Survey fun

Doing a phone survey on a drug in development this morning, and was asked this question:

"Doctor, if the drug was found to cause cataracts in dogs, but not in rats, how would this affect your prescribing?"

And yes, my practice is only limited to humans.

Tuesday night patient devotion phone message

"Hi, this is Cindy Buzz. I see Dr. Grumpy for my headaches, and he ordered an MRI. It was supposed to have been done at 4:00 this afternoon, but it was such a nice day I was driving there with my windows down, and I passed an area where they were destroying a hive, and a bunch of bees flew into my car and stung me all over and I had some kind of a reaction and lost control of my car and hit a light pole and paramedics came and I've been admitted to St. Hymenoptera's Hospital so they can watch me overnight. Can someone please call me tomorrow so I can reschedule the MRI? Thank you."

I'm an awesome doc!

You've seen it, somewhere.

Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a "Best Docs" issue, usually listing 10 doctors from each specialty who they consider the best of the best.

Dr. Grumpy, for the record, is not biased against this. I've been named a "Best Doc" in my field several times.

And I know most of the other neurologists on the list. Some of them are very good (likely better than me) but there are always a few doctors on the list who I know are incompetent, or even dangerous. Yet, they somehow made the list, too. And there are always quite a few damn good neurologists who never make the list at all.

So how does this happen?

It's hard to judge doctors. Even good doctors get sued, and have medical board complaints against them. I have a lot of patients who love me. And some who hate me and think I'm incompetent. You can't predict the vagaries of human chemistry.

Most of these magazines try to poll doctors. They send out ballots to local docs, and ask us to write down our favorites for each specialty. So to some extent it's really just a popularity contest. Other magazines have patients vote. Generally, an incompetent doctor with his name out there, doing TV and newspaper interviews, seems to be more likely to get votes then a competent person quietly toiling away in an obscure practice.

So what does it mean to be a "Best Doc" like yours truly? It's flattering, but here's what really happens:

I find out that I'm in the coveted issue about 1 month before it goes to press. This is because someone from the magazine calls me, to tell me that I made it, and (more to the point) ask me if I'd like to buy advertising space in the issue to complement my name being in it. No, thanks.

A few weeks later the magazine calls back, this time to see how many copies of the famous issue I'd like to buy, to give to friends, family, employees, patients, anyone. No, thanks. I subscribe to the mag, anyway, for my lobby, so I get one copy as it is. And that's enough.

Then the magazine hits the stands. A few things happen:

1. I get calls and letters from companies trying to sell me a plaque, framed copy of the issue, or something else to hang on my office wall to let people know I made "Best Docs". All at a special price of only $49.95 up to $199.95 (depending on what materials and how much bling I choose for my "limited edition" item). No, thanks.

2. I get calls and letters from investment companies, stock brokers, insurance salesmen, and financial planners, congratulating me on my recognition and wanting to meet with me to discuss my financial health, since obviously anyone who's on the "Best Docs" list must have a shitload of cash lying around. They even offer to take me to lunch. Sorry, guys, but whether or not we make "Best Docs" is immaterial to how much a doc really makes. And the reality of most docs today is that we're lucky to support our families. So no, thanks.

3. I get calls and letters from my city's professional sports teams, telling me that as a "Best Doc" my life isn't complete until I buy season tickets. This year a team offered me a free pair of nosebleed seats in exchange for me attending a 30 minute sales presentation on the benefits of season tickets. No, thanks.

4. A few patients see my name in the magazine and call for an appointment.

This is always the scariest bunch. I know it's not easy to find a good doc, but if you're coming to me just because Local Magazine said so, you'd do better asking your own doctor, or friends, for names.

In general, the patients who come to me solely on the magazine's referral are some of the most dreaded ones in my practice. Why? Because they've almost always been through several previous neurologists who weren't able to fix them. But, by a leap of reasoning, they assume that Dr. Grumpy, because he made the "Best Docs" issue, will be THE doctor who can reverse their 30 years of chronic pain. Who can cure Grandma's Alzheimer's disease. Who can work some incredible miracle that 7 previous, perfectly competent, neurologists were unable to. Nope. And then they get angry when they find out I'm no more of a miracle worker than the other docs were.

And what happens to the 1 copy of the magazine that I do subscribe to?

In past years I used to save them. Take them home, put them in a pile of stuff. I have no idea why. At some point I realized they were just a bunch of old magazines, and tossed them in the recycling can.

The 1 copy that comes here is glanced through by me, Dr. Pissy, and our staffs for a day or two, to see who else made the list. Then it joins the other magazines in the lobby.

And within 2 days of being put out there, it disappears. Taken by an unknown patient.

And that's what it means to be a "Best Doc".

MEOW!!!

Dr. Grumpy: "Have you had any falls since your last visit?"

Mr. Balenz: "One, but it was my fault. I wasn't using my cane properly."

Dr. Grumpy: "How were you using it?"

Mr. Balenz: "I was hitting the rose bushes with it, to try and get the cat to come out."

Bad drug rep mornings

A drug rep I like came in this morning with a tray of muffins. I went up to say "hi" and sign for samples. Mary was chatting with her.

Mary: "Did you get contacts?"

Cindy Pharma: "No. My kids broke my glasses over the weekend, and I can't find my spare pair. I have to order new glasses today. I can see fine for driving, but can't read at all."

Annie: "Well, thank you for the muffins."

Cindy Pharma: "You're welcome. You guys enjoy them. I swung by Costco and got some of their chocolate muffins, I figured you guys could use some chocolate to start the week."

Cindy left, and we took the muffins back to the break room. Mary took a big bite, and almost choked.

Cindy was right. She can't read without her glasses at all. They were bran.

Shoes for, um, swimming?

I'd like to think my reader Cheryl for submitting this.

Yes, folks, apparently the Gravity Defyer shoe company, trying to think of an eye-catching logo for it's product, has come up with this:

This is NOT photoshopped. You can find this on the company's web page if you don't believe me.

(click to enlarge)

Saturday night, 10:45 p.m.

"Hi, I'm doing my receipts here. I came into your office to settle a bill of $74.85 last month, and it looks like you guys charged my card $74.95. So, I'm really pissed off that you hosed me like this, and I want the discrepancy credited back to my card ASAP, or you'll be hearing from my lawyer."

ER Stories

Like most specialists, I hate being called to the ER. But last night I got dragged in.

I was, however, quite lucky. Because the friendly ER staff had arranged a play for my entertainment.

It was a busy Friday night in the ER. I found a computer and phone to work at, and began writing a note. As I scribbled away, some paramedics came in, wheeling a well-dressed woman in her 30's past. A nurse told them there were no rooms available, and to put her in the hallway, across from where I was working. I heard the paramedics talking. Lady who's allergic to oregano, but accidentally ate some at a restaurant. Brought in with complaints of shortness of breath.

Though this all, Mrs. Oregano didn't move. She lay there with her eyes closed. Breathing calmly. She didn't have an oxygen mask on. A blood oxygen saturation monitor reading showed her to be at a perfectly normal 97%.

After the paramedics walked away, the awesome ER nurse went over.

(curtain rises, play begins)

ER nurse: "Are you okay, ma'am?"

(Nothing. No movement. Nurse checks pulse, blood pressure, and glances at oxygen monitor)

ER nurse: "Ma'am, I know you can answer me."

Mrs. Oregano's eyelids fluttered open. "Where... where am I?"

ER nurse: "You're in the emergency room."

Mrs. Oregano: "Oh my God! I can't breathe! They gave me Oregano at the restaurant! I told them not to do that! I could have died!"

ER nurse: "Do you have any pain?"

Mrs. Oregano: "I CAN'T BREATHE, DAMNIT!!!"

ER nurse: "You're breathing fine, your oxygen saturations are normal and..."

Mrs. Oregano: "HOW CAN YOU BE SO CALM! CAN'T YOU SEE I'M NOT BREATHING AT ALL? I HAVEN'T TAKEN A BREATH IN OVER AN HOUR! IS THIS HOW YOU TREAT DROWNING PEOPLE? I WANT TO SEE A DOCTOR!"

The ER nurse, showing remarkable calm, restraint, and an iron ability to keep from laughing hysterically, walked away. She went into the doctor's area and said "We have a winner..."

(curtain falls)

Sorry, dude, you're not that good

Dr. Grumpy: "So at what point did you call 911?"

Mr. Young: "When I realized she was having a seizure."

Dr. Grumpy: "How long after the seizure started was that?"

Mr. Young: (looks at Mrs. Young, both blush, look at floor): "Well, I didn't call right away, because we were, um, having sex at the time, and when she started shaking I just thought she..."

Dr. Grumpy: "Got it. So how long did the seizure last?"

"Check this out" indeed

I'd like to thank my reader Boris for submitting this product placement issue. I suppose it's a marketing campaign of the "Warning: choose one, or get the other" sort.

(click to enlarge)

Reptile WIN!

I got a hospital consult to see a guy who'd suffered a closed head injury, so I wandered over to see him. The admitting note began like this:

"77 year old male who fell and struck his head. While working in his yard he was attacked by a snake. He pulled off his artificial leg to bludgeon the snake with it, then lost his balance and fell. He hit his head on a rock, and was knocked unconscious."

How to drive an ER doc nuts

Dr. Grumpy: "Okay, I'll swing by and have a look at her. Who's admitting her?"

Dr. Er: "Doctor Hu."

Dr. Grumpy: "Who?"

Dr. Er: "Hu."

Dr. Grumpy: "Dr. Who, the TV show?"

Dr. Er: "No! Dr. Hu, the hospitalist."

Dr. Grumpy: "That's what I asked? Who's admitting her?"

Dr. Er: "Hu."

Dr. Grumpy: "Who?"

Dr. Er: "Grumpy, you're a pain in the ass." (click)

Mary's desk, June 16, 2010

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

Miss Multiplex: "Um, yeah, I need to make an appointment for Suzy."

Mary: "Okay, what's she coming in for?"

Miss Multiplex: "She has migraines. We both have Blue Cross."

Mary: "Okay, when can she come in?"

Miss Multiplex: "Umm... I'm not sure. I don't know when she'll be here."

Mary: "Is she traveling?"

Miss Multiplex: "No, she's one of my personalities."

Addictions

Like most neurologists, I read EEG's. These are tests that record a patient's brainwaves, usually done to see if the patient may be having seizures.

During one the tech running it types notes at the bottom of the screen, letting me know if the patient is talking, blinking, whatever, because these are things that can change the way the record looks.

So this morning I was reading a study, and this note floated by at the bottom of the screen.

(click to enlarge)