Hmmm...

While I was at the hospital yesterday, I stopped in to read some EEG's. The studies always have a cover sheet attached, giving me a brief patient history. One had this on it's paperwork:

"Indication: Patient has spells of "tripping out" when he drinks heavily and smokes marijuana. Dr. Local ordered the study to make sure they aren't seizures."

Boob job

I got dragged in to the hospital today to see a patient, and was walking by the cafeteria.

The sign in front listed today's special as:

"Italian style roasted breasts, with rice."

Hygienic Horrors

It is a really scary, when catching up on the laundry, to realize that in the last 8 days your son has worn only 2 pairs of underwear.

How about a cheeseburger for stroke awareness?

15% off nfl scrubs with checkout code "nfl_jrl"

For various reasons this has been a CRAZY week at my office, and I'm still trying to catch up. So while I'm attacking the giant Pileofdictations Monster, I'm putting up this gripe sent in by Stacey, who's a radiology tech. At least that's what she says. For all I know she's another yak herder in the next valley over from me.

I was walking over to the fitness center on campus today when I was accosted by 3 women at a little sidewalk booth.

They were having a bake sale to raise money and awareness for heart disease. One women piped up as I walked by...she asked me if I would buy something to support their cause.

They were selling cupcakes, BIG cookies, thick slices of chocolate cake, and pastries. To raise money to fight heart disease. And they wanted me to support this fight by contributing to my own vascular risk.

I lost it. I said "Are you kidding me? Obesity is a major cause of heart disease! Don't you think that maybe, just maybe, you should be selling something healthy? Maybe you should try selling something healthy to promote heart health, awareness and raise money at the same time".

They all looked at me like I'd just bitten the head off a puppy and spit it on the sidewalk.

Finally one of them said "Well, we have oatmeal raisin cookies... they're kinda healthy..."

This could mean a lot...

From a patient intake form yesterday afternoon.

(click to enlarge)

Delay in game

I went up front to get a patient from the lobby.


Dr. Grumpy: "Mrs. Fourdown? Come on back to my office."

Mrs. Fourdown: "Oh dear. Can you take someone else ahead of me?"

Dr. Grumpy: "No, you're the only one here right now, and it's time for your appointment. Is something wrong?"

Mrs. Fourdown: "No, but I just started a crossword puzzle."

Annie's desk, September 8, 2010

Mr. Jade: "So what's my sed rate?"

Annie: "5".

Mr. Jade: "Is that good?"

Annie: "Yes".

Mr. Jade: "Did you ask the doctor?"

Annie: "Yes. He said 5 is fine."

Mr. Jade: "Was that today that you asked him?"

Annie: "This morning."

Mr. Jade: "Is 5 in the normal range?"

Annie: "Yes."

Mr. Jade: "What is the normal range?"

Annie: "Less than 20."

Mr. Jade: "So that's less than 20?"

Annie: "Yes."

Mr. Jade: "Which is normal, right?"

Things that make me grumpy

B12

Sounds simple, huh?

1 letter, 2 numbers. One of the B vitamins. It's important in a number of body functions, particularly the nervous system and blood cell production. It's in pretty much all meats and vegetables, and multivitamins you can buy.

To me, it's also a good example of what's wrong in health care.

Let's take Mrs. Olde.

She goes to her internist, and is complaining of feeling weak and tired. So he checks a B12 level, thyroid labs, and other stuff.

A week later, she's out with some friends, and trips in a movie theater. She breaks her leg, and lands in ER. She gets admitted to the hospital.

There she mentions that she feels weak and tired to the admitting hospitalist. So, with the usual pre-surgical labs, she checks a B12 level, thyroid labs, and other stuff.

She does fine in surgery, but afterwards has a mild anemia, which doesn't improve. So after she gets out of the hospital she goes to a hematologist. This doctor doesn't have any of the previous tests, and so orders another B12 as part of the work-up.

While she's recovering, she's taking Percocet for her broken leg. She mentions to her daughter that her memory is foggy, and so the daughter takes her to see a neurologist.

The patient comes to the neurologist. He thinks the problem is due to Percocet, but to cover himself he orders a head CT. Since he doesn't have access to her hospital records, and she doesn't have any of her previous labs with her, he orders a bunch of blood work, including a B12, thyroid labs, and other stuff.

Story over.

Now, a B12 level, according to Local Lab, costs $198. So this lady has had 4 done, for a total of $792, in less than a month. B12 levels generally don't change that dramatically in a month, so only 1 was really needed (yes, I know some of you are thinking a methylmalonic acid level is more useful than a B12, and I agree with you. But that's not the point here. And try getting Medicare to pay for an outpatient methylmalonic acid).

$198 isn't that much, is it? But multiply it by thousands of patients a month with similar stories. That's a HUGE amount of money wasted. And then extrapolate it to many other redundants tests: CBC's, TSH, chest X-rays. And then add pricier items (though not as commonly reduplicated) like CT's and MRI's.

I generally don't order labs if I know a patient has recently had them. I try to get the old records, then order anything I need that hasn't already been done. But many docs don't do that. And sometimes the patients are less than helpful. They forgot they had stuff done 2 weeks ago. Or don't remember the name of the doctor/hospital who did them, making it impossible for me to track them down (you'd be amazed how many times people have no idea what hospital they were in recently, or what doctor ordered their tests).

I'm guilty of this myself. Yesterday I admitted a guy to the hospital, who told me his outpatient work-up hadn't included any labs. So I ordered a bunch. This morning I came into my office to find everything I had done last night was also done 3 days ago, and was sitting on my fax machine. According to the hospital labs, the total cost on these duplicated labs was $1278.

I don't think the patent did this intentionally. He'd either forgotten, or (and this is common, believe it or not) thought that the labs his internist ordered wouldn't be ones a neurologist would want, and therefore didn't count.

Redundant tests, I think, are a huge waste of money. I'm not sure what the answer is here.

Some would say we need to have ALL these records in a humungous database, searchable from anywhere, and protected by elaborate security checks. This would likely be the best answer, but I think all of us have huge concerns about the security and privacy issues involved.

Better communication between doctors would help. You have no idea how much I appreciate it when a referring doctor sends labs and test results in advance, or even with the patient. That way we all save time, money, and blood on further tests.

Another option is to put the patient in charge of their records. Some are good at this, bringing copies of labs going back to their childhood. But most don't. Giving them a memory stick or CD with past tests sounds good, but those things can be forgotten. Or lost. Or not work on a different type of computer.

I don't have an answer for this. I wish I did. A good solution on a large scale would likely save a huge amount of time, money, and aggravation for all of us.

Yes, I have kids

I have a patient who always starts his sentences with a long "Ohhhhhh..."

Like this:

Dr. Grumpy: "How many physical therapy sessions have you had?"

Mr. Star: "Ohhhhh... maybe 5 or 6."


And I have to say, when he does the "Ohhhhhhh..." thing, it's REALLY hard not to yell "Who lives in a pineapple under the sea?"

Tuesday morning, 1:55 a.m.

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

Mrs. Wokeme: "Yes, I see you for migraines, and I have one. What should I do?"

Dr. Grumpy: "Didn't I give you a prescription for Painbegone? Have you tried one?"

Mrs. Wokeme: "No, but I have the package right here. It says to take as needed for migraine."

Dr. Grumpy: "So take one, if you have a migraine."

Mrs. Wokeme: "Okay. I just wanted to be sure. I thought I once read that 'take as needed' was some sort of medical code meaning I should call the doctor first."

Tips from Dr. Grumpy

I'm spending this holiday weekend being abused by my kids AND evil archenemy (the Wii Fit trainer). So to keep you guys entertained until I return to my desk, I'm providing awareness of important news stories (this and the previous post).

Obviously, if you're a veteran of huffing paint/glue/whatever, I don't expect you to still have all brain cells working.

BUT here's a tip: walking around with the lower half of your face spray-painted a lovely shade of metallic gold, like this guy, WILL NOT help you blend in with a crowd (at least most crowds).


I'd like to thank my reader Kayden for submitting this.

NEW! Treats pain AND fatigue!

I'd like to thank my reader Ellie for submitting this.

(click to enlarge)

Excuses

Dear Patients:

Apparently this 3 day weekend snuck up on many of you, to the extent that you frantically canceled yesterday's appointments at the last minute. I assume this was so you could leave town/start drinking/both early (Americans love a reason to drink. I think we're the only country that steals holidays from other countries, like St. Patrick's Day or Cinco De Mayo, just to have an excuse to drink).

Anyway, the day started with a typically full office schedule, but by the time you guys were done canceling, I'd worked a total of 2 1/2 hours, and we gave up and closed down at 1:25.

I appreciate those of you who were considerate enough to call. This is actually preferable to the ones who simply don't show up, leaving me in suspense. At least by calling you let us know we can shut down early.

I'm sure some of you had legitimate reasons not to come in. But it's hard for me to tell. So here, in no particular order, are some of the excuses we received.

1. I broke my arm.

2. My kid broke his arm.

3. My car died on the freeway, and I'm up here on the off-ramp waiting for a tow-truck (the message on this one featured loud music and a guy ordering beer in the background).

4. My hemorrhoids are killing me.

5. I don't remember why I see you anyway (possibly legitimate given the nature of my practice).

6. My ex-husband is in town.

7. My kid lost my car keys.

8. I have to go to Costco.

9. My cat threw-up.

10. I'm in the middle of my pap smear, and my GYN just called out for an emergency, and I'm up in the stirrups and don't know when she'll be back.


THE WINNER, however, has to go to Mr. Bowman. He's been a reliable patient of mine for a long time, and knows I'll forgive him. He also knows my sense of humor. And he left this message (Mary didn't get it, but I did).

"Hi, this is Mr. Bowman. I need to cancel my 2:15 appointment today because OH MY GOD! IT'S FULL OF STARS!" (click).

Have a good weekend everyone.

Good answer

Dr. Grumpy: "Is that mark on your eye a lifelong thing?"

Mrs. Literal: "Well, it's been there since I was born. Before that I'm not sure."

Geography FAIL!

Okay, I'm doing a research survey this morning, and screen #1 asked me which country I resided in. So I checked "USA".

The next screen came up, and asked me what state I lived in. It featured a drop-down menu with all the states. And the "A's" went like this:

Alabama
Alaska
Alberta
Arizona
Arkansas...


I REALLY hope they did that to see if I was paying attention.

Another one bites the dust

I don't do that much teaching anymore. I like it, but the constraints of time with a family and solo practice make it damn near impossible.

But I still do it, albeit rarely, on special requests from friends, nurses or docs I know, etc. And yesterday was one of those days.

I got my start in a college program where I shadowed docs to see if I wanted to be one, and so I have a tender spot for those kids. Last week one of the hospital nurses called me. Her son is in his 2nd year of college, and is thinking about medicine. She was calling around to see if anyone would let him watch for a day. And since I'm a softy, I said sure.

He shows up, neatly dressed, trying to look young, eager, and professional. My first patient was in for an EMG (electrical test of the nerves and muscles), and she didn't have a problem with the student watching.

I fired up the machine, and made some notes. Joe College leaned over my shoulder to see what I was doing. I stuck a needle in the patient's deltoid, and turned to the machine to look at the results.

There was a loud "thunk" behind me. The patient and I both turned to see Joe College sprawled unconscious on my exam room floor.

The patient began laughing. I pulled the needle out of her arm and called Mary for help. We got Joe out to the break room as he woke up, and got him some water.

By the time I was done with the EMG he was gone. He'd told Mary he was thinking about becoming a pharmacist or accountant. He also asked for her phone number.

History FAIL!

"I had my kids way back, in the 1970's. They were complicated births, because they hadn't invented the C-section yet."

Only outside Sleepy Hollow

Mr. Patient: "My chiropractor says this is because the top of my neck attaches to my head. Is that a common problem?"

Attention Drug Rep!

Thank you for bringing lunch today.

I am married. You may not have noticed my ring. Or my kid's drawings all over the place. Or the brief phone call I had with Mrs. Grumpy in front of you to work out who's picking up the tribe tonight.

Batting your eyelashes, adjusting yourself in your chair so that all of us could see you're wearing a thong, talking about how lonely you are being new in this town, and giving me a card with your home phone on it "just in case you have questions about the drug, or anything else" does NOT score you points in my office.

Try the plastic surgeon downstairs. His trophy wife (3rd wife, 28 years younger then he is) just turned 35, so he's likely looking for a newer model.

Thank you.

Is that your final answer?

I'd like to thank my reader Kate for submitting this. She found it on Answers.com.

Beyond the question of "Why the hell is this listed under 'math'?", is the remarkable answer itself.

(click to enlarge)

Early monday hospital rounds

Dr. Grumpy: "Why did you call 911?"

Mr. Phlush: "Because my toilet was clogged."

Dr. Grumpy: "Why on Earth did you do that?!!!"

Mr. Phlush: "I don't know any plumbers."

Today's Health Tip

Just reminding all my readers to eat plenty of ice cream, because it supports a healthy lifestyle. After all, it says so on the carton.

(click to enlarge)




And thank you to my reader Trout for submitting this!

Memories...

One of the most hated parts of residency is having to call an attending at night about a new admission. In most programs this is required, and you don't have a choice. It consists of dialing up the senior doc on call, running a case by them quickly, and making sure they agree with what you're doing.

Generally you try and make it quick. You're busy. They're trying to sleep.

There was one doctor in my program, Dr. Flat, who was notorious for his rapid monotone. He spoke at warp speed, but his voice never changed, and he never strayed from business. If he had a sense of humor, none of us ever saw it.

One weeknight I was on call, and was admitting a stroke patient. It was about 10:00 p.m, and I made the obligatory call to Dr. Flat.

Dr. Grumpy: "So I'm admitting him to the telemetry floor, and started him on Aspirin. I've ordered an MRI, and..."

Dr. Flat: Mmmmm. YAWNNNNNN

Dr. Grumpy: "I'm sorry, sir. Did I wake you up?"

Dr. Flat:"No, my wife and I just finished having sex. What's his blood pressure?"

Patient quote of the day

"I forget the things I can't remember. When I was younger I used to remember that stuff. I mean, I'd remember the stuff I hadn't forgotten."

Fashion and medicine

Dr. Grumpy: "Okay, we're done with the EMG. I'm going across the hall to my office. Why don't you toss the paper gown in the trash, put your shirt back on, and meet me over there to discuss the results."

Mrs. Hedinbutt: "It's not a shirt. It's a blouse."

Dr. Grumpy: "Okay. Anyway, after you have it on, come over and..."

Mrs. Hedinbutt: "Don't you even know the difference?"

Dr. Grumpy: "Well a..."

Mrs. Hedinbutt: "For crying out loud! You're a doctor and you can't even tell a blouse from a shirt! How did you get through medical school!"

(long pause)

Dr. Grumpy: "Look. Do you want to go over the EMG results or not?"

Mrs. Hedinbutt: "I don't have time for this. Just send them to Dr. Imed and I'll discuss it with him." (puts on blouse/shirt/vest/tunic/upper body garment/whatever and leaves).

Attention patients!

Your appointment is over. You are certainly welcome to wait in my lobby for your ride, to complete paperwork, or to have some water to recover from your grueling appointment with me.

However, please DO NOT USE my lobby for any of the following activities:

To use a phone (mine or yours) to make political calls on behalf of whatever candidate you're supporting this year. I respect your right to be involved in politics, but my waiting room isn't the place to do it. Not everyone out there agrees with you.

To have the sandwich, pickle, and bag of chips you've been carrying around in your purse. I don't mind you grabbing lunch in a hurry, but spending an hour here eating, calling friends, and using my magazines as napkins is a bit much (If this sounds familiar to you, asking Mary if we had any salt and a can of Sprite was over the line).

To call several local restaurants to set up catering for a party.

To try and sell real estate opportunities to other patients who are waiting to see me.

To see how much more (or less) your specialist co-pay is compared to other patients.

To hand out flyers to see your band play at Bubba's Roadhouse this weekend.

To argue about ANYTHING featured in "People" magazine.

To wait and see if a drug rep with samples of your medicine wanders in, and then assault them.

To ask my other patients what they think of your stock-market investment picks.

To appoint yourself schedule monitor, and tell Mary who signed in before whom.

To get out a scissor and cut coupons, articles, pictures, and anything else that strikes your fancy out of my lobby magazines.

Thank you.

Comparing apples to apples

Like most docs, I use Epocrates on a PDA for medication info. It's not perfect, but very helpful.

So today I had to look up something on Topamax and found this, under "Look/Sound alike drug names"

"Topamax may be confused with Topiramate"

They're the SAME FREAKING DRUG, for crap's sake!!!

(For those of you looking this up on your PDA, it's under "Safety/Monitoring")

Tuesday night, 7:15 p.m.

"Hi, Dr. Grumpy. My husband sees you for Parkinson's disease. Anyway, I'm in Calorie Counters, and we have a meeting tonight in the church down the road from your office, and our scale is broken, and I know you and Dr. Pissy have one in your hallway there, and I was wondering if you could meet us at your office and let us in to use your scale for a few minutes."

Mary's Desk, August 24, 2010

Mary: "Dr. Grumpy's office, can I help you?"

Mrs. Hiazakite: "HI! I need to get in to see Dr. Grumpy! I've heard he's wonderful!"

Mary: "Okay, we have a new patient appointment this Thursday at 2:00. Will that work?"

Mrs. Hiazakite:"I really wanted to get in today. Please? Pretty please? I'll bring you cookies!"

Mary: "That's nice of you, but I'm sorry. Thursday is our next availability."

Mrs. Hiazakite:"Will he give me some Percocet at least, like this afternoon? Just to tide me over?"

Mary: "We don't prescribe to patients that aren't established."

Mrs. Hiazakite:"That's totally unfair! Please! I said I'll bring you cookies!"

Mary: "I'm sorry, but you need to find a different doctor. I'm getting off the phone now."

(click)

That ISN'T normal?

I went to ER yesterday afternoon to see a consult, and found this in the chart.

For my non-medical readers: EMS = Emergency Medical Services (i.e. paramedics).

(click to enlarge)

Patient quote of the day

"My headaches and stuff are about the same. I didn't start that medication stuff you prescribed last time, because I wanted to try massage and exercise stuff to see if the head stuff got any better. But the headache type stuff is worse, cuz my husband and kids and stress and stuff have had all kinds of stuff going on, so I wanted to talk about more stuff with you, like the pills and stuff, because my head stuff is getting out of control."

Can't we all just get along?

Dr. Pissy and I have shared an office for 11 years. We joke, bitch, whine, and try to make the most of our bizarre days as we work through the schedule. Day in and day out. 11 years now.

And guess what? We're on opposite sides of the political fence.

And we discuss health care, and politics, and war, and peace, and all kinds of other stuff. And we've never had an unfriendly moment doing it. Sometimes we come up with ideas that might actually work, and be an acceptable compromise. Sometimes we don't.

I'm not saying we should be in charge of anything. I mean, hell, what do we know? Maybe our ideas wouldn't work.

What I want to know is why politicians end up as the jerk-offs they often are. They must start out like us, at some point. On both sides of the aisle. Willing to talk and work things out. I mean, most of them are married, so should be used to the negotiations and compromise of REALLY complex human relationships.

So why is it that, as soon as someone actually gets elected, they revert to a preschool level of immaturity? Instead of trying to work things out, all they can do is scream, pout, and point fingers at the other children (who do the same back at them).

Every government in history has been founded on the idea of compromise. Every marriage, friendship, business, and child-raising depends on it to work out differences. So where the hell did it go in the modern government?

Is this kind of idiocy and inability to work together really something that anyone sees as being good? People refuse to work together, and then run for re-election on that idea- that they acted like a child (except I think politicians like to call it "standing up for my principles").

I suspect part of the problem is vitriolic idiots from both sides on cable news, who aren't running for office (and therefore have nothing to lose), spewing idealistic shit that may sound good to their audiences, but in reality won't work. And any politician who actually tries to work out a problem reasonably gets chewed out by these clowns as being weak and worthless.

I think all these political types need to go back to the sandbox, and re-learn basic playground etiquette: Be polite, wait your turn, share, make friends, treat others as you'd like to be treated, and WORK IT OUT.

Most governments were founded on the idea of negotiation and compromise. So why is it considered better now to just scream, pout, and do absolutely nothing? Or (my pet peeve) putting pissy little issues at the forefront to distract attention from the fact that they aren't trying to actually solve anything. It's easy to scream, but a lot harder to actually work out a solution. I don't think any of us are paying you guys to be petulant crybabies.

As you guys know, the Grumpy family likes cruise vacations. The crews on these ships are a remarkable polyglot of races, nationalities, and cultures. And they work very well together, BECAUSE THEY HAVE TO. If not, the passengers are unhappy, or the ship breaks, and they all get fired (at the minimum). So why the hell can't our elected representatives (who get paid A LOT more)?

Screaming and yelling may get you favor with whatever local groups whose ass you're kissing, but isn't in the best interests of any group as a whole. No matter what country you live in, or what side you're on.

Haiku

Summer neuro call
Lightly sleeping with a live
Bedside hand grenade

On Call Non-Sequitur

Dr. Grumpy: "Are you a diabetic?"

Mr. Blackout: "No, but I drink decaffeinated coffee."

I'm not following this

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Gait: "I'm allergic to Flagyl."

Lady Gait: "I thought I was the one who's allergic to Flagyl?"

Mr. Gait: "No, it's me. I get a rash."

Lady. Gait: "Are you sure? I thought it makes my lips swell?"

Mr. Gait: "No, that's Penicillin. That's what you're allergic to."

Lady Gait: "No, you're allergic to Sulfa, and one of the kids is allergic to Penicillin."

Mr. Gait: "Then who's allergic to Flagyl?"

Lady Gait: "Doctor, what's Flagyl?"

Hot August Night

Last night was "Meet the 4th grade teachers night" at the twins' school. For most families only one parents needs to go, but when you have 2 kids in the same grade, you both go and take notes.

This is never fun. Because it's pretty damn hot in the building. School ends at 3:00, and the district, to save money, turns off the air conditioning at 3:15. In the middle of freakin' Summer. So by 5:00 the classrooms are sweltering.

The teachers aren't too fond of this either, because they have to stay late in the hot room, and deal with that most dreaded creature of all, the crazed parent. I show up with nothing but my clothes and cell phone (which I silence) and most parents do the same.

But there are a terrifying minority who show up with detailed print-outs of their kids capabilities, restrictions, non-allergic and non-religious dietary requirements ("Suzy likes PBJ and chips, so I pack those. Make sure she eats 1/2 sandwich, THEN the chips, then the other sandwich half. Any other order is bad for brain growth. I read that in a magazine once"- Yes folks, I really did hear a parent say that last year).

So we file in. The room is hot. Many parents are pouring sweat, having just come from work in bulky business clothes. Then we have to find OUR kid's desk, and cram our big fat overweight adult butts into seats designed for a 9 year old.





So now, in addition to being hot, we were all miserably uncomfortable and complaining about back pain. Seeing an opportunity, I handed out some business cards.

As if it wasn't hot enough already, the door opened and Craig's teacher, Miss Reba walked in. And the room went from hot, to hot and steamy.

She was sizzling. Suddenly all the Dads who'd been bitching about having to go to this were quiet. Now they were pissed off their kid didn't have a desk closer to the front of the room.




Miss Reba, as seen by the male parents.

And then the fun began.

Miss Reba had organized a detailed Powerpoint presentation, which was shown on some sort of interactive board at the front of the room (I guess blackboards and chalk have finally gone the way of the dinosaur). To advance slides, she had to tap on the board. Unfortunately, the board didn't grasp this concept very well, and so her taps had a 25% chance of advancing to the next slide, 25% chance of going to the previous slide, and a 50% chance of doing nothing. When the last happened, she'd pound on it repeatedly, getting louder each time, until we were afraid the board would crack or fall down.

Come to think of it, I think many of us were hoping it would fall, and knock her out. Some would get to leave early, and the rest would fight over who got to resuscitate her. As a doctor sitting in the front row, I figured I had a good shot.

She was a fast talker, but had only 1 hour to cover the entire school year. As a result, she leaped from topic to topic, ending each slide's summary by saying "And I update my website daily, so you can see what the kids are doing. Please check it regularly."

As usual, parents asked some remarkably stupid questions:

"You said the kids wouldn't have homework over the weekends. What about Fridays? Will you be sending stuff home for them to do on Friday nights?"

"If I send lunch with my kids, can you tell them what the nutritional value is? I think it's important that they know these things."

"Do you watch iCarly?"

"Do we need to check your website? Or can I just make my kid do it?"

And my personal favorite:

Miss Reba: "In music next month, the kids will learn about strings. Check my website for the dates."

Zealousfreak parent: "You mean string theory? Like in advanced physics?"

Miss Reba: "No. I said it's a music class. As in string instruments. Like a violin."


At this point, Miss Reba uttered the most dreaded words in the history of parent-teacher relationships: ""Now, I'll need some parents to volunteer..." Suddenly all of the hormonally charged fathers were checking their cell phones. Mothers suddenly had urgent texts to send. Nobody, not even the single fathers, made eye contact with Miss Reba as she ran down the list of class party organizers, reading assistants, paper copiers, and other volunteers that were needed. Usually there's some hyperactive-mother-on-speed who immediately leaps out of her chair and signs up for all of this, but she wasn't here tonight. I began picking at my face and loudly mentioned that my Leprosy treatments kept me from working with kids.


After getting home, Mrs. Grumpy and I compared notes, and now she wants to kill me.

She'd filled up a notebook listing times, dates, subjects, schedules, and phone numbers from Marie's teacher.

I had a piece of scrap paper I'd pulled out of Craig's desk on which I'd written "Check website regularly."

Everybody sing!

Dr. Grumpy: "Where is the pain?"

Mrs. Mom: "Everywhere! It hurts in my head, shoulders, knees, and toes!"

Back-to-school

As a public service, I'm re-running this from last August for those of you who missed it the first time around. It's certainly relevant.


Dr. Grumpy's Guide to Life, Chapter 2: Shopping for school supplies

Okay, so this is the 2nd edition of my helpful newsletter (If you missed the 1st one on surviving your child's birthday party, click here).

Today's issue will focus on what I discovered to be a horribly traumatic life-altering experience: Back-to-School week at OfficeStaplesMaxDepot. There's one right across the street from my office, so I go there regularly for supplies. It's quiet, the employees are generally helpful, and I know my way around it pretty well.

I naively thought this would be easy.

So on to the lesson:

1. Do NOT volunteer for this job (flip a coin, or arm wrestle, or have a duel to decide instead).

Silly me. When Mrs. Grumpy was wondering when she'd have time to get the school supplies, I volunteered. I figured "How hard can it be? Hell, it's just some pencils and a bottle of glue". DUMBASS!!! The list is HUGE, and features items from the mundane (No. 2 pencils), to the specific (Expo dry erase markers, wide tip, in blue, green, yellow, and black) to the odd (1 Pringles can with lid, original flavor, empty). It took me 2 freakin' hours!

2. Be prepared. Normally there are 5-10 other quiet business-type people in there. NOT THIS WEEK! Holy Crap! An African street bazaar is an orderly affair compared to this! Deranged parents running on caffeine! Kids running amuck! Store clerks running for their lives! And all the crazed parents are trying to read off a list, push a cart, yell at kids, text, and scream into a cell phone at the same time. Bring a water bottle, food, a map, a cattle prod, and a flashlight. A card with your blood type, hospital preference, and next of kin is also a good idea.

3. Do not leave your cart unattended. People will steal your shit out of it. I AM NOT MAKING THIS UP! I had my cart 2/3 full with the crap on my list, when I left it at the end of an aisle to go find notebooks (spiral, wide-ruled, 100 pages each, single subject, 1 red, 1 blue, 1 green). When I returned 3 minutes later about half the stuff I'd already put in it was GONE! I watched a few minutes later as it happened to others. Apparently, when you walk away from your cart, people think it means they can raid it for supplies they haven't had a chance to pick up yet. "Hey, this guy has those index cards (2 sizes, lined and unlined, 100 each) that my kid needs. Cool. I'll scratch that off my list".

If another parent asks you what school your kid goes to, or who their teacher is, DO NOT ANSWER. Ignore them. Pretend you're deaf, or that you don't speak English. They are not making conversation. They are casing your cart, and if they find out your kid is in the same class as their kid, they'll wait until you aren't looking to take your stuff (or just switch carts).

Best part was when I went to ask an employee for help finding something (Flair Correction Pens, in 4 colors). When I got back to my cart the box of 12 ultra-fine tip Sharpies I left in it had been opened, and someone had taken one of them. They'd even doodled on the shopping list I left in my cart to make sure they were taking a pen that worked.

Oddly, you can leave valuables in your cart. Your wallet, purse, and gold jewelry will be perfectly safe if left unattended, but the $2.69 box of high-lighters (12 markers, large tip, in 3 colors) will vanish.

My recommendation: bring a child to guard your cart, preferably one with an iron bladder and who's old enough to use a Taser or firearm if needed. If your kids don't meet this requirement, stop by Home Depot and hire one of the day laborers who hangs out in front looking for work.

4. Do not look for certain numbers of things. The people who make these lists have no idea how things are sold, so it lists things as "1 Expo dry erase marker, chisel-tip, red). Great. They don't sell red ones individually, just in boxes of 4. Or the Flair Correction Pens don't come in only 4 colors, but they do come in 8. Just buy it. If you aren't certain what item the teacher wants, just buy everything in sight and return the rejects later.

Alternatively, if the teacher only wants 1 of an item, such as, say, an ultra-fine tip Sharpie (which only come in boxes of 12), you can always look for an unattended cart with a box of them in it, and take one. If paper is handy, try doodling on it to make sure you are stealing one that works.

5. Hold your place in the check-out line AT ALL COSTS. Reserve it as soon as you walk in the store BEFORE shopping. Use a child (preferably your own) if possible. Other options include day laborers from Home Depot, mannequins, dogs, and aggressive Venus Fly Traps.

6. When in doubt, ask the bleary-eyed, terrified employees for help. If nothing else, it's fun to watch them try to convince you that they don't speak English as they run outside for a cigarette.

Good luck!

Grumpy, incognito

My casual look (or lack of fashion sense, as Mrs. Grumpy calls it) sometimes pays dividends. Today it got me out of a sales talk.

Mary had gone out to lunch with Dr. Pissy's staff, and I wandered up front to fax something. As I'm standing there, 2 well-dressed ladies in their 30's come in, and stare at me.

Dr. Grumpy: "Hi, can I help you?"

Stuffy #1: "Yes, we represent Neverfuckingworks computerized chart systems and..."

(offers right hand, Dr. Grumpy shakes it)

(Stuffy #2 whispers something into the ear of Stuffy #1)

Stuffy #1: "Anyway, here's some information about our chart system. Can you please give it to the doctor, or office manager, or someone important who works here?"

Dr. Grumpy: "Will do."

Stuffy #2: "What do you do here?"

Dr. Grumpy: "I clean the fish tank." (technically, this is true)

They turned to leave. As they did so, Stuffy #1 pulled some Purell out of her purse and frantically started scrubbing imaginary fish germs off her right hand.

Researchers at work

Now, I know bariatric surgery is somewhat controversial. Like all docs, I've seen my share of patients who didn't benefit from it, or had serious complications. But this post isn't a forum for that.

Let's look at this practically. If a person has bariatric surgery, they should be more likely to lose wieght, and have fewer long-term complications of obesity, then someone who doesn't have the surgery. Right?

Of course, somebody felt the need to study this. I assume this was done to be able to improve insurance coverage of the procedure.

(click to enlarge)




I'd like to thank my reader Jennifer for submitting this.

Great Moments in Psychiatry

Mrs. Lithium: "I'm so much better now that I'm on medication. They used to tell me all kinds of stuff before they finally decided I was bipolar."

Dr. Grumpy: "What did they say you were before bipolar?"

Mrs. Lithium: "Italian."

Blatant Plagiarism

I found this AWESOME back-to-school advice on The Mother's site. And she should know. She's a mother with 4 boys- and she's also a doctor. In other words, don't mess with her.

The Mother's 12 Step, Back-to-School Program.

Step #1: Refill the kid’s lunch money account online at least a week ahead. That way, you can shove the little angels out the door without hunting down spare change or playing lunchbox roulette.

#2: Prepare the child’s necessary school supplies three weeks in advance. Nowadays most schools have packet lists on the internet, and a whole lot of grocery stores sell them in those packets. Buy them prepackaged. It’s worth the extra buck, because the guys who do the prepackaging have bought out all the orange folders in town, and the English teacher only wants orange folders, and you do NOT want to have to go to the next county to get a damn orange folder. Don’t wait, though, or the little packets will be extinct.

#3: High school kids NEVER get a list in advance. They get a list from each teacher on the first day, prompting the Mad, Mad, Mad World remake at the local office supply store. YOU DO NOT WANT TO BE A PART OF THIS. Go ahead of time. Buy a $100 gift card. Give it to high schooler. Have him call you for a ride when he’s done. There’s always a Starbucks nearby.

#4: Make friends with the Amazon team. Kids always come home with a list of the books they’ll need to get for the year. They never remember to give it to you. You will then be regaled five times a year with a “last minute request.” The book will be sold out in every bookstore in the tri-county area. Steal the list from the child’s backpack on the way in the door. Go directly to Amazon. Do NOT pass go. Type in each book, and click “buy it now.” Then, when they arrive in two days , HIDE THEM until they are needed– trust me on this one.

#5: Plan take out for the first night. Stock up on advil, and buy one of those hand splints in advance, because the cramping from filling out the forms will leave you in agony for days. If you have more than one child going to the same school, get one of your kids to rig up a scanner. Or borrow a photocopier. Extra points if you are ambidextrous. Extra, extra bonus points if you make your high schooler fill them out himself and just sign. Post all emergency numbers on the white board in the kitchen and hand them all sharpies.

#6: Make sure you have money in your checkbook. It’s someone’s conspiracy that schools generally start at the end of the month, when everyone is low on funds. Then the four thousand little checks that have to be written add up–$10 for a directory, $5 for a lab manual, $15 for the debate briefs, $6 for the PTA lunch fund, … Double check your check stock, too.

#7: Do not, under any circumstances, accompany a child older than 12 into the school. They have to learn to fend for themselves sometime–Junior High seems like a good spot. Younger, if you think you can get away with it.

#8: If you do walk in with your child, leave as soon as said kid gets interested in something else. Ask any teacher–parents who hang around cause problems. Unless this is your little tyke’s first day of kindergarten, beetle out.

#9: Make transportation arrangements early. If you start driving your kids to school, they begin to expect it. Bikes, trikes, trains, buses and anyone else’s automobile are preferred.

#10: Do not allow inter-child comparison of teachers. As a mom of four, I now have three who have had many of the same teachers. They have three different takes. Squash it, fast, before poor Ms. Jones, the English teacher, gets maligned by the kid with superior math skills and NO ability to parse prose.

#11: Take advantage of the state-tax-free weekend. Take each kid out (separately). See what fits. Put that size back and buy the next size up.

#12: When the teacher asks for volunteers, RUN, do not walk, to the nearest exit. Bonus points for getting there first. (Of course, if you hadn’t gone IN, you wouldn’t be in this position).

Monday morning

Wandered in this morning to find the fax tray on my machine sagging under a pile of multiple copies of THE SAME DAMN MRI REPORT.

On perusing it I found this line at the bottom (obviously, I can't scan the real one):

"Please send copies of this report to Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D., Ibee Grumpy, M.D., Thelma Fizzy, M.D., Woody Uro, M.D.


Woody and Thelma, hope you guys had plenty of paper in your machines when you left on Friday.

It's here! It's here! It's finally here!

For the 2nd year in a row, this post is dedicated to Mrs. Grumpy.

More Dragonisms

It's a slow day, so I thought I'd just put up some Dragonisms.

(What is a Dragonism?)


Dr. Grumpy: "The MRI showed a brain tumor."
Computer: "The immoral eye showed a brain tumor.


Dr. Grumpy: "Naprosyn helps her back pain."
Computer: "A Mac person helps her back pain."


Dr. Grumpy: "He has paresthesias in both feet."
Computer: "He has penises in both feet."


Dr. Grumpy: "Joan takes Acetazolamide."
Computer: "Joan's seat is alive.


Dr. Grumpy: "On MRI he has a bulging disk in his neck."
Computer: "On MRI he has a bulging dick in his neck."

Patients from the future

Local nursing home sent this paperwork over today with a patient.

Their math sucks, regardless of how you look at it.

Just Shoot Me

Mrs. Handz: "I think I have Carpal Tunnel Syndrome. My hands and fingers go numb when I'm typing."

Dr. Grumpy: "What about when you're holding the steering wheel, while driving?"

Mrs. Handz: "Yeah, then too, and OH MY GOD! YOU'RE GOING TO TAKE MY LICENSE AWAY!"

Dr. Grumpy: "No, not at all! I'm just trying to get an idea of what triggers the symptoms."

Mrs.Handz: "I don't believe you! My friends warned me this might happen! You're going to turn me into the MVD and stop my driving!"

Dr. Grumpy: "I'm honestly not. I ask because Carpal Tunnel Syndrome can..."

Mrs. Handz: "I'm leaving before you ask more questions! I know your game!"

(patient storms out of the office)

Thursday afternoon

Mrs. Daughter: "Thank you for seeing Mom today. She's blind, and hard of hearing, so getting through to her can be difficult."

Dr. Grumpy: "How do you communicate with her?"

Mrs. Daughter: "She speaks Braille."

Neurologists- the original party animals

This picture was featured in a mailing I received. It's for a DVD program on Parkinson's disease. It is, I swear, a video of 4 neurologists arguing. Yeah, like I'm just dying to watch that.

(click to enlarge)



The distinguished faculty in the picture are named as (left to right) Drs. Sethi, Obeso, Olanow, and Stern.

Believe it or not, this is about as exciting as a party of neurologists gets. They sit around and discuss Parkinson's disease and other invigorating topics. And people wonder why I'm in solo practice.

I'm not convinced that's water in their glasses, either. Vodka, maybe.

Obviously, the star of the picture is Dr. Olanow. He looks like he's one step away from wearing a lampshade on his head. I'd like to think he's talking about his windsurfing trip over the summer, and how he accidentally ended up starring in an Absolut vodka commercial with the Sports Illustrated swimsuit models. More likely, though, he really is talking about Parkinson's disease. Only a neurologist can look so happy while talking about something that would scare everyone else away.

Let's try to guess what they're thinking:

Dr. Sethi: "Wow. Olanow has had too many already. He always gets the spotlight, and the hot drug reps. And what the hell did he do with my tie? As soon as I walked in he asked to borrow my tie because he forgot his, and now he isn't even wearing it. I have to remember to get the phone number for that Absolut girl who keeps refilling our glasses. I hope she saw that I drive a Porsche."

Dr. Obeso: "I have noooooo idea what they put in the vodka. I've only had 2 so far. I'm not touching it again. Holy crap, I hope I don't puke at the table. Olanow would never let me live that down. He'd probably show slides of it at next year's academy meetings. How come I'm the only one here who's wearing a tie?"

Dr. Olanow: "Man! Thish party is great! I better hit up Stern for cab fair back to the hotel, because I spent the travel stipend on the keg party last night. I hope nobody notices the tie I took from Sethi is missing. I gave it to that hot drug rep after writing my hotel room on it with her lipstick."

Dr. Stern: "I have to pee, and Olanow won't STFU. Maybe if I cross my legs. I didn't even see a bathroom when we came in. Maybe there isn't one. What do I do then? What the hell is he even talking about, anyway? Why does he need $20? He still hasn't paid me back from the last meeting. At least I have a good chance of getting laid tonight, because that sizzling drug rep gave me a tie with a room number written on it in lipstick."

Attention staff!

This morning I dragged in early because I couldn't sleep. To keep it quiet at home I decided to brush my teeth and shave at the office. I keep stuff here for the occasional times this happens.

You guys know that I'm usually half asleep when I come in on these days.

If I figure out which of you filled my little toothpaste tube with K-Y jelly while I was gone, you're fired.