Annie's desk

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

Mrs. Sig: "Hi, I need a refill to cover me for the holiday weekend."

Annie: "Um, this isn't a holiday weekend."

Mrs. Sig: "Okay, I'll call back another time."

(click)

Weird Science

Apparently alchemy is making a comeback.

Thank you, Jodi!

Details

Mr. Wool: "I'm doing much better. I don't need the walker any more, and am just using a cane."

Dr. Grumpy: "It's a nice cane, too. I like the carved handle."

Mr. Wool: "Thank you. It used to be my grandfather's. It has a big knife hidden in it..." (whips off handle) "that he used for slaughtering sheep."

"Do this! Maybe you'll get on Dr. Grumpy's blog!"

Yes, because sometimes being drunk just isn't enough.

Thank you, L.T.!

Things that make me grumpy

I have nothing against doctors making money. Hell, I'm trying to do that myself.

So medical journals are full of ads offering ways for doctors to increase revenue. Some of them practical, some hokey, and some that really piss me off.

Like this one:

(click to enlarge)




I have nothing against doctors who are doing concierge work, or sinking money into tech stuff, or marketing their practice.

But what ticks me off about this ad is that of the 4 things they claim to offer, doing what's best for patients is the very last thing listed.

If I ever reach the point where making money, investing in gadgets, or marketing my practice take precedence over doing what's right for patients, I hope someone tells me it's time to hang it up.

And if you've reached that point and don't see a problem with it, than maybe you've forgotten why you became a doctor.

Extreme sports

Yes, just another day in the competitive, gut-wrenching, in-your-face world of professional Scrabble.

Thank you, M!

Mary, call the psychic hotline

I'd like to thank my reader Tony, who says he found this on his fax machine this morning.

(click to enlarge)

Doctor talk

Dr. Grumpy: "Your hands are pretty sweaty. It looks like you have hyperhidrosis."

Mr. Thermo: "Um, no, I'm Italian."

How's the other foot?

Found this in a hospital chart today:

"She has dementia and osteomyelitis in her right foot."

All Quiet on the Western Front

He stood there, shell shocked, with a thousand yard stare
In the last 48 hours he'd survived unspeakable horrors, but never left his station
Now, I needed to talk to him.
I didn't want to, but only he could answer my question.
I'd rather have left him alone.

He was like you and me until recently
But now front-line combat had turned him into a broken shell
Clothes disheveled, hair uncombed, hands shaking
An unlit cigarette hung from his quivering lips

But he was still a man with job to do
As I began speaking to him he summoned his composure
And softly answered my question
"Sorry, sir," he said "We're all out of the iPhone 4s."

Crime update

For those of you losing sleep over the marauding bridge thieves I reported on earlier this month, I can now bring you some good news: They've been caught.

Thank you, Moose!

Shameless promo

Because I think Fizzy is absolutely one of the best medical cartoonists (Netter wasn't a cartoonist, people) I'm suggesting you have a look at her new book.

It's a collection of her best cartoons, and is available in both paper and eBook forms.

You can buy it here.

Please note: Dr. Fizzy did not pay me to write this. I just think she's great at capturing the insanity of medical training in her work.

THANK YOU, NORDSTROM!

Although I should note November 27 is a Sunday this year, and this may be an old picture. But thank you to everyone who sent it in.

Dependence

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

Mr. Sofa: "Um, I stopped by my pharmacy on Tuesday to request a refill, and I still don't have it."

Annie: "Hang on... It looks like Dr. Grumpy approved the refill on Tuesday afternoon."

Mr. Sofa: "Well, I still don't have it."

Annie: "Did you call them to see if it's ready?"

Mr. Sofa: "No. I don't have their number. Could you look it up for me?"

Annie: "It's right here. It's 867-"

Mr. Sofa: "Actually, can you call them for me and ask if it's ready?"

Today's criminal tip

When shoplifting, there are some things you shouldn't leave behind.

Thank you, Lee!

House calls are back in style

And they're free!

Thank you, Lawjok!

Germ theory

Mr. Irritant: "Did you just wash your hands?"

Dr. Grumpy: "Uh, yeah. You watched me."

Mr. Irritant: "That's pretty damn insulting. So you think I'm dirty?"

Dr. Grumpy: "No. I wash my hands after every patient, sir. It's good practice."

Mr. Irritant: "That's bullshit. I didn't come here to be treated like a second-class person."

Rescue Heroes!

Yes, yet another busy day for the police department and their K9 corps.

Thank you, Outrider!

Public Service Announcment

Today is World Arthritis Day, and WarmSocks has asked me to help with raising public awareness of Rheumatoid Arthritis.

She wrote in because recently Dr. Phil said on national television and still has it on his web page that obesity is a risk factor for developing rheumatoid arthritis. This is incorrect. Weight is a risk factor for developing osteoarthritis, but not rheumatiod arthritis. These disorders ARE NOT the same.

Her organization is doing a "post your numbers" (or numbers in support of someone else) project Similar to the Facebook "colors" project for breast cancer awareness. They're asking people to post weight/age of onset/current age.

She writes that if you don't know someone with Rheumatoid Arthritis, to please think about "80 pound Lori, diagnosed with juvenile arthritis at age nine. Now fourteen years old, she's lived with arthritis for five years. There is no cure. Please post 80-9-14 as your Facebook status and help raise awareness."

Chemistry of Walmart

People of Walmart + Chemistry 101 = Bad Idea.

Mary, bring me a strong drink

Dr. Grumpy: "You haven't had a seizure in years. What happened?"

Mrs. Flake: "I stopped taking my epilepsy medication last week. It was causing all kinds of terrible side effects."

Dr. Grumpy: "But... You've taken ShakeAway for 5 years, and never had a problem with it before."

Mrs. Flake: "Well, I took my pills at bedtime one night, like I normally do. And the next morning I woke up with a fever and sore throat. I was achy all over, and my nose was stuffy. After 2 days of this I realized it was probably from ShakeAway, and stopped it. The next day I was feeling better, so it must have been the drug."

Dr. Grumpy: "Ma'am, it sounds like you just had a cold. That's all. The medicine had nothing to do with it. Let me give you a schedule to restart it."

Mrs. Flake: "That poison! I just told you, it made me sick! Don't you listen? I refuse to start it again."

Today's news

In a new meaning to the phrase "water hazard" an Australian golf course has a family of sharks living in a water trap.

And in Florida, a legislator concerned about the unemployment issues facing people of below-average-height is trying to revive the bizarre sport of dwarf tossing.

Celebrity Endorsement

Craig and his hair were picked to read the morning announcements for 2 weeks on Wingnut School's closed-circuit TV channel

He took this very seriously, so he'd bring the announcements home each night and practice them endlessly for the next day.

Let me tell you, there are very few things that can drive you crazier than a kid re-reading ad infinitum things like "Band practice is at 12:45 on the north field. The chess club will meet in the library at 2:15. There will be a bake sale to support the 6th grade field trip at 3:00 in front of the cafeteria." Over and over and over again.

Anyway.

This past weekend was the annual Boy Scout popcorn sale in front of Local Grocery. So Craig and his hair were out accosting shoppers, when a tween girl stopped in front of the table.

Craig: "Would you like to buy some popcorn?"

Tween Girl: "Hey! You're that kid on school TV!"

Craig: "Yes I am! Would you like an autographed bag of Scout popcorn?"

Tween Girl: "Yeah! And I love your hair!"


In a few hours he sold $600 worth of popcorn

Attention patients

Leaving the message "Oh my God! Are you fucking kidding me?!!!" On my voicemail at 8:59 p.m., with no other information, will not get you a call back.

Random pictures

All right, today I'm going to put up some shots you guys have sent in.

First, is an older ad for Viagra. I'm unsure if the image is inspired by the song line "Get your motor running" or the juice commercial tag-line "I could have had a V-8!".






Next, in a sign that the apocalypse is coming, the world has apparently run out of names for wine.






To send email attachments, they now sell internet shipping labels. I had no idea you needed them, and obviously I've been doing email all wrong.







And last is this fortune cookie I got recently. I can only assume it refers to the occasional vegetables I see in my practice.

"Pssst... Hey, you wanna buy a bridge?"

Yes, it actually happened. Police in Pennsylvania are reporting that someone has stolen an entire bridge, 50' by 20'.

So, if you happen to notice that your neighbors have installed a new bridge over their pool, or see someone selling a bridge door-to-door in your neighborhood, please call police immediately.

Thank you, Webhill!

Today's mail

Got a letter from Grumpy National Bank saying they're increasing the fee on all fuel purchases made on my office premises.

Mary, have those gas pumps removed from the lobby. I guess they weren't my best idea. We'll also have to stop selling ziploc bags full of premium unleaded to the patients.

Games

Dr. Grumpy: "Your memory test was fine."

Mr. Bogus: "But I didn't have a memory test!"

Dr. Grumpy: "You did, last week. I have the results here. You did fine."

Mr. Bogus: "That's impossible. I couldn't answer half the questions! And the girl who did the exam was confusing me!"

Dr. Grumpy: "So... you do remember the test?"

Mr. Bogus: "Yes! I mean no! I have terrible memory problems! I can't remember anything! What are we talking about?"

Dr. Grumpy: "Never mind. Hey, when is your disability paperwork due?"

Mr. Bogus: "Next Wednesday, before 5:00 east coast time. The fax number is 867-5309. Do you need the address? I have it in my wallet."

Dr. Grumpy: "How did you remember that?"

Mr. Bogus: "How did I remember what?"

WTF?

Dr. Grumpy: "That could have been serious. Why didn't you go to ER?"

Mr. Spacecadet: "I considered it, but the whole ER concept is such an intangible."

Business

Dr. Grumpy: "So we'll see how you do with physical therapy, and then..."

Mr. Cullet: "Hey, doc, who installed your office windows?"

Dr. Grumpy: "I have no idea. I just rent the space, and it was built long before I moved in."

Mr. Cullet: "Well, you could have better windows. I can get you a great deal on new ones."

Dr. Grumpy: "Thanks, but I don't own the building. You'd have to talk to the managing company."

Mr. Cullet: "The new ones would be good quality, all-weather windows, with top-notch energy saving features."

Dr. Grumpy: "Okay, but I can't buy new windows for a building I don't own. Let's focus on your arm pain. So I'll see you back after therapy, and then we'll decide if more studies are needed."

Mr. Cullet: "Okay, doc, but you're missing out on a great deal."

Goodbye, Steve

Thank you.

IG

p.s. Stay hungry. Stay foolish.

Mary's desk, October 5, 2011

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

Ms. Newpatient: "Hi, I have an appointment for tomorrow, and have a question."

Mary: "Okay?"

Ms. Newpatient: "On your website it says you use Grumpyville Billing Service."

Mary: "Correct."

Ms. Newpatient: "You need to change that. I refuse to come in unless the doctor fires them immediately. They've turned me into collections for several other doctor's offices, and I'm tired of them doing that."

More reasons I use Rogaine

Dr. Grumpy: "At your last visit you switched to generic Noshakes. How's it been working for you?"

Mr. Ictal: "I need to go back to the brand name. I've had 3 seizures in the last week."

Dr. Grumpy: "That's not good. Let me write you a new prescription."

Mr. Ictal: "Okay. I need one. I ran out of all my pills 2 weeks ago, and haven't taken any since then."

Stump the expert

Okay, it's time again for you armchair neurologists out there to help me with a challenging case. Here is, verbatim, the first paragraph of my note. See if you can guess the diagnosis:

"When working outside in the Summer, or inside baking, she becomes warm, sweaty, and lightheaded. The symptoms resolve with drinking cold water and cooling down. They don’t occur if she keeps up on her fluid intake."

The Omen

Dr. Grumpy: "Did someone refer you to me?"

Mr. Damian: "Your name was in the letter I got from Dr. Lastsucker when he fired me."

Sunday, 7:15 p.m.

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

Mr. Albuquerque: "Hi, I want to know if I should be taking Plavix for a stroke."

Dr. Grumpy: "Did I prescribe it for you?"

Mr. Albuquerque: "No, my neurologist did. I've never seen you."

Dr. Grumpy: "Sir, I can't give out medical advice if you're not even my patient. Why don't you call your neurologist?"

Mr. Albuquerque: "I'm calling different parts of the country to get a consensus on if I should or shouldn't take it."

Dr. Grumpy: "You're welcome to make an appointment to see me, and discuss it."

Mr. Albuquerque: "That's ridiculous. I live in New Mexico, and there's no way I can travel that far."

Sunday reruns

It's been 2 years since I put this up, and I must say that one (but only one) of the insurance companies I deal with has significantly improved in that time.


I'm not taking sides in the health care debate, but I do want to clarify something.

I see people on the news screaming that they don't want "bureaucrats" between them and their doctor, and are afraid that's what government health care will bring.

WTF? THAT'S THE WAY IT IS NOW, PEOPLE!!! I hear my assistant Annie on the phone all day trying to get approval from non-government insurance companies for tests, medications, physical therapy, ANYTHING that I order.

Look at your insurance card. Doesn't it say things like "in-network" and "formulary"? Who the hell do you think came up with those? Not us docs. Dat be dem dere byoo-row-kratz!

Look back at some of my posts (like this, or this). I routinely have medications (both brand name and cheap generics) and tests refused by insurance companies. For an excellent commentary on this from the pharmacy side, this was written by FranticPharmacist.

So if you don't want bureaucrats between you and your doctor- TOO BAD. They've been there for years. THE ONLY PEOPLE WHO DON'T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING!

In fact, for those of you who don't want the government running this, THEY ARE ACTUALLY ONE OF THE BETTER ONES TO WORK WITH! Just ask Annie. Medicare doesn't question the majority of my tests, or meds. Yes, they don't cover everything, nor should they, but they don't fight with me over stuff like MRI's on stroke patients. Uncle Sam (unlike Aetna, Cigna, Humana, and many others) tends to leave these things to the doctor's discretion. Annie prefers Medicare patients for this very reason - they make her life easier.

So what happens to you the way it works NOW, with your non-government insurance?

You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.

Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page "pre-auth" form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn't enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).

So a few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don't cover Capricorns when the moon is in Pisces. And we don't know this until Annie calls back after a few days, because they're hoping we forgot about it.

Eventually they'll deny the whole thing, on the grounds that you don't meet criteria for an MRI and MRA. This decision is usually made by a non-medically trained person with a minimum of a GED. They do this because they want to see just how badly I want the test.

So they tell me I can appeal this via "peer-to-peer" review. Which means I need to personally call their "physician reviewer" to argue with them as to why I want the study.

So, during my insanely busy day at the office I have to call them. I'm promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. In fact, it's usually something like a retired dermatologist, who hasn't done neurology since medical school in 1938. Or an OB/GYN who hated his job, and is doing this now instead. Or some doctor who immigrated from Lower Swazbodiaczk and can't get a U.S. medical license (but your insurance company hired him to decide what medical care you need). But it's almost NEVER someone actually in my field, who might understand why I want the study.

So after telling your life history to Dr. Denial, one of 2 things will happen. They'll deny both studies, and want you to try medication or physical therapy or psychotherapy or holistic reflexology or whatever, and if you fail that THEN I can try to resubmit a request for the test. OR they will flip a coin and say they will cover the MRI, but not the MRA. Or vice-versa. They'll say that if the first test is fine, THEN I can start over trying to get the other covered. Maybe.

And many of these companies actually pay these "reviewers" bonuses based on HOW MUCH MONEY THEY SAVED THE COMPANY BY DENYING TESTS.

This can at times become comical. One of my patients is a doc who works part-time as one of these insurance company "physician peer reviewers". And when he needed an MRI, guess what? HIS OWN COMPANY DENIED IT! He paid out of pocket for it (and yes, it was abnormal).

So how did I get on this tangent? Because yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: "I'm calling because you people denied an MRI on a stroke patient?"

Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."

Annie: "Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."

Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."

Annie: "Oh, now THAT's a surprise."

Pinhead: "What do you mean?"

Annie: "Is this line really being recorded?"

Pinhead: "Yes. It's to improve customer satisfaction."

Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."

Pinhead: "We do this to save our customers money on unnecessary testing."

Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"

Pinhead: "Um, I hadn't..."

Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"

Pinhead: "No, but I..."

Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."

Pinhead: "Oh, but you can't mean that?"

Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."

Pinhead: "I..."

Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".

Pinhead: "No, wait! I..."

Annie hung up.


So bottom line here: if you don't think bureaucrats are currently between you and your doctor- THEY ARE! GET REAL! IT'S BEEN THAT WAY FOR THE LAST 10 YEARS OR MORE!

Lego Scorpion

Last week my kids got some new Lego things, and put them together yesterday.

This is one of them.



It's about a foot long.

And in poor lighting, at 2:00 a.m., silhouetted against white carpeting, it can scare the crap out of you.

I learned this the hard way.

Biochemistry FAIL

Mr. Biochem: "What did my labs show?"

Dr. Grumpy: "Well, your homocysteine level was high, and..."

Mr. Biochem: "That's impossible! I'm not gay!"

Medical Miracles

I found this impressive quote in another doctor's letter last night:

Ask and ye shall receive

Around Jewish holidays Local Grocery always puts up a display which varies depending on the holiday, featuring Matzoh, or Hanukah candles, or Hamantashen, or whatever is appropriate. They always hang a banner over it that says "The Jewish Experience."

Earlier this week I joked with a friend that if they really wanted to give shoppers "The Jewish Experience" they'd have some old lady there, telling people to stand up straight and making them feel guilty about something.

It was a joke. That was all.

So last night, on the way home, I stopped at the store for apples and a round challah for Rosh Hashanah. I found the "Jewish Experience" display with a pile of challahs, grabbed one... And was blindsided. This ancient silver-haired grandmother pounced on me out of nowhere.

Grandma Crabgrass: "That one's not fresh."

Dr. Grumpy: "Excuse me?"

Grandma Crabgrass: "That challah. It isn't fresh."

Dr. Grumpy: "It feels fresh."

Grandma Crabgrass: "It's not."

Dr. Grumpy: "Fine" (puts down challah A, grabs challah B, starts to turn away)

Grandma Crabgrass: "That one's stale, too. They're all hard as rocks."

Dr. Grumpy: "They're fine. It's not like they're leftover from last year's Rosh Hashanah."

Grandma Crabgrass: "How do you know? Your mother wouldn't approve of that challah."

Dr. Grumpy: "Look. I'm taking this challah and leaving."

Grandma Crabgrass: "You'll need two."


She wasn't even one of my patients.

No kidding

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

Mrs. Morton: "Yes, ether makes me lose consciousness."

Sigh

Look, sir. I think it's great that you want Mom to be able to reach you.

You're obviously a devoted son, and I respect that. In spite of Mom having advanced Alzheimer's disease, you're doing your best to take care of her.

Wanting her to be able to call you at any given time is a noble idea.

BUT

Let's face it. Mom can't work a toaster. So buying her an iPhone was not a great idea.

Great patient moments

"Doctor, I saw something on television last night. They have a machine, called an MRI, that can take pictures of your brain. Have you ever heard of this?"

Schedule

Dr. Grumpy: "Hi, I'm Dr. Grumpy. What can I do for you, sir?"

Mr. Gregorian: "My previous neurologist retired, so I want to get established with one for this year."

Dr. Grumpy: "Okay. What's up?"

Mr. Gregorian: "I was looking at my calender, and realized that I have heart attacks in even-numbered years and strokes in odd-numbered years. Since it's getting late in 2011 I need to get ready."

Survey

Over lunch I was doing a medical market research survey, and got this question:

"What incidence of injection site reactions would you find acceptable in an oral medication?"

Uh, I guess that would be zero.

Mary's desk, last Friday

(door flies open, really huge wild-eyed guy runs in)

Mary: "Can I help you?"

Really huge wild-eyed guy: "OH MY GOD! IT'S EVERYWHERE! DO YOU HAVE ANY PAPER TOWELS?"

Mary: "Um, sure, back in our kitchen, let me go..."

Really huge wild-eyed guy: "I CAN'T WAIT THAT LONG! NEVER MIND!"

(runs out door)

Crime in America

I guess this trio has redefined "making a clean getaway."

Thank you, William!

Why you need an iPhone

Dr. Grumpy: "Have you ever smoked?"

Mr. Precise: (whips out iPhone, taps a few times): "One cigarette, on September 21, 1958, at around 2:00 in the afternoon. It was when I was at Ohio State."

"I can't stand a wet car, your Honor."

In a world of lame excuses, some people are better at it than others.

Thank you, Alison!