grateful for you guys bailing me out on one in particular last week).

But the drug rep? No. Their job is to make me aware of, educate me about, and convince me to prescribe, their product. Which is fine. But they aren't part of the medical chain between me, Mrs. Patient, and her pharmacist. To give them her name to bandy around Local Pharmacy is, at least to me, a pretty serious breach of her privacy.

Not only that, but my loyalty, and my staff's, and the pharmacist's, are on her side of the equation. We are working for her benefit. The drug rep may claim to be doing so, and some may even believe they are. But at the end of the day, they work for a large publicly-traded pharmaceutical company. Once I give them her info, they have a snippet of personal data on her. Who's to say it won't be used to send her mail about great offers on their other products, and/or sold to clothing companies and banks that want to mail her ads for underwear, new low-fee once-in-a-lifetime credit card offers, or robocall her with great deals on trips to Bermuda?

Obviously, if she gives them this information herself as part of an assistance program or freebie offer, that's different. Then it's her call and informed consent. But I'm not going to.


2. Have you ever watched a pharmacy staff at work?

You don't have to stand there in a creepy I'm-casing-the-joint way, but next time you're at the supermarket, just look over and see what's going on in the pharmacy. Odds are there's 1 pharmacist and 1-2 techs working. At least one of them will be on the phone, the other will be at the patient window or getting something off a shelf, the phone is ringing, there will be lines at both the drop-off and pick-up windows, and some random guy at the counter interrupting them to ask where ketchup is.

They're swamped.

So pretty much the last thing they need in their daily shit storm is for a well-coiffed drug rep to wander in and demand they order & stock their latest and greatest drug (currently $95 a pill per Epocrates), when there's a reasonable chance the patient may never even show up for it. Mrs. Patient could wind up going to a different pharmacy, or find the sample didn't work and she doesn't want to pick up the script, or suffer a nervous breakdown when she hears the price and calms down by strangling the ketchup guy.

In summary, I'm pretty sure the pharmacy doesn't have time for this idea.


I know there are drug reps reading this. Don't take it as an insult. I know you're just doing your job, and that's why I meet with you. I really do appreciate the samples for the product so my patients can try them and see if they're worth fighting with insurance over. Me and Pissy and our staff enjoy the lunches (although if you go to that vegan wrap place again we'll put a restraining order on you).

But don't expect me to betray my patients' confidence to you. You can ask me, if that's what your company requires you to do. I understand that. But don't be too upset when I don't. At the end of the day, I work for their best interests, not yours.

I wish it was that simple

Seen in a chart section on improving patient medication compliance. The spelling error and bad grammar only make it worse.

On call

Mr. Angry: "I demand you order an MRI of my abdomen."

Dr. Grumpy: "Sir, we've been through this before. I'm not the doctor seeing you for those issues. I was consulted because of your headaches. The GI doctor saw you yesterday, and has ordered a work-up for those issues."

Mr. Angry: "She didn't order an MRI of the area, and I want one. She ordered other stuff."

Dr. Grumpy: "I'm going to have to defer that work-up to her. It's not my specialty."

Mr. Angry: "This is ridiculous."


I left the room, wrote a note in the chart, and moved on to the next patient. As I scrolled though some test results my cell phone rang.


Dr. Grumpy: "This is Dr. Grumpy."

Officer: "Hi, doctor. This is Officer Badge of the Grumpyville Police Department."

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

Officer: "I'm sorry to bother you with this. Our 911 desk just got a call from a Mr. Angry. He says you're refusing to order tests on him, and called the emergency line to ask that we arrest you."

Dr. Grumpy: "I..." (I started giggling)

Officer: "Yeah, I know... But we have to address each call."

Dr. Grumpy: "I understand..."

Officer: "I'm just going to note that I spoke to you and nothing further was indicated. Have a good Sunday."

Seen in a chart

On a patient with a heart attack.

Time to light up, apparently.

Mary's desk

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

Mrs. Call: "Hello, I was referred by Dr. Unka to see Dr. Grumpy."

Mary: "Sure. What insurance do you have?"

Mrs. Call: "Sikazchit PPO."

Mary: "Oh... I'm sorry. We don't take that insurance. Let me give you the names of some other neurologists you can try..."

Mrs. Call: "Dr. Unka wanted me to see Dr. Grumpy."

Mary: "He probably doesn't know we're not contracted with Sikazchit PPO. There's Dr. Brain, who..."

Mrs. Call: "I. Don't. Think. You. Understand. This is Dr. Unka who referred me. He wants me to see Dr. Grumpy. So make me an appointment."

Mary: "But we don't take your insurance. Do you mean you want to do this as cash pay?"

Mrs. Call: "Don't be ridiculous. Since Dr. Unka referred me you should be seeing me as a courtesy to him."

Losing my religion

Dr. Grumpy: "Let me fill out the MRI form... Are you claustrophobic, sir?"

Mr. Lumbar: "No, I'm Episcopalian."

Aged out

Dr. Grumpy: "Okay, we should have the test results later today, so I'll check back afterwards to discuss them. Who's your regular internist?"

Mrs. Fainting: "It's Dr. Olde."

Dr. Grumpy: "He's still practicing? Wow. Okay, I'll call and let him know you're here and what's going on."

Mrs. Fainting: "You don't need to. He was in ER across from me. They were putting him on life support."

Can you narrow that down a bit?

Seen in a chart:

New Year's Eve

 

This is Craig Grumpy. Dad asked me to write about my New Year's Eve.

Marie and I had an out-of-state college band competition on December 31st, with an 8 hour bus ride home afterwards. Since the competition ended around 7:00 p.m... It was going to be a long night.

When we boarded the bus (which was not some luxury tour bus, think more Partridge Family) to go home, we found our band director had hung a "Happy 2019!" banner over the back seats. There was a piece of lined notebook paper with "2020" written in Sharpie stapled over the "2019." She excitedly told us that this way we could take pictures in front of it for our Instagram accounts so people would think we were at a real NYE party, instead of, say, on an aging repurposed school bus driving all night through the frozen wastelands of the American Midwest.

A few of us took pictures, but with the pile of musical instruments in the back of the bus, and the broken "occupied" sign on its bathroom behind the banner, I'm pretty sure we didn't fool anybody. One of Marie's classmates saw her post and wrote "Where are you? That looks like an old bus!"

We'd only been on the road for an hour when the heater broke.

Starting around 10:00 the bus driver and band director began hinting at a New Year's "surprise" they'd planned, leaving us all breathless with excitement. We were hoping it involved food and a slightly less disgusting bathroom.

Approaching midnight they let us in on the big secret: we were going to be stopping at a large gas-station that was locally famous for it's NYE celebration for truckers, with fireworks and a special take-out menu. At this point anything was starting to sound good, as the only food anyone had brought was 2 boxes of Ding-Dongs and a Costco package of Goldfish.

Right on time, at 11:55 we pulled into the place's parking lot...

To find it was closed. And I don't mean "closed for the night." I mean "closed down, abandoned, with broken windows and graffiti." The only other living thing there was a coyote slinking off behind the empty drive-through.

The bus driver wished us all a happy new year and got off the bus to smoke, but warned the rest of us to stay on board for safety.

Then it was midnight. As the calendar turned to 2020, I was standing in line to use a bus' bathroom in the parking lot of a post-apocalyptic truck stop, watching our driver smoking outside as the snow came down. The closest thing we had to fireworks was the tuba players having a belching contest.

After all that excitement, to settle down Marie and I played pool on our phones until we started to doze off.

We were woken up by screaming about 30 minutes later when the bus' toilet finally gave up the ghost and backed-up into the aisle to cap off the party. So we drove the last few hours back to school with the windows open, preferring death by hypothermia to that of asphyxiation.

And to all a good night and happy new year.

That wraps it up

Shutting down for the next 3 weeks. See you in 2020!

For those who didn't see it

Toxic

Phone rings.

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

Mrs. Latrodectus: "Hello, I need to make an appointment with Dr. Grumpy."

Mary: "Let me put you on hold for a sec, I'm scheduling another patient right now."


Mary finishes scheduling the other patient in < 1 minute, goes back to Mrs. Lactrodectus, finds she hung up.

Phone rings.


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

Mrs. Latrodectus: "How DARE you put me on hold. I'm a VERY busy woman!"

Mary: "Sorry, but there's always a lot going on here. Okay... We have an opening next Wednesday afternoon... what are you going to be seeing Dr. Grumpy for?"

Mrs. Latrodectus: "Excuse me? Are you the doctor?"

Mary: "No, I'm his secretary."

Mrs. Latrodectus: "Well, I don't have to tell underlings why I'm coming in. Unless he's willing to get on the phone right now, I have no plans to discuss this on this call."

Mary: "The only reason I ask is because there are several disorders he doesn't handle, and so I don't want to waste your time, or his, if you come in and he doesn't see your condition."

Mrs. Latrodectus: "I'm a very busy woman and don't have time for this nonsense. Why don't you just tell me all the things he doesn't treat and I'll decide if this is worthwhile."

Mary: "I'm not going to do that. Do you want to make an appointment or not?"

Mrs. Lactrodectus: "You have some nerve!"

Click.

Seen in a chart

Day at the Races

Early last Friday morning Mr. Party, a heavy-drinking patient of Dr. Smith (an internist downstairs in my building) wasn't feeling well. He'd quit drinking 2 days before, and decided to go to his doctor's office and wait for it to open.

While standing in the hall, Mr. Party was passed by a drug rep (yes, this one) coming to bring breakfast to me and Pissy's office. She markets anti-seizure medications, and her company has been promoting a campaign to make its reps more aware of the special needs of epilepsy patients.

Anyway, just as she was walking by Mr. Party, he suddenly collapsed and had a generalized seizure, wetting himself and lacerating his forehead on the doorknob as he fell. She then showed her newfound awareness of the special needs of seizure patients by running screaming through the building yelling "Help! Someone call 911!" repeatedly. The whole time she had a cell phone in her hand (Richard Dreyfuss did something similar in "Down & Out in Beverly Hills" for those who remember the flick).

Her meeting with me forgotten, she ran out to her car and decided to, um, I'm really not sure. As she was getting into it she suddenly realized she had a phone in her hand and called 911 herself. She then sat there for 15 minutes, trying to work up the courage to go back and look for her sample case and the tray of bagels she'd dropped in the excitement.

In the meantime, Dr. Smith had arrived at work to be greeted by one of his patients lying unconscious in a pool of blood and urine in front of his office door. At about the same time the police, firemen, and paramedics all arrived. They'd been summoned by the somewhat nonspecific nature of people in the building calling 911 when they heard the rep yelling, but not knowing what was going on.

Mr. Party was admitted to the hospital and is suspected of having had an alcohol-withdrawal seizure.

Dr. Smith waited until they loaded Mr. Party into the ambulance, then called building maintenance to shampoo the carpet in front of his office.

The drug rep found her sample case and bagels, and rescheduled her meeting with Pissy and I to later in the morning. During it she mentioned that she's considering a career change.

Midnight. Not a sound from the pavement.

Dr. Grumpy: "So that was 2 weeks ago that you were in the hospital... How have you been doing?"

Mr. Percheron: "I'm fine, I mean, I don't remember much about that day, but everything else has come back. What was that called?"

Dr. Grumpy: "Transient Global Amnesia. It's uncommon, and fortunately generally benign. You'll probably never remember the day it happened, but that's not a big deal."

Mr. Percheron: "Maybe you can help me with this?" (hands me a folded paper).

Dr. Grumpy: "What is it?"

Mr. Percheron: "It's from the hospital. They sent me a satisfaction questionnaire about my stay. But I don't remember anything about it."

"That's not my specialty."

Seen in a chart:

Research

I think we'd all agree that going through alcohol withdrawal is a bad thing.

I think even more of us would say that having a stroke is also pretty serious.

So you definitely don't want to do BOTH at the same time.

Of course, someone had to actually study this. So they did.

In a landmark piece of research, it was discovered that people who have a stroke AND go through alcohol withdrawal during their admission have more complications, poorer outcomes, and tend to be in the hospital longer than stroke patients who don't withdraw and see pink elephants.

Really.

This creates an all new research path: think of other conditions that are worsened by alcohol withdrawal. It's just like Mad Libs! Write a series of articles where you fill in the blank:

“Alcohol withdrawal is associated with worsened outcomes in  _______.”

If you play your cards right, this kind of research could get you an academic appointment! Let me throw out some suggestions, and you guys can take it from there:


"heart attacks"

"life"

"karaoke"


Have fun! And keep me in mind when you become chairman!


Thank you, SMOD!

"Play with me, kids"

There's a pediatrics office down the hall from me. Yesterday a letter for them accidentally ended up at my place, so I took it over there. I noticed this on the waiting room toy shelf:

Adulting

11:45 at night. My cell phone rings, waking me from sleep.

It’s Craig.

Dr. Grumpy : “This is doctor. … I mean, hi, Craig. You okay?”

(loud noise, someone yelling in background)

Craig: “Hi, Dad. Hey, how do I put out a fire in a microwave?"

I’m suddenly REALLY AWAKE.

(loud crash)

Craig: “Never mind, my roommate put it out.”

Voice in background: “What a mess, I'm going to get some towels."

Dr. Grumpy: “What’s going on?”

Craig: “Oh, nothing big, I guess. Hey, what’s a good way to get smoke out of a dorm room?”

Dr. Grumpy “Open the door and all the windows and put that fan you have in one of them.”

Craig: “Hang on… Okay, where’d I put the fan… guess that outlet isn’t going to work anymore, I’ll call maintenance in the morning.”

Dr. Grumpy: “Craig, what’s going on?”

Craig: “We were just making cookies, it’s fine now. I mean, it will be when the smoke is gone. Hey, can you order me a new microwave ramen dish thing from Amazon or something?”

Dr. Grumpy: “Why do you need a new one?”

Craig: “The other one is, um, kind of melted. I don’t think I can use it again.” (voice in background says something) “can you toss me some towels? Thanks. Sorry, Dad, there’s water everywhere. We had to throw a few buckets of water inside the microwave. (voice in background says something) I don’t think we can eat it, with the plastic melted into it on that side.”

Dr. Grumpy: “What…”

Craig: “Hand me the bag, I’ll just toss the ramen thing in there. OW! SHIT! IT’S HOT! SHIT! Hey, Dad, I think I burned my hand.”

Dr. Grumpy: “Put ice on it.”

Craig: “Will a cold Diet Coke can be okay?”

Dr. Grumpy: “If it’s all you have.”

Craig: “Okay.”

Dr. Grumpy: “Craig, What’s going on?”

Craig: “Oh, … We were just trying to make cookies. My roommate and I felt like cookies, so we bought a tub of cookie dough at the store.”

Dr. Grumpy: "You were making them in a microwave ramen dish?”

Craig: “It’s all we had, so we filled it up with dough, more like a cookie cake, I guess, figuring that way we’d be able to cook it all at once."

Dr. Grumpy: “Didn't the dough's microwave directions give you a time?”

Craig: “The tub didn’t have microwave directions, just regular oven, so we used those, but i guess that was too long. The cookie cake exploded and the bottom of the ramen pan melted and was smoking, then caught fire. My roommate tried to smother it with some paper towels, but then they caught fire, too."

Dr. Grumpy: “I wouldn’t…”

Craig: “Some guy on YouTube said it would bake them, but it didn’t. Hey, how long will it take all the smoke to clear from my room? I want to go to bed.”

Dr. Grumpy: “So go to bed.”

Craig: “I don't want to go to bed and leave all the doors and windows open, someone might steal my stuff.”

Dr. Grumpy: “Maybe a few hours.”

Craig: “Oh, good. I thought it might be days."

Taking a break

Gang, due to a great deal of insanity I'm going to take a few weeks off from the blog. Hoping to be back on November 18, 2019.

All is fine, but I need to decrease the things I'm juggling for a short time.

See you then!

I'll tell you where you can put your shoe

Here's another great computer chart system. When you order a shoe for someone who just had foot surgery, it gives you a list to pick where the shoe should be worn:

Thank you, J!

"I should do WHAT with it?"

Casa De Mentia

Jack is a nice guy, unfortunately now progressing through Alzheimer's disease. Although his cognition is shot, his baseline friendly personality has stayed with him. He's always accompanied by his doting daughter, Susan, and yesterday there was a guy with them I hadn't previously met.


Dr. Grumpy: "Hi Jack, hey Susan. Have a seat. Hi, sir. I don't think we've met. Are you Jack's son?"

Guy: "No, I'm, uh, actually a tax auditor."

Dr. Grumpy: "A tax auditor?"

Susan: "Yes, I asked him to come with us today. He's auditing our taxes."

Guy: "They asked me to come today. I don't normally go to doctor appointments with people. Actually, this is a first."

Dr. Grumpy: "What's going on?"

Susan: "Apparently there's an issue with our taxes. Can you explain?"

Jack: "Hi, Dr. Gravy."

Susan: "It's Dr. Grumpy, Dad."

Guy: "I was sent to audit their taxes because of errors that were, incredulous, to say the least, and my department was concerned about fraud, but when I got there I found that..."

Susan: "Me and Larry have been letting Dad do our taxes."

Dr. Grumpy: "WHAT? You mean, recently?"

Susan: "Yes, ever since we got married 35 years ago. He's always done them."

Dr. Grumpy: "Jack, have you been doing their taxes?"

Jack: "Are we going to be done here before the Cubs game starts?"

Susan: "Daddy, it's football season."

Dr. Grumpy: "Wait... Susan, you let your Dad, who we've done all kinds of paperwork and POA and legal forms on for his Alzheimer's disease, DO YOUR TAXES?!!!'

Susan: "I asked him if he'd still be able to do them, and he said yes."

Jack: "I'm a CPA. Last week I was named to the top 10 CPA's in Bayonne."

Susan: "Daddy, you've been retired for 15 years."

Jack: "Is the Cubs' game on tonight?"

Guy: "Excuse me, doctor, but just to make sure, is this man mentally capable of doing income taxes?"

Dr. Grumpy: "NO. Absolutely not. Do you need me to put in writing?"

Guy: "Please."

Susan: "Dr. Grumpy, I have a question?"

Dr. Grumpy: "Yes?"

Susan: "Do you know a good accountant?"

License plate of the year

Thank you, Glenn!