Patient quote of the day

"When things are the same they're the same, but when they're different they're not the same."

Practice makes perfect

I'm examining Mr. Patient, with his wife sitting off to the side.


Dr. Grumpy: "Okay, hold your hands out in front, like this... now close your eyes... good, now open your eyes, and tap your right fingers like this... okay, now your left fingers..."


Out of the corner of my eye I notice Mrs. Patient doing the same things I'm asking her husband to do.


Dr. Grumpy: "Ma'am, why are you doing that?"

Mrs. Patient: "Just practicing, in case I ever need to see a neurologist."

Great moments in Jewish parenting

"DAD! YOU DON'T KNOW WHAT IT'S LIKE THAT YOU TOOK AWAY MY NINTENDO 3DS! YOU TOOK AWAY MY DIGNITY TOO! THIS IS WHAT IT WAS LIKE TO BE ONE OF THE MACCABEES, WHEN PHARAOH MADE THEM WORSHIP HIS GODS AND MADE THEM SLAVES AND JUDAH SAW THE BURNING BUSH FOR 8 DAYS AND SENT MOSES WITH A MENORAH TO TELL THE ROMANS TO LET MY PEOPLE GO!!!"

Mary's desk, October 9, 2012

Mrs. Bulova: "Hello?"

Mary: "Hi, Mrs. Bulova. This is Mary, at Dr. Grumpy's office. I'm calling because you're 10 minutes late for your appointment, and you're always punctual. So I wanted to make sure everything is okay."

Mrs. Bulova: "That can't be! My appointment is at 2:30, and my watch says it's only 1:15 now!"

Mary: "I'm sorry, but it's actually 2:40. I can re-schedule you, though. Maybe your watch is broken? Or you need to wind it?"

Mrs. Bulova: "It's funny, I noticed last night that it said 1:15 while I was having dinner, and it said the same thing later when I was getting ready for bed, and also this morning, when I woke up. I thought that was weird, but it makes sense now."

Reasons to keep beer in the break room

Like most offices, we have stuff on the front counter. A clipboard with a sign-in sheet. A little clock. A pen holder. A plastic & metal cow-like thing that shows the date. Business card holders.

Yesterday a lady came in for an appointment, towing 3 toddlers with her. After signing in she took everything except the clipboard off the counter and handed them to her kids to play with!

When Mary asked her to put them back, she got angry and said "You act like this is my problem, that your office doesn't have stuff around to keep kids busy."

For those of you wondering: No. Neither of us sees kids in our practices.

Sunday

Yesterday I was at local mall with the kids, when they started whining about being hungry. So I took them to the food court.

While they were inhaling burgers, I got a phone call from the ER, and wandered off to a quieter area to talk. Without paying attention, I ended up standing next to a kiosk selling phone accessories.


Dr. Grumpy: "Is she on Coumadin?"

Kiosk Guy: (comes over, taps me on shoulder) "Hey! You need a new iPhone case!"

Dr. Grumpy: "No thank you, I'm busy right now. What did her head CT show?"

Kiosk Guy: "This one is on sale! It lights up when you're on the phone!"

Dr. Grumpy: (waves guy away again) "Who's her cardiologist? Do they know what's going on yet?"

Kiosk Guy: "Your phone case is falling apart! You should get this one!"

Dr. Grumpy: "Hang on, ERP... Look, this is an important call. Can't you see I'm on the phone?"

Kiosk Guy: "No! That's why you need a case that lights up!"

Weekend reruns

When the kids were younger, we had a part-time nanny named Syndee. I was anything but fond of her. I don't remember how Mrs. Grumpy found her.

Syndee did a good job with the kids, so I turned a blind eye to her many shortcomings (which could be several posts alone). Her main issue was a remarkable lack of IQ and common sense. It was not uncommon to realize she'd been outsmarted by Snowball (and he's slow). She occasionally still calls to see if we need a babysitter. Rarely she'll call me for medical questions, as she does not grasp the concept of what being a specialist means. She's also learned (since she knows our home number) that it's easier to reach me than her own doctor.

Last week Syndee got married, and went off to Hawaii for her honeymoon.

This morning, at 12:05 a.m., I was woken by our home phone ringing.

Dr. Grumpy: "Mmmph, hello?"

Syndee: "Hi! Dr. Grumpy! It's me, Syndee!"

Dr. Grumpy: "What the hell?... Syndee do you know what time it is?"

Syndee: "Sure! It's just after dinner! Why, is your clock broken?"

Dr. Grumpy: "No, it's after midnight here."

Syndee: "It is not! I wouldn't call that late!"

Dr. Grumpy: "Syndee, you're in another time zone."

Syndee: "What's a time zone?"

Dr. Grumpy (sigh): "Why did you call Syndee?"

Syndee: "Well, um, In the last few days I've developed a bladder infection and..."

Dr. Grumpy (seeing an opportunity to get even): "What the HELL have you been doing on your honeymoon to get a bladder infection?"

Syndee: "Well, um, my husband and me, um we, um... Can you just call in some antibiotics for me?"

Dr. Grumpy: "Why don't you call your regular doctor for this?"

Syndee: "Her office is closed, and I don't want to bother her."

Dr. Grumpy: "Good night, Syndee." (hangs up)

Overheard at the nursing station

Morning shift-change check-out:

Nurse 1: "Your patient in room 822 is going to a nursing home in 20 minutes."

Nurse 2: "Oh, good. I love to start my day with a discharge."

Surrounding nurses & doctors start snickering.

Wednesday afternoon

Mrs. Bos: "I need to find a new internist."

Dr. Grumpy: "What's up? You've been with Dr. Moonray for years?"

Mrs. Bos: "He went to some seminar on 'natural health' and now he tells me that my epilepsy is from drinking milk. He said that if I stop all dairy products, my epilepsy will cure itself, and I can quit taking Depakote."

Dr. Grumpy: "You've had epilepsy since you were a kid, haven't you?"

Mrs. Bos: "Yeah, and it runs in my family. My sister actually died a few years ago when she stopped her medications, and he says I should sue her doctor because he never discussed stopping milk with her."

Dr. Grumpy: "Wow."

Mrs. Bos: "Yeah, and when I told him that I liked and trusted you, he told me you were secretly being paid by the pharmacy and dairy companies to hide the truth about medications and milk from your patients."

Dr. Grumpy: "WHAT?!!!"

Mrs. Bos: "Yeah, that's exactly what I said."

Pause

Dr. Grumpy: "Let me give you some names..."

Rounding in the ICU

Dr. Lung: "Ibee! Do you drive a Hyundai Sonata?"

Dr. Grumpy: "No. I have an old Nissan Maxima."

Dr. Lung: "Well, someone in a Hyundai Sonata hit me in the parking lot."

Dr. Grumpy: "I'm sorry, I hope you find out who it was."

Dr. Lung: "It had to be another doctor. The Hyundai next to me has a dent that matches mine."

Dr. Grumpy: "Okay, I'm going down to ER..."

Dr. Lung: "It's going to cost a fortune to fix, too. Can you believe the way people are?"

Dr. Grumpy: "No, I'll see you later..."

Dr. Lung: "It makes you wonder whatever happened to professional courtesy when things like this happen. Maybe it was a medical student. Or a PA. Or..."

Dr. Grumpy: "I think they have to park across the street. Oh, I better take this call...Hello? This is Dr. Grumpy." (psychotically answers phone that didn't ring, walks away quickly)

I bet

Dr. Grumpy: "Any major illnesses run in your family?"

Mr. Cath: "My father had heart disease, but didn't know it until after he was dead. When his doctor told him he'd died of a heart attack, Dad was shocked."

"Hey, this Mu Shu pork tastes like..."

Yep. Not much more to say.

Thank you, Don!

Red, too

Mrs. Ganglia: "And when the headache was really bad, the right side of my face was drooping."

Dr. Grumpy: "Was it really drooping, or just feel like it was drooping?"

Mrs. Ganglia: "It was really drooping! Wait, hang on, Gary took a picture of it..."  whips out iPhone, holds it up. "Here, take a look."

On her iPhone is displayed a picture of a remarkably muscular 20-something human male, with washboard 6-pack abs, naked except for his snowboots. He's holding his erect penis in his right hand and pointing to the camera with his left.

Mrs. Ganglia: "Oh GOD! That's not it..." (swipes frantically a few times) "Here it is. You can see my face is drooping."

Dr. Grumpy: "Yes, yes, you can."

Memories...

In college I lived in a building where all the windows faced a center courtyard.

One day, when it was nice out and most people had their windows open, a couple decided to have a loud fight in the courtyard, completely oblivious to the fact that pretty much everyone in the building could hear.

I don't remember any of the details, but at some point the girl yelled: "So tell me what you want to do! If you want to break up, we'll break up! If you want to go inside and fuck, we'll go inside and fuck! Just tell me what you want!"

There was a long pause.

Then some unseen guy on the 3rd floor yelled: "Tell her you want to fuck!"

The couple looked absolutely horrified. They got in a car and left.

Candor

Mrs. Camel: "I only get migraines when I snort cocaine."

Dr. Grumpy: "Why don't you quit?"

Mrs. Camel: "Nah. I'd rather just take a headache pill."

Guilt

Dr. Grumpy: "Have you tried any pain medications for this?"

Ms. Nurse: "Well... Yeah..."

Dr. Grumpy: "What's wrong?"

Ms. Nurse: "I'm really scared to talk about it... I took something that a friend gave me. I don't have my own prescription, so I'm worried about losing my nursing license if people find out."

Dr. Grumpy: "Well, I'm not looking to get you in trouble, and to help you I need to know what you've already tried."

Ms. Nurse: "It was" (looks down) "Ibuprofen."

(pause)

Dr. Grumpy: "Did you say Ibuprofen?"

Ms. Nurse: "Yes. Oh, God, please don't report me. I know it was wrong."

Dr. Grumpy: "Um, it's over-the-counter."

Ms. Nurse: "You don't understand! This was the prescription-only 800mg! It wasn't even my prescription! I'm sorry, I can't believe I did something like that. I'm really not that kind of person!"

Dr. Grumpy: "I wouldn't worry about it."

Annual peeve

For the 4th year in a row I'm going to run this column. I'll keep running it until this practice stops. Which likely means the post will be here every damn year until I retire/die/get institutionalized.

In the past I've addressed it to the President. But since nobody (except me) running for office this year considers it to be a major issue, I'm making it the center of my campaign platform. And, if elected, I will carry it out!

Fellow citizens,

We now face a national crisis of such serious proportions that it dwarfs other issues, such as global warming, health care, and middle-east peace. It now threatens the very fabric of our society, and directly affects every citizen. And I can remain silent no longer.

It's still September, and every store near me ALREADY HAS THEIR CHRISTMAS DECORATIONS UP!

I have nothing against the holidays. Peace on Earth and all that stuff. But moving them up as if they were being held in another time-zone or alternate universe is getting out-of-hand. As far as I know, Christmas hasn't budged in my lifetime. And treating every day like it was Christmas (like the stores seem to want me to do) is not helping.

The well-respected Nick documentary program, The Fairly Oddparents, has carefully researched what would happen if Christmas were held every day (Episode 107, air date 12-12-01 I have kids, OKAY!). Their conclusion? It would be catastrophic.

There also seems to be a degree of unintentional discrimination. For example, Hanukkah starts several weeks before Christmas this year, but I don't see Hanukkah decorations going up yet. In fact, I haven't seen any at all. Or Kwanzaa stuff. Or Festivus. Or New Year's.

This seasonal perversion extends to other holidays, too. I mean, by January 2nd most stores are decked out with Easter junk, and on July 5th the Halloween crap is up.

So, if elected, I promise the following, federally mandated solutions (please note: I'm only including those holidays that retailers love. Let's face it, not many of us are out there buying gifts for Groundhog day or cards for Columbus day. I'm also leaving out local holidays like Delaware Statehood Day, the Montana Huckleberry Harvest Celebration, and the Byron, Illinois, Turkey Testicle Festival).

Valentine's Day Decorations will NOT be put up until the 3rd week of January.

St. Patrick's Day Decorations will NOT be put up until after March 1st.

Passover/Easter decorations will NOT be put up until after St. Patrick's day.

Independance day decorations (July 4th) will NOT be put up until the 3rd week of June.

Halloween stuff will NOT be put up before October 1st

Thanksgiving Stuff will NOT be put up before November 1st.

Christmas/New Year/Hanukkah/Kwanzaa/Festivus stuff will NOT be put up until the day after Thanksgiving.

(Please note: there should be some flexibility here, as Hanukkah and Easter/Passover may vary, but decorations should NOT be hung more then 3 weeks prior to holiday onset).

An alternative plan would be to have a single annual holiday combining all of the above, called St. Christmukahpasseastkwanpatfourthnewfestgivingween. Decorations for the combined holidays may be hung for 30 days prior to this event, and MUST be removed the day after.

Punishment for business owners who violate these laws would be on a 3-step basis:

1st offense: Business license revoked for one month.

2nd offense: Tarred, feathered, and forced to eat fruitcake.

3rd offense: Drawn and quartered, then served with fava beans and a nice chianti.

Yours truly,

Ibee Grumpy, M.D.

Mary's desk, September 24, 2012

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

Phone lady: "Hi, I need to make a new-patient appointment with Dr. Grumpy."

Mary: "Okay... We can see you this Friday, at 1:30. Does that work?"

Phone lady: "Yes. I have Major Illness insurance, do you take that?"

Mary: "We certainly do. We'll see you on Friday. Any other questions?"

Phone lady: "Yes, do you think I need to see a neurologist?"

Mary: "I really can't answer that. Didn't your internist refer you?"

Phone lady: "Yes, but I don't trust her medical judgment, so I'm asking you."

On call this weekend

Dr. Grumpy: "Can you move your right arm?"

Mr. Stroke: "No... The leg isn't working either."

Nurse ER: "Hang, on, I'm going to put the blood pressure cuff on you."

Dr. Grumpy: "What time did this start?"

Mr. Stroke: "About 2 hours ago."

Dr. Grumpy: "Any headache?"

Mr. Stroke: "No, but my dick itches."

Nurse ER: "Your left arm still works."

More from the artisanal mailbag

Okay, it's been a while since I bitched about the overuse of the word artisanal (see my artisanal whining page if you miss this sort of thing), so today I'm going to pick a few out from the pictures that I keep in a handcrafted folder on my computer desktop.

First we have perfume, which is likely handmade in some 3rd world chemical plant. The ad gets bonus irritant points for using handcrafted and artisan in the same sentence:

"We could fill these bottles with donkey piss, and people would still buy them. So let's do it."

This picture was sent by a reader living in China, to show that the word is now planet-wide, regardless of economic system.

"It sounds better if you use the word twice. As least that's what I think the English-as-a-2nd-language teacher said"

Next, from the United Kingdom, we have this place:

Is the trench digger artisanal? Or the power generator? Or the guy who takes your credit card when you order one?

Of course, no artisanal posting would be complete without something that grows in the dirt, was picked by someone making minimum wage, packaged by a machine, and had a label slapped on it.

Here in the U.S even a piece of paper is now artisanal:

If you're going to buy artisanal paper, you probably want a printer equal to the task:

"Handcrafted by mass-production assembly line machines in a Chinese sweatshop"

Lastly, it's important to remember that artisanal things can boldly go where no one has gone before:

"We canna go any faster, Captain! We're all out of handcrafted anti-matter!"

Thursday afternoon

Dr. Grumpy: "Have you been using anything for the shoulder pain?"

Mr. Strain: "My friend gave me a cream she bought, and I've been rubbing it on the area. I don't remember the name. It's like Ben-Gay, but gayer. I mean stronger."

Faces in the crowd

Evolution does interesting things, with unintended consequences.

Obviously, a key feature for the survival of any species is the ability to differentiate between friend and foe. If you don't recognize a predator coming toward you, or don't realize the hot girl in the cave next door is one of your own kind, you're unlikely to pass your genes on to the next generation.

As a result we're hardwired to recognize other human faces. We may have left the caves way behind us, but the basic programming is still in place, and damn near impossible to override.

Anyone recognize this picture?

How long did it take you to see a face? Likely 1 second or less.

It's an area of Mars called Cydonia, photographed by the Viking 1 probe in 1976. Scientists at the time dismissed it as a coincidence of light and shadow, but that didn't stop a number of writers (particularly Erich Von Däniken) from including it in horseshit pseudoscience. It got great publicity in non-scientific circles as "proof" of life on Mars, or as evidence that extraterrestrials had previously visited our backwater solar system.

The area in question, of course, is still on Mars, and been imaged many times since then. Here's a shot from 2000: Doesn't look much like a face anymore, huh?

This is called pareidolia, and is, in my opinion, a fascinating phenomenon.

We see faces in clouds:

In cars:

Pretty much anywhere:

Of course, with particularly famous faces, such as Jesus, Mary, or Elvis, this gets even weirder. Even before the internet age the news had occasional stories about figures (usually religious) being seen on toast, tortillas, trees, ceiling stains, and shadows on walls. With the advent of the web, however these sorts of things attract considerable attention quickly. Our continuing fascination with them is an ironic commentary on an ancient survival mechanism that keeps us from becoming something else's dinner.

It's also led to a rather bizarre cottage industry where you can now modify your toaster to put Jesus, or other famous faces, on your breakfast.

So my point here is that when you see a face on anything, whether it's bread, woodgrain, or a cloud, to just marvel at it. It's the way your fascinating brain functions to make sense out of random patterns, and keep you from becoming lion poop.

And beyond that, it's nothing.

The end.

Never mind

I'm walking a forgetful elderly lady up front after an appointment, and notice on the info sheet that today is her birthday.

Dr. Grumpy: "Happy birthday!"

Mrs. Taubeta: "Oh, is it someone's birthday?"

Dr. Grumpy: "It's your birthday."

Mrs. Taubeta: "I have a birthday coming up, too!" (looks at Mary) "Well, have a happy one!"

Mary: "It's your birthday."

Mrs. Taubeta: "Really? My birthday is next week, too! What a coincidence."

Dr. Grumpy (giving up): "Well, I hope you have a happy one."

Mrs. Taubeta: "Thank you. And to you, too. I'm sorry you have to work on your birthday."

Soap Opera

Dr. Grumpy: "Any seizures recently?"

Miss Scorned: "I don't think you've had any?"

Mr. Ictal: "Yeah, about 2 weeks ago. Remember? I was sleeping, and pissed the bed."

Miss Scorned: "I don't remember... YOU BASTARD! YOU'VE BEEN SLEEPING AT DIANA'S AGAIN!!!"

Mr. Ictal: "No! I mean, I must have been on a, uh, business trip or something..."

Miss Scorned: "YOU'RE A FUCKING GARDENER! YOU DON'T GO ON BUSINESS TRIPS!"

Mr. Ictal: "You're right, I..."

Miss Scorned: "I AM SO OUT OF HERE!" (grabs purse, leaves)

Long pause

Mr. Ictal: "So, anyway, I had one seizure, about 2 weeks ago. Hey, can you download a bus schedule? I'm going to need a ride home."

Dining out

This past Friday night Mrs. Grumpy was out with a friend. So, in the tradition of single dads everywhere, I took the kids out for a gourmet meal at Costco.

This is a surprisingly complex task that involves juggling orders for hot dogs, pizza, chicken bakes, ice cream, churros, and drinks in your head, while sending the kids on a seek-and-destroy mission to find an open table and hope they don't kill an old man eating a hot dog and hide his body under a 50 lbs. bag of dog food in the process.

I found myself in line behind a lady who was torturing the poor 16 year-old kid working the counter, and got to hear this:

Ms. Food: "I can't decide between the pizza or a hot dog."

Counter Guy: "Okay, do you want someone to go ahead of you?"

Ms. Food: "No... Which one has more calories?"

Counter Guy: "Um, not sure... I can look it up."

Ms. Food: "Well, I want something low-calorie."

Counter Guy: "Well, the salad has fewer than either of them."

Ms. Food: "Okay... I'll take a hot dog, with a piece of cheese pizza."

Happy New Year!

Wishing all a happy Rosh Hashanah.

Patient quote of the day

"When it's really dark outside, and I've closed all the window shades, and all the lights are out, then things look really dark to me. Especially if I close my eyes."

Today's criminal tip

When trying to use a stolen credit card, don't hand it to the guy you just stole it from.

Thank you, Don!

Behavior

The twins, for whatever reason, are both running for student council this year. Elections are next week.

Last night they had to attend a mandatory "election rules" class. So, while Mrs. Grumpy picked up Frank from jail the bus stop, I took Craig and Marie to the meeting.

(There were some touchy issues. Craig's Hair, his running mate, had threatened to leave the ticket in a dispute over the newest member of his entourage, Craig's Cast, recently receiving more attention. The situation was defused by an agreement that Craig's Cast will be removed in 4 weeks. Craig's hair has now agreed to stay onboard for another 20 years, after which it will have the option of leaving at its own discretion and be replaced by Craig's Cheap Rug.)

Anyway, all kids were required to shake hands with the people they're running against, and then the following points were covered:

1. Keep it positive.

2. No negative statements. Give people a reason to vote for you, NOT a reason to vote against your opponent.

3. Don't make promises you know you can't keep.

4. Stick to the real issues (I have no idea what "real issues" there are in student council).

5. Be honest.

6. No screaming, blaming, or finger-pointing.

7. Be a good sport.

8. All campaign posters must be removed by the end of the day after the election.


I know I've touched on this before. And listening to the talk, I wonder: Why can't we do this on a national level? What the hell kind of world is it where grown-ups behave worse than kids? Aren't we supposed to be the ones setting a good example?

I still like my idea of a reality show called "Modern Sandbox:" Politicians who espouse screaming and yelling at the opposition will be dropped into a desert with an equal number of equally stubborn people from the other side, under circumstances where their mutual survival depends on finding ways to work together and be polite. Advertising revenue and T-shirt sales will go toward the national debt.

Serious WTF*ckery

Words fail me.

Dedication

Dr. Grumpy: "How you doing? You look tired."

Mrs. Colostrum: "It was a long night."

Dr. Grumpy: "Aren't you supposed to have your baby soon?"

Mrs. Colostrum: "Yeah, I delivered her this morning."

Dr. Grumpy: "THIS MORNING?"

Mrs. Colostrum: "Yeah, at Local Hospital next door."

Dr. Grumpy: "And they discharged you already?!!!"

Mrs. Colostrum: "Oh, no." (opens jacket, shows hospital gown underneath) "I just hate to miss scheduled appointments, so I walked over to your office. They think I'm at the gift shop."

Today's contest

Okay, folks, since Dr. Killpatient gave me the idea...

A catalog pushing Halloween-themed nursing scrubs was lying around the hospital yesterday, with this picture on the cover:

So let's see what captions you guys can come up with. I'll toss out a few:


"Dr. Grumpy is sending a patient to the ER!"

"Dr. No Bullshit is on vacation again!"

"Shipping charges on Halloween scrubs are how much?!!!"

Mary's desk

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

Mr. Bling: "Yeah, this is Mr. Bling, and I need to make an appointment to see Dr. Grumpy."

Mary: "Mr. Bling, you sent us a letter 2 weeks ago saying you were firing Dr. Grumpy, and wrote a number of unkind things about him."

Mr. Bling: "Yeah, I know. But I decided it's too much of a pain to find another neurologist."

Mary: "I'm sorry, sir, but our policy is that once a patient has dismissed us, we won't take them back. It's just not good for the doctor-patient relationship after that."

Mr. Bling: "That's bullshit! I need a neurologist, and you're refusing to see me! I don't have time to find another one."

Mary: "Sir, you should have thought of that before you fired Dr. Grumpy."

Mr. Bling: "See, it's reasons like this that I fired you guys in the first place."

Hangs up.

Saturday at the park

Dr. Grumpy: "What's going on? Why are you fighting?"

Craig: "FRANK ATE ALL THE BROWNIES!!!

Marie: "YEAH! I PACKED 3 BROWNIES FOR US TO HAVE AS SNACKS AND HE ATE ALL OF THEM!"

Dr. Grumpy: "Frank, did you eat all the brownies?"

Frank (with chocolate all over his face) "Mmmph. Yeah, but I had to."

Dr. Grumpy: "Why?"

Frank: "Because! Look at this wrapper! They all expired last month, so it wasn't safe for them to eat! I did it to make sure they'd be okay."

Nudge nudge, wink wink, say no more

Dr. Grumpy: "Anything that makes the symptoms worse?"

Miss Carpal. "Um... I'd say the hand falls asleep whenever I'm holding long, slender, objects."

Rebuttal

In late July I re-ran my "Dr. Worthless" post, about the (alleged) migraine specialist who didn't do shit for one of my patients.

On August 28, nearly a month after I put it up, the following comment was posted:

"Dr Worthless: Pretty much every neurologist in my metropolitan area. I am sick and tired of managing issues that fall into the realm of neurology because of the laziness of your specialty. I really miss the days when a neurologist could actually make a diagnosis without an MRI."

Here is my rebuttal:

Dear Dr. Whoever You Are:

Thank you for kindly painting all neurologists with the same brush.

I'm sorry some in your area aren't up to your personal standards in work ethics. By a similar definition I know some "lazy" internists who seem to feel that I should be treating bladder infections, sinus problems, or foot ulcers simply on the grounds that the patients also have a neurological disorder, and therefore tell them to call me for their general medicine needs. So I suppose I could say I'm sick and tired of managing issues that fall into the realm of general medicine because of the laziness of your specialty.

But I won't do that. To make generalizations based on 1 or 2 people is what leads to idiotic stereotypes. I'm sorry you feel that way based on the few neurologists you've encountered. So stop referring to them and find others.

Please try to keep in mind that medicine is a team sport. When you view other doctors (or nurses, or whatever) as the opposition, the only person who really loses is the patient.

Diagnosing people without an MRI is fairly easy. I (and many other hard-working neurologists) do it every day. Bear in mind that many neurological conditions (migraines, Parkinson's disease, epilepsy, Bell's palsy, and Alzheimer's disease, to name a few) are clinical diagnoses. This means they're based on what the doctor thinks after taking a history and doing an exam. The purpose of MRI's (which, I admit, are often overused) is usually to exclude other causes, rather than confirm the diagnosis.

MRI's, like all forms of technology, are like genies. You can't put them back in the bottle. If you don't like it, perhaps you should consider going back to the days when an internist could actually make a diagnosis without a CBC. Or CMP. Or stethoscope (after all, in 1840 the flexible binaural stethoscope was cutting edge). MRI's may be overused, but I find them to be more effective at excluding/confirming serious neurological disorders than sacrificing chickens over the patient and dancing naked under the moon.

I'm going to guess that you've never been sued (I have). Nowadays you can get legally reamed out for NOT ordering tests, regardless of any guidelines that say it's fine not to do them. You can tell me that I'm practicing defensive medicine, and guess what? I don't care. If doing everything I can to protect my family and my livelihood is being lazy, than so be it.

Ordering a test often has more to do with CYA than diagnostics in ANY branch of medicine. If you have some magic power that exempts you from legal action and allows you to make 100% accurate diagnoses without using that newfangled stuff, than you have my respect for being a better physician than little old me.

Yours truly,

Ibee Grumpy, M.D.

Germ theory

Mr. Bassi: "I'm surprised I caught a cold. I've been washing my hands a lot."

Dr. Grumpy: "These things can spread through the air, too."

Mr. Bassi: "Yeah, but I was hoping the washing would help me ward off anything."

Dr. Grumpy: "What do you mean?"

Mr. Bassi: "Well, they say washing hands helps prevent disease."

Dr. Grumpy: "That's true..."

Mr. Bassi: "Isn't it because water and soap boost your immune system?"

Why do I see this causing trouble?

I just know I'll hear:

"Well, I read an article about it, so I took mine out and rubbed it all over my forehead. But it didn't make the migraine any better, and the other people on the subway all started staring at me." *

*Admittedly, I've seen far stranger things while riding the Grumpyville Subway System.

Back-to-school reruns

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

Today I'm going to 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 amok! 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!

Sunday vacation pictures

On our recent trip we spent a few days in Las Vegas. At the AdventureDome amusement park they had this air hockey table:

"Winner gets free Premarin!"

While walking to the rollercoaster Marie suddenly yelled "There's a toilet out there!" This porcelain throne, and what looks like the remains of a bathroom stall, are lying outside on the roof of the casino.

Another victim of El Burrito Grande.

Afterwards we went to a food court, where the neurologist in me noticed this burger place:

Do they hire Parkinson's patients? Seizure patients? Both?

Browsing through a candy store, I saw a PEZ set for the most devoted LOTR fans:

The place also sold a brand of chewing gum called "I Love My Penis." I swear.

Of course, some of you may prefer non-fiction PEZ, and they have that covered, too:

Screw Mount Rushmore. THIS is the big time.

And, predictably, some things you just can't escape from:

Friday guest post- Officer Cynical!

From our favorite man-in-blue:


Last night, near the end of my shift, I happened upon a disabled car in the middle of a busy intersection. I pulled in behind him and put my overhead lights on, then went to talk to the driver to see what needed to be done.

The driver and a passenger were there, waiting for traffic to clear so they could push it out of the street. As I was talking to them, I noticed a guy in one of those serious, heavy-duty, motorized wheelchairs cruising by on the sidewalk, but didn't pay him much attention.

Well, as we started pushing the car, this guy suddenly jumped out of the StephenHawkingmobile, ran over, got behind the dead car, and helped us push it through the intersection and onto a side street. Then he ran back to the chair, hopped in, and motored away. It was like seeing a new-fangled superhero or something.

I still don't know what the hell happened.

Annie's desk, August 29, 2012

Mrs. Autoclave: "Hello?"

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

Mrs. Autoclave: "Do you have my test results?"

Annie: "Yes, your neck MRI was fine, and so he'd like to schedule you for an EMG."

Mrs. Autoclave: "Is that the test where they stick needles in your arm?"

Annie: "Yes."

Mrs. Autoclave: "Does he use clean needles?"

Annie: "Of course!"

Mrs. Autoclave: "He's not, like, re-using the same needle on every patient, is he? Or just rubbing it down with a paper towel between patients?"

Annie: "No. It's a disposable needle. He throws it away, and uses a new needle for every patient."

Mrs. Autoclave: "How do I know he's not just fishing it out of the garbage?"

Annie: "You can watch him open the package before the test."

Mrs. Autoclave: "I'm going to have to think about this. I don't trust you people." (click)

Skool Nerse announcement

This is Mrs. Grumpy.

Look, kids.

There are all kinds of ways to fake being sick/injured/dead to try and get sent home from school.

Pretending to have a weird rash that "suddenly came up" before the math test is not a good one.

Especially if you do it by rubbing your face and hands vigorously with Cheetos.

Your neon-orange "rash" washed off pretty damn easily when I took a washcloth to it.

And now you smell like the inside of a vending machine.

Nice try, though.

Patient quote of the day

"My blood pressure is intermittently sporadic. It happens randomly."

Life on rounds

I recently got a new doctor's bag because my old one fell apart. While talking to a nurse at the hospital, I started fiddling with the shoulder strap.

Nurse: "What's wrong?"

Dr. Grumpy: "My bag is hanging funny."

Hysterical laughter breaks out at nurse's station.

Dr. Grumpy: "That didn't sound good, did it?"

Saturday afternoon

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

Mrs. Adna-Thompson: "Hi, I'm one of your patients, and I'm at Glove World amusement park today."

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

Mrs. Adna-Thompson: "Well, we're in line for the Fiery Fist O' Pain, the roller coaster that goes upside down a few times. I'm afraid the upside down part will give me a migraine."

Dr. Grumpy: "So..."

Mrs. Adna-Thompson: "So, can I hand my phone to the attendant? I want you to tell him not to send my car on the upside-down part."

Dr. Grumpy: "Um, I think that's a function of the track. There's nothing he can do about it. Why don't you just not go on the ride?"

Mrs. Adna-Thompson: "That's what the attendant and my husband both said! You're no help at all!"

Random Sunday Pictures

First, from our recent trip, we have this picture taken at Lagoon. Apparently to dissuade masochists and guys looking for a painful prostate check:

I really love Lagoon. But not this much.

Next, in a similar vein, we have this unusual public service announcement tie-in from Local Grocery:

Have some wine. Then bend over.

It was a long driving trip. Fortunately you can try and amuse yourself with Siri:

"What do you mean? African or European?"

Emma sends this picture, which she says was taken at a store in Hackney:

And, lastly, yet another example of...

"My, what lovely dentures you have."

Sentence structure

English, like any language, has rules that are needed to convey whatever a sentence is trying to say.

Sometimes those are at odds with space limitations in a newspaper.

While I understand this headline for a "human interest" story, it still doesn't sound good.

 

Thank you, Lee!

BUSTED!

Yesterday I got dragged into doing a car accident evaluation for an insurance company. Generally I try to avoid these, but for various reasons couldn't get out of this one.

The hallway from my exam room to the lobby is a straight 10 feet, so I use it to watch patients walk when they come in.

On the way back to my room the patient limped on his right leg, and held a cane in his right hand.

Afterwards, on the way back to the lobby, he limped on his left leg and held the cane in his left hand.

Breaking medical news

In case you missed this groundbreaking work last month, the Journal of Caffeine Research (with a name like that they should be hanging out in my office taking notes) found that:

(drum roll, please)

DRUNK COLLEGE STUDENTS ARE MORE LIKELY TO DO STUPID THINGS THAN SOBER ONES!

Shocker, isn't it? You'd think that with all the previous pioneering research in this field (Landis, J. et al. Animal House, Universal, 1978) further studies wouldn't still be needed.

Better yet is how they obfuscated the subject to make it sound more interesting: they put sex into it. This is a guaranteed way of getting your paper more attention than it deserves.

Basically, they interviewed 648 college students about "risky sexual behaviors" and found that if you're drunk you have a much higher incidence of having casual sex, or inebriated sex, or both. I suppose this could also be done using a more mundane topic such as "more likely to incorrectly sort the recyclables" but who would read that?

Since such information is hardly new, they decided to put a twist on it by studying risky sex following the consumption of energy drinks, both with and without alcohol. And, in a stunning conclusion, found that the incidence of banging near-strangers went up considerably when alcohol was involved, rather than just a plain old energy drink.

Now, on the surface this may sound like some vaguely interesting paper about regular energy drinks (such as Red Bull) vs. those mixed with alcohol (i.e. Jägerbombs) but let's face the facts: it basically found that alcohol consumption leads to a greater incidence of risky behavior than being sober. No shit, Sherlock.

You could do the same sort of research about coffee vs. coffee + bourbon, or milk vs. milk + schnapps. Those haven't been done yet, so if you're a grad student desperate to publish in the "Spiking Drinks Quarterly" (or just trying to meet girls) this is your big chance. Please see the definitive paper on the subject (Ramone, JJDTMR Somebody Put Something in My Drink, Sire Rec., 1985).

This research was supported (according to the article) by a government grant from the National Institute on Drug Abuse. Sadly, I'm not making that up.