Annie's desk

Phone person #1: "Thank you for calling Low-Cost Radiology, where our prices reflect our quality every day! Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #1: "What's a tax ID number? Is it how much we paid in taxes? Last year I paid..."

Annie: "No, it's the number your facility is assigned for tax and business purposes. The insurance companies need it so they can pay you for the MRI."

Phone person #1: "Is that the same as my social security number? I can give you that. It's 738..."

Annie: "No. It's the assigned..."

Phone person #1: "Let me transfer you."

 

On hold with a subdued piano & cello version of "Smells Like Teen Spirit."

 

Phone person #2: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #2: "Hmmm... Is that the number you just called to reach us?"

Annie: "No, that's your phone number. It's..."

Phone person #2: "Oh, is that like a special number the IRS calls us on?"

Annie: "No it's..."

Phone person #2: "Let me transfer you."

 

On hold with a subdued piano & cello version of "Safety Dance."

 

Phone person #3: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #3: "I don't think we have one."

Annie: "No, you do, every business has one, it's assigned to you before you open by the..."

Phone person #3: "Let me transfer you." 

On hold with a subdued piano & cello version of "Paint It Black."

 

Phone person #4: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #4: "Oh, hang on. Let me look that up for you. Hmmm. I thought I had it on a Post-It note somewhere... maybe it's behind the take-out menu for Blumenthal's Chinese... no, maybe it got stuck to the menu for the place we ordered lunch from on Monday, I can't remember the name though... that may be over by the fax machine with the Chipotle forms, hang on... you know, I may have accidentally thrown it out because a bunch of stuff got marinara sauce on it when I was eating yesterday... let me transfer you."

 

On hold with a subdued piano & cello version of "Girls Just Wanna Have Fun."

 

Phone person #5: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #5: "I hate you phishing scams. Fuck off."

click

Current status

Sir, if you don't stop tapping "Rock Lobster" out on my desk with your horribly untrimmed fingernails I am going to have to kill you with a Trömner.

Fore

Mr. Lewy was brought in by his son.

 

Dr. Grumpy: "So, what happened? I mean, I spoke to the police earlier, but want to..."

Son: "A neighbor called the police, Dad was chasing invisible people down the street, screaming at them and waving a golf club."

Mr. Lewy: "There were people all over the house! And in my yard! And they were having a party, and I told them to leave, and they wouldn't! So I told them to get out or I was going to clobber them, and when they didn't I chased them outside and down the street!"

Son: "The police calmed him down and searched the house and yard, there were no signs of anyone besides Dad. They also took away the golf club."

Mr. Lewy: "It wasn't just a golf club. It was a 3-wood. And I need it back before the tournament next week."

Son: "Dad, you aren't in a tournament next week."

Dr. Grumpy: "Okay, so..."

Son: "And it was a 9-iron, not a 3-wood."

Mr. Lewy: "I'm not that far gone. It was a 3-wood. Know your damn Callaways."

Dialing for dollars

Doing some marketing surveys for $ over the long holiday weekend.

They often include questions to see if you're paying attention, like this one:

Then there's this, asking me how many patients with a given condition I've seen in the last month:

The first choice (which I had to look up) is from a Roald Dahl book. It's a disease contracted by eating shoelaces that turns you into a rat. Although personally I think it would be much cooler if it turned you into a cassowary.

Then you get stuff that makes no sense whatsoever:

 

 

 

Or this one, which didn't give me any options in case this wasn't the case:

 

And lastly, in the middle of a survey on treatments for Alzheimer's disease, I encountered this question. I can only assume the survey writer had a personal interest in the topic.

Reality check

Yesterday I was on my way home from work when there was a loud noise and the Grumpymobile immediately veered right. I pulled into a side street to assess the damage:

 

Sigh.

So I dug out the spare and its gear and got started, jacking up the car, unbolting the shredded tire, tossing it in the trunk...

I'd just started rolling the spare around to the front when a crew from the Grumpyville fire department drove by. They pulled over and 4 guys piled out. One of them took the wrench out of my hand, another handed me a bottle of water. They bolted the spare on, lowered the car, and put all the stuff back in the trunk in what seemed like 15 seconds (maybe they were secretly an Indy pit crew).

As they piled back in their truck one of them said, "sir, it's pretty hot out, and a guy your age should know better than to do stuff like this."

Random pics

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

First, we have this, from a patient medication form:

 

I never thought of this product coming in different grades, and I really don't want to know what the difference is between "professional" and "amateur."

 

Next, in the way only Amazon can, we have this juxtaposition from their "you might also like" algorithm:

 

One reader is currently on an Alaskan cruise, and one night at dinner they were serving uh...

 

 

 

And lastly, the same reader saw this in a brochure on board. While I'm sure the award is well-deserved, I really don't want the details. I'm sure it involved being called at 2:00 a.m., was really disgusting, and had something to do with the all-you-can-eat buffet.

 

"Helluva diuresis, eh?"

One of my patients landed in the hospital overnight for mild pneumonia, and his wife asked me to look at the records to make sure there weren't any changes in his Parkinson's medications.

In the discharge summary I noticed this:

 

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)

I'm not following this

 Seen in a chart:

 

 

Quiz time

Okay, as required to maintain my hospital privileges (in addition to sending in a check) every 2 years I have to take mandatory online testing to make sure I can deal with situations at the hospital.

So, without further comment (that's your job, isn't it?) here are some of the questions I was asked, along with the answer options:

 

Here

LOOK, PEOPLE! JUST BECAUSE LADY GAGA IS ADVERTISING FOR A MEDICATION DOESN'T MEAN SHE'S GOING TO PAY FOR YOURS IF YOUR INSURANCE WON'T!

Waiting list

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

Ms. Frantic: "Hi! I really need to see a neurologist! All the ones at Massive Clinic are booked out to July, so I was hoping your office might have something sooner."

Mary: "Actually, you're in luck. We just had a cancellation for tomorrow, so Dr. Grumpy can see you at 10:00 in the morning if that works."

Ms. Frantic: "Dr. Grumpy has an opening for tomorrow?"

Mary: "Yes, would you like it?"

Ms. Frantic:" Um... no. Honestly, if your doctor isn't booked out, than he probably isn't very good. I'll just wait for July."

Detective stories

Did anyone else out there read "The Problem of Cell 13" by Jacques Futrelle?

I'm assuming I'm not the only one, as it was in the standard 6th-grade reading textbook my generic public school used in the early 1970's.

It was one of several early 1900's detective stories by Futrelle featuring his character Augustus S. F. X. Van Dusen (AKA The Thinking Machine), a reserved, brilliant, scientist who solved problems solely by logic (kind of a 1905 Mr. Spock). Almost 100 years later Van Dusen also appeared in the comic book series "The League of Extraordinary Gentlemen."

"The Problem of Cell 13" featured Van Dusen being voluntarily incarcerated in a high-security prison to prove that, by thinking, he could figure a way out and escape within a week - which he did. Probably Futrelle's most well-known story, it's since been adapted, both in whole and in part, several times for TV and radio. Most recently was in 2019 for an episode of the NBC TV series "The Blacklist."

For whatever reason it was a handful of stories I read growing up that I never forgot ("The Long Sheet" by William Sansom was another) and when the internet age dawned the story was long in the public domain and easy for me to find.

The writer, Jacques Futrelle started as a journalist. He began the sports section for the Atlanta Post, then was hired by the New York Herald where he covered the Spanish-American War. Afterwards he worked in Boston, then left journalism to become a full-time, and successful, detective writer.

His wife, Lily May Futrelle, was also a prominent author. She wrote for the Saturday Evening Post. Her first novel "The Secretary of Frivolous Affairs" was on the U.S. bestseller list from 1911 to 1915 and made into an early silent film (one of the first movies written by a woman).

Besides raising a son & daughter, and their separate writing careers, they collaborated on a Van Dusen story, "The Grinning God," in which she wrote the first half of the mystery to set the stage and he wrote the second half, with Van Dusen solving it.

They both did well as authors, allowing them to build a coastal home in Scituate, Massachusetts and enjoy the newfangled luxury of an automobile.

In early 1912 they left the kids with his parents and headed to Europe for 2-3 months to promote their books. The trip was successful, to the extent that they were given a complimentary first class suite by a shipping line for the journey home.

 

 

112 years ago tonight, the Futrelles stood together on the sloping decks of the Titanic.

Offered a chance to get in a lifeboat with her, he refused, and insisted the space be given to another woman.

After returning home, she wrote a 2-part piece on the disaster for the Boston Post, published on April 21-22:

 

"The last I saw of my husband he was standing beside Colonel Astor. He had a cigarette in his mouth. As I watched him, he lighted a match and held it in his cupped hands before his face. By its light I could see his eyes roam anxiously out over the water. Then he dropped his head toward his hands and lighted his cigarette. I saw Colonel Astor turn toward Jacques and a second later Jacques handed the colonel his cigarette box. The colonel screened Jacques' hands with his own, and their faces stood out together as the match flared at the cigarette tip. I know those hands never trembled. This was not an act of bravado. Both men must have realized that they must die."

 

His body was never recovered. He was 37.

Lily May never remarried. She raised their children, published her own novels, completed & published those Jacques hadn't, taught writing clinics, and hosted radio shows. In 1940 she spearheaded efforts to extend authors' copyrights for an additional 28 years, which was signed into law by President Roosevelt. She was given the pen that he used.

Every year, on the anniversary of the sinking, she walked from their home to the seafront to cast flowers in for Jacques.

She died in 1967.

Inside Job

A long time ago, when I was first starting out, I worked at a hospital that had only one MRI-compatible ventilator.

For my non-medical readers, a ventilator is the "breathing machine" that keeps you alive when your body needs a break, during surgery, etc.  Once you're better we take you off it. It's a very complicated gadget, with a fair amount of ferrous metal.

As a result, a standard ventilator can't go in an MRI. Since patients on one sometimes need an MRI (usually once a pesky neurologist gets involved) there are MRI-safe ventilators. These are stripped down machines, mostly plastic and non-ferrous metal. They're less durable than a regular ventilator and don't have all the features, but they're fine for an hour or so that a patient needs it while in the MRI machine.

Anyway, back at Small Hospital, one day the MRI-safe ventilator was missing. This was a real problem, because now we couldn't do MRI's on ICU patients who needed them. We were able to temporarily get an extra from a larger hospital across town, but still needed ours back. They ain't cheap.

Security searched, literally, every square inch of Small Hospital. The kitchens, the bathrooms, every patient room, the storage areas... it wasn't there. Small Hospital didn't have the array of video monitoring they do now, so looking for someone leaving with it wasn't possible.

One early morning during rounds I was in ICU, chatting about it with some of the nurses when one of them said, half-joking, "maybe it's on Ebay."

Since I was on the computer looking up labs, I switched over to Ebay... and there it was. A used MRI-compatible ventilator, same model, which had been up for sale since one day after it had gone missing. The seller's name was an easily-recognizable variant on the name of a guy who worked as a hospital radiology transporter.

The ventilator was back a few day later.

The transporter spent some time as a guest of the state, in spite of his clever defense that he'd seen it standing next to a dumpster at his apartment complex several miles from the hospital and had just kept it as a decoration because he didn't know what it was but it looked cool.

The machine was at the hospital for several more years before it was replaced by a newer model. For the rest of its service the nurses kept a sign on it that said "NOT FOR DECORATION."

Doctors behaving badly

I'm with a patient when Mary wanders back.

Mary: "Hey, Dr. Hypothec is on line two, he asked me to interrupt you."

Dr. Grumpy: "Okay. Hang on, Mrs. Fonebone, let me get this... Hi, this is Dr. Grumpy."

Dr. Hypothec: "Hi, this is Mort Hypothec across the street. Thank you for taking my call."

Dr. Grumpy: "What's up?"

Dr. Hypothec: "I had a a question about my wife, did you ever see her as a patient?"

Dr. Grumpy: "Not that a recall."

Dr. Hypothec: "Well, she works in mortgages, and was wondering if you were interested in refinancing your home? She can get you an excellent rate."

Seen in a chart

 

Happy Springtime!

(or Autumn, if you're on that side of the planet).

My favorite ode to spring, courtesy of the great Tom Lehrer:

Spring is here
Spring is here
Life is skittles and life is beer
I think the loveliest time
Of the year is the spring
I do, don't you? 'Course you do
But there's one thing
That makes spring complete for me
And makes every Sunday
A treat for me

All the world seems in tune
On a spring afternoon
When we're poisoning pigeons in the park
Every Sunday you'll see
My sweetheart and me
As we poison the pigeons in the park

When they see us coming
The birdies all try and hide
But they still go for peanuts
When coated with cyanide
The sun's shining bright
Everything seems all right
When we're poisoning pigeons in the park

We've gained notoriety
And caused much anxiety
In the Audubon Society
With our games
They call it impiety
And lack of propriety
And quite a variety
Of unpleasant names
But it's not against any religion
To want to dispose of a pigeon

So if Sunday you're free
Why don't you come with me
And we'll poison the pigeons in the park
And maybe we'll do
In a squirrel or two
While we're poisoning pigeons in the park

We'll murder them all
Amid laughter and merriment
Except for the few
We take home to experiment
My pulse will be quickenin'
With each drop of strychnine
We feed to a pigeon
(It just takes a smidgin!)
To poison a pigeon in the park

Semantics

 "What do you mean the drug doesn't work? We can't write that! Find a better way to say it!"

Happy Pi Day!

In honor of Pi Day, AKA Einstein's birthday...

 

Hi, this is Craig Grumpy.

A few years back, you may remember, I worked at Local Grocery's bakery.

One of my co-workers there (besides my sister) was Josie.

Josie was no pussycat, but was good at her job, except for the whole dealing-with-customers bit. Polite conversation was not one of her strong points. Because she was otherwise a good employee management tended to overlook this, and the rest of us tried to deal with people and let Josie do her thing in the back, mixing dough, baking stuff, decorating cakes, etc.

Unfortunately, this wasn't always possible, and there was an afternoon where she and I were the only ones on. She was out putting bagels on the shelves and I was leaning into the donut case, cleaning it for the next morning. So I didn't see a lady walk past a large display that said "PIES," and head for Josie... until it was too late.

Lady: "Excuse me! Where are the pies?"

Josie: "Uh, over there, behind you, on the left."

Lady: "Thank you."

The lady went over and began carefully inspecting the pies that were out. I turned back to the donut trays, glad that it had been straightforward.

In the meantime the lady was going through the pies, carefully reading each box (these are generic supermarket pies, folks). After a minute I realized she'd followed Josie back to the bakery counter and it was too late for me to run interference.

Lady: "Excuse me again!"

Josie: "Yes?"

Lady: "I was looking at your pies. Do you have any that are sugar free and gluten free?"

Long pause.

Josie: "Ma'am, this is a bakery."

Josie disappeared into the back.

Sigh

Look, calling my phone every 2 hours all weekend is NOT going to make your lab results come any faster.

You go, dude

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

Dr. Hyper: "HI! THIS IS MIKE HYPER! I'M THE HOSPITALIST ON CALL OVER NIGHT, AND I NEED YOU TO HAVE A LOOK AT A GUY I THINK MAY HAVE HAD A SEIZURE! HE FAINTED OVER AT THE HOCKEY ARENA!"

Dr. Grumpy: "Okay, I'll swing by in the morning."

Dr. Hyper: "THAT SOUNDS GREAT! HANG ON, LET ME JUST GET MORE COFFEE HERE... ANYWAY, HE BIT HIS TONGUE, BUT DOESN'T HAVE ANY HISTORY OF SEIZURES!"

Dr. Grumpy: "Was he incontinent?"

Dr. Hyper: "HE CERTAINLY WAS! IN FACT, I CHECKED HIS PANTS MYSELF!"

Sunday afternoon

My current hospital consult is apparently unable to finish any sentence without putting the word "diarrhea" into it somewhere.

Quote of the day

 "I have insomnia, but it's only a problem when I'm trying to sleep."

Seen in charts

Here's some things you guys have sent in that somehow made it into medical records. Just remember folks, somewhere out there your doctor may be the culprit.

First, from the "wait, what?" department is this unusual treatment for anxiety:

 

"I guess it depends on what's making you anxious, nudge nudge wink wink"

From the "I'd like to buy a vowel" category cums comes this gem:

"I guess that's nudge nudge wink wink again"

From the case files of Captain Obvious, M.D. we have these notes:

and

 

 

And, lastly is this note from the "How lazy can you get?" department:

 

This brings back memories from when I worked at the VA 30 years ago. A patient would come to the floor, and the admitting note said "Past history: see old chart." The old chart was inevitably at least 5 volumes, each one 3-4 inches thick.

Random pictures

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

First off, we have this label from a home sander:

Next is this, from the insanely long line for Radiator Springs Racers at Disneyland:

"That's tongue in cheek... I didn't mean it that way."

In a tribute to capitalism, I have to respect the location of this cookie store:

Love these stupid ads. Here's a tip: don't try to sleep in the surf. Was this Harold Holt's idea?

 

 

 

 

 

Lastly, since we're on the subject of things to help you sleep, Netflix wants to play "one of these things is not like the others."

Modern technology

After having one for a few months, I highly recommend the Amazon Ring to anyone who's ever wanted to see regular pictures of themselves, in pajamas and a robe, carrying out the trash.

Kill me

Currently trapped in line at a pharmacy behind a woman demanding generic Emgality and refusing to leave until she gets it. So I guess I'll be here until 2034.

Memories

Dr. Hurricane was an attending where I trained.

He was one of these people who lived at warp speed. While he was a good teacher, and had an excellent fund of general neurology knowledge, it was all limited by his frenetic manic speaking style of rattling off facts, statistics, and teaching points at an insanely high speed on rounds. In fact, he reminded us of John Moschitta, the star of FedEx commercials in the 1980's.

Yeah, and that was what Dr. Hurricane sounded like on a slow day.

I carried a clipboard and notebook with me on rounds, and would frantically, if unsuccessfully, try to keep up with his teaching points. This only resulted in severe hand cramps and my notebook bursting into flames.

Another resident, Karl, made the immortal comment that "Dr. Hurricane doesn't talk. He has lip fasciculations."

In clinic, patients were terrified of him. Not for him actually being threatening, but for his ability to rapidly give them the entire diagnosis and treatment plan in about 10 seconds, at a speaking frequency far beyond the ability of others to discriminate individual words. Dr. Hurricane blew into the room, Dr. Hurricane blew out of the room, leaving a prescription behind, fluttering gently in the breeze.

And, of course, I (the resident) was left standing there as the patients asked "what did he just say?"

Damned if I knew. Their guess was as good as mine.

 

Taking a break for a few weeks

 See you next year!

Up front

Several months ago Mary and her family got a new puppy. He's still a puppy, but these days he's a 70 pound puppy.

He has a lot of energy.

She and her husband both work, and the kids are in school, so for a few hours each day Monster puppy and his den mates have free run of the kitchen and family room, with a doggie door when they want to venture out. The other dogs are older and sedate. Monster is anything but, and began randomly destroying things he found (toys, clothes, furniture, wall hangings, light fixtures, Amazon drivers, etc.).

So, since Mary spends her office day staring at a screen scheduling my victims patients, she hooked up some cameras and a speaker in the dog area at home. So now she sits at work and keeps an eye on Monster, occasionally telling him to get off the couch or stop mangling the postman. The other 2 dogs don't care, but the effect on Monster is hysterical. He looks up and around in terror, like people in old movies when God speaks to them.

Anyway, one afternoon last week Mary was doing her usual thing. She'd just checked in a new patient, who'd picked up a copy of "Good Housekeeping" and sat down in the lobby. She was then rescheduling another patient when she happened to glance up at the corner of her screen and saw Monster in the process of destroying one of her kid's toys.

Without thinking she grabbed her microphone and yelled "YOU DROP THAT RIGHT NOW AND GO OUTSIDE!!!"

The elderly woman in the lobby startled, dropped the magazine on the floor, and ran out of the office in terror.

She hasn't come back.

Research

 "What should we name our stroke study? Something positive, scientific sounding, helpful..."

Up front

Mary: "Okay, on Tuesday Dr. Grumpy can see you at 11:00, or on Thursday we can do 4:15, or on..."

Mary took a sip of too-hot coffee and began coughing.

Ms. Miasma: "I'm hanging up. Can someone else call me back? I don't want to catch whatever you have over the phone."

Be prepared

Body armor? Check.

Taser? Check.

Pepper spray? Check.

Marie riding shotgun on the cart with a baseball bat and tranquilizer gun? Check.

Heading to Costco for pies.

Dynamics

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

Ms. Daughter: "My dad had cancer. That's about it."

Ms. Mother: "I have high blood pressure."

Ms. Daughter: "No you don't."

Ms. Mother: "Yes, I do. I take Petrolololololol for it."

Ms. Daughter: "You have high blood pressure, and you take medication for it? How come I never knew this?"

Ms. Mother: "It's not a big deal. Most people my age are being treated for high blood pressure."

Ms. Daughter: "It's like my whole fucking life I'm living a lie."

Sigh

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

Ms. Sesame: "I'm allergic to all medications that have a letter 'D' in them, regardless of whether it's the brand or generic name, or both."

Math

Dr. Grumpy: "What have your blood pressures been running at home?"

Mr. Decimal: "They average 127.384 over 73.879"

Vivisection in the headlines

 

Happy Halloween!

With the costume party season upon us, I'd like to remind everyone of what was probably the single greatest newspaper headline ever.

Six Degrees

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

Mr. Bacon: "Hi, Dr. Grumpy, I need to get in to see Dr. Needle urgently, and she's booked out for 3 months. I was hoping you could call her office and ask them to work me in?"

Dr. Grumpy: "Did I refer you there? Are you one of my patients? I'm not finding you in the system."

Mr. Bacon: "No, but I'm a friend of one of your patients, Heddy Paine."

Dr. Grumpy: "Look, I really can't help you... She's not in the system either."

Mr. Bacon: "Well, she says she saw you a year or two ago. She was visiting her uncle in the hospital, and says you were talking to a nurse outside the room of the patient next door."

Thud

Dr. Grumpy: "So... this visit is to follow-up on how you're doing with the medication - Fliniberzap - that I prescribed about a month ago."

Ms. Headdesk: "Yeah."

Dr Grumpy: "It's been a month, so how are you doing?"

Ms. Headdesk: "I'm not any better... I mean, I filled the scrip, but then I left it in a rental car and returned the car."

Pause

Dr. Grumpy: "So you haven't started it?"

Ms. Headesk: "Not really, I mean... no."

Dr. Grumpy: "Why didn't you just call so we could send a new script in?"

Ms. Headdesk: "I left your phone number in the car, too."

Touché

Mary: "Okay, Mrs. Humor, I have your follow-up down for next Tuesday, at 8:15 a.m. I should warn you that Wednesday's test of the national Emergency Alert System activated our microchips and turned Dr. Grumpy and all of the staff here into zombies."

Mrs. Humor: "Like anyone would notice."

FML

 Current insurance company hold music is an endless loop of "O Fortuna."

Stayin' Alive

My 11:00 patient, while we were talking at my desk, took cans of Red Bull and beer from his backpack, mixed them together in an empty water bottle, and is drinking it.

Sunday morning, 5:58 a.m.

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

Ms. Simon-Bond: "Hi, Dr. Grumpy... there's a dead cat on my back patio."

Pause

Dr. Grumpy: "Why are you calling me?"

Ms. Simon-Bond: "I... I guess because I didn't know what to do about it."

Pause

Dr. Grumpy: "I didn't know you had a cat."

Ms. Simon-Bond: "I don't... I don't know whose cat it is."

Dr. Grumpy: "Okay, this really isn't something I can help you with, or even a reason to call me."

Ms. Simon-Bond: "My internist said the same thing."

Your EHR is making you look stupid

EHR (or EMR) is the generic name given to the various medical chart systems that have been crammed down our throats. Most are worthless.

The problem is that they're primarily designed to meet regulation-required "quality metrics," to show that we told someone to quit smoking, wear a seatbelt, or take prenatal vitamins regardless of whether the patient is a 6 month old infant, 28 year old guy, or 97 year old woman. Because, you know, those things are for more important then talking about the patient's chest pain or new-onset hemiparesis.

As a result, the EHR's are full of horseshit that tell you absolutely nothing about the patient that  relates to, say, WHY THEY CAME TO THE DOCTOR.

When I was in training I was taught that, within the SOAP format (subjective, objective, assessment, plan) your note should tell a story of sorts: what's happened to the patient, what do you think it all means, and what are you going to do about it. It should be written so that the other doctors involved in the person's care can understand what you're thinking and doing. It also should be that way so you can pick up the thread when the patient returns.

That, sadly, isn't the case anymore. Now a note is just a string of vital signs, discontinued prescriptions, the same family history that's in every previous note in the chart, cut & pasted test results (some going back years and completely irrelevant now) and boxes that have either been checked or unchecked.

Physical exam, for example. To describe the tongue, most neurologists include it in a stock phrase like "Cranial Nerves II-XII are normal." If something isn't normal, most ad an "except for..." or "with the exception of..." and go on to describe the issue.

Of course "normal" isn't good enough for an EHR. Neither is "intact," "unremarkable," or "within normal limits." You have to have computer-generated shit like this:

After all, why use one word when 36 will do?

Here's another example. It's no longer enough to just put something like "family history is unknown" (you often hear that in the adopted) You need a whole, stupid, repetitive, idiotic, PARAGRAPH to say that:

Then there's horseshit like this. Although labeled as "Previous Therapy" it doesn't even mention therapy, just a nonsensical sentence:

 

 

Or similar gibberish which basically says "we didn't do any of this, we aren't sure why we did or didn't, but it met some quality measurement goal so it doesn't matter."

 

Then there are things that are just plain ridiculous, like this:

Or this:

This doesn't exactly inspire confidence, either:

 

Or this strange complaint:

 

On that note I think I'll save the rest of my bad EHR excerpts for another day. Fortunately or unfortunately, I doubt I'll be running out of them any time soon.

Keep the party going

Demented Church Lady: "I can't believe you and my kids won't let me drive! All of you are going to hell for this!"

Dr. Grumpy: "Okay,  at least I can go to the Jimmy Buffet concerts."

Her daughter nodded and gave me a fist bump.

Phrase

 If this guy doesn't stop saying "I don't know, you know?" I may have to throttle him.

Thank you for the music

"Some of it's magic,

Some of it's tragic,

But I had a good life all the way."

 

Goodbye, Jimmy. Thank you.

'Murica

 1:00 patient called me a "Pinko Jew." What a country.

Hard at work

Your hero, Dr. Grumpy, is (along with a lot of other docs) certified by the American Board of Psychiatry and Neurology (ABPN).

You can be certified in either or both (I have no idea why anyone would want both).

All of us neurologists and psychiatrists pay the board a hefty amount to stay certified. It's a few hundred bucks a year, and every 10 years it's a few thousand more to prepare for and take a written test to maintain certification. This is in addition to all the continuing medical education required.

What the ABPN does with this money, besides writing new test questions and issuing certificates, I have no idea. But, in a recent newsletter I received, it was nice to see that the money is being put to good use: