Uh... What kind of work do you do?

This is from a form on a patient's ability to do the following at work. It was the last one that caught my attention.

Jawohl!

Dr. Grumpy: "What brings you in today?"

Mrs. Mom: "I'm worried about my son. I think he drinks too much, and I know it's bad for him."

Dr. Grumpy: "I'm sorry to hear that."

Mrs. Mom: "The only person he'll listen to is Dr. Intern, but he refuses to go back to see him about this."

Dr. Grumpy: "How are you..."

Mrs. Mom: "Anyway, here's my son's phone number. Can you please call him tonight, and pretend to be Dr. Intern to talk to him about the drinking? The doctor is from Germany, so you'll have to fake an accent, and..."

Not Helpful

Mrs. Papers: "Here's my background information."

Dr. Grumpy: (looking it over): "Okay... What's this say about your sister?"

Mrs. Papers: (leans over desk) "Let me see. Looks like it says 'Sister in NH'."

Dr. Grumpy: "What does 'NH' mean? Nursing home? New Hampshire?"

Mrs. Papers: "I don't remember. Could be either, or both. It's been years since I typed that up."

Technology marches on

A friend recently suggested I try Cleverbot. She figured that since my life has reached a point where I routinely talk to Siri, I might as well converse with other computers (and to think I started out chatting up Eliza on a TRS-80). After all, Cleverbot even has a picture of a brain on the site, endearing it to my profession.

I'm well aware that querying these things is like using a Magic 8-Ball. But, while seeing a patient yesterday, I decided to ask it a question for the hell of it.

Thanks, Cleverbot. That was very helpful. And no, I don't.

Mary's desk

Wild-eyed lady runs in, stands at counter, loudly bangs pen on sign-in clipboard.

Mary: "Can I help you?"

Mrs. Wild: "MY SCAN WAS ABNORMAL!"

Mary: "Okay, what is your..."

Mrs. Wild: "HOW COULD YOU NOT TELL ME IT WAS ABNORMAL? WHAT IS WRONG WITH YOU PEOPLE?"

Mary: "I'm sorry, let me look into this. If I could have your name..."

Mrs. Wild: "THIS IS INSANE! HOW CAN YOU SIT THERE SO CALMLY WHEN MY SCAN IS ABNORMAL?"

Mary: "I..."

Mrs. Wild: "DON'T JUST STARE AT ME! DO SOMETHING! MY SCAN IS ABNORMAL! I DEMAND TO SEE DR. CARDIO IMMEDIATELY!!!"

Mary: "Dr. Cardio is upstairs, in suite #805."

Mrs. Wild: "SHIT!"

(runs out, slams door)

May 18, 1980

I'd like to offer a remembrance for David A. Johnston (1949-1980, age 30). He died 33 years ago today in the service of his country and humanity. His body has never been found.

He believed scientists sometimes had to take serious risks if the knowledge gained would save the lives of others.

David Johnston, roughly 12 hours before his death.

Artisanal, or whatever

In case you live under a rock, the BEST news story of the week didn't involve murder (unless you consider a reputation), terrorist attacks (unless you consider an undercooked pizza as such), or hurricanes (except for one named Amy).

It involved the bizarre online meltdown of a restaurant in Scottsdale, Arizona called Amy's Baking Company. This place was featured on Gordon Ramsay's cooking show, and became the first place he was ever entirely unable to help, and actually walked out on. If that was the whole story it would be forgotten by now.

What made it much better than anything else, though, were the antics of the place's owners as we watched them steal tips, abuse costumers (and not in a semi-lovable Edsel Ford Fong sort of way, either), and pass off pasta from a grocery store as homemade. If you haven't seen it, be sure to watch it on Kitchen Nightmares. You won't be disappointed.

But what made it a moment for the ages was their bizarre online complete meltdown (well chronicled elsewhere) with them throwing obscenities, claiming the high ground of a deity supporting them, and using ALL CAPS randomly. Then they claimed a hacker had done it all, and not them (although they've done similar things before).

Now, I know nothing about restaurants, beyond which ones have banned my kids from ever coming back. But I have made misuse of the word "artisan" and its derivatives a sort of crusade.

So, looking at their site I noticed the inevitable word "artisan" on it (oddly capitalized, along with "Gourmet" and "Pizzas").

In the same paragraph it noted they serve "house made Artesian Pastas."

Look: "artesian" means an aquifer or spring in the ground, which provides water. It has nothing to do with "artisan." Water can never be artisanal, but it is often artesian. Capisce?

So, Amy, unless you've found some sort of natural spring that produces a steady stream of pasta (sort of like the famous spaghetti farms), I want to make these points:

1. Unless it came flowing out of the ground, it's NOT artesian.

2. If you made it yourself, by hand, you can call it artisanal.

3 If you bought it from the grocery store and are reselling it as your own, it's not "house made," "artisanal," or "artesian."

4. You should also use a comma. To the best of my knowledge there is no such thing as "Artesian Pastas fine wines."


Thank you, Webhill!

Front counter

So.

A guy shows up at 9:30 with a lady. She signs in on Pissy's sheet, and they sit down next to each other. After a few minutes Pissy's staff takes her back, and he sits out there reading a magazine.

In the meantime, Mary and I are waiting for my new patient at 10:00. At 10:15 we called it a no-show, and at 10:30 my 11:00 patient wandered in early. So I took her back and started the appointment.

At 10:40 the lady who was seeing Pissy leaves - by herself - and the guy who came in with her wanders up to the counter.

Mary: "Can I help you sir?"

Mr. Magazine: "Yeah, when will Dr. Grumpy be seeing me?"

Mary: "What time was your appointment?"

Mr. Magazine: "10:00."

Mary: "Sir, you didn't sign in... We didn't know you were here."

Mr. Magazine: "I would have said something sooner, but there was a good magazine article."

Mary: "I thought you were with that lady you came in with... I'll have the doctor squeeze you in over his lunch break..."

Mr. Magazine: "I'd just met her, in the hall outside your office. I wonder why she didn't sign in for me?"

Tuesday morning, 2:17 a.m.

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

Mrs. Batter: "Oh, Dr. Grumpy, I'm glad you're still up."

Dr. Grumpy: "I'm not. What can I do for you?"

Mrs. Batter: "I feel so terrible."

Dr. Grumpy: "What's wrong?"

Mrs. Batter: "I'm just torn up about your talk."

Dr. Grumpy: "The talk I gave last night at the hospital? Why, what did I say?"

Mrs. Batter: "It's not you doctor. I just... I, I, I wasn't there!" (starts crying)

Dr. Grumpy: "Okay... And you called me because...?"

Mrs. Batter: "I feel awful. My husband and I were planning on coming to it, but then he got tickets to last night's baseball game from his friend Ed, so we went to that instead. You remember Ed? I think he sees you for his foot problem. And now I can't sleep because I feel so awful about not going to your talk, because I knew you'd be offended that I wasn't there."

Dr. Grumpy: "It's okay Mrs. Batter. I'm not offended. The local Stroke Association chapter had announced the talk, so there was a decent turn-out."

Mrs. Batter: "You didn't even notice I wasn't there, did you?" (starts crying louder, hangs up).

Zzzzzzzzzzzzzzzzzzzzzzz

Dr. Grumpy: "Is the new sleeping medication helping?"

Mr. Stats: "Absolutely!" (whips out iPad) "As you can see from this graph, I"m sleeping 22.8% more than I was before trying Dozaway, and here... (swipe) it shows how I'm falling asleep 17.3% percent faster, and on this next screen... (swipe)"

Is this the Turing Test?

Snowball recently got some shots and had a tooth pulled, so spent a few hours at the veterinarian. That evening I noticed they had our phone number wrong on the bill, so called the next morning to correct it.


Phone Girl: "Local Animal Hospital, I..."

Dr. Grumpy: "Hi, this is Ibee Grumpy, and..."

Phone Girl: "I'd like to wish you a very happy National Hug-Your-Cat-Day this month!"

Dr. Grumpy: "Okay, I picked up Snowball yesterday, and realized you have our contact info wrong."

Phone Girl: "Did you know National Hug-Your-Cat-Day is this month? Cats do so many wonderful things for us, that it's important to take care of their heath, too!"

Dr. Grumpy: "I don't have a cat. I'm just calling about an error..."

Phone Girl: "Well, now would be the perfect time to consider getting one! We have 3 cats looking for loving homes here, and several animal shelters we're working with for National Hug-Your-Cat-Day are running offers to help you enjoy them!"

Dr. Grumpy: "Look, I don't want a cat. I just need to give you our correct phone number."

Phone Girl: "Cats are wonderful companions! I'm sure if you came over and met some of the adorable ones available for National Hug-Your-Cat-Day you would..."

Dr. Grumpy: "What time do you work to?"

Phone Girl: "I'm here until noon, but National Hug..."

Dr. Grumpy: "I'll just call back later."

Space Oddity

Commander Chris Hadfield, the Canadian astronaut departing the ISS, posted this awesome cover today of the classic David Bowie song. Filmed, of course, on site.

Sunday reruns

Mrs. Hyve: "I'm allergic to all medications. I'm even allergic to Benadryl."

Dr. Grumpy: "What happens?"

Mrs. Hyve: "All medications give me a rash, so to safely take any pill, I have to take another pill first, to prevent the rash from happening."

Dr. Grumpy: "What do you take to keep the rash from occurring?"

Mrs. Hyve: "Benadryl."

Green bananas

Mr. Hills: "I need a refill on my Fukitol while I'm here."

Dr. Grumpy: "Sure..." (Grabs script pad, starts writing) "Hey, do you need this written for a 30 or 90 day supply?"

Mr. Hills: "Just 30 days. For crap's sake, doc, I'm 91 years old."

And you couldn't use your 1 phone call?

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

Mr. Bar: "Yeah, this is Don Bar. I'm a new patient, and I need to reschedule my appointment from last month."

Mary: "Okay... It looks like you had an appointment last month, that you no-showed."

Mr. Bar:  "That's why I need to reschedule it."

Mary: "I'm sorry, but we have a strict policy for new patients who no-show and don't call at the time. You can't be rescheduled, and will have to ask your doctor to refer you to another neurologist."

Mr. Bar: "I was in jail, and just got out."

"Why can't you be more like that Khatri boy? He makes a nice living."

Every medical study has a "financial disclosure statement" in it, listing all the people who did the research, how much they were paid for doing it, and who financed it.

So, while glancing through an article this weekend, I noticed the usual disclaimer paragraph at the end. This caught my eye:

Personally, if I were Dr. Hartung or Montalban, I'd be pretty insulted. Worse, I'd be embarrassed that my friends (and my mother!) saw how much better everyone else was doing.

Why fathers go bald

Craig: "Dad, we need your help."

Dr. Grumpy: "What's up?"

Marie: "I lost my school ID today."

Dr. Grumpy: "Where did you lose it?"

Marie: "While we were walking home."

Dr. Grumpy: "Any idea where? It's a 2 mile walk."

Craig: "Along the road, somewhere between here and school."

Dr. Grumpy: (sighs) "Thanks, Craig."


(loads up car, drives SLOWLY to school and back, with kids peering out the windows and other drivers honking and giving me the bird for blocking traffic, while I randomly slam on the brakes any time a kid sees a leaf, or crushed paper cup, or piece of dog shit that vaguely resembles a school ID and screams "THERE IT IS!!!")

I finally gave up and drove back home.


Dr. Grumpy: "Marie, it doesn't appear to be out there anywhere."

Marie: "It has to be! It was while we were walking home today that I noticed it was missing!"

Dr. Grumpy: "When was the last time you remember seeing it?"

Marie: "Last Wednesday, during the field trip to City Park."

Drugs 'R' Us

Tonight we have two great tales about upstanding members of society.

First, we have Jarvis Sutton of St. Petersburg, Florida.

Mr. Sutton was unusually hopeful that if he called 911 enough, the police would deliver marijuana and munchies to his home. When they showed up and failed to bring either, he consoled himself by eating the police car instead.


Second, we have the remarkably organized Carolyn Murray of Pennsylvania.

This fine lady was involved in a car accident. While providing her insurance forms to officers she handed them a shopping and to do list, which included such items as "potato salad," "Xanax," and "cocaine." It also had a helpful reminder to "get high."


Thank you, Tanya and Webhill!

The Karate Octogenerian

Mr. Miyagi: "I need to get off Zuclox."

Dr. Grumpy: "What's wrong? You've been on Zuclox for almost 10 years without any problems."

Mr. Miyagi: "It's affecting my balance."

Dr. Grumpy: "Why do you say that?"

Mr. Miyagi: "I fell this weekend."

Dr. Grumpy: "What happened?"

Mr. Miyagi: "I was at the senior citizens dance, trying to meet some ladies. You see, back in 1946 I was stationed in Japan, and learned karate there. I was really good at it, too, and won a few tournaments. I haven't done it since I left the army though. Anyway, at the dance, some of the ladies and I were having drinks at the bar, and they were talking about those karate films, so I decided to show them my moves. I lost my balance and fell on my butt, and all those ladies started laughing at me. One of them laughed so hard her friend had to bring in her oxygen tank."

Dr. Grumpy: "I'm not sure Zuclox is why you fell."

Mr. Miyagi: "I looked it up. Balance problems are in the side effects."

Dr. Grumpy: "Yes, but you never had them with it before."

Mr. Miyagi: "Look, just tell me how to stop it. The next dance is in 2 weeks."

Patient quote of the day

Mr. Eosinophil: "I'm allergic to all man-made chemicals, including MSG, nitrates, glucose, oxygen, all proteins, and hemoglobin."

Negotiations

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

Ms. Oxy: "Hi, I need to make an appointment to see Dr. Grumpy."

Mary: "I can help with that. Our next opening is..."

Ms. Oxy: "Wait, before you get to that, I need to know how many Percocets Dr. Grumpy will allow me per month."

Mary: "Did you just ask me..."

Ms. Oxy: "Because my current doc only gives me 150 a month. I'm not going to switch unless you guys make this worth my while. I'm thinking 180 Percocet per month would be enough."

Mary: "Okay, we don't work that way."

Ms. Oxy: "Of course you do. Patients are money to you people, and you need the money. All right, let's say 170 Percocet. I'll settle for that."

Mary: "I think you should stay with your current doctor. It doesn't sound like you're a good match for this practice."

Ms. Oxy: "Okay! 160 Percs a month, and I'll do co-pays in cash, will..."

Mary hung up.

50 Shades of Blue

A few months back I poked fun at Fycompa, a new epilepsy drug with an interesting side effect profile. Little did I realize I'd have the chance to do it again (different drug this time) so soon.


Like neurologists everywhere, I was surprised to hear the news Monday about a newly reported side-effect concerning the epilepsy drug Potiga.

Namely, that it makes people blue.

I'm not talking depression here, either.

Let's look at the official FDA announcement:


"FDA is warning the public that the anti-seizure medication Potiga (Ezogabine) can cause blue skin discoloration... (and) does not currently know if these changes are reversible.

The skin discoloration in the reported cases appeared as blue pigmentation, predominantly on or around the lips or in the nail beds of the fingers or toes, but more widespread involvement of the face and legs has also been reported. Scleral and conjunctival discoloration, on the white of the eye and inside eyelids, has been observed as well."


Now, with that said, I want to remind you that if you look at the side effects of ANY drug, you'll find scary shit on all of them. I'm sure I'll put patients on Potiga, and most will likely do fine. But that doesn't mean we can't have some fun with it.

For one thing, they don't even tell you what shade of blue. There are 45 of them. Some people if given the choice, would like a nice turquoise, while others would prefer royal blue. Hopefully further research will shed light on this important topic.

The interesting part is this: Let's say a patient had a choice between this drug and one with a "YOU COULD DIE FROM THIS!!!" black box warning. Felbatol, for example, while very effective for seizures, has the potential to cause TWO (not one, but TWO) great ways to die: severe liver failure and/or destruction of your bone marrow.

Yet, human nature is such that most people would prefer Felbatol, figuring the risk of death is preferable to that of turning blue. After all, death generally isn't socially embarrassing. We ALL die. But blue skin? That's just not fashionable.

Unfortunately, GSK (the drug's manufacturer) is likely going to see this as a drawback to Potiga. They'll tell their sales reps to minimize it and move on to something else. Or mumble "and they might turn blue" hurriedly under their breath.

The truth is they should turn it around, and make it a strength of their spiel. The best way to do this, as I see it, would be to go after some commercial tie-ins.

I've compiled a few modest examples:


Live theater:

Potiga is a proud sponsor of tonight's appearance by:

Blue Man Group

1960's psychedelic movies:

United Artists

To treat seizures, All You Need is Love. And Potiga.

1970's psychedelic movies:

Paramount Pictures

"Violet Beauregarde has been seizure free on Potiga. Next month she'll be endorsing juicers, too."

2000's movies:

Twentieth Century Fox

Potiga for epilepsy: It's out of this world!

2000's remakes of 1970's psychedelic movies:

Warner Brothers

Potiga is now available as chewing gum for your patients who won't swallow pills. Violet Beauregarde set a world record with it!

Music acts:

Atlantic Records

"We're both proud to be on Potiga. Otherwise we wouldn't be able to drive as safely as we do."

Historical tie-ins:

Bunker Hill: Would history be different if British officers had given their men Potiga beforehand?

Using it as an excuse...

ABC television

"No, officer, he wasn't into that sort of thing. He's that color from taking Potiga."

Currently Potiga is only approved for ages 18 and up. But maybe it will work in kids. If that happens, GSK is fortunate to have a wide range of endorsers to choose from!

Dupuis Cartoons

Shaky Smurf, Seizey Smurf, Ictal Smurf, and Aurette are all doing great on Potiga! If it's right for Papa Smurf, isn't it right for your child?

And, of course, who could forget

Sesame Street

New Potiga powder! You can sprinkle it on all your child's favorite foods! EVEN COOKIES!!!

Thank you, SMOD, for bringing this to my attention!

Tuesday guest post

Today I'm honored to have a contribution from everyone's favorite man-on-the-beat, Officer Cynical!


Today I tried to stop a woman with a revoked license. We went 10 blocks with my lights and siren going, and she acted like I wasn't there.

She finally pulled into her driveway, and rolled down her window. The alcohol fumes rolling out of the passenger compartment were almost visible. She said she'd taken "some pain pills and a few muscle relaxants and maybe some other stuff" on top of it.

I arrested her and headed downtown. On the way to jail, she said she had to go to the hospital because "the left half of my brain is numb." So, to be safe, I took her to ER.

I told the ER doc what she said, and he responded (with a straight face), "Well, that doesn't sound right". He agreed with me that it was more likely the whole brain - not just the left half - that was numb.

He went out to my squad car in the ambulance port and told her, "When whatever you're on clears, if your brain is still numb you can come back." Then he signed off on the jail clearance and we left.

Outstanding.

Memories...

Years ago, Freebase Pharmaceuticals assigned a pretty blond sales rep to my office. Like most reps, she scheduled lunches with us here and there.

One lunch, in spite of the fact that Pissy and I, and our staffs, were there, she decided to try to increase sales by aggressively coming on to me. Asking questions like:


"Does your wife ever travel and leave you alone?"

"I live on the north side. Let me give you my number,  in case you're ever in that area."

"I have a meeting near here this Saturday. Any chance you'll be at your office that day?"


The highlight, however, was what she didn't know.

This was at a time when Mary was out on maternity leave. And filling in for her was Mrs. Grumpy.

Who was sitting directly behind Miss Hooters (who she figured was just the secretary).

So, while Miss Hooters was discussing her pharmaceutical wares and underwares, my wife didn't say a word. She just made faces at me over Miss Hooter's shoulder, occasionally holding up bunny ears behind the rep's head, or the finger, or her sandwich, or whatever office supplies were within reach.

Pissy, who had the same view of the show as I did, pretended to have a coughing fit to keep from laughing, and ran out.

"Dude, does this mean I have to roll my own?"

Actual CNN headline from April 26, 2013:

Dear OBG Management,

A colleague recently sent me a cover shot of this recent issue:

It looks pretty generic on the surface. Just another medical journal. But then you look closer.

A story on surgical robots? Fine. A story about vibrators? Okay. BUT DID YOU REALLY HAVE TO JUXTAPOSE THEM LIKE THIS?

Better living through machinery

I mean, in this sense it looks like an ad for a 1950's horror flick about giant vibrators from outer space, that arrive on Earth pretending to be friendly.

 

Of course, while we're on the topic of juvenile humor, I also noticed this headline in the top right corner:

Thank you, ER's Mom!

I'm stumped

Okay, people, time to see how good you are at being armchair neurologists.

This is an unusually challenging case I saw yesterday, involving a 54 year-old lady. Her internist had referred her to me because of  some recent changes in her vision. The following is quoted verbatim from my chart note:


"She has 2 glasses prescriptions, one for near and another for distance. 1 month ago she had an annual optometry check-up, and was told she needed a new near-vision prescription. She ordered the new glasses, and picked them up last week.

Since then she finds that when she puts on the new glasses things look “funny and unclear.” This resolves with taking them off, and doesn’t occur with the distance-glasses on, or using her previous prescription."


This case really has me stumped. So if any you are able to figure out what the problem is, please write in.

Mary's desk, April 23, 2013

Guy walks in, stands at counter.

Mary: "Hi, can I help you?"

Guy: "Yeah, I want to know if I need an MRI?"

Mary: "Let me look up your chart. When did you see Dr. Grumpy?"

Guy: "I've never seen him. I just want to know if I need an MRI?"

Mary: "I really can't say, sir. I'm not a doctor, but..."

Guy: "I have this neck pain, and my right hand feels numb. So does that need an MRI?"

Mary: "...but I can set you up with an appointment to see the doctor to discuss this. We have an opening Thursday afternoon at 2:30."

Guy: "I don't want to come in. I just want to know if I need an MRI, and if so, to get one."

Mary: "I can't answer that, sir, and the doctor would need to evaluate you before deciding what's needed."

Guy: "You people are just in it for the money."

Leaves and slams door.

Sleep deprivation

I couldn't sleep, so finally gave up and went to the hospital to see a consult that had come in during the night.

I sat at the nurses station and called up the CT scan on a computer. It looked like a stroke, but the dictation wasn't transcribed yet. So I dialed the radiologist covering nights.

Dr. Radar: "This is Dr. Radar."

Dr. Grumpy: "Hi, Mike. Can you look at the scan on Mrs. Platelet? It looks like she has a right frontal stroke."

Dr. Radar: "Hang on... No, that's not a stroke. That's volume averaging artifact."

Dr. Grumpy: "Really? It looks like a stroke."

Dr. Radar: "No, definitely volume averaging."

Dr. Grumpy: "Okay, thanks."

I hung up and was a bit surprised. I began writing a note, when a nurse came over to tell me Dr. Radar had just called back looking for me.

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

Dr. Radar: "Yeah, it's me again. Did you say right or left?"

Dr. Grumpy: "Right."

Dr. Radar: "Oh, sorry. The left is artifact. On the right, that's a stroke. Big one, too."

Prize giveaway!

Congratulations, sir! You've won a free clipboard!

Now, we at the Grumpy Neurological Emporium are pretty protective of our office supplies. It's been 4 years since drug reps were allowed to give us bountiful gifts of pens and post-it notes. But, in some cases, an exception should be made, and you, sir, are the lucky recipient of our benevolence.

Even in this digital age, every practice has paperwork. Usually it involves an info sheet with your contact information. You fill it out on a first visit, and maybe once a year after that. Mary hands you the clipboard and form when you come in.

Most people sit in the waiting room and fill them out while she copies their insurance card.

Why you decided to take it in the bathroom with you, I have no idea. But it was blank when you went in, and completely filled out when you exited 10 minutes later.

You can keep the pen, too.

Sunday reruns

One of my favorite patient quotes:

"I was on my way to my girlfriend's place and did some meth in the car because if I waited till I got there she and her roommate might use it all. But there was something wrong with it and I began shaking, and got real dizzy, and then began puking all over the steering wheel. Then my vision got blurry and I couldn't see the road very well, and I was afraid to pull over cause then a cop might come try to help me, and I'd be in deep shit, so to be safe I started driving as fast as I could to get to the nearest emergency room."

Theater

Mrs. Drama: "I apologize for being late. It's been an awful day. I lost my son this morning."

Dr. Grumpy: "Oh, that's terrible. I'm so sorry."

Mrs. Drama: "It's okay. We eventually found him playing games at the arcade."

Games and players

Recently, some of you may have seen ads for "Fresh & Sexy," a new product on the market with somewhat provocative ads. Basically, they're "intimate wipes," to be used for frantically wiping off your naughty bits in situations where you're filthy, and desperately need to clean up before getting laid.

Now, I personally have to question the need for this product, at least in civilized societies. The majority of us bathe regularly, and hopefully don't need such items. A friend of mine commented that if she were "in a situation where I was that disgustingly filthy, like a long camping trip away from water, I'm pretty sure I wouldn't have the wipes with me. Or be near a store where I could buy them." By the same token, societies where regular bathing is rare are unlikely to carry "Fresh & Sexy" in local stores.

There's also the point that people have been banging each other for roughly 2 million years, of which only the last 100 or so have seen regular washing. So filth, and the absence of "intimate wipes," has never stopped them for >99.9% of human history.

But this is modern marketing. Necessity is no longer the mother of invention. Nowadays, instead of making a product that people actually need, it's easier to make a product, then convince people they need it. It's how P. T. Barnum got rich.

The same trend is in pharmaceuticals. There are a lot of drugs that are legitimately useful, but some companies try to create drugs we don't need, then hope to convince us we do.

Let's take the fictitious drug Ophelicia, which is an overpriced knock-off of a cheap generic, polonicoxib.
 
R&G pharmaceuticals (the original manufacturer of both) knows their aging drug has been used off-label* for a boatload of stuff, and its profitable patent life is running out. So they're sinking research dollars into getting more indications for it, rather than, say, a new drug that might benefit people.
 
Sometimes you get a REALLY painful hangnail. It hurts more if you accidentally bang your finger on something, you can't pick your nose with it, and start screaming if Purell or salsa get on it.

There are MANY dirt-cheap generic drugs, such as polonicoxib, that can be used for a hangnail, all reasonably effective.

R&G, smelling a market opening, sinks a few hundred million bucks into getting Ophelicia OFFICIALLY FDA APPROVED for hangnail pain. Granted, their data didn't show it was any more effective than the 20 cheap generics out there, but now their sales reps can proudly say "We are the ONLY drug with an FDA approval for this debilitating condition."

Unfortunately, there aren't enough people with painful hangnails to make this indication financially worthwhile. Besides, any insurance company will force you to try 5 cheap generics before they'll let you think about prescribing Ophelicia and it's $20/day price tag (I agree with them).

BUT it adds to the razzle-dazzle. Your average doctor will figure it has so many indications for pain, it must be good for anything, and grab it off the shelf without trying a generic. It's much easier to hand someone a bottle of samples than it is to write a script (R&G knows this. Why do you think the companies give away all those samples?). If the patient is hooked, maybe they'll pay for it. Or the doctor will find it easier to have her staff fill out a pre-authorization form than call in for some cheap polonicoxib. After all, it's not her problem.

This gets back to the need for intimate wipes: Is it really there in modern societies? Probably not. But there isn't a need for a drug that's specifically indicated for hangnail pain, either. It's the game, and R&G and their competitors are simply players looking for an edge.

The key to selling is marketing, and the gold standard of marketing is making people think they need something that they don't.


*Prescribing it for something other than what the official FDA rules say you should use it for. This is very common. Odds are that you've taken something off-label.

Dear Kids,

As the weather warms up, I think it's great the 3 of you want to walk home together after school. It's about 2 miles, certainly nothing awful, and gets you home sooner than riding the bus, or waiting for me to finish at work, would.

I also think it's good you guys want to get some exercise now that the snow has gone.

BUT

Stopping about 1/3 of the way home at Kwik-E-Mart to get "snacks" of chili-dogs, candy, and slushees, then hanging out with friends there and calling me to come get you, is sort of defeating the whole idea.

I bet the Powerpoint can cure insomnia

A friend of mine does consulting work for the FDA. Recently she was invited to this meeting:

"I can't wait to go! The excitement is killing me!"

I couldn't do it. I am SO not the meeting type.

Memories...

One of the other residents in my neurology program was a nurse in her previous life. As a result, she moonlighted with a nursing registry at different hospitals, and made far more money than the rest of us starving residents combined.

So one night, when I was on call, I was woken at around 2:00 a.m. by a page from the ICU.


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

Dr. Violet: "Hi, Ibee. I need an order for Tylenol on Mr. Stroke. He spiked a fever."

Dr. Grumpy: "Peggy, is this you? What's going on?"

Dr. Violet: "He has a fever. The resident taking care of him didn't write a Tylenol order before they left."

Dr. Grumpy: "His resident is... HEY! He's your patient! You signed him out to me before you left."

Dr. Violet: "Uh... yeah."

Dr. Grumpy: "Why are you calling me, anyway? Why don't you order it?"

Dr. Violet: "I'm his nurse tonight, not his doctor. I have to page the resident on call, which is you."

Dr. Grumpy: "Am I on Candid Camera?"

Letting it all out

WHY? WHY? WHY?

Dr. Grumpy: "Are you right or left handed?"

Mr. Whack: "I write with my left, but masturbate with my right."

Phone calls

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

Mrs. Coordinate: "I'm calling to update my address, you have the wrong one."

Mary: "Okay, let me look this up... I show you as living at 42 N. Fred Gwynne Drive."

Mrs. Coordinate: "Yes, that's correct."

Mary: "All right, so it looks like we do have the right one."

Mrs. Coordinate: "NO, you DO NOT have the right one. Otherwise I wouldn't have gotten this bill with the wrong address on it!"

Mary: "But how did you get the bill if it had the wrong address on it?"

(pause)

Mrs. Coordinate: "I guess you do have the right address. Never mind."

(click)

Great moments in research

For whatever reason, Dr. Brian Mautz of Canberra decided to research penis size in the homo sapiens male, and how it relates to other body features.

I suppose there are a lot of oddball studies out there. Competition to get published is stiff, so you need eye-catching hard data to penetrate journals.

But this upstanding one just gave me the giggles.

It was published in the Proceedings of the National Academy of Sciences, better known by the acronym PNAS.

Dr. Mautz's co-authors included Drs. Wong and Peters, of Melbourne.

And, inevitably, Dr. Peters' first name is........ Richard.

Thank you, SMOD!

DANGER! DANGER, WILL ROBINSON!

EVERYTHING in medicine comes with a little packet of paper that tells you what it is, what it's for, how dangerous it is, and how to handle emergencies it might cause.

Bizarrely enough, this includes the most common liquid on planet Earth: water.

Yes water.

And this is the actual warning label that comes with water:

 

So, as per the last paragraphs, let's keep these important points in mind:

1.  If you accidentally get water in your eyes, IMMEDIATELY flush them with more water for 15 minutes.

2. If you accidentally drink water, induce vomiting.

3. If you get water on your skin, wash it off with soap and water.

4. If the water catches fire, extinguish it immediately with something "appropriate."

5. And always call poison control if you drink water! It says so!

Thank you, Webhill!

Whatever

Mrs. Adenoca: "I want you to know, right now, that I won't take any medications. I don't believe in your pills. I'm an intelligent woman, and I do a lot of research on my own. Every drug you use has the potential to cause cancer, and I know you doctors lie and say they don't. I'm smarter than that, and refuse to take anything that could do that to me."

Dr. Grumpy: "Didn't you tell me earlier that you smoke?"

Mrs. Adenoca: "Yes, 2 packs a day."

Dr. Grumpy: "And you don't think that causes cancer?"

Mrs. Adenoca: "You guys lie about that, too."

Neurology made ridiculously simple

Uh, where you fix a Prius?

Thank you, Jennifer!

Wednesday

Dr. Grumpy: "Have a seat, Mr. Needsglasses. Boy, I haven't seen you in about 10 years."

Mr. Needsglasses: "Wow. That long? I can't believe it."

Dr. Grumpy: "Yeah, it looks like you were last here in 2003."

Mr. Needsglasses: "Had no idea. 10 years. Boy, doc, you haven't aged well. You look awful."

Today's contest

A marketing rep dropped off a booklet today, featuring better living through a company's various gadgets. Normally it wouldn't get my attention, but with this picture it was hard not to stare.

So, let's all try to think of some creative captions. Here's a few to get started:

"Yes, nothing makes you smile like matching his & hers pelvic floor stimulators."

"Crank it up and we'll REALLY start swinging."

"These go to eleven."

It's fun to stay at the A.N.Z.C.A!

Next month, for those of you who don't follow meetings outside your own hemisphere, is the annual Australian & New Zealand College of Anaesthetists convention. This year it's being held in Melbourne.

Normally I don't pay attention to ANY meetings. Not even the ones in my own specialty, let alone someone elses' on the other side of the International Date Line. But my reader Rebecca (thank you, Rebecca!) brought this one to my attention.

All these meetings are composed of various lectures and workshops you sign up for, and this one is no different. Here's a sampling of the exciting courses available:

  

If anything sounds more stimulating than a course on coagulation management, I don't know what it is. Oh wait, I do. A can of Diet Coke.

But if you scroll farther down the list, there IS a stimulating course:

Of course, caffeine isn't the only thing you can learn about at the meeting. If your anaesthesia machine (the one that goes "ping!") is all tuned up, why not work on...

After that course, a few cups of coffee, and a bathroom break you'll be ready to move on to...

After a long day of such interesting meetings you've done all sorts of things, but on the way out of the building you discover the elevator has no windows and no doors, which offers you this chilling challenge: to find a way out!

Of course, there's always my way...

Annie's Desk

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

Mr. Lombardi: "Hi, I see Dr. Grumpy for my seizures, and he increased my Nomoshakin dose last week."

Annie: "Okay, let me look up your note."

Mr. Lombardi: "Anyway, yesterday I was playing football with my buddies, and one of them stepped on my left hand, really hard. Today that wrist hurts and is all swollen."

Annie: "Did you have a seizure?"

Mr. Lombardi: "No, but do you think the wrist problem is from the medication increase? Because I didn't have it on lower doses."

Patient quote of the day

"I understand, but I don't understand. Do you understand?"

Mary's desk, March 27, 2013

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

Mrs. Khwarizmi: "Yeah, I'm driving all over, and can't find your office."

Mary: "Okay, we're in Medical Office Tower 6."

Mrs. Khwarizmi: "Yes! That's where I am! But there isn't one marked 6!"

Mary: "We're the building farthest to the east. There's a sign in front that says 'MOT 6'."

Mrs. Khwarizmi: "I must be in the wrong place. The only sign I see just says 'motvi'."

Mary: "Motvi? Wait... Okay, you ARE in the right place. The 'MOT' sign uses Roman numerals."

Mrs. Khwarizmi: "Roman numerals? Damnit, doesn't anyone speak English anymore?"