On the road again

(Guy walks in, stands at counter)

Mary: "Hi, can I help you?"

Mr. Distance: "I was referred to see Dr. Grumpy." (pulls out piece of paper, hands it to her)

Mary: "Okay, I can make an appointment for you. How about..."

Mr. Distance: "You mean you can't see me NOW?"

Mary: "No, today is full, but on Tuesday we have..."

Mr. Distance: "But I just drove over 200 miles to get here! You can see from the referral that I live in Waywest!"

Mary: "I'm sorry, but..."

Mr. Distance: "I saw Dr. Referral this morning, and she said that I should see Dr. Grumpy. So I decided to just come on over."

Mary: "Why didn't you call for an appointment?"

Mr. Distance: "I thought that would complicate things. Hey, can I use your bathroom?"

Clarification

I'm not sure what these guys want. Can anyone out there help me? They're pretty vague.

Thank you, Nos!

Hey, it's all your insurance will cover

Great medical ads:




Thank you, Jillian!

Thursday afternoon

Dr. Grumpy: "Are you allergic to anything?"

Mr. Anaerobe: "Chlorophyll, and all other oxygen producing substances."

Kissing up

About a month ago I had a pre-med student spend an afternoon with me. Actually, it wasn't even that. After 2 hours she looked liked she was bored out of her mind (I'd warned her about that, but she still wanted to come in) and left at 3:00, saying she was meeting a friend for lunch.

Anyway, I didn't hear from her again until yesterday, when this neatly typed note showed up in the mail:

Dear Dr. Grumpy,

Thank you for taking the time and allowing me to shadow you last month. I understand that having me there required a tremendous amount of time and effort, and I genuinely appreciate your support. My time with you was an unparallelled pleasure.

You are a great leader, humanitarian, and physician. I will always cherish the knowledge that you shared with me.

Yours truly,

Katie Brownnose



Dear Katie,

Thank you for your kind note. I'm sorry I wasn't able to keep you awake during your brief time here, but I warned you that office neurology, to an outsider, is less than exciting.

I'm glad you wrote, because I've been meaning to get in touch with you. Based on our brief time together I'm concerned you may have narcolepsy, and suggest you see a sleep specialist. If it would be easier, try to spend time with one (like you did with me) and they'll likely notice.

Thank you for your kind words. I've always considered myself a great leader here in my practice, but given that I'm solo this is easy. The real truth, though, is that Mary and Annie are in charge, and I just do what they tell me. If you become a doctor, you'll figure that out at some point.

I'm assuming that someday you'll hit me up for a letter of recommendation. Based on my interaction with you, I can certainly reassure them that you're neatly dressed, speak English when wide awake, and have 4 limbs, 1 head, and 2 eyes.

Yours truly,

Ibee Grumpy, M.D.


Actually, folks, I understand her note. I wrote my share of similar stuff back in the day, and now I realize even more so how awful it sounded.

My staff is awesome

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

Mrs. Memory: "Hi, I need to come back and see Dr. Grumpy."

Mary: "Um... Actually, you have an appointment today, at 1:45."

Mrs. Memory: "No I don't."

Mary: "You do, ma'am."

Mrs. Memory: "I most certainly do not. Otherwise I wouldn't be calling you. Now, as I was saying, I need to see Dr. Grumpy again."

Mary: "Okay, well, if you'd like to come in today we have an opening at 1:45?"

Mrs. Memory: "Oh, that works perfectly. I'll be there."

Mary: "Great! See you then."

Mrs. Memory: "Thank you for getting me in so quickly."

Dear Azilect,

Recently, one of my patients applied to your Azilect assistance program, to help those unable to afford a prescription for it.

She filled out the papers, got them together with her Azilect prescription and financial info, and I signed the forms and put them in the mail.

So, I was somewhat puzzled when she brought in this letter last week:

What's up with this? I mean, if the Azilect Patient Assistance Program DOESN'T provide Azilect, what do they provide? Oven mitts?

For future clarification you should consider renaming the program "Non-Assistance" or "No-Azilect Program."

Or, simply have it supply Azilect in the first place.

Yours truly,

Ibee Grumpy, M.D.

From the slushpile

Okay, it's time to hit the mailbag for more examples of artisan/artisanal junk you guys have sent in.

Again, this is not to make fun of tradesman who are genuinely working on handmade artisanal products. This is to highlight, as I have before, the many bullshit uses of the word being slapped on pretty much anything that's mass-produced, or grown (if it grows on a tree, you didn't make it), or other abuses of the word.

First, we have this:

I mean, it's SEAWEED for crap's sake. It grows in the ocean and washes up on the beach, making a rotten, smelly, mess. How is that artisanal?



What else is artisanal these days? Maybe something made in small quantities... Like hot dogs and their fluffy buns:

I'm pretty sure ANYTHING advertised on a roadside billboard isn't artisanal.

What about the security guard who drives around your neighborhood looking for suspicious characters, and calls your house when you set off the alarm while putting out the dog? Is he an artisan? Apparently so.

"So, Mr. Zimmerman. You say you're an artisan?"

Hopefully, having a good artisanal security system will bring you some peace of mind. But, if it doesn't I suppose you can always go buy it:

"Handcrafted tranquility is in aisle 4. Do you have a note from your doctor for that?"

Speaking of peace, have you been trying to find a nice place for Grandma? How about...

"What does artisanal mean? What does artisanal mean? What does..."

And, lastly, while the overuse of "artisan" certainly brings an uncertainty principle of what it means, I still have to respect it when it's tied to a good joke.

"Hey, what's this blue candy inside my baguette?"

Nigel? Is that you?

Back when my kids were younger, they loved the Toy Story stuff. Including the Evil Emperor Zurg:

So, it's no surprise that Frank had to have the Zurg Blaster gun, which fired green ping-pong balls.

Anyway, they're beyond that now, so recently we were getting together some old toys to donate to charity. On the side of the Zurg Blaster, I noticed this:

How awesome is that?

If you don't get it... I feel sorry for you.

Nitrogen, CO2, you name it.

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

Mr. Lung: "No, but I need to breathe during the test. There's air and oxygen and all for me in there, right?"

Modern crime

More valuable than gold. Rarer than platinum. More coveted than oil. Yes, the most prized substance on Earth is clearly...

Shortbread.

Yeah, you read that correctly.

I didn't think so either, but I'm not much of a shortbread fan. Honestly, I had no idea it was so valuable, until this morning.

This past weekend a daring group of Scottish thieves, in what would have easily been a crime to rival anything in Agatha Christie's works, attempted to steal £15,000 (that's $26,000, folks) worth of shortbread.

That better be some damn good baking. I mean, why the fuck would you steal shortbread? I'm pretty sure these 4 guys weren't planning on eating it (they'd have to be pretty hungry). Is there a huge black market for shortbread in Scotland? While I've encountered my share of seedy characters around my downtown office here in the states, I don't recall anyone in an alley saying "Pssst! You want to buy some shortbread?" and showing the inside of a jacket with cookies hanging off it.

Granted, I suppose it could have gold or diamonds in it, or be a baking operation as a front for Walter White, but... probably not.

Anyway. So, a bunch of guys stole a truck full of shortbread. Thankfully for civilization, however, their dastardly plot was foiled.* Not by Hercule Poirot or James Bond or Scotland Yard, either.

Their attempt to drive the stolen goods away failed because, instead of filling the fuel tank with the recommended diesel (they should have read the owner's manual) they used cleaning fluid.

Really.

How you get Windex mixed up with petroleum derivatives is beyond me, but they did. And thank heavens for it, or the economies of western Europe might have collapsed due to the shortbread shortage. Not only that, it probably saved these guys from dying while having cookies and diesel fuel that they mistook for milk.

Thank you, Webhill!

*The original article used the word "scuppered." That's a great word. Why can't American news outlets use cool words like that?

Memories...

Dr. Balboa was a cardiologist at my medical school. He was good at what he did.

Unfortunately, he also had a confrontational personality, short temper, and complete inability to back down from conflict. These are not good traits to have when you're just over 5 feet tall, slender, and have absolutely no training in Karate/Kung Fu/Krav Maga/whatever.

So, on a relatively frequent basis, the hospital ER docs were used to sewing him up for injuries sustained in bar fights, traffic altercations, or any number of minor arguments that he escalated to stupid levels.

One night, during my 4th year cardiology rotation, I was also covering an ER shift for a friend who needed to trade. And, of course, Dr. Balboa came in. He'd been at a sports bar and the waitress accidentally knocked over his drink. Rather than accepting a replacement, he decided to hash it out with the bouncer. Which is never a good idea.

Since the inner-city ER was swamped, he was stuck with having me sew him up (or wait a few hours for a real doctor, or go to another ER). Hey, it wasn't something I wanted to do either, but I was stuck.

So, while I'm trying my best to professionally put in stitches, he began telling me what I was doing wrong, grilling me about the patients on our cardiology service, pimping me on side effects and half-lives of various drugs, and arguing with no one in particular about how today's medical students weren't as tough as they used to be. None of which helped keep me focused on the job at hand.

After he was discharged, I went back to the staff lounge to get some coffee. The window there looked over the parking lot. As I watched, Dr. Balboa went out to his BMW and began arguing with a guy who'd set a Gatorade bottle on its roof.

Five minutes later he was back in triage with a broken wrist.

Verbiage

Back in the early, sexist, 80's, I had a teacher who'd say "writing should be like a girl's skirt: long enough to cover the subject, short enough to keep it interesting."

Now, times and expressions may have changed, but his point is still well-taken. This was driven home to me recently while reading an article about the effects of concussions on college football players.

I'd have to say the gentleman on the right nailed it:

Sunday night call check out

Dr. Grumpy: "Next one, in room 734 is Mr. Spin, admitted for severe vertigo. I think it's peripheral, but ordered an MRI and..."

Dr. Nerve: "What kind of vertigo?"

Dr. Grumpy: "Positional vertigo. It happens when he turns his head left."

Dr. Nerve: "Which of the semicircular vestibular canals is involved?"

Dr. Grumpy: "Are you serious?"

Dr. Nerve: "Yes. Which canal is involved? Superior, Horizontal, or Posterior? They taught you that in residency, didn't they?'

Dr. Grumpy: "I have no fucking clue. I had 29 consults this weekend, and breaking that down isn't going to change my management."

Dr. Nerve: "I think these things are important."

Dr. Grumpy: "I don't when I'm swamped. On call my main question is whether it's central or peripheral. You want more than that, call an ENT."

Dr. Nerve: "Personally, I examine them closely until I've localized the canal."

Dr. Grumpy: "You do that. He's in 734. The MRI is pending. The next patient is..."

Erev Independence Day

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

Ms. Triptan: "Hi, I need to get in to see him tomorrow. My headaches have gotten worse."

Mary: "We're closed tomorrow. It's a holiday."

Ms. Triptan: "But this is important. I'm really miserable, and need something done! Couldn't he meet me there? Just for a short while?"

Mary: "No, but we had a cancellation for today, at 4:15. He can see you this afternoon."

Ms. Triptan: "I can't do that, I'm going to the casino. It's Bonus Slots Thursday."

Help wanted

You need to have brain surgery. Wouldn't you want a surgeon who had experience in the field (as opposed to, say, removing ingrown toenails)?

Me, too.

So, this is an interesting job ad. A hospital is looking for an anesthesiologist. That's the person in charge of making sure you're deeply out when they cut you open, watches your vital signs to make sure you're not dying on the table, and then (hopefully) wakes you up after the surgeon has put you back together.

So shouldn't they want someone who'd previously done that a few times?

Apparently not:

Yes folks, you read that correctly. They want an anesthesiologist, but experience using anesthetic drugs and procedures is "preferred" though not, say, "necessary" or "required" or "a really good idea."

Let's look at it this way:


Astronaut wanted to fly large rocket full of highly explosive fuel at 17,000 miles per hour to International Space Station. Experience at operating rockets preferred.

Scientist needed to calculate origins of matter and to evaluate data relating to Higgs Boson. Experience with physics preferred.

Person needed to maintain nuclear warheads. Experience with handling lethally radioactive materials with potential to wipe out a city preferred.


Now, realistically, I'm aware it would be hard to become a board certified/eligible anesthesiologist without actually doing the procedures and giving drugs... but you never know. I trained with a guy who got through a 3 month surgical rotation without ever setting foot in the OR. And he passed.


Thank you, Jess!

Full service neurology

I'm between patients when Mary tells me a doctor is on hold.


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

Dr. Veoli: "Hi, this is Al Veoli, the pulmonologist across the street. We have a mutual patient, Don Epazil, who you're seeing for memory problems?"

Dr. Grumpy: "What's up?"

Dr. Veoli: "I'm not sure what to do here. I guess he was going to haul his clothes to the cleaners, but got the addresses mixed up. He took the bus here, and now he's out in the waiting room, trying to give bags of dirty duds to my staff."

Dr. Grumpy: "I'm sorry. His son lives with him, but is out of town this week. Tell him to come over here. I'll call his sister, who's handling this stuff."

Dr. Veoli: "He's showing stains to people in my lobby asking how to get them out. One nice lady is trying to give him pointers. I don't think she realizes what she's dealing with."

Dr. Grumpy: "Okay. Direct him here, and I'll give his family a ring."

Dr. Veoli: "Thanks. Sorry to bother you."

10 minutes later

Mary: "Hey, doc, Mr. Epazil is up front with 3 bags of dirty clothes. He says he was supposed to bring them here to have them done? Laundry WAS NOT in my job description."

Perspective

My daughter left her hairbrush on the kitchen counter last night.

That's not a big deal, but when I first walked into the kitchen, this is what I saw:

Sunday night, 11:23 p.m.

The following message was left on my office voice mail last night:

"Hello, I'm a patient of Dr. Grumpy's. It's Sunday night, about twenty minutes after 11:00, and I'd like someone to call me back. Thank you."

That's all. Never called back with anything more helpful, like a name or phone number.

Random weekend pictures

All right, time to hit the e-mail bag of stuff you guys have sent in.


First, this was taken at an art museum in Budapest (it's actually the name of the artist being featured).

"On your right is the Sheriff Jim Clark display, and in the next hall are Ernst Zündel's works"

Next, we have this. Apparently telling someone to "go pick up paper towels" at the store is no longer enough. I had no idea the world needed this many varieties. I mean, IT'S A FUCKING PAPER TOWEL!!!

7 varieties of paper towels. For this we evolved from microbes.

Then there's this massage company, who probably should have thought out their logo a bit more carefully:

"The pun sucks, too."

Speaking of interesting signs, I have no idea what this means:

"The counter lady yelled at me. Maybe they mean bitches."

The box makes it sound like they sing, dance, and perform theater:

"I'm trying to eat, and my fork keeps doing the Macarena."

Next is an ad for a group that does bio-identical hormones. The name sounds like they're all clones.

"Did you want to see Dr. Grumpy, Dr. Grumpy, or Dr. Grumpy?"

And last, I have no idea why this company couldn't come up with a better way to say "non-allergic pet food"

"Which end of Fluffy do we put it in?"

Great Public Service Announcements

Whirrrrrrrrrrrrrrrrrrrr

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

Mrs. Sikorski: "You saw my daughter yesterday? I was at the appointment if you recall, and you started her on Migrazap?"

Dr. Grumpy: "Yes, I remember. Is there a problem with the medication?"

Mrs. Sikorski: "No. I'm calling because she drove back to college today, and I don't think she's getting enough sleep."

Dr. Grumpy: "Well, the medication won't affect sleep, so it..."

Mrs. Sikorski: "That's not the issue. I need you to call her and discuss how important sleep is, because it's going to affect her grades. She also needs to study more."

Dr. Grumpy: "Well, that's not really my place. I mean, she's 21 years old, and away at college, and..."

Mrs. Sikorski: "Could you at least bring it up at her appointment next month? Also, can you say a few words about her current boyfriend? I don't think he's good for her."

Annie's desk

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

Mr. Valproate: "I want to know why the doctor won't refill my seizure meds!"

Annie: "Let me see... I don't show that we have a request for that. Did you call your pharmacy?"

Mr. Valproate: "Yes! They told me they've sent it to Dr. Intern 3 times, and all she does is say that she doesn't prescribe my seizure meds. So why won't Dr. Grumpy refill it?"

Annie: "Why are they sending it to Dr. Intern? Did you ask them to fax it to Dr. Grumpy?"

Mr. Valproate: "No. Am I supposed to?"

Memories...

As readers know, my roommate for all 4 years of medical school was a guy named Enzyme.

Enzyme was about 6'3" and maybe 190 lbs. He was calm, cool, and confident, the perfect model of the U.S. Navy officer that he is today. Handsome and a ladies man. He knew how splendid he looked in his uniform. He loved the military, and didn't let anything alarm him.

Until one night.

It was, maybe, around 2:00 a.m. I'd gone to bed at midnight after giving up on studying for the day, and was in a deep sleep.

While I slumbered, deeply napping, suddenly there came a tapping, as of someone gently rapping, rapping at my bedroom door.

Med student Grumpy: "Hello?"

Enzyme: "Ibee, are you awake?"

Grumpy: "I am NOW. What's up?"

(silence)

Grumpy: "Are you okay?"

Enzyme: "I... Need your help."

Grumpy: "It's 2:00 a.m. What's going on?"

(silence)

Grumpy: "Enzyme?"

Enzyme: "There's a spider in my room."

Grumpy: "What?!!!"

Enzyme: "I said there's a spider in my room."

Grumpy: "What the hell? So squash it and let me sleep."

(silence)

Grumpy: "Hello?"

Enzyme: "I'm scared of spiders."

It wasn't even that big, FFS.

"Are you shitting me?"

Awesomeness

For those of you who don't follow Twitter, I'm going to have to put this up.

My random observation was good. But WhiteCoat's response made it great:

Senior citizens behaving badly

A "Neurology Update" sent out recently by MDlinx. Hazards of leaving the "T" out...

Thank you, Gene!

Postage stamps

While waiting in line at the post office yesterday, I saw this stamp in a machine:

I had a brief thought about trying trying to ask for one at the counter:

"I need a great sparkled fraternity. I mean, a freight spanked fickle lilly. No, wait, a crate mangled fritterfrilly. No? A great teutonic titterwilly? Trait-specific hereditary? Um... fate frazzled hillbilly? Razzle-dazzled pickled lorrie?

"Fuck it. I need a 70-cent stamp."

How not to get an appointment

Mary: "Okay, Mr. Suidae. Now, let me give you some forms... here's a clipboard, and a pen... I'll need to get a copy of your insurance card. Any questions?"

Mr. Suidae: "Yeah, will you go down on me?"


And no, folks, he had no neurological reason to act like that.

Beware of the Dragon

Seen in a vascular ultrasound:

"We're gonna need a really big ultrasound machine."

For non-medical readers: It should have said "left lower extremity."

Thank you, Homebru!

12:07 a.m.

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

Miss Myelin: "Hi, I'm a Multiple Sclerosis patient of yours, and I wanted you to know I'm in the emergency room. The doctor here is probably going to call you."

Dr. Grumpy: "Okay... Why did you go to ER?"

Miss Myelin: "I lost vision in my left eye. I didn't want to bother you, so I came right in. I was worried that I should get it checked out."

Dr. Grumpy: "Sounds like you did the right thing. Has the doctor seen you yet?"

Miss Myelin: "No, but they just got me back here."

Dr. Grumpy: "When did you lose vision in your eye?"

Miss Myelin: "About a month ago."

Dr. Grumpy: "A MONTH AGO? Why didn't you call me?!!!"

Miss Myelin: "Like I said, I didn't want to bother you."

Dr. Grumpy: "Did you start the MS medication, the Tyglatfiderexa, that I prescribed 2 months ago?"

Miss Myelin: "No. I don't know why you gave me that. I informed you at the first visit that I won't take narcotics."

Dr. Grumpy: "It's not a narcotic! I told you that. It's for your immune system. Who said it was a narcotic?"

Miss Myelin: "This lady I met."

Dr. Grumpy: "Is she a doctor?"

Miss Myelin: "No, she's the cashier at Qwik-Mart. But I think her boyfriend's dad is."

Back from the trenches

Frank and Craig returned yesterday from 10 days at Camp Befouled, where they did outdoors type stuff with other guys in the forests of northstate.

To the horror of all (except the boys) we discovered they were wearing the same clothes they'd left our home in 10 days earlier. And, on looking through their bags, we discovered no dirty clothes at all. Just neatly folded shirts, underwear, socks, etc. So they'd been wearing the same outfits, day and night, for 10 days.

They didn't seem to have a problem with this, but on the drive home Mrs. Grumpy and I sure did. In the high humidity of a hot day we had no choice but to keep the windows down so we wouldn't die. If I'd thought to bring some twine I might have just put them on the roof rack for the ride.

Upon getting home, even the dogs didn't want to get close to them. When you smell so awful your dog isn't interested... That's really bad.

We immediately directed them to the shower closest to the garage.

Weekend reruns

Dr. Unka is in my office building. When he refers a patient to me, he often walks them upstairs to my office and waits with them up front (while his own waiting room backs up) until Mary has scheduled the patient. He often asks that I drop everything I'm doing to come meet his new referral, instead of just, say, having them call us to make an appointment.

So today Mary grabbed me to say Dr. Unka was up front, and wanted me to come meet a new patient. So I excused myself from my current patient and went up front, to see him standing there with a familiar, somewhat irritated-looking, older lady.


Dr. Unka: "Ibee, I'd like you to meet Mrs. Ancient. I'm referring her for memory loss."

Dr. Grumpy: "Uh, I saw Mrs. Ancient 3 weeks ago for that."

Mrs. Ancient (glaring at Dr. Unka): "I told you! Why didn't you listen to me?"

Dr. Unka: "She did?"

Mrs. Ancient: "Yes!"

Dr. Grumpy: "Yes, I sent you a note."

Dr. Unka: "You did?"

Mrs. Ancient: "Yes! He did! It was even in my chart at your office! I pointed it out to you!"

Dr. Unka: "You did? Um, I mean, then have her make a follow-up." (leaves my office).


So, in this situation, who REALLY needs to be seeing the neurologist?

Thursday afternoon

Dr. Grumpy: "Hello, sir, I'm Dr. Grumpy. Have a seat... so what can I do for you?"

Mr. Thebaine: "My life is a never-ending orgy of pain and misery."

Ma-Ma-Ma Bell

 Mrs. Dementia lives with her daughter. She's on the ball enough to remember that she doesn't like me because I took away her driver's license, but that's about it. Anyway...


Mrs. Dementia: "Hello?"

Mary: "Hi, Mrs. Dementia. This is Mary, from Dr. Grumpy's office."

Mrs. Dementia: "Hi, Mary. You have the wrong number. I don't live here anymore."

Mary: "Okay, well, I'm calling to remind you about your appointment tomorrow."

Mrs. Dementia: "I won't be able to go. My daughter's car isn't working, and can't be fixed. I can't go to doctor appointments anymore."

Mary: "Is your daughter there?"

Mrs Dementia: "No, she drove to the grocery store because we're out of bread."

Mary: "Can you have her call me when she gets home?"

Mrs. Dementia: "She doesn't live here anymore, either. I don't know when she'll be home."

Mary: "Okay, I'll just call back later, thank you."

Mrs. Dementia: "You can't. Our phone is broken, and no one has been able to reach us for days."

Mary: "Does your daughter have her cell phone with her?"

Mrs. Dementia: "That's broken, too. I think you have a wrong number."

Mary: "Okay. Thank you. I'll try..."

Mrs. Dementia: "Our phone is broken, so don't try to call back. The grocery man told us it can't be fixed."

Daughter (picks up extension): "Hello? This is Sue. Mom, who are you talking to?"

Mrs. Dementia: "I'm sorry Sue, I think you also have a wrong number."

Mary: "This is Mary, at Dr. Grumpy's office."

Mrs. Dementia: "Our phone is broken, and we can't hear you."

Sue: "Hi, Mary. Is this about tomorrow?"

Mary: "Yes, at 2:45.

Sue: "We'll be there."

Mrs. Dementia: "You both have a wrong number because the phone is broken. I didn't hear it ring."

Mary: "Thank you. See you then."

Decimal points. Use 'em.

Seen in a hospital chart:

Thank you, Kim!

Stop!... Shovel time!

 While catching up on reading last weekend I came across this in a medical journal:


"The goal of the project is to supply an interactive system that translates vast amounts of data and scientific literature into insights that professionals can consult to inform their treatment decisions.

"A database, in this case big data, provides the foundation for the potential to use state-of-the-art analytics to generate truly actionable insights."


WTF does that mean?

This is the problem with modern buzzword bullshit. It is, like Macbeth said, "full of sound and fury, signifying nothing." Yet, medical journals are full of similar crap that tells you zilch.

EHR today is the same way. 5-page notes that automatically fill in what medications someone is on, what their allergies are, what their blood pressure is... yet only rarely do you find anything comprehensible telling you what the physician's impression and plan are- WHICH IS THE MOST IMPORTANT PART OF THE NOTE. Usually it's hidden in the ICD numeric codes, and oftentimes the "plan" says something like "see orders database." Which doesn't help me at all.

Quantity has replaced quality in medical writing, and the problem shows no sign of getting better.

The above collection of horseshit, BTW, was from an article about epilepsy treatment.

Rorschach

This is a neuron. It's the basic nerve cell that runs your brain, my brain, pretty much everything's brain:

Sometimes it's hard to leave my job at the office. Work is always on my mind.

One night, when I got home, I found my kids had spilled something in the kitchen. And it reminded me of...

Sigh.

June 6, 1944

"There have only been a handful of days since the beginning of time on which the direction the world was taking has been changed in one 24-hour period by an act of man. June 6, 1944, was one of them.

"No one can tell the whole story of D-Day. Each of the 60,000 men who waded ashore that day knew a little part of the story too well. To them the landing looked like a catastrophe. Each knew a friend shot through the throat, shot through the knee. Each knew the first names of five hanging dead on the barbed wire offshore, three who lay unattended on the beach as the blood drained from the holes in their bodies. They knew whole tank crews who drowned when their tanks were unloaded in 20 feet of water.

"There were heroes here no one will ever know because they're dead. The heroism of others is known only to themselves.

"What the Americans and the British and the Canadians were trying to do was get back a whole continent that had been taken from its rightful owners. It was one of the most monumentally unselfish things one group of people ever did for another.

"It's hard for anyone who's been in a war to describe the terror of it to anyone who hasn't. How would anyone know that John Lacey died in that clump of weeds by the wagon path as he looked to his left towards Simpson and caught a bullet behind the ear? And if there had been a picture of it - and there weren't any - it would've shown that Lacey was the only one who carried apples for the guys in his raincoat pocket.

"If you think the world is rotten, go to the cemetery at Saint-Laurent-sur-Mer on the hill overlooking the beach. See what one group of men did for another, D-Day, June 6, 1944."

- Andrew Rooney (1919-2011)

Medicine by committee

I'm with a new patient.


Dr. Grumpy: "What did the MRI show?"

Mr. Triad: "I'm not sure, my other neurologist said..."

Dr. Grumpy: "Wait, you have another neurologist?"

Mr. Triad: "Actually, I have 2 others. I saw both of them earlier this week."

Dr. Grumpy: "Why are you seeing 3 different neurologists?"

Mr. Triad: "Well, it seems like a good idea. I mean, this way if I disagree with something one does I can call the other two, and see what the majority opinion is."

Dr. Grumpy: "Who are the other 2 neurologists?"

Mr. Triad: "I don't want any of you to know who the others are. I think that will help keep all of you impartial."

Long pause.

Dr. Grumpy: "Honestly, I'm really not comfortable with this situation. I can understand someone wanting a 2nd opinion, or even a 3rd, but to have 3 different neurologists trying to manage the same condition, ordering tests, and prescribing medications at the same time... I'm going to have to end this appointment. I won't charge you for it, but I just don't think this is a good idea, and don't want to be a part of it."

Mr. Triad: "You know, that's funny. My 5th cardiologist said the same thing yesterday."

Great deals on prions! This week only!

Dear Major Chrysler, Jeep, & Dodge,

A reader sent me your flyer about the recent Memorial Day car & truck sale.

I can only assume you don't have a lot of customers who are neurologists...

Methinks I smell a rat

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

Mr. Gad: "Hi, I saw Dr. Grumpy a few years ago, and am worried about my records there."

Annie: "What's the problem?"

Mr. Gad: "Well, I'm concerned they might affect a legal action I'm in, and would like to change them."

Annie: "We can't change records, sir. If you feel something is incorrect you can send us a letter and we'll note it in your chart, or you can make an appointment to discuss it further with the doctor."

Mr. Gad: "That won't do. I need you to change my diagnosis."

Annie: "We can't do that."

Mr. Gad: "Okay... How about if you shred my chart and destroy any scheduling records, bills, and whatever that says I was there? I'll pay you, in cash, for your time."

Annie: "I'm sorry, sir, but that's illegal, and we can't do that."

Mr. Gad: "Don't you believe in 'the customer is always right'?"

Annie: "That's not the issue here."

Mr. Gad: "Thanks for nothing." (hangs up)

Numbers

How much did your employer give to charity last year?

Contrary to popular belief, American doctors and hospitals give away free care quite often, to the tune of $74.9 billion for 2013. That, in case you don't understand numbers, is a fuck-ton of money. Let's look at the zeros: $74,900,000,000.

Of course, most of it isn't voluntary. There are a lot of uninsured people in America, and, whether you like it or not, you're still paying for them (and always have been, long before the current health policies). Even though they don't have insurance, that doesn't mean they won't get sick or injured and land in the hospital. There they'll likely need labs, tests, medications, supplies, and (of course) doctors and nurses. Since the amount of money charged for medical services are realistically beyond what most can pay, the doctors and hospitals have no choice but to write them off as losses. So you pay for them by higher insurance rates (I've addressed this before).

But the office is a different matter. Most doctors, including me, collect payment up front. Maybe not the full amount, but we copy your insurance card and charge your $50 co-pay (or whatever) before seeing you. The rest we'll bill to your insurance company. For the record, I don't like billing people before their appointment, but it's amazing how many people have "forgotten" their wallet if you try to collect after the visit. Me and my staff have families to support, too.

My point here is that office care generally isn't free, unless previously arranged. To make an appointment you have to have insurance (or agree with our cash prices). Before you even get seen we copy your insurance card and charge you for your share.

Like most doctors, though, I still see the occasional uninsured patient for free. Sometimes as a courtesy to someone else, sometimes because I genuinely feel bad for someone and am trying to help. Most doctors do.

So how much free office care are U.S. doctors voluntarily giving up? Well, for 2013 it was $10.5 billion. $10,500,000,000. I'd still call that a shitload of money (shitload < fuck-ton).

For comparison, let's look at America's biggest retail company: Walmart. According to their own website, last year they gave away roughly $1 billion in cash and merchandise to various charities.

That's a lot, but it's not even 10% of the amount that doctors like me provided. Sam, you're a cheap-wad compared to us (but I love the way your shoppers dress).

Keep that in mind next time you hear some politician or "patient activist" talking about how doctors are all greedy bastards who don't really care about people. Maybe you should ask that person what they gave up to help others.

Odds are they don't have a 6-figure educational loan hanging over their fat heads, either.

Random weekend pictures

Okay, time to hit the mailbag for images you guys have sent in.


First, we have this delectable name for an alcoholic beverage:

If you can't make out the back bumper, it looks like "Drink Responsibly. Don't be an ass."



Next we have this name for a WiFi network:

The person who sent it in says she was on a street between a hardware store a nursing home. I'm not going to even try to guess.



Then there's this ad. Given the common slang definition of "dump" it doesn't sound like ANYTHING I'd ever want to eat, no matter what's really in it.

"I am NOT baking anything I just dumped."

Next, we have this strange command seen at a retail store:

"I'm tired of all this sex on TV. I keep falling off."

Mrs. Grumpy had me stop at Chipotle recently to pick up dinner, and I got this receipt:

Unfortunately, being a medical person, I erroneously read it as "Our guaiac rocks" and was (briefly) pretty horrified wondering what they're doing with guaiac in a restaurant.

Great reasons for referring a patient

"I get blurry vision when I watch TV. But only channel 7."

Head job

Recently, the Cefaly gadget was introduced. It's an electrical headband being promoted to treat migraines.

I'm not here to knock or praise it. I think the jury is still out, and have previously given my thoughts on the various electrical gadgets coming to market.

However, I can't help but notice there are a lot of promotional pics out there showing women (none of whom look anything like my patients) using this product:

"Do I look blissful enough? Is the Dalai Lama here yet?"

"The card you're holding is the 3 of hearts"

"Isn't this more artistic than touching my temples?"

OR

"The bells! The bells! They torment me!"

"Mine is blue. It matches my shoes. And that's all I'm wearing."

 

Anyway, after looking at these, I think they missed a chance to REALLY boost sales by putting a star in the middle. You know, something like this...

"The batteries are in the bracelets. They also deflect bullets."

Tangled

Annie: "Hey, Mr. Memory just called. Says he's still waiting for his Aricept refill?"

Dr. Grumpy: "Really? I thought I called it to DrugMart a few days ago."

Annie: "He says they never got it."

Dr. Grumpy: "Hang on... Here it is. Yeah, I called it in on Thursday."

Annie: "Let me call DrugMart."

(5 minutes later)

Dr. Grumpy: "What did DrugMart say?"

Annie: (sighs) "He picked it up yesterday."

The buzz

Eric

Last week Mrs. Grumpy bought a big jar of honey.

Yesterday morning we discovered one of the kids had put it in the freezer for no clear reason (and of course, no one admitted to it).

It had crystallized, so wouldn't go back to being a liquid easily. Since she didn't want to toss the whole thing, she scooped it into a pot and set it on the stove to liquify.

Then she got distracted with fighting kids, and forgot about it. So it boiled and went all over the stove and gave off a shitload of smoke. Which set off the smoke detectors, and then the fire alarm.

While the kids panicked like it was the apocalypse, I turned off the alarm, and she began cleaning the stove. The kitchen was filled with the sickeningly sweet smell of burning honey, so I sent the tribe to open the doors and windows and turn on ceiling fans.

Then suddenly the twins began screaming and running down the hall as, attracted by the smell, a bunch of bees came flying in. So I began killing them, and sent Frank to go close the doors.

He ran to get the front door, then yelled for me to come there. So I went up front and watched as a fire truck pulled into our driveway. Our alarm company had called them without even dialing the house to check.

I apologized to the guys, and explained what happened. I told them to ignore the twins, who by now had locked themselves in a bedroom and stuffed towels under the door to keep bees out, and were yelling out the window for the firemen to come help kill the bees. They laughed and drove off.

It took about 30 minutes to get rid of all the bees inside, but the smell was so strong we had to leave the windows open the rest of the day, during which time a bunch of them hovered menacingly outside the screens.

How was your weekend?

Memorial Day, 2014

Doris Miller was born in Waco, Texas, the 3rd of 4 boys. He worked on his father's farm until he was 19, when he joined the navy.

He signed up as a mess attendant, one of the few navy positions open to black men at the time, serving meals, cleaning, and doing other jobs. In January, 1940 he was assigned to the battleship West Virginia, where over the next year he was promoted to cook.

On the morning of December 7, 1941, The West Virginia was in Pearl Harbor. Miller had just finished serving breakfast and was starting to collect the officers' laundry for the day's washing. At 0757 the ship was struck by a torpedo from attacking Japanese planes.

Miller immediately ran to his battle station in the mid-ship anti-aircraft guns - only to find they'd been destroyed by a bomb. He took the initiative of going to the ship's central passageway, where he told any officer he could find that he was available for duty. The communications officer was looking for someone to help carry wounded men, and the 6'3", 200 pound Miller fit the bill.

They went to the bridge, where West Virginia's captain, Mervyn Bennion, lay dying outside from a large shrapnel wound. They carried him to a sheltered position. He refused to leave the bridge, continuing to give orders until he died.

Next, he was grabbed by 2 officers he routinely served meals to, and the 3 ran to an unmanned machine gun position. Miller had never operated the gun before, but learned quickly. Initially the officers planned to have him feed the ammunition belts to them, but while they were setting up he loaded a gun himself and started firing at planes.

The Japanese planes eventually left, with the West Virginia sinking to the bottom of the harbor 40 feet below. Parts of the ship were flooded, and Miller now set off to help the wounded. With portions of the deck covered in water and oil, he saved many lives by repeatedly carrying wounded men through the flooded areas to the dry quarterdeck, from where they could be taken ashore. When there was no more to do, he and the others finally left the ship.

A week later Miller was back at his usual mess job, this time on a heavy cruiser.

The initial roll of men who'd received commendations for their actions on December 7 didn't even have his name on it - just listing "an unnamed negro." It wasn't until March 12, 1942 that his identity became publicly known. In April, 1942 he was personally awarded the Navy Cross - the first African-American to be so decorated - by Admiral Nimitz himself. Nimitz wrote "this marks the first time in this conflict that such high tribute has been made in the Pacific Fleet to a member of his race, and I'm sure that the future will see others similarly honored for brave acts."

Miller's next assignment was the escort carrier Liscome Bay. On November 24, 1943 she was at the Battle of Makin Island. A Japanese torpedo detonated the ship's magazine, sinking her within minutes. Out of a crew of 916, only 262 men survived. Miller wasn't among them, and rests with his shipmates at the bottom of the Pacific.

He was 24 years old.

Thursday afternoon

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

Mrs. Time: "I need to make an appointment for Monday, May 26th."

Mary: "I'm sorry, but we're closed that day for Memorial Day. He can see you on Tuesday at..."

Mrs. Time: "That's not acceptable. Monday is the only day I can come in."

Mary: "I'm sorry, but we're going to be closed. It's a holiday."

Mrs. Time: "Well, then I'll meet him there. 10:00 in the morning should be okay. Tell him I'll be outside the building's western entrance."

Mary: "Ma'am, he's not going to come see you on a holiday. Do you have an emergency?"

Mrs. Time: "That's irrelevant. This is nonsense. Are you aware that it's violation of both state and federal law? Any doctor is legally obligated to see any patient whenever requested to do so."

Mary: "That's not true."

Mrs. Time: "I read it on the internet!"

Mary: "I'm not going to argue with you, ma'am."

Mrs. Time: "That's not acceptable, either."

Skool Nerse time

This is Mrs. Grumpy.

Now, I want to start by saying I'm glad no one was even slightly injured during yesterday's events, but I think this is a good time to review what happened, and how parents at Douglas C. Kenney Elementary School can learn from it. Even though there's only 2 weeks left in the school year, it's always important to go over basic safety.

As you all know by now, Mr. Ima Scumball robbed the convenience store across the street from the school yesterday morning, then (due to poor planning in not having a getaway car), unsuccessfully attempted to carjack a driver at gunpoint, then gave up and tried to escape on foot into the neighborhood. This all happened at about the same time classes were starting.

Obviously, this sort of activity is frowned upon by the Grumpyville Police, and so the area was quickly swarming with policemen, police cars, and a helicopter looking for Mr. Scumball.

Since there was a chance he'd try to get into the school to hide or take hostages, we were ordered to put the school on lockdown. So all gates were closed and locked, with no one allowed in or out. We even woke-up Elmer, our octogenarian security guard, from his morning nap.

Unfortunately, as always, the beginning of the school day is followed by stragglers who show up 10-15 minutes late, drop off their kids in front, and head to work. By the time they did yesterday, the gates were locked, and under lockdown protocol we aren't allowed to open them again until the all clear is sounded.

So, with policemen everywhere, more police cars arriving every moment to try and cordon off the area, and a helicopter hovering loudly overhead, it was reassuring to see so many parents doing the right thing: Dropping their kids off outside the locked gate and going to work.

Now, I personally don't leave my kids alone in an area where people with drawn firearms are chasing each other. Maybe I'm just overprotective that way. But it still seemed odd to me.

So, with your kids out there in the potential firing line, we can't let them in, either. Because that's the rule. We can't do anything to jeopardize the safety of the kids already inside the school. Calling on your cell phone as you drive away to say "Hi, the gate was locked and blocked off by a police car for some reason, please let Billy in." Isn't going to change anything.

I was particularly touched by some of the responses we got, when parents were told WHY the gate was locked:


"Really? Well, I still have to get to work."

"Wow. I hadn't heard it on the news. I'll go check again."

"I figured he was safe because there were cops everywhere."

 "Huh. Okay, call me if there's a problem."

"How long will he be out there? He had to pee when he got out of the car."

"Why can't you let him in? It's not like he's the robber. I can vouch for him."

"Oh, cool! Michael loves to play policeman! Will they let him help?"


Fortunately, Mr. Scumball was quickly caught hiding in someone's backyard, and we were able to let your kids in. However, I'd like to stress the key points here:

1. On the rare occasion the school gates are locked during the day, DON'T let your kid out of the car. It means something bad is happening.

2. Armed police everywhere is NOT a sign that the area is a good place for your kids.

3. The police are here to catch bad guys, not babysit your kids so you can go to work.

Thank you, and have a great summer.