Just Shoot Me

I had a hospital consult this afternoon, the reason for which was unrelated to the cause of admission.

When I opened the chart, this is the paragraph that greeted me. I present it without further comment, as nothing could be added to make it better (or worse, depending on your point of view).


"History of present illness: This is a 78 year old male who was transferred from Big City Hospital for insurance reasons, due to a vibrating foreign object that has been impacted in his rectum causing anal obstruction. The patient states that he was using the vibrator to 'scratch an itch' around his anus and 'lost control' of it. He states that his internist was unable to remove it, and so he then went to Local Urgent Care Center. They were unable to remove it either, and he left there and went to Big City Hospital. For insurance reasons Big City Hospital has now transferred him here to get it removed."

Insurance Company Idiocy

Last week I saw a lady in her 40's, who'd had a small stroke. She had no good reasons to have had a stroke, so I ordered a bunch of routine tests, including an MRA. This is not experimental. We do these for stroke all the damn time.

So her insurance company of course refused it. They asked to see my notes (we faxed them), and the reason why I wanted it (we told them). They still refused to cover it, but told me I could appeal by calling one of their "physician reviewers". So I called him a minute ago.

He asked me why I wanted the MRA. I told him because the patient had a stroke.

His response: "Oh, why didn't you just tell us that in the first place? We'll cover that".

What a deal!

I ordered a game for one of my kids off Amazon, and stumbled across this great pricing (bottom lines of the image):

New game: $34.48

Used game: $94.98.

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Hello? Hello? Who am I?

I got dragged into the hospital this morning to see a guy for Alzheimer's disease. He was in one of the 2-patient rooms, with them separated by a curtain. And both of the guys were old and demented.

So while I"m talking to the guy in bed 1, he moves his arm, and immediately his IV pump says "downstream occlusion" and starts beeping annoyingly, a series of repeating chimes "beep-beep-boop-bop-bop".

So the guy in bed 2 thinks it's his phone ringing, and starts answering it! "Hello! Hello! Who is this?" slams it down. "Those damn kids"

And it keeps going! Every 30 seconds the pump chimes, and the other guy does the same thing "Hello! Hello!" I was in the room for 15 minutes, and he answered the phone 12 times.

It was still going on when I left the room.

Hmmmmmmm............

So this morning I had a couple in their late 20’s in the office. I'm working-up Mr. Youngcouple for some oddball symptoms, and his labs turned up a positive syphilis test.

So we discussed this at length. He was horrified. Kept insisting “there’s no way I can have syphilis! Ever! My wife is the only person I’ve ever been with!”

Once I said “syphilis” Mrs. Youngcouple stopped making eye contact with either of us. She just became very fixated on playing Tetris on her cell phone and occasionally staring intently at something on the floor.

You're a Freakin' Bozo, Sir.

This afternoon I'm seeing this guy. He has cancer, and is getting chemotherapy with a drug known to cause headaches.

So he's going into tearful detail on how he gets his chemotherapy on Wednesdays, and then on the Thursdays after he has a horrible headache that sends him to ER.

I reviewed different options (besides stopping cancer treatment): medications to get rid of his headaches, medications to prevent his headaches, etc. He then asks me this:

"Doctor, I'm not sure I want to take more medications. Wouldn't it be easier to just move my chemotherapy to Mondays, instead?"

Torturing Your Child

So, Grumpy fans, a catalog of various medical supplies showed up in today's mail (addressed to "Physician Occupant" no less).

It included this remarkable device. According to the caption, the purpose of this thing is to "comfortably help children sleep" who have breathing problems when lying on their backs.

I don't know about you guys, but I can't see how any of my kids would "comfortably" lie face down in this thing for more then, say, 5 seconds, unless I used duct tape to hold them there.

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Why are my prescriptions so expensive?

There are a lot reasons drugs are so damn expensive, gang. I'm sure research & development are most of it, but some of it is because of sheer stupidity and waste on the pharmaceutical company's part.

Case in point: If you remember, I spent a February weekend in LA at a drug company meeting, and they asked me to bill them for my expenses. So I sent them my receipt ($32) for airport parking.

I got my $32 check today. It was sent by FedEx priority overnight delivery from Philadelphia.

The cost of sending me the check was $10.55.

For the record, I didn't ask for emergency delivery. I would have been happy with a 42 cent stamp.

More Stupidity

Ok, gang, I just had to post this link. This is amazing. A woman who called 911 because she couldn't figure out how to open her own car FROM THE INSIDE!!!

Check it out!

Ride 'em Cowboy!

One of my back pain patients came in today. Showed me the new massage device he's been using for his pain, with great success.

It was HUGE. The size of 2 car batteries side-by-side. And heavy. And when he plugged it in and turned it on it sounded like a freaking lawnmower.

I asked him where he got it, and he said he saw it being used at this year's Arabian horse show. It's made to massage horses. He bought it from a trainer.

It actually had a label on it that said "NOT FOR HUMAN USE".

Idiots Among Us

I got the greatest call from a pharmacist today. Here's the story:

On September 15, 2004 I saw a lady for low back pain and gave her a script for Percocet.

For whatever reason, she never had the script filled, just shoved it in a drawer at home. She never followed up with me.

Yesterday she apparently found the script buried in the drawer, and decided she should get it filled. She figured (correctly) that the pharmacy wouldn't fill anything that was written 5 years ago.

So she changed the date on it to September 15, 2009, and took it to Walgreens.

The pharmacist who called me was laughing so hard he was crying.

Say that again?

This is a gem. From a new patient today, that I was getting some family background on:

Dr. Grumpy: "Any history of miscarriages in your family?"

Mrs. Notsobright: "My Mom had one, with me."

No, You Idiots. I Treat Dead Patients, Too.

Check this out, Grumpyites. This is a form I have to fill out every few months for patients to continue receiving a drug called Tysabri.

I direct you to question #1: Is the patient still under your care?

IF I answer "yes" to that question, THEN (in question #2) I'm asked if the patient is alive!

How much do you think they paid the bozo who wrote this form?

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True Love in the ICU

Hi, grumpy fans. Your hero was on call this weekend.

This morning I was called to evaluate a 23 year-old female who was found
floating face down in her pool. Probable suicide attempt, with brain damage.

While I was writing my chart note a nurse came over to tell me that the
patient's fiancé was on the phone, and wanted to talk to a doctor about
what was going on. I picked up the phone and had the following
conversation:

Dr. Grumpy: "Hello?."

Mr. Fiancé: "Yeah, are you the doctor taking care of my fiancé, Jane Doe?"

Dr. Grumpy: "Yes sir, what can I do for you?"

Mr. Fiancé: "Are her car keys there? 'Cause it's my car, and I need it back."

Dr. Grumpy: (astounded) "No sir, there aren't any car keys here."

Mr. Fiancé: "Well, did she leave a note saying where the car keys were, or where she left my car parked? I need it, because I have stuff to do today."

Dr. Grumpy: "No, sir, nothing like that"

Mr. Fiancé: "Well, you're no help to me" (hung up the phone).