Quote of the day

"Since my back injury I've had trouble going down. On stairs, I mean."

Foot, meet mouth

My 2:00 patient yesterday was obviously blind. She had the long white cane, and a guide dog. Mary filled out forms for her. She held onto my arm as I led her back to my office.


Dr. Grumpy: "So what can I do for you?"

Mrs. Two: "I was at the emergency room this weekend. I had a seizure on Sunday, and bit my tongue."

Dr. Grumpy: "Good heavens. Have you ever had a seizure before?"

Mrs. Two: "No. They told me I had another one in the ER after I got there."

Dr. Grumpy: "Where did the first one happen?"

Mrs. Two: "I was in the car."

Dr. Grumpy: "Were you driving?"

Pause.

Dr. Grumpy: "That was a really stupid question, wasn't it?"


She cracked up. It was a few minutes before we could start again.

Thump

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

Mrs. Phleb: "It's been 2 weeks, and I want to know what my labs showed. Nobody called me."

Annie: "Hmmm... I don't see any results in the system."

Mrs. Phleb: "Well, I took the order in. I don't know why they didn't send them to you."

Annie: "What lab did you go to?"

Mrs. Phleb: "The one in your building. I did exactly what Dr. Grumpy told me to do!"

Annie: "That's strange. Usually they're pretty reliable. Did you have the blood drawn right after your appointment?"

Mrs. Phleb: "What blood draw?"

Annie: "They didn't draw your blood? What exactly did you do?"

Mrs. Phleb: "What Dr. Grumpy told me! He handed me the order, and said to take it to the lab downstairs. I did that, and gave it to the girl at the counter. She set it aside to answer a phone call, and was talking to some lady about scheduling. So I left and went to lunch with Ed."

Annie: "You were supposed to wait for them to draw your blood. The lab order is just an order."

Mrs. Phleb: "Well, he should have explained that!"

Overheard in ER this weekend

Dr. Urgent: "What do you take for your asthma?"

Mr. Wheezy: "Methadone."

Sunday night call check-out

Dr. Grumpy: "Next is a lady in room 835 who I saw for diabetic neuropathy. I started her on Qualex, and..."

Dr. Brain: "Any exam findings?"

Dr. Grumpy: "No reflexes in the legs, and impaired pin & proprioception in the feet. I ordered some labs..."

Dr. Brain: "Proprioception? Don't you mean 'passive joint position sense'?"

Dr. Grumpy: "Okay. In room 753 is a guy who came in with an acute stroke..."

Dr. Brain: "Wait, this is important. You aren't answering my question. 'Passive joint position sense' is a much more relevant term, and you really should use it."

Dr. Grumpy: "Whatever. Anyway, the guy in 753 is weak on the right. I started him on Aspirin, and an MRI is pending. You'll need to..."

Dr. Brain: "So why do you say 'proprioception' ? The correct term should be 'passive joint position sense."

Dr. Grumpy: "Because it's shorter. In room 734 is a lady with seizures who..."

Thursday night phone message

"Hi, this is Austin, and I'm in the twin's class at Wingnut school. My Dad says he'll get me a new XBox game if I take a girl to the junior high dance, so can you please have Marie call me? Thank you."

Statistics

Rikki Phoneysmile, my least favorite drug rep, came by. I went up to sign for samples.


Rikki: "Now... just tap next to the pill strength you'd like, and sign here..."

Dr. Grumpy: "Okay." (signs off, hands iPad back).

Rikki: "Thank you, doctor. I'd like to leave you with this booklet about Dioxnyl to review..."

Dr. Grumpy: "You've left it with me before. You've been handing it out for over a year."

Rikki: "No, it's a new one. We recently discovered an error in that booklet, and it's now been corrected."

Dr. Grumpy: "What was wrong?"

Rikki: "On the efficacy graph we had the drug vs. placebo curves switched. So it made it look like the placebo was more effective than the drug."

Pause

Dr. Grumpy: (giggling) "Your company has been using a booklet erroneously showing your drug was worthless for over a year and no one realized it until now?"

Rikki: "Um, yes. Have a nice day." (drops booklet on desk, leaves)

Mary: "Did you ever notice that?"

Dr. Grumpy: "Hell no. But it's nice to know nobody else reads them, either."

Texting by voice

Marie's Wingnut School girls basketball team had their first win of the season yesterday, and Mrs. Grumpy sent me the results. So I was trying to get Siri to text "Yay!" back.

Yes, we are

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

Mrs. Chart: "Hi, I have an appointment next week, and I need you guys to get my records before then."

Mary: "Okay, but we can't get your records from other places. You need to contact them, and fax a release."

Mrs. Chart: "I've seen 3 other neurologists, and been admitted to 2 hospitals for my problems. I'd think you'd want to have their notes."

Mary: "Yes, the doctor would, but again, you'll need to contact them and have them send records. We can't get them without a release. You can come in here and sign one, or I can fax one to you."

Mrs. Chart: "I don't have time for that. I'm busy. You need to just call them yourself. You can tell them I told you to."

Mary: "Ma'am, it doesn't work that way. There are privacy laws and..."

Mrs. Chart: "Oh, you're one of those practices. Never mind."

Thursday afternoon

Dr. Grumpy: "How long have you been taking Fukitol?"

Mr. Vague: "Um, since I started it."

50 Shades of Neurology

Seen in a hospital chart:

Nudge, nudge, wink, wink, say no more!

We deliver

I needed to mail a chart to another office, which, for whatever reason, doesn't have a working fax this week. So on the way home yesterday I stopped at the post office.


Postal clerk: "That will be $5.21... Thank you. Where are you mailing this to, sir?"

Dr. Grumpy: "Lakeside Grumpyville, about 5 miles north of here, near Main & 28th street."

Postal clerk: "Under security precautions a package of this size cannot be put on a plane, so it will have to go by ground delivery with consequent delay. Will that be ok?"

Dr. Grumpy: "Um, yeah."

Memories...

The university where I went to medical school had a large indoor gym. All students were allowed to use it, but you had to show a student ID to get in. This is pretty standard.

What wasn't standard was Weather Guy.

To this day I don't know what his name was. He never wore a name tag. He was a pleasant, elderly fellow whose sole job was to sit there and check ID's before letting you into the gym.

I have no idea where the school found Weather Guy. For all I know he'd lived on the land when the school was started in 1868, and they built the gym around him and gave him a job. He was never NOT there. Weekends, nights, early mornings, holidays - I don't remember ever seeing anyone but Weather Guy working the gate. Neither did my roommate. Or professors who'd graduated from the school before I was born (the gym building, I believe, predated exercise). For all I know he lived at the entrance desk, and had a cot behind it.

But his most enduring feature was the one that gave him his name: a remarkable inability to discuss topics other than the weather. Nuclear war in progress? Let's talk about the weather. Super Bowl upset? Let's talk about the weather. Flaming car wreck outside the gym? Let's talk about the weather.

Now granted, a LOT of people ramble pointlessly about the weather. This is nothing new. What set Weather Guy apart was his lack of awareness for such.

In retrospect, I'd say he was fairly demented. It didn't take much effort to look at a plastic card and say "go on through." In fact, it would explain why he passed pretty much anyone with a plastic card, whether it was a student ID, credit card, drivers license, or Local Grocery rewards card.

So as you'd go through the line, he'd always say something like "It must be cold out there" or "it's a scorcher today." He'd say this regardless of season, so it was equally likely to be the dead of winter or blazing summer heat, and he'd have a 1-in-4 chance of being in the ballpark.

Of course, this sort of thing couldn't go ignored by college students.

There was a summer day when it was the typical hot & humid, with mosquitoes the size of dinner plates. I was in line behind a guy, and as he walked up Weather Guy guessed right and said "Gonna be a hot one."

This fellow, instead of saying the usual "uh-huh" and moving on, said "Actually a snowstorm just started. It's freezing!" And then went into the gym.

Weather Guy didn't bat an eyelash. As I came up to the counter and took out my ID, he said "It must be cold outside. I hear it's snowing."

On call, Sunday morning

 Overheard at the nurses station at 7:53 a.m.:

"So far we've had 2 try to escape, 3 wander out buck naked, a lady in DT's screaming about spiders, 4 calls to security, the lady in 17 smoking weed in the bathroom, the guy in 24 masturbating in the hallway, and it's not even fucking 8:00 yet."

Genetics

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

Mr. Flat: "My Dad was killed by a steamroller."

Wednesday afternoon

I'm at the nurses' station, writing a note. A cardiologist puts a chart next to me and sits down.


Dr. Snow: "Hi, Ibee."

Dr. Grumpy: "Oh, hi, Mike."

Dr. Snow: "You seeing the new guy with the stroke?"

Dr. Grumpy: "Yeah. Hey, how'd your family ski trip go?"

Dr. Snow: "We had to cut it short. My oldest son broke his leg on the second day."

Dr. Grumpy: "I'm sorry, is he okay?"

Dr. Snow: "Yeah, but he needed surgery. It was a compound fracture" (whips out iPhone) "See? There's the tibia sticking out below the knee, and this next one..."

Neurological nightmares

I have a pleasantly demented patient, Mrs. Tangle. She's very nice, but quite confused, and getting slowly worse. She's at an assisted living apartment.

Her husband died 2 years ago. They had a few old boxes in a closet that no one ever got around to unpacking. The family figured they were clothes, or pictures, or whatever. They were buried under blankets and photo albums and other stuff.

So a few days ago I got a call from the patient's son. He urgently needed to talk to me, and Annie told me that I needed to deal with this one personally. I trust her judgment when she says that. So I took the phone. At about the same time I picked him up, Mary said the police had just called wanting to talk to me about Mrs. Tangle, and were on another line.


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

Mr. Son: "I need to talk to you about Mom! She unpacked some old boxes in her closet!"

Dr. Grumpy: "Okay. What's the problem?"

Mr. Son: "We didn't know what was in them! We thought it was clothes or something!"

Dr. Grumpy: "And..?"

Mr. Son: "One had Dad's old gun, from when he was a policeman!"

Dr. Grumpy: "What! Is it loaded?"

Mr. Son: "I have no idea. The nursing home just called me! She's wandering around with it. She's not threatening anyone, but she's walking all over there waving a gun!"

Dr. Grumpy: "Has anyone tried to get it away from her?"

Mr. Son: "Um, I was hoping you would go over and do it."


I told him no, and grabbed the other line. It was the Grumpyville police, wanting to know just how mentally intact she was before they tried to reason with her.

Fortunately, the situation ended without incident. But when dealing with the aged, don't just assume that old box has harmless stuff in it. This isn't the first time I've had families tell me they've found previously unknown firearms hidden in a demented person's place. This was just the most potentially dangerous the situation got. I can only imagine what could have happened if instead of being pleasantly demented, Mrs. Tangle was paranoid/angry demented.

And yes, it was loaded.

Priorities

Brent writes in with this bit of drama from his practice:


Mr. Husband: "Can you make a house call for my wife? Her asthma is really bad, and she's having a tough time breathing. She won't go to ER, either."

Dr. Brent: "Just bring her to my office. I'll squeeze her in this afternoon."

Mr. Husband: Well, she's been coughing a lot. And, you know, she has that problem that when she coughs, she leaks urine. I can't have that in my truck."

Dr. Brent: "So bring her in her car."

Mr. Husband: "THE NEW BMW?!!! ARE YOU CRAZY???"

EHR: Making you look like an idiot

Okay...

Dr. Grumpy: "Let me order an MRI... Are you claustrophobic?"

Mrs. Orlok: "No. I lie in coffins routinely, and don't have a problem."

Dear Dr. Laser Surgery Scam,

Sorry I talked my patient out of letting you touch him. I understand you have to make a living, too. I know I hung up on you when you called to yell and threaten me yesterday, but, quite frankly, I don't give a shit.

My patient has pain in the right hand, which my EMG/NCV last week showed was simply carpal tunnel syndrome. I've scheduled him to see a hand surgeon in a few days.

I understand the MRI of his neck had a few disk bulges and all, which might cause hand pain. But, as is documented in the report and your own note, all those abnormalities are on the left. His symptoms are all on the right.

When he told me that you were insisting he have left-sided "laser neck surgery" for the right hand pain, I figured he'd simply misunderstood what you said, or maybe you'd read the MRI wrong. I do that myself here and there, and have to double check. Hell, I think everyone does.

But when he brought in your printed instructions, with some sort of bogus "referred dermatomal crossing" bullshit about how a pinched nerve on the left can cause "sympathetic allodynic crossover pain" and affect only the right... I told him to run away from you.

I also liked how your note specifically advised him against seeing me to discuss this, and instead recommended a neurologist you have "an affiliation" with. How much of the cut is he getting for being your partner in fraud? I can only assume you've been burned before by other outside docs (like me) telling patients the truth. The part of your note suggesting he not have an EMG/NCV "because it will only delay your pain relief" is a real piece of work. Heaven forbid someone should make the correct diagnosis and rob you of a case.

Your threat about not referring patients to me isn't particularly intimidating. You never have. Now I know why. I have nothing against surgeons. I refer patients to them (when needed) routinely. But I don't take that decision lightly, and keep a short list of surgeons I trust.

So, I don't feel particularly bad that I deprived you of a case. In fact, I hope I have the opportunity to do so again.

Yours truly,

Ibee Grumpy, M.D.

Why I love Mary

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

Ms. Tinfoil: "Hi, I need to see the doctor."

Mary: "Okay, we have an opening next Tuesday at..."

Ms. Tinfoil: "Does your office have WiFi?"

Mary: "No, we're a small practice and..."

Ms. Tinfoil: "That's good. My last neurologist was using WiFi to read my thoughts. He fired me when I told him I was reporting him to the police."

Mary: "Okay... What are you coming in for?"

Ms. Tinfoil: "I want someone to look at my MRI films. All the doctors say they're normal, but I know they work for the government. You can see the microtransistors they placed in my brain to use WiFi on me, and I need a neurologist who can see them, too."

Mary: "I'm not sure Dr. Grumpy is the kind of doctor you need..."

Ms. Tinfoil: "They put them there with special government-trained tics, that bit me and injected the receivers into my bloodstream."

Mary: "I'm sorry, you know, I completely forgot. Dr. Grumpy installed WiFi just last week, so people in the lobby could surf while waiting."

Ms. Tinfoil: "Oh shit, you're part of it, too!"

(click)

Why doctors drink

Mr. Badhair: "I'm here because I want to see an aneurysm specialist."

Dr. Grumpy: "Well, sir, I certainly can discuss them, but I'm a neurologist, not a neurosurgeon. So I can't claim to specialize in them."

Mr. Badhair: "Well, on your office website it says you do, and that you trained at UBS."

Dr. Grumpy: "Sir, I'm not an aneurysm specialist, I've never made that claim, and I didn't train at UBS. I went to BSU."

Mr. Badhair: "Liar! I can't believe you have the nerve to tell me that! I saw it on your site this morning!"

I call up my practice site and turn the iMac around.

Dr. Grumpy: "Sir, this is my site. It clearly says I went to BSU, and says nothing about aneurysms."

Mr. Badhair: "That's because you just changed it."

Dear WebCME,

I understand you're trying to do a medical education tie-in with Valentine's day, but perhaps next year you should stick with something a little less heartwarming:

Thank you, Tab!

Patient quote of the day

"I have to accept that I'm 40. That means I'm not 39 anymore."

Bwahahahaha

Dr. Grumpy: "Didn't you have a hysterectomy?"

Mrs. Giggle: "Yes, why do you ask?"

Dr. Grumpy: "Just to be safe. This medication can cause birth defects."

Mrs. Giggle: "Oh, that's not a problem. My birth defects are both in high school."

Great speech therapy reports

Life is a highway

Mr. Octane: "I need a note saying I had a doctor's appointment."

Dr. Grumpy: "Okay, for your job?"

Mr. Octane: "No, for the police."

Dr. Grumpy: "The police?"

Mr. Octane: "I got a speeding ticket on the way here."

Dr. Grumpy: "I don't write notes for that."

Mr. Octane: "If I hadn't been speeding I would have been late."

Dr. Grumpy: "You came in 15 minutes after your scheduled appointment time."

Mr. Octane: "Well, I would have been later."

Stating the obvious

Last year, for those of you who missed it, a large potato-chip company had a nationwide contest to come up with a new flavor.

So, although the contest is over, there are still some bags of chips announcing the results out there. Yesterday, at a Boy Scout meeting, some bags were opened and I noticed this on one. It showed the top 5 ingredient suggestions people had sent in for a new potato chip flavor:

I want to know how "potato" is the 2nd most popular ingredient suggestion. I mean, they're freakin' potato chips! While I like bacon, it's certainly not the first ingredient I think of if someone says "what should we use to make potato chips?"

And chocolate? Yeah, I know someone was selling chocolate covered potato chips over the holidays. But even chocolate has its limitations, and I'm not dipping it in ranch dressing or guacamole.

Ironic placement of a promoted tweet

CME har de har har

Patient Quote of the Day

"I have very little memory that I forgot that, whatever it was."

Tonight on National Geographic

These majestic creatures are some of the most faithful, devoted, servants a medical office will ever have. They endure daily burdens. They get twisted, tilted, leaned upon, smashed into desks and filing cabinets, and never complain about their lot in life.

Eventually, as happens to all things, their time comes to an end. Sometimes they tilt too far. Or stop rolling. Or dump their once-loyal masters one too many times.

And then, because no one seems to ever want to take them outside, or thinks that someday they'll have time to fix them, they go to their final, secretive, resting place:

This picture is a rare peek at the mysterious chair graveyard in the back of the Grumpy/Pissy medical compound. Every medical office, however, has one of these rooms. Every law office. Every office in general.

As the years go by they're joined by outdated computers, broken printers, seasonal decorations, telephones, and other aging items. Why we keep them is a mystery. Perhaps because no one wants to take them to the dumpster, or the recycling place. Or we're hoping the Smithsonian will call, needing one for their "Prehistoric Offices" display. Or we're simply afraid to toss them, with a strange belief that someday they'll magically fix or update themselves.

Anyone need a chair?

Attitude

Dr. Grumpy: "Also, since you had a seizure, you'll have to stop driving for 2 months."

Mrs. Imspecial: "That's ridiculous. My husband is a doctor."

Dr. Grumpy: "Yes, but that doesn't change anything. The law is pretty clear. No driving until you've been seizure-free for 60 days."

Mrs. Imspecial: "I'm married to a doctor. You work with him at the hospital. I'm sure there's some exemption you can get for me."

Dr. Grumpy: "No, there isn't. The only thing that matters here is that you had a seizure."

Mrs. Imspecial: "I'm very busy with our kids, and don't have time for such nonsense. My husband is a doctor."

Dr. Grumpy: "That doesn't place you above the law. Think about what would happen to the kids if you had a seizure while driving."

Mrs. Imspecial: "Don't play scare games with me. I'll have to get a second opinion. I can't believe he referred me to you. He's a doctor, you know."

Font issues

Dear Biogen,

Thank you for your Avonex demo pack.

In a recent nonscientific survey, 8 out of 11 people thought the C and L were a little too close together, and read the box somewhat differently.

Relevance

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

Mr. Heme: "My grandmother once had a blood clot in her nose. It was really gross, too. With snot and everything."

2:17 a.m.

My cell phone rings.


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

Officer Peel: "Hi, doctor, this is Officer Peel, of the Grumpyville police. Sorry to wake you."

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

Officer Peel: "Do you know a lady named Dee Mentia?"

Dr. Grumpy: "Yes, she's one of my patients. Actually, she's in Local Hospital at the moment, with pneumonia."

Officer Peel: "Yeah, she keeps calling 911 from her hospital room and says she's being held hostage in your basement."

Dr. Grumpy: "Oh my..." (starts laughing) "Do you need to come search my basement?"

Officer Peel: "Nah, but can you do something to stop her? The 911 operators are busy enough as it is."

Dr. Grumpy: "Will do, sorry."

Office Peel: "Thanks. Have a good night, doc."

Mary's desk

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

Mrs. Flush: "Hi, I have an appointment in 20 minutes with Dr. Grumpy, and won't be able to make it. My kid clogged the toilet, and it's backed up all over the floor. I have to stay here and wait for the emergency plumber."

Mary: "Okay, that's fine. Just call us when you have time to reschedule and..."

Mrs. Flush: "I will. Are you going to charge me for the last minute cancel? I can text you a picture if you need proof."

Seen in a hospital chart

Helluva long week.

Saturday afternoon

I'm on the weekend Costco run with Craig.


Mrs. Patient: "Hi, Dr. Grumpy!"

Dr. Grumpy: "Mrs. Patient. Good to see you. Stocking up here, too?"

Mrs. Patient: "Yes, me and my friend Cindy came over to get some things."

Cindy: "This is your neurologist?"

Mrs. Patient: "Yes, it's Dr. Grumpy."

Cindy: "Can you tell me about the vaccination schedule for cats? I was thinking of getting a kitten."

Mrs. Patient: "Dr. Grumpy only treats humans."

Cindy: "Well, he's still a doctor isn't he?"

Craig: "Dad, can I get a pizza sample?"

Dr. Grumpy: "Sure."

Cindy: "You're a doctor and you let your kids eat cheese?"

Mrs. Patient: "Cindy, shut up. I'm sorry, doctor."

It's the word!

Swedish marines stationed in Afghanistan re-enact the classic scene from Grease.

Yes, it did

Dr. Grumpy: "How have you been doing since the carpal tunnel surgery?"

Mr. Wrist: "Great! The numbness is gone. The surgeon you recommended did a great hand job! Uh, I mean, job on my hand. I, uh, oh shit, that sounded bad."

Mary's desk

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

Mrs. Troponin: "I need to make an appointment with Dr. Grumpy."

Mary: "Okay, we can see you next Thursday, at 10:00."

Mrs. Troponin: "That sounds great!"

Mary: "What will you be coming in for?"

Mrs. Troponin: "I'm having chest pain when I go up stairs, and my internist told me to see a cardiologist."

Mary: "Dr. Grumpy is a neurologist. He doesn't see this kind of thing."

Mrs. Troponin: "I know, but I can't find a cardiologist who takes my insurance and can get me in this week."

Mary: "Well, you'll have to call your internist about that... But Dr. Grumpy isn't what you're looking for. I'll cancel the appointment and..."

Mrs. Troponin: "How about if I say I'm coming in for foot numbness or something. Will he treat my chest pain then, if I just kind of mention it?"

Mary: "No. Call your internist."

Seen in a medical journal

This is an advertisement for:

A. The new James Bond flick? Did they fire Daniel Craig?

B. That hot new cologne, eu d'Charcot.

C. Boy, those leather scrubs are really sexy. Wish my neurologist looked like that.

D. The DocMatic electric shaver for when (like this guy) you spent the night on the doctors lounge couch.

E. The sequel to "Hysteria" showing Dr. Granville perfecting his invention.

F. An ultrasound machine? Really? Are you kidding me? An effing ultrasound machine?

The tube

Mr. Barone: "My symptoms all get worse around 8:30.”

Dr. Grumpy: "Didn't we talk about this at your last visit? I suggested taking your pills at 8:00, to see if that helped. Did you try it?"

Mr. Barone: "It doesn't work. I can't take them at 8:00.”

Dr. Grumpy: "Why not?"

Mr. Barone: "I'll miss the beginning of "Everybody Loves Raymond."

Weekend on call

On Saturday night I was at the nurses station, writing a note. A demented elderly man kept calling for his daughter, (who'd gone home for the night).


Patient: "Dana! Dana! Dana!"

Nurse: "Morris, Dana went home. She'll be back in the morning."

Patient: "Dana! Dana! Dana!"

Nurse: "Morris, Dana's not here. You're okay, and she'll be here again tomorrow."

Patient: "Dana! Dana! Dana!"

Nurse (in deep voice): "There is no Dana, only Zuul."

Overheard at the nurses station

"I'm so pissed. I paid $80 for this eyelash treatment, and it looks like I'm being attacked by tarantulas."

Dear Webmaster,

Thank you for your recent letter asking that I send $75 to remain in your online doctor directory. I'd put its name up here, but I'm not even going to give you the traffic.

Regrettably, I won't be sending you the $75, and really don't give care if you remove my name.

I'm sure this hurts your feelings, so I'd like to explain why I'm not sending you any money.

1. I never signed up for your directory in the first place. In fact, your letter asking me to renew was the first I'd heard of you.

2. Most companies take credit cards for payment. The fact that you only accept 2 methods of payment is a little alarming. One was for me to do a direct bank-to-bank transfer, and your letter included your bank name, account number, and routing information. This is not a typical way to pay for a medical listing.

3. The other way you accept payment is for me to send a cashier's check to an address in Bucharest, Romania. Nice try.

4. Your math was somewhat concerning, as the letter says that for $75 I get "1 year + 3 FREE months! That's 18 months for only $75." Granted, maybe you use a different calendar than I do.

5. You spelled "doctor" as "docter."

6. You didn't spell my name correctly. Or my street name for that matter. Or even my fucking city. This does not give me a lot of confidence in your ability to provide an accurate listing for my $75.

7. Lastly, as if the above weren't big enough concerns, I was still curious to look at the website listed on your letter. I was suitably impressed to see that it:

- Had nothing on it mentioning a doctor locating service.

- The first link featured said "MEET BEAUTIFUL RUSSIAN GIRLS!"

- The second link was for an online Viagra pharmacy (maybe useful if you click on the first link).

- The third link said "This domain name is for sale! Click here to buy it."

Yours truly,

Ibee Grumpy, M.D.

Mary's Desk, Tuesday afternoon

Mary: "So we can see you this Thursday at 4:00. What's your insurance?"

Mr. Ximénez: "Major Illness, Incorporated."

Mary: "Are you on their PPO or HMO plan?"

Mr. Ximénez: "PPO."

Mary: "And what's your birthday?"

Mr. Ximénez: "My, this is a lot of questions. I didn't expect the Spanish Inquisition!"


Sadly, she didn't get it, and asked me about it later.

"NOBODY..."

Queen Square

Dr. Grumpy: "Now I'm going to check your reflexes. Let me tap you with this rubber hammer..."

Miss Temmi: "My boyfriend has one of those hammers, and also taps on my knee reflexes with it."

Dr. Grumpy: "Oh, is he a doctor?"

Miss Temmi: "No, he says it turns him on."