Rebuttal

In late July I re-ran my "Dr. Worthless" post, about the (alleged) migraine specialist who didn't do shit for one of my patients.

On August 28, nearly a month after I put it up, the following comment was posted:

"Dr Worthless: Pretty much every neurologist in my metropolitan area. I am sick and tired of managing issues that fall into the realm of neurology because of the laziness of your specialty. I really miss the days when a neurologist could actually make a diagnosis without an MRI."

Here is my rebuttal:

Dear Dr. Whoever You Are:

Thank you for kindly painting all neurologists with the same brush.

I'm sorry some in your area aren't up to your personal standards in work ethics. By a similar definition I know some "lazy" internists who seem to feel that I should be treating bladder infections, sinus problems, or foot ulcers simply on the grounds that the patients also have a neurological disorder, and therefore tell them to call me for their general medicine needs. So I suppose I could say I'm sick and tired of managing issues that fall into the realm of general medicine because of the laziness of your specialty.

But I won't do that. To make generalizations based on 1 or 2 people is what leads to idiotic stereotypes. I'm sorry you feel that way based on the few neurologists you've encountered. So stop referring to them and find others.

Please try to keep in mind that medicine is a team sport. When you view other doctors (or nurses, or whatever) as the opposition, the only person who really loses is the patient.

Diagnosing people without an MRI is fairly easy. I (and many other hard-working neurologists) do it every day. Bear in mind that many neurological conditions (migraines, Parkinson's disease, epilepsy, Bell's palsy, and Alzheimer's disease, to name a few) are clinical diagnoses. This means they're based on what the doctor thinks after taking a history and doing an exam. The purpose of MRI's (which, I admit, are often overused) is usually to exclude other causes, rather than confirm the diagnosis.

MRI's, like all forms of technology, are like genies. You can't put them back in the bottle. If you don't like it, perhaps you should consider going back to the days when an internist could actually make a diagnosis without a CBC. Or CMP. Or stethoscope (after all, in 1840 the flexible binaural stethoscope was cutting edge). MRI's may be overused, but I find them to be more effective at excluding/confirming serious neurological disorders than sacrificing chickens over the patient and dancing naked under the moon.

I'm going to guess that you've never been sued (I have). Nowadays you can get legally reamed out for NOT ordering tests, regardless of any guidelines that say it's fine not to do them. You can tell me that I'm practicing defensive medicine, and guess what? I don't care. If doing everything I can to protect my family and my livelihood is being lazy, than so be it.

Ordering a test often has more to do with CYA than diagnostics in ANY branch of medicine. If you have some magic power that exempts you from legal action and allows you to make 100% accurate diagnoses without using that newfangled stuff, than you have my respect for being a better physician than little old me.

Yours truly,

Ibee Grumpy, M.D.

Germ theory

Mr. Bassi: "I'm surprised I caught a cold. I've been washing my hands a lot."

Dr. Grumpy: "These things can spread through the air, too."

Mr. Bassi: "Yeah, but I was hoping the washing would help me ward off anything."

Dr. Grumpy: "What do you mean?"

Mr. Bassi: "Well, they say washing hands helps prevent disease."

Dr. Grumpy: "That's true..."

Mr. Bassi: "Isn't it because water and soap boost your immune system?"

Why do I see this causing trouble?

I just know I'll hear:

"Well, I read an article about it, so I took mine out and rubbed it all over my forehead. But it didn't make the migraine any better, and the other people on the subway all started staring at me." *

*Admittedly, I've seen far stranger things while riding the Grumpyville Subway System.

Back-to-school reruns

Dr. Grumpy's Guide to Life: Shopping for school supplies

Today I'm going to focus on what I discovered to be a horribly traumatic life-altering experience: Back-to-School week at OfficeStaplesMaxDepot. There's one right across the street from my office, so I go there regularly for supplies. It's quiet, the employees are generally helpful, and I know my way around it pretty well.

I naively thought this would be easy.

So on to the lesson:

1. Do NOT volunteer for this job (flip a coin, or arm wrestle, or have a duel to decide instead).

Silly me. When Mrs. Grumpy was wondering when she'd have time to get the school supplies, I volunteered. I figured "How hard can it be? Hell, it's just some pencils and a bottle of glue". DUMBASS!!! The list is HUGE, and features items from the mundane (No. 2 pencils), to the specific (Expo dry erase markers, wide tip, in blue, green, yellow, and black) to the odd (1 Pringles can with lid, original flavor, empty). It took me 2 freakin' hours!

2. Be prepared. Normally there are 5-10 other quiet business-type people in there. NOT THIS WEEK! Holy Crap! An African street bazaar is an orderly affair compared to this! Deranged parents running on caffeine! Kids running amok! Store clerks running for their lives! And all the crazed parents are trying to read off a list, push a cart, yell at kids, text, and scream into a cell phone at the same time. Bring a water bottle, food, a map, a cattle prod, and a flashlight. A card with your blood type, hospital preference, and next of kin is also a good idea.

3. Do not leave your cart unattended. People will steal your shit out of it. I AM NOT MAKING THIS UP! I had my cart 2/3 full with the crap on my list, when I left it at the end of an aisle to go find notebooks (spiral, wide-ruled, 100 pages each, single subject, 1 red, 1 blue, 1 green). When I returned 3 minutes later about half the stuff I'd already put in it was GONE! I watched a few minutes later as it happened to others. Apparently, when you walk away from your cart, people think it means they can raid it for supplies they haven't had a chance to pick up yet. "Hey, this guy has those index cards (2 sizes, lined and unlined, 100 each) that my kid needs. Cool. I'll scratch that off my list".

If another parent asks you what school your kid goes to, or who their teacher is, DO NOT ANSWER. Ignore them. Pretend you're deaf, or that you don't speak English. They are not making conversation. They are casing your cart, and if they find out your kid is in the same class as their kid, they'll wait until you aren't looking to take your stuff (or just switch carts).

Best part was when I went to ask an employee for help finding something (Flair Correction Pens, in 4 colors). When I got back to my cart the box of 12 ultra-fine tip Sharpies I left in it had been opened, and someone had taken one of them. They'd even doodled on the shopping list I left in my cart to make sure they were taking a pen that worked.

Oddly, you can leave valuables in your cart. Your wallet, purse, and gold jewelry will be perfectly safe if left unattended, but the $2.69 box of high-lighters (12 markers, large tip, in 3 colors) will vanish.

My recommendation: bring a child to guard your cart, preferably one with an iron bladder and who's old enough to use a Taser or firearm if needed. If your kids don't meet this requirement, stop by Home Depot and hire one of the day laborers who hangs out in front looking for work.

4. Do not look for certain numbers of things. The people who make these lists have no idea how things are sold, so it lists things as "1 Expo dry erase marker, chisel-tip, red). Great. They don't sell red ones individually, just in boxes of 4. Or the Flair Correction Pens don't come in only 4 colors, but they do come in 8. Just buy it. If you aren't certain what item the teacher wants, just buy everything in sight and return the rejects later.

Alternatively, if the teacher only wants 1 of an item, such as, say, an ultra-fine tip Sharpie (which only come in boxes of 12), you can always look for an unattended cart with a box of them in it, and take one. If paper is handy, try doodling on it to make sure you are stealing one that works.

5. Hold your place in the check-out line AT ALL COSTS. Reserve it as soon as you walk in the store BEFORE shopping. Use a child (preferably your own) if possible. Other options include day laborers from Home Depot, mannequins, dogs, and aggressive Venus Fly Traps.

6. When in doubt, ask the bleary-eyed, terrified employees for help. If nothing else, it's fun to watch them try to convince you that they don't speak English as they run outside for a cigarette.

Good luck!

Sunday vacation pictures

On our recent trip we spent a few days in Las Vegas. At the AdventureDome amusement park they had this air hockey table:

"Winner gets free Premarin!"

While walking to the rollercoaster Marie suddenly yelled "There's a toilet out there!" This porcelain throne, and what looks like the remains of a bathroom stall, are lying outside on the roof of the casino.

Another victim of El Burrito Grande.

Afterwards we went to a food court, where the neurologist in me noticed this burger place:

Do they hire Parkinson's patients? Seizure patients? Both?

Browsing through a candy store, I saw a PEZ set for the most devoted LOTR fans:

The place also sold a brand of chewing gum called "I Love My Penis." I swear.

Of course, some of you may prefer non-fiction PEZ, and they have that covered, too:

Screw Mount Rushmore. THIS is the big time.

And, predictably, some things you just can't escape from:

Friday guest post- Officer Cynical!

From our favorite man-in-blue:


Last night, near the end of my shift, I happened upon a disabled car in the middle of a busy intersection. I pulled in behind him and put my overhead lights on, then went to talk to the driver to see what needed to be done.

The driver and a passenger were there, waiting for traffic to clear so they could push it out of the street. As I was talking to them, I noticed a guy in one of those serious, heavy-duty, motorized wheelchairs cruising by on the sidewalk, but didn't pay him much attention.

Well, as we started pushing the car, this guy suddenly jumped out of the StephenHawkingmobile, ran over, got behind the dead car, and helped us push it through the intersection and onto a side street. Then he ran back to the chair, hopped in, and motored away. It was like seeing a new-fangled superhero or something.

I still don't know what the hell happened.

Annie's desk, August 29, 2012

Mrs. Autoclave: "Hello?"

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

Mrs. Autoclave: "Do you have my test results?"

Annie: "Yes, your neck MRI was fine, and so he'd like to schedule you for an EMG."

Mrs. Autoclave: "Is that the test where they stick needles in your arm?"

Annie: "Yes."

Mrs. Autoclave: "Does he use clean needles?"

Annie: "Of course!"

Mrs. Autoclave: "He's not, like, re-using the same needle on every patient, is he? Or just rubbing it down with a paper towel between patients?"

Annie: "No. It's a disposable needle. He throws it away, and uses a new needle for every patient."

Mrs. Autoclave: "How do I know he's not just fishing it out of the garbage?"

Annie: "You can watch him open the package before the test."

Mrs. Autoclave: "I'm going to have to think about this. I don't trust you people." (click)

Skool Nerse announcement

This is Mrs. Grumpy.

Look, kids.

There are all kinds of ways to fake being sick/injured/dead to try and get sent home from school.

Pretending to have a weird rash that "suddenly came up" before the math test is not a good one.

Especially if you do it by rubbing your face and hands vigorously with Cheetos.

Your neon-orange "rash" washed off pretty damn easily when I took a washcloth to it.

And now you smell like the inside of a vending machine.

Nice try, though.

Patient quote of the day

"My blood pressure is intermittently sporadic. It happens randomly."

Life on rounds

I recently got a new doctor's bag because my old one fell apart. While talking to a nurse at the hospital, I started fiddling with the shoulder strap.

Nurse: "What's wrong?"

Dr. Grumpy: "My bag is hanging funny."

Hysterical laughter breaks out at nurse's station.

Dr. Grumpy: "That didn't sound good, did it?"

Saturday afternoon

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

Mrs. Adna-Thompson: "Hi, I'm one of your patients, and I'm at Glove World amusement park today."

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

Mrs. Adna-Thompson: "Well, we're in line for the Fiery Fist O' Pain, the roller coaster that goes upside down a few times. I'm afraid the upside down part will give me a migraine."

Dr. Grumpy: "So..."

Mrs. Adna-Thompson: "So, can I hand my phone to the attendant? I want you to tell him not to send my car on the upside-down part."

Dr. Grumpy: "Um, I think that's a function of the track. There's nothing he can do about it. Why don't you just not go on the ride?"

Mrs. Adna-Thompson: "That's what the attendant and my husband both said! You're no help at all!"

Random Sunday Pictures

First, from our recent trip, we have this picture taken at Lagoon. Apparently to dissuade masochists and guys looking for a painful prostate check:

I really love Lagoon. But not this much.

Next, in a similar vein, we have this unusual public service announcement tie-in from Local Grocery:

Have some wine. Then bend over.

It was a long driving trip. Fortunately you can try and amuse yourself with Siri:

"What do you mean? African or European?"

Emma sends this picture, which she says was taken at a store in Hackney:

And, lastly, yet another example of...

"My, what lovely dentures you have."

Sentence structure

English, like any language, has rules that are needed to convey whatever a sentence is trying to say.

Sometimes those are at odds with space limitations in a newspaper.

While I understand this headline for a "human interest" story, it still doesn't sound good.

 

Thank you, Lee!

BUSTED!

Yesterday I got dragged into doing a car accident evaluation for an insurance company. Generally I try to avoid these, but for various reasons couldn't get out of this one.

The hallway from my exam room to the lobby is a straight 10 feet, so I use it to watch patients walk when they come in.

On the way back to my room the patient limped on his right leg, and held a cane in his right hand.

Afterwards, on the way back to the lobby, he limped on his left leg and held the cane in his left hand.