Survey Fun

I'm doing an early morning market research phone survey about a new drug in development. The guy just asked me this question:

"Do you prefer prescribing drugs that are more effective? Or less effective?"

You Don't Say!

Okay, Grumpyites.

Our Science Marches on Department has brought this earth-shattering research to my attention.

In today's edition of ScienceDaily.com a study was published which found that...

(drumroll please)

PEOPLE WHO DRINK COFFEE (or use caffeine in general) BEFORE THEY TRY TO SLEEP HAVE TROUBLE SLEEPING!!!

This is not a joke. They kept a bunch of people up all night. 3 hours before they were allowed to sleep half of them took a 200mg caffeine pill (equivalent to 2 cups of coffee or 5 Diet Cokes) and the other half didn't get caffeine.

They found (sarcastic astonishment) that the patients who got the caffeine had more trouble sleeping than the ones who didn't! No shit!

I am not making this up. Here's the link.

Does Anyone Read My Notes?

Dear Dr. Bozo,

I'm not sure if you're lazy, or stupid, or too busy, or all of the above.

I appreciate you sending Mrs. Oldlady to me. Her symptoms certainly were concerning for a TIA, so I ordered a work-up.

Her MRI yesterday showed a small right brain stroke, while the MRA showed a critically narrowed right carotid artery.

I saw her urgently this morning, and set up plans to change her medications and to see a vascular surgeon. After she left I quickly typed up a letter to you summarizing my plan. Since I believe in good communication, I faxed over all the MRI/MRA reports with my letter.

I therefore found it comical that about an hour after I faxed it over, your office immediately faxed the MRI report AND MY OWN NOTES back to me, with your handwriting on the report saying "HAS HAD STROKE! GET HER INTO A NEUROLOGIST ASAP!"

My Readers Write

Given that my name is Ibee Grumpy, you'd think I'd be the last person to laugh at someone else's name.

But, since my alert reader Stephanie brought this to my attention, I thought I should share it with all of you (I should be above such juvenile humor, but I'm not). I suspect this group is known in local circles, but...

Anyway, this is a Urology group in Texas, whose members include Dr. Wang, Dr. Hardemann, and (of course) Dr. Dick Chopp.



Sorry, Drs. Wang, Hardemann, and Chopp, but I'm sure you guys hear the jokes all the time. Plus, there's no such thing as bad publicity!

For those of you who don't believe me, here's their website.

And a great big Dr. Grumpy thank you to Stephanie!

No, You Can Do That Yourself

I'm examining a guy this morning who's chewing a toothpick, repeatedly doing the thing where he turns it around in his mouth, then gnawing on it some more.

I asked him to open his mouth and stick out his tongue.

So he takes the spit-covered, chewed-up, soggy toothpick out of his mouth, holds it out, and says "Can you hold this for me?"

Product Testimonial

I saw a 62 year old guy this afternoon with diabetic nerve pain, which is controlled on the medication Neurontin.

Dr. Grumpy: "Fred, the last time you were here, in June, your wife was complaining that the Neurontin made you irritable. How has that been going?"

Fred: "It's fine now. I left her."

Dr. Grumpy: "Uh, you what?"

Fred: "Well, she told me it was either her or the Neurontin, and I decided I liked Neurontin better."

Mrs. Grumpy Writes

Mrs. Grumpy just sent me the following email:

"I took the kids for their flu shots (regular and H1N1) this morning, before school.

"Frank always goes nuts when he gets a shot. I tried to bribe them by offering ice cream if they behaved. We walked in and Frank started wailing and yelling uncontrollably. He got louder when the nurse told us that he would have to have 2 shots because of his asthma.

"Craig and Marie were able to get 1 nasal mist and 1 shot. After they found out that they were going to have to get a shot (although we've been telling them for the last week!) they started crying. Frank was already nuts so I just had him go first. He was crying and yelling, but took the shots.

"Craig grabbed his chair and refused to let go. A nurse and I had to pry him off it. We almost broke his fingers. He screamed and cried through his shot.

"Then Marie started screeching and screaming and yelling during her shot. A doctor and another nurse from the office came running into the room to find out what was happening. They wouldn't leave even after we assured then that everything was okay. I kept expecting the police, fire department, and CPS to come rushing in.

"When we were done I said to the kids, "What do you say"? Frank and Marie said, "Thank you". Craig yelled, "Thank you for trying to kill me!"

"They stopped crying as soon as they got a sucker. When they got to the car, they all told me that it didn't hurt.

"I think we owe that office a lunch."

Brevity is the Soul of Wit

I'm reading some notes on a new patient who's coming in later today. This was from her previous neurologist:

"Impression: Headaches.

Plan: Appropriate treatment.

Thank you for this consult."

Halloween Nightmares

Daddy, my stomach hurts from all the candy. Bleeaaghhhhhhhh!!!!!





Last night, while walking my kids around trick-or-treating, I noticed a new degree of laziness. I suppose nothing should surprise anymore, yet it still does.

Parents driving their kids between houses.

For the record, we were in a decent, safe, low-crime, area. Front doors were roughly 50-100 feet from each other. The streets and sidewalks are in good condition and well-lighted, and the weather was nice.

Although most people and their kids were doing this the old-fashioned way, by walking, I saw several cases where a humungous SUV would pull up in front of a house and disgorge 5-7 kids. The kids would run up to the house, get candy, pile back into the family truckster, which would then drive 50 feet down to the next house and the process would repeat itself. While the kids were out, the parents would sit there revving the engine.

I saw several cars doing this, none of them with handicapped plates and way too many to be explained by a parent or child who was unable to walk. In addition to SUV's I also saw this being done with a few golf carts.

Let's look at this: Childhood obesity and diabetes are approaching insane levels. I have nothing against pigging out on candy here or there (especially on Halloween), but couldn't kids use the exercise of walking? Oh, and besides encouraging our kids to be couch potatoes, let's burn some gas, pollute the Autumn air, and contribute to global warming.

At one point An SUV went by, towing a flatbed trailer with a bunch of unfastened plastic yard chairs on it. Each with 2-3 small kids sitting on it. THAT looks safe! And these same people, when their kid ends up in ER with a serious head injury, will blame society for having Halloween in the first place. Dipshits.

But, since this is a humor blog, a horrifyingly humorous ending.

One cul-de-sac had a block party going on in a driveway. In front of it they'd set up a table with a bunch of bowls of candy, the combined neighborhood trick-or-treat buffet. As kids went up there a lady in a witch costume would tell them to take one thing from each bowl.

We'd brought Snowball along, so he was happily padding away next to me. When Mrs. Witch saw him, she began looking around the table, and said "How cute! I love dogs! Hang on, I have some treats for dogs."

Then she called her husband: "Dave, honey, have you seen the bag I had over here?"

Dave came over: "Um, you mean the little yellow bag?"

Mrs. Witch: "Yeah"

Dave: "I gave it to some kid who came by. Why?'

Mrs. Witch looked horrified, and slowly turned back to me "Uh, I guess we don't have any dog treats anymore, sorry."

So, if your kid found a bag of mini-Milk Bones in his candy sack, it was an accident. Mrs. Witch felt sorry.

Happy Halloween!

(When I was 7, I screamed and cried so loudly in the elevator part that they stopped the ride to let me out. And my parents still remind me. Like I could forget.)

When the crypt doors creak,
And the tombstones quake.
Spooks come out for a swinging wake.
Happy haunts materialize
And begin to vocalize.
Grim grinning ghosts come out to socialize.

Now don't close your eyes,
And don't try to hide.
Or a silly spook may sit by your side.
Shrouded in a daft disguise,
They pretend to terrorize.
Grim grinning ghosts come out to socialize.

As the moon climbs high over dead oak trees,
Spooks arrive for the midnight spree.
Creepy creeps with eerie eyes,
Start to shriek and harmonize.
Grim grinning ghosts come out to socialize

When you hear the knell of a requiem bell,
Weird glows gleam where spirits dwell.
Restless bones etherealize,
Rise as spooks of every size.
Grim grinning ghosts come out to socialize.

If you would like to join our jamboree,
There's a simple rule that's compulsory.
Mortals pay a token fee.
Rest in peace, the hauntings free.
So hurry back, we would like your company.

Hurry back...

Hurry back...

Be sure to bring your death certificate...

Got Wild Kids?

"Daddy! Why do we all have to dress up as babies for Halloween?"

"Shut up, Frank, and put on the diaper."

Like, You Know

Okay, Grumpyites, the following quote was uttered to me by a drug rep about 5 minutes ago:

"So, Dr. Grumpy, you know, I came in because I'd like to know, you know, what you, like, know about our new product, and what your patients know about it, and, like, what you think about it, and all that stuff, like that, you know?"

You're Driving Your Pharmacist and I to Drink

Before an appointment ends I always ask patients if they need any refills or scripts written. It saves time later.

So yesterday I asked Mrs. Brainless if she needed any refills on her seizure medication, and she said no.

Last night, around 9:00, a pharmacist called me. Mrs. Brainless was there, needing a refill on her med. The same one I'd offered to refill earlier (for the record, she told the pharmacist it was "my seizure pill, whatever it's called". Fortunately, they know her there and could look it up).

I authorized the refill, then called her cell phone (1-800-BRAINLESS), and asked her why she'd told me she didn't need any refills a few hours earlier.

"I didn't then. I still had one pill left for my night dose. But I took it, and now I'm all out, so I'll need some for tomorrow morning".

Bank Of Idiots, Can I Help You?

Late this afternoon Annie came looking for me. She'd just gotten off the phone with our branch of BigBuck Bank. Britney, an account manager, had called and said she needed to talk to me about the Grumpy Neurology, Inc. account.

Since I'm not one to screw around with the financial health of my business, I called her back between patients.

Britney: "BigBuck Bank, this is Britney."

Dr. Grumpy: "Hi, this is Ibee Grumpy, returning your call."

Britney: "Oh! Thank you for calling me back so quickly. I was reviewing your account, and found you qualify for a BigBuck Bank corporate Visa card!"

(pause)

Dr. Grumpy: "I already have a BigBuck Bank corporate Visa card."

(longer pause)

Britney: 'You're right! Thank you for calling me back, and have a nice day!"

Guy Anatomy Issues

Mr. XY: "I have prostate cancer."

Dr. Grumpy: "Is it being treated?"

Mr. XY: "Yeah, they said it had spread to my uterus or something."

H1N1

Dr. Grumpy has now had his H1N1 vaccine. And I have to say that I'd have preferred a shot to the H1N1 vaccine I got, which involved having a few drops of liquid sprayed up each nostril.

It tickled like hell, and made me sneeze constantly for the next 5 minutes. I'm pretty sure that anyone who'd like to be vaccinated could get treated by licking my desk, phone, pens, and anything else that was in front of me during my sneezing fit.

Nevertheless, I'm glad I got it.

Sometimes Breast Isn't the Best

Yesterday afternoon I was seeing a lady who'd recently had a baby. She came in to talk about resuming her migraine medications after pregnancy.


Mrs. Nursing: "I couldn't wait for this appointment, so I restarted Topamax after I got home from the hospital."

Dr. Grumpy: "Are you breastfeeding?"

Mrs. Nursing: "Of course! You know what they say, 'breast is the best'."

Dr. Grumpy: "You shouldn't be taking Topamax while you're breastfeeding."

Mrs. Nursing "Oh, I don't. I wait till the baby is done".

Reality Check

"I don't want to pay for insurance for illegal aliens."

"I'm not going to pay for someone else's insurance."

"I have good insurance! Why should I pay for somebody else's medical care?"


I hear crap like this everyday. Somehow people really believe this, too.

GET REAL PEOPLE! YOU PAY FOR IT NOW! AND GUESS WHAT? THERE IS NO MODEL OF HEALTH CARE WHERE YOU WON'T!!!

Let's look at this: Mr. Poorsap has no insurance. Maybe he's unemployed. Or an illegal immigrant. Or he's working his ass off, but his job doesn't give him benefits.

Mr. Poorsap has a heart attack. Or gets cancer. Or falls down a manhole. Whatever. He goes to Local ER, and needs to be admitted. Legally, Local Hospital can't turn him away.

He's sick as shit. He needs surgery, maybe more than one. A lot of medications. He has a lot of tests. And a few complications. He's in the hospital for a month before he's finally able to go home.

His bill is $1 million dollars (hypothetical number). There's no way in hell he'll ever be able to pay a significant portion of that.

Local Hospital has to pay the nurses who took care of him, and the companies who sold them medical supplies and drugs to take care of him. They really can't afford to write off that $1 million. So they raise the rates on EVERYONE who comes to the hospital, to help offset the costs of the uninsured.

So they send all these bills to Giant Insurance, Inc., who pays them. Of course, Giant Insurance, Inc. has staff and rent and office supplies to pay for. They need to make-up the money to offset their losses on what the hospital charged them to make up their uninsured patient losses. And so Giant Insurance, Inc. passes the increased costs on to YOU, by raising your premiums.

And multiply this by tens of thousands uninsured Mr. Poorsaps every day, across the country.

Look at this like shoplifting, people: I don't shoplift (well at least not non-Diet Coke items), and I hope you don't shoplift. But somebody does. So if over the course of a year Local Grocery loses $100,000 to shoplifting, they need to make up that loss by increasing their prices. And we ALL pay those when we go grocery shopping.

So regardless of whether you oppose or support the current plans, or voted red or blue, the bottom line is that YOU ALREADY DO, AND ALWAYS WILL, pay for someone else's insurance. The only people who don't are the ones who have no coverage in the first place. Any politician on either side who tells you otherwise is full of shit.

This is a standard model of business (and health care is a business), and has been since the first business opened its doors a long time ago. You have to make up your losses somewhere.

Ideas From TAP. And Spooky Polls.

Nobody has an ideal health care solution.

BUT

My esteemed colleague over at The Angry Pharmacist put up an excellent post a few days ago. I want to direct everyone's attention over to it. He makes some valid points and backs them up with reasonable arguments, and I think it's worth reading.

AND

What makes health care reform so hard, and so scary, is stupidity on both sides.

I missed this story when it first came out, but my awesome reader Lisa was kind enough to send it to me.

Basically a firm called Public Policy Polling surveyed 900 voters here in the USA, asking them if the government should stay out of Medicare.

To my horror, 39% said "Yes"! So, more than a third of eligible voters are entirely unaware that Medicare IS a government program, and always has been.

This poll cut across a frighteningly broad swath of income and education.

At least I get blog material from them.

And a great big DR. GRUMPY THANK YOU TO MY READER LISA K. for bringing this to my attention.

We Have Medication For People Like You

I saw a new patient today, who brought his briefcase. I don't care. Maybe he hates leaving it in his car. Maybe he's a courier. Maybe he's a part time nuclear "bag-man" for the President. Whatever.

I asked him if he'd had any headaches recently.

He opened the briefcase, pulled out a HUGE notebook, flipped through it for a minute, then said:

"Yes, mid-afternoon on October 10, 2003. I took 1/2 of one of my wife's Percocets for it, and it resolved in 45 minutes".

The notebook and briefcase can't come back here anymore.

Boredom, Redefined

One of you wrote in this morning that you're trapped in a boring teleconference, and so to kill time you decided to add up my monthly posts over time, and graph them.

And then you sent it to me.

(click to enlarge)



While I appreciate this kind of devotion, I have to say a few things:

1. I hope you're not a pilot flying a plane that's just overshot your destination because you're playing on a laptop doing this.

2. If you aren't really in a meeting, and do things like this for fun, you need a life.

Fun With Patients

Attention! Alert! Local Grocery has Coke stuff on sale for $2/12-pack!

When this happens I stop by pretty often after work. They only allow you 5 cases per person, so I make repeat trips, with varying combinations of Diet Coke, Coke Zero, and Vault Zero being thrown into my trunk until:

1. My rear tires are squashed flat.

2. My arms fall off.

3. The store runs out

4. I max out my credit card.

So today I was there, deciding what my next soda run should consist of. I was so engrossed in this serious issue that I didn't see it coming.

I was sighted and approached by a patient.

An Alzheimer's patient.

Bill.

Bill: "Uh, excuse me? Hello."

Dr. Grumpy (looking up): "Yes, I (oh shit!), oh, uh, hi"

Bill: "I know you, um" (he leaned forward, and to my horror I realized I had my hospital ID clipped to my shirt) "You look familiar, um Ibee Grumpy?"

Dr. Grumpy: "Yes, Bill, how are you?"

Bill: "Don't tell me, it'll come! I know! You work here!"

Dr. Grumpy: "No, Bill, I'm..."

Bill: "Can you tell me where cereals are? My wife told me to get some Corn Flakes."

Dr. Grumpy: "Uh, aisle 16, that way, about halfway down."

Bill: "Thank you."

As he walked away, and I was stunned at my good fortune, I realized he had a box of Corn Flakes in each hand.

"I've been aware of the time going by,
They say in the end, it's the blink of an eye."

(If you recognize the title- congratulations!

For those who remember, one of my 20+ high school reunions has been coming up, and it was this past weekend. [If you don't remember, I commented on it last month here and here.]

The following is a personal letter I wrote to a friend after my 20th reunion a few years back (he didn't attend). I re-read it last night, and decided my feelings haven't changed since then. So I'm putting it up for your perusal. I should note that in the 20 years prior to the reunion I'd had only incidental contact with anyone from my high school class, except for the one I wrote the letter to.

It was interesting. I didn't go to any of the previous ones, and almost didn't go to this one. But I'm glad I did.

20 years is a long time. It erases a lot of animosity. At some point you find that the majority grew up and became (reasonably) mature, decent human beings. I found there was no competition like there might be at 5 or 10 years. At this point most everyone is set in their lives and has answered the elusive questions of "who am I and what do I want to be?"

Even people who I hated once and never wanted to see again I was glad to see, oddly enough. Instead of being enemies they're now simply people I share a common background with, and it's interesting to talk to them and see where life took them. You don't really have time to sit and talk to anyone for more than a few minutes, because everyone is constantly running to the next vaguely familiar face (or name tag) to say "Hi". Most conversations are long enough to cover your spouse, your job, your kids, and where you've lived in the past 20 years, and then it's on to the next person. In a strange sort of way I imagine an afterlife would be the same way.

I was amazed at how many people came from all over the country just for this, also at how many are on their 2nd and 3rd marriages already. Some have kids who are taking the SAT's themselves. A lot of people (including me) had twins.

Cindy, that girl we were both chasing back then, looked about the same, very thin, same face, just a few more lines. Her short brown hair is now long and dyed raven black. She never married, never had kids, and is still looking for Mr. Right. In fact, she asked me if I knew anyone. I think the whole thing is interesting. As you pointed out in our phone call, she came across as unattainable to everyone back in high school. And now she's the rare one who's still alone.

What's interesting is that on talking to them now, I found that almost all the girls I had crushes on back then are so unbelievably incompatible with me that any relationship with them would have been short-lived, if it had actually happened at all. It's amazing what hormones did then, and what the retrospectoscope shows now.

Ron wasn't there, though he lives locally. Some people had gotten his phone number, but he never returned their calls (said his voice on the machine was still the same, though). No one has had any contact with him for over 10 years, and the ones who had the most recent contact said he'd become very bitter and unhappy, which is why they'd stopped keeping in contact with him. Diane commented that she felt like "he'd become someone who needed rescuing, but nobody else could help him".

Phil and Lisa married and had kids. Phil was an obnoxious jackass in HS. Now I found him to be a polite, decent person who was actually interesting to talk to. He has some sort of administrative job. He's very quiet and down to Earth. Time, raising kids, and having a mortgage and bills has a way of doing that to people. Lisa is now thin as a rail. Phil must weigh 300 lbs.

Pete works locally for an insurance company. He is the same personality as he was then, but pleasant and mature. Not married, no kids. Looks about the same but now has long hair down his back. Mrs. Grumpy, who'd never heard of him before, saw him come in and said "Who is that guy? He looks like the missing link." I think that sums it up.

In high school Pete had this POS 1972 Toyota jeep, that looked like it was about to fall apart. He still has it, was parked next to my car. Oddly, after 20 years, his once-POS 1972 Toyota Jeep is now likely worth more than my 2000 Maxima. Time is a great equalizer.

One of the girls, Laurie, I went back to 6th grade with. Others I went as far back as 4th grade with. The night after the reunion, Laurie was on the local news in a feature story on what it's like to be fighting breast cancer and be raising young children. She hadn't mentioned any of it to anyone there all night.

Sunday afternoon was the final reunion event, a family picnic at Local Park. It was a lot of fun. You realize from watching everyone that the only accomplishments and achievements that really matter to everyone are their kids.

The low-point of the reunion was when I introduced Mrs. Grumpy to Cathy, an old friend from the school paper. Mrs. Grumpy asked her when she was expecting. She wasn't. I told Cathy that Mrs. Grumpy had had too much to drink (actually she doesn't drink at all, but Cathy didn't know that).

We all got a 2-CD set of top hits from our high school days. Scary to think the songs are 20 years old. In front of the ballroom was a table, where several current Local High band students were selling raffle tickets for a fundraiser. Later in the evening I was returning to the ballroom after using the restroom, and the students at the table were looking over the songs on the CD they gave us. They were making comments such as "who is Duran Duran?" and "Boy, I think my dad listens to these guys.".

Perhaps more frightening was when the MC pointed out that when we were in HS "Born in the USA" by Springsteen was released as the FIRST CD SOLD IN THE US.

They had a slideshow going on in one corner the whole night, with various old and new pictures. The most interesting slides:

Arnold Schwarzenegger as Conan the Barbarian then and now as governor.

Michael Jackson on the cover of Thriller, and on his mug shot (remember- this letter was written several years ago).

Madonna then, and still Madonna, now.

In an ironic note, an item on the "Onion" recently was "What did we think we'd be doing with our lives by now:

"1. Dancing professionally
2. World famous truck driver
3. Overseeing vast empire of some sort
4. Making at least assistant manager
5. Presenting own line of designer handbags
6. Owning a car with gull-wing doors
7. Not this telemarketing shit, that's for sure."

It's just amazing how time flies. As cliched as the phrase is, it's really true. When I was 7 and first learned about Halley's comet, the wait for it's next visit seemed like forever. Now, in the blink of an eye, it's been here and gone. My 3 kids are all temporally closer to high school graduation than I am now. Life happens, so enjoy it.

If there was one thing I learned, it was that I wouldn't change anything. You find yourself thinking about all the alternate paths your life might have taken. What if I had asked this girl out, or gone on that trip, or taken that class. I came to realized that if I could go back and do it all over again, I wouldn't change anything. I'm very happy with where life has taken me, and for all the ups and downs of growing up and growing old I wouldn't trade any of it for anything.

Sunday Afternoon, 4:35 p.m.

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

Mrs. Sickandtired: "Yeah, um, I didn't get any sleep last night, because my kids were both up sick, and now I'm exhausted and have a headache and shaky all over."

Dr. Grumpy: "What's your question?"

Mrs. Sickandtired: "Do you think it would help if I got some sleep tonight?"

My inner voice: "No! I think you should stay up all night tonight, too! Stay up for the next week! Make a big pot of coffee and guzzle it! See how long you can go without sleep, and see what it does to you! Suck it up!"

Dr. Grumpy: "Yes, I'd try to get some rest and see how you feel tomorrow."

Mrs. Sickandtired: "Okay, thank you."

My Dog is Stupider Than Your Dog

I ordered a bunch of books last week and they came yesterday. I opened the box and absently tossed a big sheet of bubble wrap on the floor of my home office.

This afternoon Snowball wandered in, and apparently noticed it for the first time. He went over and walked on it. And a plastic bubble popped.

Snowball leaped back like he'd been shot. He barked and growled at the bubble wrap, going into attack position, ready to lunge if it so much as breathed (it didn't).

After a few minutes of glaring intently at it, he was apparently sure he'd killed it, or scared it into submission. So he went over to walk on it again.

And a few more bubbles popped.

He leaped off it, howling in terror. Ran like hell for the far end of the house. He's now hiding under Marie's bed, shaking all over.

Your Insurance Premiums Hard At Work

One of my normally stable Multiple Sclerosis patients (Mike) went south on me today, so I saw him emergently over my lunch hour.

When this happens, the standard treatment is to give high doses of steroids through an IV line for 3 consecutive days. Generally it's done either with home health going to the patient's house to do the infusions, or the patient goes to an outpatient infusion center each day for 3 days to have it done there.

So I got Annie on it fast. Miracle worker that she is, she found both a nursing service and an outpatient infusion center that could do this over the weekend, giving me both options. Then she called the patient's insurance to get approval for one or the other.

Guess what? Mike's insurance company didn't have a supervisor available to authorize either one of these on a Friday afternoon. And the underling Annie spoke to (and then I got on the phone to argue with them) told me she wasn't allowed to give approval for this, and there was no one else around who could. So what did she suggest? She told me to admit Mike to the hospital over the weekend to do this, since that didn't require pre-authorization!

So let's think about this:

Home health OR an outpatient infusion suite would cost roughly $200-$400 per day (including nurse time, supplies, and drug) for 3 days.

BUT since Bozo Insurance, Inc. didn't have some magical person around on a Friday (which is a workday last time I checked) or anyone else who could approve this, they told me to admit Mike to the hospital.

I called a friend in hospital accounting. The rate for the basic room Mike is now in is roughly $1800/day. This does NOT include the costs of drug, supplies, or physician fees for docs having to round on him (since we're required to). All together, the hospital stay will cost the insurance $2500-$3000 per day for 3 days.

And Mike is pissed, too. Because he'd rather be at home.

And this is where your insurance premium dollars are going, and how your insurance company is working hard to cut back on costs and save you money.

Personalized Medicine

These electronic chart systems are so amazing. This came over my fax a few weeks ago.

The only thing I've done to it is delete the patient's name and hack off the other doc's letterhead. Otherwise what you see is what I got.


(click to enlarge)


For the record, the "copies of my chart notes" never showed up.

Drug Rep Training FAIL!

Yesterday we had lunch from a drug rep marketing an antidepressant. He was new to the office, and the lunch had been set up by his predecessor.

To my astonishment, about halfway through the sales spiel he suddenly asked, "Hey, what kind of doctor are you, anyway?"

"Uh, I'm a neurologist."

"Really? What does a neurologist do? I didn't even know I was calling on one."

Who's Throwing Stones Here?

DO NOT EVER CHEW ME OUT FOR MY DIET COKE HABIT WHEN YOU JUST TOLD ME YOU DRINK 2-3 SIX-PACKS OF BEER AND SMOKE 2 PACKS A DAY!!!

Um, Not In My Office

I was flipping through a throw-away medical journal last night when I came across this picture.

Gotta tell you guys, if I did something that looks like this to a patient (especially one in hot pink undies!) I'd get my butt dragged in front of the state medical board.

(click to enlarge)

It's That Time of Year, Again!

The season for sharing is almost upon us, and my kids have started early by sharing some irritating variant of the creeping crud with me.

So in honor of that, I'm going to steal (uh, I mean copy and properly credit) from my esteemed colleague The Mother this excellent post on managing family illness.

She has extensive training in 2 remarkably difficult fields, being both a Mother (of 4 boys) AND a doctor, and so is eminently qualified for all kinds of stuff. Like me, she is a history buff. She can be read at mothershandbook.net.

The Care and Feeding of Illness

by The Mother

Wednesday, October 21, 2009

In the light of the mounting cases of the flu among my bloggy friends, and the fact that, where I live, even DOCTORS can’t get the H1N1 vaccine, I feel compelled to do what I can to make everyone’s lives just a little bit easier during the (nearly mandatory) ten days when the household goes to pieces.

The care and feeding of a sick family, while not an exact science, certainly has a few well-established principles.

1. No wife is allowed to be sick alone. Husband will immediately find a way to be sicker.

2. The child with the most tests that week will get sick first. The child who is in preschool and has absolutely nothing to do with his life (and, because he has nothing to do with his life, MUST be entertained) will miraculously escape disease.

3. They don’t make enough trees for a family of six to all have colds at the same time. Ditto decongestants.

(Corollary to rule 3: You will run out of decongestants within a day. You will buy the biggest box you can legally buy, and then run out in two more days. You will then be forced to beg your neighbor to go to the pharmacy and score you some decongestants. This corollary leads to:

The Mother’s Rule of Decongestant Procurement: Go buy the biggest box you can get, NOW. Set your calendar alarm for one month from now. Repeat, whether anyone gets sick or not.)

4. Even if the mother is on her deathbed, she has to do chores. Someone has to feed everyone and buy toilet paper (and tissues).

(Corollary to rule 4: Everyone gets sick the day before grocery day, when you have no food in the house.)

5. Everyone starts throwing up the minute MOM gets nauseous.

6. Children who are vomiting have an amazing knack of finding the most expensive, least cleanable thing in the house on which to do it.

7. Every sick child regresses at least three years.

8. Husbands who are sick regress to childhood. Somewhere around three or four years of age. The age where they, too, must be constantly entertained.

9. Even with 900+ channels and three televisions, there will be nothing on TV that will keep your children and husband busy for even an hour. Ditto the entire collection of DVDs.

(Corollary to rule 9: The internet gods will pick that week to upgrade their systems, taking down WOW and all of the streaming video sites every five minutes.)

10. (applies only to Jewish households) No matter how much medical education hubby has, he is absolutely convinced that Chicken Soup fixes everything. Sick wife will either be standing over a stove with a pullet or phoning her mother-in-law begging; extra points if she chooses option B.

Hey, I don’t make the laws of physics. I just report them.

Games People Play

Medicine is a business. Believe me, as a doc in solo practice I REALLY understand that. I want to help people, but also have to pay Mary & Annie, and my mortgage, and Diet Coke bills, and office rent, etc.

In a perfect world, healthcare would be free and unlimited. But our world isn't perfect, and the issue becomes balancing finite dollars against virtually infinite need.

We all try to do our best (I hope) to care for patients within our means.

Unfortunately, the system gets abused from all sides.

1. Insurance companies sometimes try to rip-off doctors and hospitals (and many others in between).

2. Hospitals and doctors (and many others in between) sometimes try to rip-off insurance companies.

3. Futile care is often given, usually due to family members feeling guilty. All of us in this business have seen a 90+ year old person with advanced dementia and other serious medical issues, being kept alive with machinery at a family's insistence.

4. Unnecessary admissions for bullshit reasons are common, and a huge waste of resources. My esteemed colleague ERP recently wrote an excellent post on this over at WhiteCoat's Call Room.

5. In my career I've known some system-abusing nurse managers. For example: Years ago I worked at a hospital where one floor's nurse:patient ratio was supposed to be 1:4. Instead, it was often 1:5 or 1:6. This lowered quality of care and increased nurse burn-out, and most docs sure noticed it (I don't go to that hospital anymore).

At a meeting to address these concerns the floor manager was asked why this problem kept occurring. She explained to us that her year-end bonus was based on how far under-budget the floor was, and that she needed to run the floor understaffed because she was trying to afford a down payment on a new car.

6. Some insurance companies have policies where doctors are paid a bonus based on how much care they DON'T do (I don't participate in those contracts). In other words. Big Insurance, Inc., says to Dr. X. "Here is $100,000 (hypothetical number) to pay for all our patients' tests this year. If you only spend $75,000, then you get to keep the other $25,000."

This is grossly unfair. In a perfect world the doctor would ignore this. But it ain't perfect, and we all have bills and families, and so it puts the doc in a difficult situation. And of course, if he doesn't do a test and gets sued, who gets nailed? Not Big Insurance, Inc.

These contracts, fortunately, are in rapid decline. They were most popular during the 90's. But are dying now as more and more docs refuse to accept them.

7. Pay-for-performance (also called P4P). This has been kicked around in the last few years. The idea is simple. Docs who have good patient outcomes will get paid more. After all, shouldn't they be rewarded for being better docs?

The problem here is that some conditions are basically untreatable. And some patients don't care about their own health. If something like this happened, WTF would I want to see someone with something incurable, like Alzheimer's disease? I'd only want to see simple stuff with generally good outcomes, like a young, healthy patient with carpal tunnel syndrome or occasional migraines.

If you've had a stroke, or brain cancer, or something else that ain't so good, then good luck finding a doc who's going to take you on with P4P. Because sick people are only going to cut doctor reimbursements since their outcomes will be worse. And, like I said, in a perfect world docs wouldn't look at the bottom line. But in this world we all have bills and families.

Not only that, but if I beg Mr. Marlboro to quit smoking, and he doesn't, and has a stroke, then I get penalized for a poor outcome that was out of my control.

For P4P to work, it's going to need A LOT of tinkering.

8. And my last whine, and the one that got me thinking to write this:

I got called to ER early yesterday morning to give an older gentleman TPA, the clot-busting drug. He had right-sided weakness, but fortunately got better on his own. Later in the morning, however, he worsened again, then got better again, and kept fluctuating. I kept running back & forth between my office and the hospital as the situation changed. I finally got him stabilized with medications, and ordered a bunch of tests (MRI, MRA, echocardiogram).

About 6 hours after I left the floor, I got called by Dr. Hungry Hospitalist.

Dr. Hungry: "Yeah, this stroke guy. Can I send him home now?"

Dr. Grumpy: "He hasn't had any of his tests yet, has he?"

Dr. Hungry: "No. Can't you just do them as an outpatient?"

Dr. Grumpy: "I'm not comfortable with that. He needs a work-up. His last TIA was only 6 hours ago, and I'm not even sure he's neurologically stable at this point. It's too soon to see."

Dr. Hungry: "I'm sure he's stable. Can't you just see him in your office in a few days?"

Dr. Grumpy: "Why are you so eager to toss him,?"

Dr. Hungry: "Um, well, uh, my, um, year-end bonus is based on how short I'm able to keep my average patient length of stay, and I had a really sick lady a few months ago who was here forever, and blew my average to hell, so I really need to bring it down because I've got a med school loan lump sum payment due in January and..."

I hung up on him.

Mary's Desk, October 20, 2009

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

Ms. Daughter: "Yeah, I need to make an appointment for my Mom, she has Alzheimer's disease".

Mary: "Okay, what about Wednesday at 2:00?"

Ms. Daughter: "No, I need all day Thursday".

Mary: "All day?"

Ms. Daughter: "Yeah, I mean, it's not really an appointment. I've got to drive to Southern City for a business meeting, and need someone to watch my Mom."

Mary: "Uh, we don't do that."

Ms. Daughter: "Come on. The nursing homes charge a fortune for adult day care. Can't I just leave her there for a few hours and you can bill Medicare for an appointment? I'll be back by 4:00, and I'll supply her lunch and insulin."

Mary: "Ummm..., ma'am, we really aren't an adult day care service or care home."

Ms. Daughter: "You won't do this, either? Great. I've tried almost every damn doctor in the area. What is wrong with you people?! Don't any of you care anymore?"

(hangs up)

Holy Toast, Batman!

Following this morning's Darth Vader toast post, so many of my awesome readers have sent me this link that I'm just going to put it up.

This site shows you how to order parts to convert your own toaster into a Jesus toaster.

Uh, That's, Uh, Great, Thanks.

While doing some advance holiday shopping last night I stumbled upon this remarkable gadget.

(click to enlarge)





I want to know if it comes in a Batman model? What about Superman? Or Jesus?

I Don't Really Want To Know More...

I'm in the hospital stairwell, heading for the 4th floor. From somewhere up the staircase a female voice drifted down.

"Sometimes it's like some kind of yogurt, sometimes randomly like cottage cheese..."

Then a door somewhere upstairs closed, mercifully cutting off the rest of the sentence. I'll just tell myself she was discussing a new dairy product diet.

Getting Even

As you may remember, Mary saw fit to torture her poor, aging, employer a few weeks ago.

One of her jobs (besides playing Farmtown online) is to fax my notes to other physicians' offices. So late this morning she had a bunch of them to send.

Around 11:30 the girls decided to order lunch from Chipotle, and faxed over an order. Mary went to pick it up.

While she was out I fished the fax confirmation sheet from Chipotle out of the trash, along with some of the medical office fax confirms on my patient notes. I doctored them up to make it look like she'd accidentally faxed all the patient notes to Chipotle. I put them on her desk, and went back to my office.

When she found them she was frantic for about a minute. Then she came back here to kill me.

It was SO worth it.

Monday Morning, 12:14 a.m.

My cell rings. It's that most dreaded of all numbers, the Local Hospital ER.

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

Clerk: "Please hold for Dr. Wokemeup."

(pause, bad music)

Dr. Wokemeup: "Hi, Grumpy?"

Dr. Grumpy: "What's up?"

Dr. Wokemeup: "Do you know a patient named Mr. Headbleed?"

Dr. Grumpy: "No, doesn't sound familiar."

Dr. Wokemeup: "I didn't think you would. He's visiting from out of state, and says he doesn't have any local docs. Anyway, it doesn't matter. At the family's request we're transferring him to Major Neurology University Medical Center. Thanks for returning my call."

And he hung up.

Getting Ready for Monday

There are Emergencies, and then there are EMERGENCIES!

From an internist's orders on a 34 year old lady admitted with a stroke (she'll be okay, don't worry):

"1. Brain MRI: Routine.

2. Head and neck MRA: Routine.

3. Echocardiogram: Routine.

4. Bring patient some tampons ASAP!!!"

On Call Follies

Dr. Grumpy (starting to look through a chart): "Why did they consult neurology on this guy?"

Nurse: "He had a seizure this morning. Dr. Stevens came by an hour ago, and thought it was from the antibiotic."

Dr. Grumpy: "Hmmm... Why is he in the hospital in the first place?"

Nurse: "Dr. Stevens? Uh, I think he was making rounds."

Life's a Bitch, and Then You Die

I'm on call this weekend, but am going to bitch about something unrelated.

A friend died last week. Not a close friend, or even someone I'd talked to recently. We did residency together, and practiced in the same city. But as time and geography do, we hadn't been in contact for a while. Not that we ever had a falling out, as much as we had our own lives. Occasionally we ran into each other at various places, and it was always good to see him.

He died of shit luck. That's all. And he was in his early 40's, a year younger than me. When a young person dies we always hope they did drugs. Or committed suicide. Or some risky behavior we can blame it on so we can say, "Geez, I don't do that sort of thing, so it won't happen to me". Not here. Just shit luck that can't really be prevented.

In residency we had all kinds of odd adventures, besides the usual war stories of medical training. Like when our hospital paid for the residents to go to a Neurology Academy meeting in Seattle. A bunch of us played hookie, and used our department stipends to go barhopping. Since we had no money for cabs, we were limited to bars in walking distance from our cheap motel. And they were all gaybars. So we wandered in and out of 10-15 gaybars over the course of the day.

All the geeks in neurology residency (let's face it, that was all of us) would watch Babylon 5 together once a week, and he and I would argue about it for the next week.

When I was trying to decide if I should ask Mrs. Grumpy to marry me, he gave me some advice that helped push me in what's turned out to be the right direction.

And it just sucks. Like me, he busted his ass through a combined 14 years of college, med school, residency, and fellowship. Then building a solo practice from scratch. And now he leaves behind a wife and 4 kids (younger than mine, too).

Anyway, don't mean today to be a downer, and I'm not looking for sympathy. Just venting.

But since this is a humor blog, I'll end it with a memory of him.

He was known for being gruff, and didn't really give a shit about what people thought of him or who he offended.

There was a day in the late 90's, when a drug rep had brought lunch to the practice we'd both started out in. She was obnoxious beyond belief. She would not shut up. And at the end of each sentence she'd ask "With this information, is there anything else I can do to help improve your patient care?"

We were trapped. And being new physicians, I was afraid that if we walked out we'd get in trouble, as her company was sponsoring some research at our institution. Gruff wasn't as concerned with this as I was.

So at one point in her sales monologue from hell, I passed him a note that said "We're trapped and will die here". He passed it back, and had written "I'll take care of it".

A second later she asked her standard "With this information, is there anything else I can do to help improve your patient care?"

And Gruff said, "Yeah! Show us your tits!"

She froze in horror, and in that second we both bolted.

We didn't get in trouble. Better yet, we never saw her again, either.

Goodnight, Dr. Gruff.

It's Happened! In My Lifetime! Hallelujah!

Ladies and Gentleman, one of the most horrible, awful, traumatic diseases in history HAS BEEN CURED!

Kapidex is a rehash of Prevacid, a drug used to treat gastric reflux (that's a fancy name for heartburn, huh?)

But Kapidex also treats Non-Erosive Reflux Disease. AKA NERD!!!

(click to enlarge)




There you go! Nerdhood, one of the most socially debilitating diseases known to man, has been CURED!

To give credit where credit is due: this breakthrough wouldn't have been possible without the 1970's efforts of renowned researchers H. Winkler and A. Fonzarelli to bring the condition to widespread public attention.

The data is preliminary, and hopefully more information will be forthcoming. Will the drug cause one to grow a leather jacket? Or make hair follicles part themselves differently? Or alter one's taste in music to something other than "Men Without Hats Greatest Hit?"

And, most importantly, can the drug be dissolved in Diet Coke (uh, not that I'd personally have a reason to want to know that).

(Many thanks to my reader Jason, who sent me the PI for the drug)

Bad Ideas in Currency

A few weeks ago I had a long phone meeting for $275. It was for a market research company, who wanted my opinion on migraine treatments.

So today I received payment from them, with this awesome check;





I was worried the bank teller would hit me over the head 275 times with a hammer. Fortunately, they just credited the money to my account, although the guy began giggling.

From Hawaii, With Love

When the kids were younger, we had a part-time nanny named Syndee. I was anything but fond of her. I don't remember how Mrs. Grumpy found her.

Syndee did a good job with the kids, so I turned a blind eye to her many shortcomings (which could be several posts alone). Her main issue was a remarkable lack of IQ and common sense. It was not uncommon to realize she'd been outsmarted by Snowball (and he's slow). She occasionally still calls to see if we need a babysitter. Rarely she'll call me for medical questions, as she does not grasp the concept of what being a specialist means. She's also learned (since she knows our home number) that it's easier to reach me then her own doctor.

Last week Syndee got married, and went off to Hawaii for her honeymoon.

This morning, at 12:05 a.m., I was woken by our home phone ringing.

Dr. Grumpy: "Mmmph, hello?"

Syndee: "Hi! Dr. Grumpy! It's me, Syndee!"

Dr. Grumpy: "What the hell?... Syndee do you know what time it is?"

Syndee: "Sure! It's just after dinner! Why, is your clock broken?"

Dr. Grumpy: "No, it's after midnight here."

Syndee: "It is not! I wouldn't call that late!"

Dr. Grumpy: "Syndee, you're in another time zone."

Syndee: "What's a time zone?"

Dr. Grumpy (sigh): "Why did you call Syndee?"

Syndee: "Well, um, In the last few days I've developed a bladder infection and..."

Dr. Grumpy (seeing an opportunity to get even): "What the HELL have you been doing on your honeymoon to get a bladder infection?"

Syndee: "Well, um, my husband and me, um we, um... Can you just call in some antibiotics for me?"

Dr. Grumpy: "Why didn't you call your regular doctor for this?"

Syndee: "Her office was closed, and I didn't want to bother her."

Dr. Grumpy: "Good night, Syndee." (hangs up)

Tricky Case

I just got interrupted for a call from the ER.

68 year old male.

Family noticed he's staggering today, and has slurred speech. They brought him to ER.

Head CT, EKG, all labs normal EXCEPT for a blood alcohol level of 0.277 (which is more than 3 times the legal limit).

AND HIS INTERNIST WANTS ME TO COME ADMIT HIM FOR A STROKE!!!!!!!!!!!!!!!!!!!

Geography FAIL!

I had an elderly couple here this morning. They're going to Florida in a few weeks, and asked for an Aricept script to take with them.


Dr. Grumpy: "Why, don't you have enough pills?"

Mrs. Mapquest: "Well, it's so expensive, and we're in the Medicare donut hole. We thought maybe one day we could go over to Cuba to see if it's cheaper there."

Dr. Grumpy: "Have you ever been to Florida? Or Cuba?"

Mrs. Mapquest: "No, but isn't it like Mexico or Canada, where you can just walk across the border?"

Parks for Vampires

It's Fall Break. So I knocked off early today to take the kids hiking, and drove to Intheforest State Park.

Most state parks here are open from 10:00 a.m. to dusk, but they change opening/closing times as the seasons change.

So when we got up to the park we were greeted by this sign:




Your tax dollars hard at work.

Do I Look Like the Shell Answer Man?

Dr. Grumpy: "Any other questions about this medication?"

Mr. Irritant: "No, but my wife and I were looking into adopting a child from Guatemala. Do you know how I'd reach their embassy for more information?"

Dear Smuckers,

The bozo in your "Sundae Syrup" division who developed your "No Mess Cap" bottle has obviously not met my kids.

This is false advertising, and I'm sending you the bill for having to repaint my kitchen.

Yours truly,

Ibee Grumpy, M.D.