Today's helpful hint: Finding a doctor

People often ask me "How do I find a good doctor?"

That's a tough question, and it can be tricky. So here are a few tips to warn you that your doctor may not be real. Any one of these (not to mention ALL of them, FFS) should alert you to look for another doctor.

1. A reputable physician's sole listing will likely NOT be in a Bulgarian language newspaper in Skokie, Illinois.

2. A reputable physician generally will NOT be seeing office patients at 6:30 on a Saturday night.

3. A reputable physician will NOT wait for you, alone, in a dark, locked, building with a "CLOSED" sign in the window.

4. A reputable physcian will NOT let you knock for a while before letting you in himself.

5. A reputable physician will NOT stick toothpicks in your chest.

6. A reputable physician will NOT give you a bottle of pills labeled "Prosperous Farmer" that expired in 2002 (or anything called that, no matter when it expired!)

7. A reputable physician will ALWAYS have some sort of office paperwork.

8. A reputable physician will NOT jump into his car and try to drive away when you return for a follow-up visit.

If your physician does this, and you paid $150 cash for it, then you must have been seeing this guy.

And, for the record, I think it's absolutely pathetic that the patient involved didn't see a problem with items #1-6.

Afternoon interlude

Between patients today I went to talk to Dr. Pissy. He was in his office, calling his father on the speaker phone. Pissy's family lives in a fairly remote area, and I got to hear this:

Dr. Pissy: "Hi, Dad, how are you?"

Pissy Senior: "I'm working".

Dr. Pissy: "What are you working on?"

Pissy Senior: "Cleaning a 'possum."

Going in circles

Dr. Grumpy: "How often do you get migraines?"

Mr. Vague: "Every so often."

Dr. Grumpy: "Well, how much time goes by between headaches?"

Mr. Vague: "A while."

Dr. Grumpy: "I'm trying to get an idea of how often you get migraines. Can you be more specific? Do you get them every day, or every week, or once a month?"

Mr. Vague: "Sometimes."

Mary's desk, May 25, 2011

My 10:00 was a new patient today, a lady in her 60's. At 10:03 her daughter showed up, and had this conversation with Mary:

Mary: "Hi! Where's your mother?"

Mrs. Daughter: "Oh, she'll be here. She had a lot of errands to run, and won't get here until 10:30."

Mary: "Her appointment is now, not 10:30."

Mrs. Daughter: "I know that. It's why I came in on time. I'm holding the slot for her."

Mary: "Excuse me?"

Mrs. Daughter: "I'm here, since she can't be. I'm holding the slot, so you won't cancel it before she gets here. She'll be here at 10:30, I promise, and in the meantime I'll wait here in her place."

Mary: "But you're not the patient!"

Mrs. Daughter: "What does that have to do with it? I'm here on her behalf."

"This has RUINED my manicure! IT'S VERY SERIOUS!"

The emergency room is staffed to handle a lot of things. But, unfortunately, most don't have a 24/7 manicurist available.

Like this lady wanted.

Thank you, Lydia!

Hunka hunka burnin' love!

A nurse at Local Hospital is getting married soon, so they had a shower at work for her yesterday. One of the gifts had been left out by the desk where I was writing in a chart, and I glanced it over.

It was a small bottle of "chocolate flavored body paint, for intimate moments". On one side of the bottle it said "before using, light candles for a romantic mood."

On the other side it said "Warning: Flammable. Do not use near open flame."

Another satisfied customer

Mr. Shakes: "This is my last time here. I've decided to find a new neurologist."

Dr. Grumpy: "May I ask why?"

Mr. Shakes: "Because I didn't have Parkinson's Disease before I came here! Then you told me I have it, and now I do, and I don't like having it! It's your fault!"

Idiocy abounds

Last week I renewed my subscription to my favorite journal "Neurology and the Art of Sarcasm". It was 3 years for $400 (that, believe it or not, is considered to be a good deal).

So I sent them a payment for $400.

On Saturday I received a box containing the last 3 years of issues (which I already have), and a letter asking me if I'd like to subscribe to the next 3 years for another $400.

Needless to say, I'll be calling them this morning.

It's that time of year again

I've been reminded that USMLE part 1 is fast approaching. So I'm reposting my own memories of the test.

And this clip, from the movie "Real Genius". In 30 seconds it summarizes perfectly what studying for USMLE is like.






Anyway...

At the end of the second year of medical school is the USMLE-1 (United States Medical Licensing Boards, Part 1- the name is misleading, several countries use it). This covers every subject from the first 2 years of medical school: Anatomy, Biochemistry, Pathology, Pharmacology, Microbiology, Neuroanatomy, Physiology, Histology, and a few others. 2 years of learning, all in 1 awful test. When I took it the test consisted of 4 sessions spread out over 2 days. Each session had 200 questions, and 3 hours to answer them.

At my school, if you failed the test, you had to take it again. If you failed it twice, your medical career was over (though you still owed your student loans back).

It was the Summer of 1991.

I don't remember the specific dates. But basically, between the time med school ended for the Summer, and the dreaded test, was roughly 1 month. You had 30 days to re-study everything that had taken you 2 years to learn to that point. And pretty much your chances of a career in medicine depended on how you did.

So it was stressful. And, to this day, I still feel for all of you who are out there studying for it now. Any classmate, resident, or attending who tells you they weren't scared is lying.

Within hours of the semester ending, my class had gone into hiding.

I stopped shaving, to save time. My roommate, Enzyme, disconnected our TV, moved it across the room, and piled furniture in front of it.

My days consisted of me getting up at 7:30. I'd either stay at my apartment desk or walk over to campus to find an empty classroom to study in. I'd put in my trusty earplugs and the world around me ceased to exist.

Around noon I'd go back to my apartment for a PBJ, then go study again. At 5 I'd go back to my place for a sandwich, or ramen soup, or Rice-a-Roni. I'd sit out on my balcony and eat, for 15 minutes of relaxation. Or I'd read a book with dinner (Enzyme and I were both reading a single copy of "The Price of Admiralty" by John Keegan. It sat on our kitchen table for the month, and we'd have different eating times so we could share it). I never spent more than 30 minutes on a break. After dinner I'd go back to my desk, or campus. I'd study until around 3 a.m., then go home to sleep for a few hours.

I called my parents a few times. My daily outfit consisted of gym shorts (the short kind, from the 80's), T-shirt, sneakers, and the growing beard. Days blended together. There were no differences between weekends and weekdays. People I encountered were superfluous to my existence. I saw my classmates a few times, and we exchanged glassy-eyed nods as we passed.

I shaved a night or two before the test. I studied until around 11:30 p.m. on the eve of the test, re-reviewing a few last points.

It was weird, like I was living alone on another planet for 30 days. I have no idea what happened in the news that month. I was out-of-touch with everything but my books.

If there's one thing I came out of medical school with, it was this: The realization that there was absolutely, positively, no way you were EVER going to get everything read, studied, and reviewed that you needed to before the test.

And, somehow, when the test was over and the dust had settled, you'd done it. And you'd have no idea how. I still don't.

Good luck, everybody.

Memories

Occasionally someone will write in wondering why I became a neurologist. It was mostly by process of elimination, as I learned other things just weren't for me.


My pediatric career died fast in med school.

That rotation, during my 3rd year, was 8 weeks long. It took me 15 minutes to realize I didn't want to do this for a living. So I was left with 7 weeks, 6 days, 23 hours, and 45 minutes of waiting it out (and pretending to have a deep interest in hearing about the color of a child's diarrhea/mucus/whatever).


1. I can't see a tympanic membrane in a baby's ear canal (and am convinced most pediatricians just confabulate the "it's a little red" line).

2. I remember trying to examine a hysterically screaming infant in pediatric clinic. It was screaming before I went, in, and me trying to listen with a stethoscope only made things worse (and damaged my hearing).

Finally the mother said "FOR GOD'S SAKE! MAKE HIM STOP CRYING!!!"

So I left the room. That seemed to do the trick.

And that was how I realized I had absolutely no interest in doing peds.

And I feel fine...

If the world does end, I guess I'll be going to hell. So like I told Mary and Annie, I'll see them at the office on Monday no matter what happens.

Whatever

Mr. Ancient: "My pediatrician said I have nerve damage in the foot."

Dr. Grumpy: "You mean podiatrist?"

Mr. Ancient: "Whatever."

Dear patient I didn't see,

Sorry I refused to work you in yesterday afternoon. I had an open slot, and would much rather see you here, and get paid for it, then have an empty hour.

But when you called Mary and said you'd had a horrible headache all morning, and couldn't move your right arm very well, she quickly became alarmed that this wasn't something that should be handled in my office. In fact, she told you to call 911, and you refused, saying you'd rather just drive over to see me.

That personally alarmed me, because obviously you shouldn't be driving in your condition. When Mary told me that I decided to get on the phone myself.

Your speech was a bit slurred, and I again reiterated that you should call 911. I even offered to call them for you, and asked for your address or phone number, so I could get them to your house. You refused, on the grounds that your co-pay for an ER visit was higher than it was to come to my office.

Then you told me that you didn't want to see me anyway, because obviously I didn't care about someone who needed help. And you hung up.

Believe me, if I didn't care, I wouldn't have tried to get you to ER.

Overheard at home

Thing 1: "Pete was back at school today."

Thing 2: "Was he sick?"

Thing 1: "He was in the hospital. They had to do surgery."

Thing 2: "What happened?"

Thing 1: "He had appendagitis. His appendage was hurting. It's near your stomach. Anyway, the doctor cut it out."

Thing 2: "I didn't know that."

Thing 1: "I read somewhere that you don't really need your appendage anyway. I bet you could sell it for a lot of money."

Nowhere to hide

Our office break room is small, but practical. A table, microwave, toaster, fridge, coffee maker. A few chairs. A bathroom off to the side.

Yesterday a new drug rep brought lunch. She was a nice lady.

After lunch the staff were cleaning up the kitchen. Packing up leftovers, wiping the table. As usual they were chatting about the patients, Dancing With The Stars, their kids, etc.

At some point the conversation turned to the drug rep, and they were guessing as to how far along in her pregnancy she was, and whether she was having a boy or a girl.

And then the bathroom door opened. The drug rep was in there the whole time. They thought she'd left.

And she isn't pregnant.

My readers write

Okay, folks, time to hit the mail bag!

This letter came in today from a reader who says he's working at the NIH.

"I shadowed a pediatric neurologist this week. It was certainly interesting, but up until today I'd have guessed your blog was a little exaggerated in terms of humor.

That was before clinic this afternoon.

I saw the patient, an adorable four year old girl, grab the neurologist's reflex hammer from out of her coat, run over to the PA, and, uh, test his reflexes.

I'm not a physician, so I'm not sure if grabbing your crotch after it's been walloped with a reflex hammer is actually a reflex, but it sure was funny. Well, maybe not for the PA.

The kid really, really liked that hammer. The attending actually GAVE IT BACK to her later to buy her cooperation in the exam. I shielded my groin, so the patient had to settle for beating my leg with it.

Seems like a great field. I'll just remember to wear a cup."

Thank you! Just remember, folks- anyone who thinks this stuff doesn't happen, hasn't had the misfortune to work in the medical field.

So much for healthy eating

Apparently barter is becoming popular again.

She could at least have included some breadsticks.

Reliable sources

Mrs. Popliteal: "I've been having terrible pain in my knee. It needs an MRI."

Dr. Grumpy: "Hmmm. Have you talked to your internist about this?"

Mrs. Popliteal: "No, I talked to this lady at the Post Office."

Dr. Grumpy: "A lady at the..."

Mrs. Popliteal: "She was wearing a knee brace, so she must have known what she was talking about. Anyway, she said I need an MRI. Will you order one?"

Sounds right

Mr. Vague: "My mom died of vascular disease."

Dr. Grumpy: "What kind?"

Mr. Vague: "I don't know. The bad kind, I guess."

Oh no! Not BOTH!

I found this entry, presumably from the Department of Redundancy Department, in a hospital note this morning.

(click to enlarge)

Flattery

Mary: "Okay, your co-pay for today's visit is $50."

Mr. Aetna: "No, my co-pay is $25."

Mary: "It's $25 for your internist, sir. According to your card, a specialist, like Dr. Grumpy, is $50."

Pause

Mr. Aetna: "Here's $25. He wasn't that special."

Always in fashion

I'm ordering supplies this morning, and found this picture in the online catalog.





I just love the way they try to make the flimsy white paper gown look sexy. Maybe they should add a caption that says "Perfect for work, cocktail parties, and medical exams."

Today's criminal tip

When planning a burglary, you may need to ask your friends for help.

Or your family for help.

But, whatever you do, DON'T ASK THE COPS FOR HELP!!!

Homework

This weekend Craig had to read a chapter on world hunger, and answer a few questions on it.

So I was checking to make sure he'd done it, and encountered this:

"What are some causes of world hunger?"

He'd written: "In those countries they don't have stuff like pizza and hamburgers. They only eat gross food, and who wants that?"

Weekend Reruns

Dear Mr. I. M. A. "Rich" Azzhole III,

I'm sorry about the way things went at your appointment yesterday. I guess you and I just didn't have great chemistry.

I can understand you being frustrated with me. Obviously, a man of your means is used to people kissing his ass constantly. But here at Grumpy Neurology, it doesn't buy you much. Let's face it, Medicare pays me the same amount to put up with you as it pays me to put up with Mr. Nice Butpoor. If you were paying me $1000/hour to listen to your stories about the yacht club I might be more inclined to do so. But I'm only going to get Medicare's flat $115 for you, and my billing company gets 10% of that, and I have to pay Mary, Annie, my rent, the Diet Coke bill, and my malpractice insurance out of the rest.

Anyway, we were obviously off to a bad start when you told Mary that your regular doctor (who you pay cash to) dresses up for you. And this was before you even had a look at me. You also were not happy that, when you asked Mary what kind of refreshments we offer for waiting patients, she pointed to the water cooler.

I SO enjoyed being grilled over my credentials. I really am a doctor, I swear, not some homeless person who decided to rent an office, hire some staff, and buy some cheap office furniture just for the hell of it. You were clearly not impressed that I went through public schooling most of my life. Of course I've heard of your alma mater, but it was so much more fun to watch the horrified expression on your face when I pretended I hadn't, and then asked you if it was in Arkansas. The devil made me do, what else can I say?

I think we reached the low point during the appointment when, after I'd spent 30 minutes taking your windy history, and another 20 minutes examining you, your heavily plasticized wife (who may be putting arsenic in your prunes- watch out) asked me "So when will the doctor come in to talk to us?" That made me feel real special.

So when I heard you tell Mary that you didn't want to schedule a follow-up with me, and wanted to discuss matters with your internist, I knew this translated to "I'm never coming back here and am complaining to my internist about you". And guess what? I don't care.

Be careful the automatic door doesn't hit... oh, sorry, guess I should have warned you sooner.

This is your brain on drugs

You saved $60 (no idea how you got it) to buy your favorite treat: crack cocaine.

But your dealer has hosed you, and only sold you $20 worth of rocks, and won't give you the $40 change he owes you.

So who ya gonna call? Ghostbusters?

Nope. If you're this dude, you call 911.

Thank you, Alex!

But that's the problem, isn't it?

I'd like to thank Nicole, for sending in this headline from an online Psychology journal.

(click to enlarge)

Compliance

Dr. Grumpy: "Pete, it's been years since your last seizure. What happened?"

Mr. Ictal: "I didn't take it on Saturday."

Dr. Grumpy: "Why did you stop?"

Mr. Ictal: "Because you told me to!"

Dr. Grumpy: "What?... I don't have anything like that in your notes."

Mr. Ictal: "At our last visit you reminded me not to drink excessively on Noseizure! So, since my buddies were all in town, and I knew we were going to get wasted on Saturday night, I stopped taking it for the day."

Neither did I

"My Mom had bladder cancer. They killed the cancer, but said her bladder spread everywhere in her body. I didn't know bladders could do that."

Is there an echo in here?

Dr. Grumpy: "Mrs. Tangle, how has your memory been?"

Mr. Tangle: "It's the same, doc."

Mrs. Tangle: "HEY! I have a mouth, too, Ed! Don't answer questions for me! He asked me!"

Mr. Tangle: "I'm sorry."

Dr. Grumpy: "Okay, let me try this again. MRS. TANGLE, how has your memory been?"

Mrs. Tangle: "It's the same, doc".

Beer: Go buy it yourself

Look, people there are a lot of good reasons to call the police. Traffic accidents, crimes, whatever.

However, they are NOT there to bring you beer.

So please don't call them to make a beer run for you.

Affirmation

Mr. Radic: "Do you think my symptoms are coming from my heart?"

Dr. Grumpy: "No."

Mr. Radic: "Good. I've seen 3 cardiologists for it, and they didn't think so, either."

Breaking Artisanal News!!!

We now take you to Victoria, British Columbia to answer this age-old question:

"Where do I put the artisanal wine and beer after I've run it through my kidneys?"

Victoria has taken the lead on other cities in North America by introducing...

(drumroll, please)

AN ARTISANAL PUBLIC URINAL!!!

(at a cost of $60,000 to build, I should put processed Diet Coke in it at my next visit, just for the experience).

Dear Chester County Health Department,

I must say, your recent press release gave my inner adolescent some serious giggles.

(click to enlarge)




In doing further research I learned that the wild beaver attacked a man who was out fishing. I can only assume he was quite surprised to be assaulted in such fashion. He is reportedly doing fine at this time.

How can I help you?

As my regular readers know, I hate going to Walmart. I'm afraid of ending up on People of Walmart. I've actually seen some of my patients on the site (REALLY!).

But, yesterday afternoon, Mrs. Grumpy stopped at one because it was on the way home, and since it was Mother's day I didn't want to argue.

So we go in, and (of course) one of my Alzheimer's patients is working as the entrance greeter. His wife is also there, keeping an eye on him.

Mr. Cognex: "Hi! Welcome to Walmart!"

Dr. Grumpy: "Hi."

Mrs. Cognex: "Oh, it's Dr. Grumpy, honey! You remember him?"

Dr. Grumpy: "Hi, Mrs. Cognex."

Mr. Cognex: (looks at me): "Oh, do you see Dr. Grumpy?"

Mrs. Cognex: "No, honey, you see Dr. Grumpy."

Mr. Cognex: "Who's Dr. Grumpy?"

Mrs. Cognex: "This gentleman is Dr. Grumpy."

Dr. Grumpy: "Hi."

Mr. Cognex: "Welcome to Walmart! Are you on your way to see Dr. Grumpy now?"

Mrs. Cognex: "Enjoy shopping at Walmart, Dr. Grumpy."

Dr. Grumpy: "Thank you."

Mr. Cognex: "Nice meeting you. Maybe I'll see you at the doctor's. Welcome to Walmart!"

Maybe now my wife will understand...

Playing 20 questions on Sunday morning

Dr. Grumpy: "Okay, I'll call in a refill right now. What's your pharmacy's phone number?"

Mr. Callmeonsunday: "I don't know. What is it?"

Memories...

My first rotation as a 3rd year medical student (determined randomly at my school) was psychiatry.

Your first day on clinical rotations you never know what to expect. I was assigned to evaluate Mr. Binford, who'd been picked up by police (for vandalism) the night before.

I sat down and nervously spoke to Mr. Binford. He was a bit disheveled, but seemed intelligent and reasonable. He owned a home improvement company. He employed several handymen (including himself) and had a central dispatch office. They did all ranges of home and yard work.

It all sounded pretty reasonable to me. So, being young and naive, I presented the case to my attending psychiatrist. When he asked me what I thought, I told him that this person didn't seem to need psychiatric care.

Then he asked me if I'd read through his past chart. Sheepishly I admitted I hadn't, because I'd been in a hurry to interview the patient early on my first day.

So he handed me the chart.

OMG

The patient owned no such business. He had a remarkably intricate delusional system.

He owned a truck full of power tools, paint, and various other home repair supplies. Of which he had some knowledge about using them.

He drove around the city, day and night, and would randomly stop at houses where he thought they'd called him for work.

People would come home (or be woken up at night) to find him doing unneeded work on their houses. Cutting down trees. Painting their outside walls. Knocking holes for windows in their homes. Taking apart pool filters. In one case he'd actually painted a guy's car with house paint.

I learned that old charts were useful.

I also learned that even the incredibly delusional could make a lot of sense when you didn't know their background.

We called him "Psycho Home Repairman".

And to this day, if one of our neighbors turns on a lawnmower or other loud equipment after dark, I go to the window... Just to make sure.

Crime fighting apps

Okay, crooks, when planning to rob a place, it is generally NOT a good idea to accidentally call the cops so they can listen to you make plans.

Like these guys.

Thank you, Sarah!

Lost & Found

While reading another doctor's office note this morning I found this line:

"Vital signs were taken and documented somewhere in the chart. I have no idea where."

Annie's desk, May 5, 2011

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

Mrs. Seeker: "Yeah, my husband sees Dr. Grumpy, and knows a lot about his case."

Annie: "Okay, let me open his chart... What can I do for you?"

Mrs. Seeker: "Where do you think he'd have put our car title? I can't find it anywhere."

Wild times

SEX!

DRUGS!

EXPENSIVE CARS!

OLDER MAN!

YOUNGER WOMAN!

AND A 6 HOUR SEXUAL MARATHON!

Is it a typical day at the Playboy Mansion?

Nope. Just an Endocrinologist and his P.A.

The Mind of a Neurologist

Between patients I'm sitting here listening to iTunes on the computer, and it picked Supertramp.

At the end of "It's Raining Again" there's a chorus of kids singing "It's raining, it's pouring, the old man is snoring. He bumped his head and went to bed and didn't get up the next morning."

And I immediately think "Huh. He must have had a subdural hematoma."

Sigh.

I've been doing this for too long.

Online learning

Last night I did some online CME (Continuing Medical Education), which featured a webinar. The speaker was discussing ways to improve patients' overall health.

One of the techniques he recommended was having them keep monthly exercises diaries, and reviewing them at each visit. He called them, logically enough, "Patient Exercise Diaries" or PED.

His suggestion was to keep older diaries in files at my office, and at each appointment compare them to a patient's most recent one. Then he put up a slide summarizing this idea:

It said "COMPARE PED-FILES AT EVERY VISIT." (try saying "PED-files" out loud).

It's a good thing they couldn't see or hear me. Because I lost it.

I bet you did

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

Mr. Webster: "Yes. When I was five I had an autopsy."

More Doctor's Lounge Horrors

Coming on the heels of the Doctor's Lounge Muffin Massacre...

This morning, as usual, I started at the doctor's lounge. I grabbed some Diet Cokes and a bagel, and trundled off to see patients.

This is the bagel I randomly picked up, without paying much attention:





Later, at the nurses station, I unwrapped the bagel, to discover this:





I'd like to thank my anonymous colleague who bit/tore a hunk out of this bagel, wrapped it back up, and returned it to the tray, for helping to support my diet.

Annie says I'm causing trouble.

Mrs. Azul: "I'm allergic to everything blue. Blue paint, blue berries, pills with blue dye."

Dr. Grumpy: "You're wearing blue jeans."

Mrs. Azul: "I am? Oh, I'm color blind. I'll have to change when I get home, so I don't get a rash."

Patient quote of the day

"The pain is constant, but not all the time. It's intermittently constant."

Relativity

Last night Mary called me at home to ask a question about the week. Craig was in the room, and overheard the conversation.

After I got off the phone he came over to me.

Craig: "Dad, how old is Mary's little girl?"

Dr. Grumpy: "She'll be 5 this year."

Craig: "5! Wow! That makes me feel so old!"

Voodoo doll

An anonymous reader says she works for a group of surgeons, and keeps this near her desk to take frustrations out on.




Having to deal with neurosurgeons, I sympathize. I thought about getting my own, but would likely destroy it after a weekend on call.

Saturday Re-runs

Due to various amounts of family junk this weekend, I'm re-posting this from a while back.


As my regular readers know, I moonlight as a consultant for various medical market research companies. It's a thankless job, but somebody has to pay for the tomatoes.

So last night I had a dinner meeting with neurologists and sundry other specialists to review data on an up-and-coming product.

These are never fun, because neurologists by nature are a remarkably pathological group of personalities. Back when I worked at Humungous Neurology, Inc. the partners would argue if it was dark or light outside. I think they invite the other specialties to these as a buffer.

But I digress.

So I was seated next to Dr. Harangue, who I'd had the good fortune of not having seen in at least 5 years. In his own mind he's a giant in his field. To those outside his mind he's an obnoxious boil. He may have once been a good doc, but as they say in Hollywood "you're only as good as your last picture". And his was made before Casablanca.

Neurologists will argue over anything. The meal started with a dispute across from me over who's bread plate was who's (right or left? GET YOUR BREAD OFF MY PLATE!) followed by a fight over which fork is used for salad. Somebody actually dragged the maitre d' to the room to settle the issue (no, it wasn't me. I sit still and keep my mouth shut as much as possible).

I'm not much into the swanky places they have these meetings at. I ordered a steak. I had no idea how complex this was.

Waiter: "How would you like that cooked?"

Dr. Grumpy: "Medium."

Waiter: 'That involves a light red center. Is that okay?"

Dr. Grumpy: "As opposed to..."

Waiter: "Well, rare is a pink center."

Dr. Grumpy: "Medium is fine."

Waiter: "I can do medium rare, too. That's a pink/red combo".

Dr. Grumpy: "What's wrong with medium?"

Waiter: "I'll just do medium-rare-plus for you. That's a pinkish-red."

Whatever. I'm trying to order a steak, not pick out draperies.

Then the talk began. Every time a doc involved in the study was mentioned, Dr. Harangue felt the need to interrupt and say "I know that doctor personally. We've been close friends for over 25 years." By the end of the meeting I was hoping they'd mention a study done by Hippocrates or Woodrow Wilson to see if he knew them, too.

After 15 minutes of talking, the speaker stepped out from behind the podium to show us all that his zipper was down, with his tucked-in shirt hanging out of it. A tactful internist promptly yelled "Christ! Your fly is open!" to drop a subtle hint.

Then they brought dinner. The cardiologist next to me had ordered prime rib (no comment), and the waiter accidentally set my steak in front of him, and his prime rib in front of me. I pointed this out, and he quickly switched plates.

The cardiologist had a freakin' FIT! "I don't want that now! It was in front of him! He could have H1N1, or worse! Doesn't the heath department check you places anymore?!!!" It was, literally, in front of me for less than 5 seconds.

So I quietly started my steak, while they went to get Dr. Germaphobe a new prime rib (actually, I think they just brought him back the old one).

The next speaker showed us a seemingly endless series of graphs. After 20 minutes of this, she asked if anyone had any comments. Dr. Phlame at the end of the table immediately raised his hand. "Yes, I want to know why you chose red and blue as the main colors for the graphs. I think mauve and maybe yellow would be much more aesthetically pleasing. Also, I think some ruffles or curvy lines around the slide border would be nice."

This was immediately followed by Dr. Harangue chipping in "Dr. Phlame, do you live under a freaking rock? This company has been using those colors for years. But back to the data, did any of you people think to compare these results to a 1954 study by Longdead, et al?" The speaker (and everyone else there) had absolutely no clue what he was talking about, and Dr. Harangue chewed us out, as if it had just been published last week. When I looked it up, the study investigated a drug (that's no longer in use) for an unrelated condition.

Throughout this excitement the waiters kept refilling our glasses (ENDLESS DIET COKE HEAVEN!), so dysfunctional personalities were not improving with repeated doses of Burgundy and other wines.

In one discussion, to argue a point about a competing drug, an internist actually reached into his pocket and pulled out a product insert. I swear! He had it with him, all scrunched up. After reading from it like it was a bible he sat down and began arguing with a pulmonary doc about when daylight savings time starts.

We made it through another 15 minutes of polite discussion before Dr. Germaphobe cardiologist began tapping my shoulder. "Hey, Ibee!"

I turned around "What's up?"

"Are you gonna finish your roll?"

Stunned, I looked at the bread roll I'd absently left on my plate. It was buttered, and I'd taken a few bites out of it. "Uh, no, I'm full".

"Thanks!" And he grabbed it. So the guy who'd refused to eat an untouched steak was now chomping on my partially eaten dinner roll. Amazing what a bottomless glass of wine will do.

As we sat through another set of slides, Dr. Harangue's cell phone rang. He answered it, speaking loudly enough to be heard in the next county (i.e., his usual volume). "What? Yeah. No, I've got another half hour of this shit. The drug company people won't shut up."

The dinner ended 20 minutes later. To make sure all points were covered, the moderator specifically asked "Dr. Harangue, are there any other comments?"

No answer. It was the only time he'd been quiet all night. He was in a burgundy stupor, slumped face down next to his creme bruleé. He was still there when I collected my paycheck and left.