Wednesday, June 11, 2014

Decimal points. Use 'em.

Seen in a hospital chart:


Thank you, Kim!

Tuesday, June 10, 2014

Stop!... Shovel time!



 While catching up on reading last weekend I came across this in a medical journal:


"The goal of the project is to supply an interactive system that translates vast amounts of data and scientific literature into insights that professionals can consult to inform their treatment decisions.

"A database, in this case big data, provides the foundation for the potential to use state-of-the-art analytics to generate truly actionable insights."


WTF does that mean?

This is the problem with modern buzzword bullshit. It is, like Macbeth said, "full of sound and fury, signifying nothing." Yet, medical journals are full of similar crap that tells you zilch.

EHR today is the same way. 5-page notes that automatically fill in what medications someone is on, what their allergies are, what their blood pressure is... yet only rarely do you find anything comprehensible telling you what the physician's impression and plan are- WHICH IS THE MOST IMPORTANT PART OF THE NOTE. Usually it's hidden in the ICD numeric codes, and oftentimes the "plan" says something like "see orders database." Which doesn't help me at all.

Quantity has replaced quality in medical writing, and the problem shows no sign of getting better.

The above collection of horseshit, BTW, was from an article about epilepsy treatment.

Monday, June 9, 2014

Rorschach

This is a neuron. It's the basic nerve cell that runs your brain, my brain, pretty much everything's brain:



Sometimes it's hard to leave my job at the office. Work is always on my mind.

One night, when I got home, I found my kids had spilled something in the kitchen. And it reminded me of...




Sigh.

Friday, June 6, 2014

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)

Thursday, June 5, 2014

Medicine by committee

I'm with a new patient.


Dr. Grumpy: "What did the MRI show?"

Mr. Triad: "I'm not sure, my other neurologist said..."

Dr. Grumpy: "Wait, you have another neurologist?"

Mr. Triad: "Actually, I have 2 others. I saw both of them earlier this week."

Dr. Grumpy: "Why are you seeing 3 different neurologists?"

Mr. Triad: "Well, it seems like a good idea. I mean, this way if I disagree with something one does I can call the other two, and see what the majority opinion is."

Dr. Grumpy: "Who are the other 2 neurologists?"

Mr. Triad: "I don't want any of you to know who the others are. I think that will help keep all of you impartial."

Long pause.

Dr. Grumpy: "Honestly, I'm really not comfortable with this situation. I can understand someone wanting a 2nd opinion, or even a 3rd, but to have 3 different neurologists trying to manage the same condition, ordering tests, and prescribing medications at the same time... I'm going to have to end this appointment. I won't charge you for it, but I just don't think this is a good idea, and don't want to be a part of it."

Mr. Triad: "You know, that's funny. My 5th cardiologist said the same thing yesterday."

Wednesday, June 4, 2014

Great deals on prions! This week only!

Dear Major Chrysler, Jeep, & Dodge,

A reader sent me your flyer about the recent Memorial Day car & truck sale.

I can only assume you don't have a lot of customers who are neurologists...




Tuesday, June 3, 2014

Methinks I smell a rat

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

Mr. Gad: "Hi, I saw Dr. Grumpy a few years ago, and am worried about my records there."

Annie: "What's the problem?"

Mr. Gad: "Well, I'm concerned they might affect a legal action I'm in, and would like to change them."

Annie: "We can't change records, sir. If you feel something is incorrect you can send us a letter and we'll note it in your chart, or you can make an appointment to discuss it further with the doctor."

Mr. Gad: "That won't do. I need you to change my diagnosis."

Annie: "We can't do that."

Mr. Gad: "Okay... How about if you shred my chart and destroy any scheduling records, bills, and whatever that says I was there? I'll pay you, in cash, for your time."

Annie: "I'm sorry, sir, but that's illegal, and we can't do that."

Mr. Gad: "Don't you believe in 'the customer is always right'?"

Annie: "That's not the issue here."

Mr. Gad: "Thanks for nothing." (hangs up)

Monday, June 2, 2014

Numbers



How much did your employer give to charity last year?

Contrary to popular belief, American doctors and hospitals give away free care quite often, to the tune of $74.9 billion for 2013. That, in case you don't understand numbers, is a fuck-ton of money. Let's look at the zeros: $74,900,000,000.

Of course, most of it isn't voluntary. There are a lot of uninsured people in America, and, whether you like it or not, you're still paying for them (and always have been, long before the current health policies). Even though they don't have insurance, that doesn't mean they won't get sick or injured and land in the hospital. There they'll likely need labs, tests, medications, supplies, and (of course) doctors and nurses. Since the amount of money charged for medical services are realistically beyond what most can pay, the doctors and hospitals have no choice but to write them off as losses. So you pay for them by higher insurance rates (I've addressed this before).

But the office is a different matter. Most doctors, including me, collect payment up front. Maybe not the full amount, but we copy your insurance card and charge your $50 co-pay (or whatever) before seeing you. The rest we'll bill to your insurance company. For the record, I don't like billing people before their appointment, but it's amazing how many people have "forgotten" their wallet if you try to collect after the visit. Me and my staff have families to support, too.

My point here is that office care generally isn't free, unless previously arranged. To make an appointment you have to have insurance (or agree with our cash prices). Before you even get seen we copy your insurance card and charge you for your share.

Like most doctors, though, I still see the occasional uninsured patient for free. Sometimes as a courtesy to someone else, sometimes because I genuinely feel bad for someone and am trying to help. Most doctors do.

So how much free office care are U.S. doctors voluntarily giving up? Well, for 2013 it was $10.5 billion. $10,500,000,000. I'd still call that a shitload of money (shitload < fuck-ton).

For comparison, let's look at America's biggest retail company: Walmart. According to their own website, last year they gave away roughly $1 billion in cash and merchandise to various charities.

That's a lot, but it's not even 10% of the amount that doctors like me provided. Sam, you're a cheap-wad compared to us (but I love the way your shoppers dress).

Keep that in mind next time you hear some politician or "patient activist" talking about how doctors are all greedy bastards who don't really care about people. Maybe you should ask that person what they gave up to help others.

Odds are they don't have a 6-figure educational loan hanging over their fat heads, either.

Saturday, May 31, 2014

Random weekend pictures

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


First, we have this delectable name for an alcoholic beverage:


If you can't make out the back bumper, it looks like "Drink Responsibly. Don't be an ass."



Next we have this name for a WiFi network:



The person who sent it in says she was on a street between a hardware store a nursing home. I'm not going to even try to guess.



Then there's this ad. Given the common slang definition of "dump" it doesn't sound like ANYTHING I'd ever want to eat, no matter what's really in it.


"I am NOT baking anything I just dumped."

Next, we have this strange command seen at a retail store:


"I'm tired of all this sex on TV. I keep falling off."



Mrs. Grumpy had me stop at Chipotle recently to pick up dinner, and I got this receipt:


Unfortunately, being a medical person, I erroneously read it as "Our guaiac rocks" and was (briefly) pretty horrified wondering what they're doing with guaiac in a restaurant.

Friday, May 30, 2014

Great reasons for referring a patient

"I get blurry vision when I watch TV. But only channel 7."

Thursday, May 29, 2014

Head job

Recently, the Cefaly gadget was introduced. It's an electrical headband being promoted to treat migraines.

I'm not here to knock or praise it. I think the jury is still out, and have previously given my thoughts on the various electrical gadgets coming to market.

However, I can't help but notice there are a lot of promotional pics out there showing women (none of whom look anything like my patients) using this product:


"Do I look blissful enough? Is the Dalai Lama here yet?"


"The card you're holding is the 3 of hearts"

"Isn't this more artistic than touching my temples?"

OR

"The bells! The bells! They torment me!"
"Mine is blue. It matches my shoes. And that's all I'm wearing."
 

Anyway, after looking at these, I think they missed a chance to REALLY boost sales by putting a star in the middle. You know, something like this...



"The batteries are in the bracelets. They also deflect bullets."

Wednesday, May 28, 2014

Tangled

Annie: "Hey, Mr. Memory just called. Says he's still waiting for his Aricept refill?"

Dr. Grumpy: "Really? I thought I called it to DrugMart a few days ago."

Annie: "He says they never got it."

Dr. Grumpy: "Hang on... Here it is. Yeah, I called it in on Thursday."

Annie: "Let me call DrugMart."

(5 minutes later)

Dr. Grumpy: "What did DrugMart say?"

Annie: (sighs) "He picked it up yesterday."


Tuesday, May 27, 2014

The buzz


Eric

Last week Mrs. Grumpy bought a big jar of honey.

Yesterday morning we discovered one of the kids had put it in the freezer for no clear reason (and of course, no one admitted to it).

It had crystallized, so wouldn't go back to being a liquid easily. Since she didn't want to toss the whole thing, she scooped it into a pot and set it on the stove to liquify.

Then she got distracted with fighting kids, and forgot about it. So it boiled and went all over the stove and gave off a shitload of smoke. Which set off the smoke detectors, and then the fire alarm.

While the kids panicked like it was the apocalypse, I turned off the alarm, and she began cleaning the stove. The kitchen was filled with the sickeningly sweet smell of burning honey, so I sent the tribe to open the doors and windows and turn on ceiling fans.

Then suddenly the twins began screaming and running down the hall as, attracted by the smell, a bunch of bees came flying in. So I began killing them, and sent Frank to go close the doors.

He ran to get the front door, then yelled for me to come there. So I went up front and watched as a fire truck pulled into our driveway. Our alarm company had called them without even dialing the house to check.

I apologized to the guys, and explained what happened. I told them to ignore the twins, who by now had locked themselves in a bedroom and stuffed towels under the door to keep bees out, and were yelling out the window for the firemen to come help kill the bees. They laughed and drove off.

It took about 30 minutes to get rid of all the bees inside, but the smell was so strong we had to leave the windows open the rest of the day, during which time a bunch of them hovered menacingly outside the screens.

How was your weekend?

Monday, May 26, 2014

Memorial Day, 2014



Doris Miller was born in Waco, Texas, the 3rd of 4 boys. He worked on his father's farm until he was 19, when he joined the navy.

He signed up as a mess attendant, one of the few navy positions open to black men at the time, serving meals, cleaning, and doing other jobs. In January, 1940 he was assigned to the battleship West Virginia, where over the next year he was promoted to cook.

On the morning of December 7, 1941, The West Virginia was in Pearl Harbor. Miller had just finished serving breakfast and was starting to collect the officers' laundry for the day's washing. At 0757 the ship was struck by a torpedo from attacking Japanese planes.

Miller immediately ran to his battle station in the mid-ship anti-aircraft guns - only to find they'd been destroyed by a bomb. He took the initiative of going to the ship's central passageway, where he told any officer he could find that he was available for duty. The communications officer was looking for someone to help carry wounded men, and the 6'3", 200 pound Miller fit the bill.

They went to the bridge, where West Virginia's captain, Mervyn Bennion, lay dying outside from a large shrapnel wound. They carried him to a sheltered position. He refused to leave the bridge, continuing to give orders until he died.

Next, he was grabbed by 2 officers he routinely served meals to, and the 3 ran to an unmanned machine gun position. Miller had never operated the gun before, but learned quickly. Initially the officers planned to have him feed the ammunition belts to them, but while they were setting up he loaded a gun himself and started firing at planes.

The Japanese planes eventually left, with the West Virginia sinking to the bottom of the harbor 40 feet below. Parts of the ship were flooded, and Miller now set off to help the wounded. With portions of the deck covered in water and oil, he saved many lives by repeatedly carrying wounded men through the flooded areas to the dry quarterdeck, from where they could be taken ashore. When there was no more to do, he and the others finally left the ship.

A week later Miller was back at his usual mess job, this time on a heavy cruiser.

The initial roll of men who'd received commendations for their actions on December 7 didn't even have his name on it - just listing "an unnamed negro." It wasn't until March 12, 1942 that his identity became publicly known. In April, 1942 he was personally awarded the Navy Cross - the first African-American to be so decorated - by Admiral Nimitz himself. Nimitz wrote "this marks the first time in this conflict that such high tribute has been made in the Pacific Fleet to a member of his race, and I'm sure that the future will see others similarly honored for brave acts."

Miller's next assignment was the escort carrier Liscome Bay. On November 24, 1943 she was at the Battle of Makin Island. A Japanese torpedo detonated the ship's magazine, sinking her within minutes. Out of a crew of 916, only 262 men survived. Miller wasn't among them, and rests with his shipmates at the bottom of the Pacific.

He was 24 years old.

Friday, May 23, 2014

Thursday afternoon

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

Mrs. Time: "I need to make an appointment for Monday, May 26th."

Mary: "I'm sorry, but we're closed that day for Memorial Day. He can see you on Tuesday at..."

Mrs. Time: "That's not acceptable. Monday is the only day I can come in."

Mary: "I'm sorry, but we're going to be closed. It's a holiday."

Mrs. Time: "Well, then I'll meet him there. 10:00 in the morning should be okay. Tell him I'll be outside the building's western entrance."

Mary: "Ma'am, he's not going to come see you on a holiday. Do you have an emergency?"

Mrs. Time: "That's irrelevant. This is nonsense. Are you aware that it's violation of both state and federal law? Any doctor is legally obligated to see any patient whenever requested to do so."

Mary: "That's not true."

Mrs. Time: "I read it on the internet!"

Mary: "I'm not going to argue with you, ma'am."

Mrs. Time: "That's not acceptable, either."

Thursday, May 22, 2014

Skool Nerse time

This is Mrs. Grumpy.

Now, I want to start by saying I'm glad no one was even slightly injured during yesterday's events, but I think this is a good time to review what happened, and how parents at Douglas C. Kenney Elementary School can learn from it. Even though there's only 2 weeks left in the school year, it's always important to go over basic safety.

As you all know by now, Mr. Ima Scumball robbed the convenience store across the street from the school yesterday morning, then (due to poor planning in not having a getaway car), unsuccessfully attempted to carjack a driver at gunpoint, then gave up and tried to escape on foot into the neighborhood. This all happened at about the same time classes were starting.

Obviously, this sort of activity is frowned upon by the Grumpyville Police, and so the area was quickly swarming with policemen, police cars, and a helicopter looking for Mr. Scumball.

Since there was a chance he'd try to get into the school to hide or take hostages, we were ordered to put the school on lockdown. So all gates were closed and locked, with no one allowed in or out. We even woke-up Elmer, our octogenarian security guard, from his morning nap.

Unfortunately, as always, the beginning of the school day is followed by stragglers who show up 10-15 minutes late, drop off their kids in front, and head to work. By the time they did yesterday, the gates were locked, and under lockdown protocol we aren't allowed to open them again until the all clear is sounded.

So, with policemen everywhere, more police cars arriving every moment to try and cordon off the area, and a helicopter hovering loudly overhead, it was reassuring to see so many parents doing the right thing: Dropping their kids off outside the locked gate and going to work.

Now, I personally don't leave my kids alone in an area where people with drawn firearms are chasing each other. Maybe I'm just overprotective that way. But it still seemed odd to me.

So, with your kids out there in the potential firing line, we can't let them in, either. Because that's the rule. We can't do anything to jeopardize the safety of the kids already inside the school. Calling on your cell phone as you drive away to say "Hi, the gate was locked and blocked off by a police car for some reason, please let Billy in." Isn't going to change anything.

I was particularly touched by some of the responses we got, when parents were told WHY the gate was locked:


"Really? Well, I still have to get to work."

"Wow. I hadn't heard it on the news. I'll go check again."

"I figured he was safe because there were cops everywhere."

 "Huh. Okay, call me if there's a problem."

"How long will he be out there? He had to pee when he got out of the car."

"Why can't you let him in? It's not like he's the robber. I can vouch for him."

"Oh, cool! Michael loves to play policeman! Will they let him help?"


Fortunately, Mr. Scumball was quickly caught hiding in someone's backyard, and we were able to let your kids in. However, I'd like to stress the key points here:

1. On the rare occasion the school gates are locked during the day, DON'T let your kid out of the car. It means something bad is happening.

2. Armed police everywhere is NOT a sign that the area is a good place for your kids.

3. The police are here to catch bad guys, not babysit your kids so you can go to work.

Thank you, and have a great summer.

Wednesday, May 21, 2014

You VILL have foot pain!

Hazards of misspelling "fasciitis:"



Tuesday, May 20, 2014

Making a point

Dr. Grumpy: "What's the pain like?"

Mrs. Bun: "It's stabbing, aching, burning, stabbing, throbbing, stabbing, itching, dull, stabbing, sore, stabbing, sharp... Did I mention stabbing?"


"Spam, spam, baked beans, spam, eggs, spam..."

Monday, May 19, 2014

Attention patients:

Those of you who've met Mary and Annie know my staff is pretty awesome. But, due to some recent confusion, I'd like to point out what my staff is NOT here to do:

1. Arrange tee times, make restaurant reservations, and look into available flights. We are not the hotel concierge desk.

2. Drop-off or pick-up your dry cleaning. This is not a service my practice offers.

3. If you have a letter to mail, and want Mary to put it with the rest of our outgoing stuff for her daily run to the mailbox, she doesn't mind. Asking her to look up addresses and postage rates, or to supply you with free stamps, is going too far.

4. Babysitting. This is a big one. WE ARE NOT HERE TO BABYSIT YOUR KIDS. Pissy and I only see adults, and consequently do not keep toys or copies of Ranger Rick in the lobby. We do not want your kids drawing all over our magazines, walls, and lobby furniture. Supervising them is also not the responsibility of other patients in the lobby - I see Alzheimer's patients, for fuck's sake. If you can't control your kids you will be asked to leave and given the option of rescheduling when you can get a sitter, or just seeing Dr. Darth across the street.

5. We are not going to help your kids with their homework. This is a medical practice, and my staff is busy. If junior needs a piece of scratch paper or to borrow a pencil, that's fine. But we are not here to teach spelling, algebra, or quantum mechanics.

6. Look up movie times. I mean, I can't remember the last time I saw a patient who didn't have a smart phone. There's an app for that. The fact that you handed your phone to a toddler to keep them busy is not an excuse.

7. We absolutely, positively, do not keep diapers (for ANY age) on hand. Either bring your own or hit the Target down the block. And DO NOT even think of changing them in our waiting room. There's a bathroom 15 feet down the hall.

8. Call your order over to Starbucks, Chipotle, or wherever. It's not like you even offered to treat us.

9. Give advice on pet care. We are not the vet. They are 2 blocks over, and do a great job. The fact that between us the staff has 8 dogs does not make us an animal hospital.

10. Pick up your trash. There's a trash can out in the lobby. Leaving the detritus of your McGrease lunch or little balls of snot-loaded tissues on the lobby table is rude, gross, and unacceptable.

11. Find you a pharmacy, or therapy place, or hospital, or pretty much anything in Montana. Or Canada. Or South America. Or anywhere outside of Grumpyville. Let's face it, we have enough trouble figuring out what pharmacy to call HERE when you give us directions like "it's near the place with blue awnings," "the one by the Denny's," and (my favorite) "across the street from the homeless guy in the baseball hat."

12. Call numbers you got from Craigslist of people selling furniture, clothes, themselves, etc., then reporting back to you on what we found out.

13. Buy shit that your kid is selling for a school fundraiser. Don't even go there. You wouldn't like it if we hit you up for cash outside of your office co-pay.

14. Answer your cell phone while you're with the doctor, and take messages. They do this all day for me, and I'm paying them. You are not. It can go to voice mail.

Thank you.

Ibee Grumpy, M.D.

Friday, May 16, 2014

Guest post

Dr. Coogie writes in:


Last night I got called down to ER to admit a guy for syncope.

Dr. Coogie: "What happened?"

Mr. DUI: "Well I was drinking beer at Boobpile and I passed out."

Dr. Coogie: "How long were you out?"

Mr. DUI: "Not sure. I woke up on the floor with everyone around me, but then realized I still had more beer to finish, so I had some more beer and decided I should get checked out."

Dr. Coogie: "Okay, and then you had someone bring you here?"

Mr. DUI: "No, I had spilled beer on my clothes so I drove home to change, then drove to the ER, and here we are."

Thursday, May 15, 2014

Meeting of the minds

With the school year winding down, the twins are off to Wingnut Elementary's end-of-year school music camp, to spend 4 days in the cool pines of northstate. There they'll practice their instruments, terrify wildlife, irritate hunters, and likely violate the endangered species act.

So Tuesday afternoon was the parents' meeting with the teacher leading the expedition. It was allegedly mandatory (though they didn't take attendance). Mrs. Grumpy had happy hour a meeting at her job, so I went.

I got there early, and, out of habit (amazing how we default in a classroom), took my traditional college/medical school seat (3rd row from the front, 2nd seat in). Other parents came in. A cardiologist I know, whose daughter is in the same class, came in and sat next to me.

As Mr. Allegro was trying to get the SmartBoard to work (this involves tapping it, swearing, hitting it harder, swearing, tapping it lightly, swearing, wash, rinse, repeat) Mrs. Mysomom came in. She carefully looked over several seats before selecting one that met her standards, and started to set her purse down. Then she stopped, whipped out latex gloves, put them on, pulled out a pack of bleach wipes and began scrubbing down the desk and chair (which weren't visibly filthy) before tossing the gloves and wipes in the trash and Purelling her hands.

After a few minutes the presentation began. Mr. Allegro showed us a brief video about the camp (which looked like a lot of fun, BTW), went over some rules and other points, and finally opened up the floor for questions. Boy, that was a stupid idea.

Mom 1: "It says here that no electronics are allowed. What about phones?"

Mr. Allegro: "No phones. They distract the kids from the lessons. We also don't want the boys and girls texting each other after lights out."

Mom 1: "But then how am I supposed to know where you guys are, and that you arrived safely?"

Mr. Allegro: "Either Mrs. Hendrickson or I will send a group text to all of you when we get there."

Mom 1: "Yeah, but what if something happens to both of you, like you're killed in a bus crash on the way, and the kids need help?"

Mr. Allegro: "Well, the driver also has a phone, and the bus has GPS and a radio connection to its company."

Mom 1: "It's very important that I be aware of where Sherman is at all times, 24/7. I'm his mother, you know."

Mr. Allegro: "He'll be with us, and you'll be notified if there are any problems."

Mom 2: "Wait a minute. You're not driving the bus?"

Mr. Allegro: "No, the bus is chartered from Pinto Transportation, who supply the driver."

Mom 2: (getting out paper and writing notes) "Who is the driver? What are his home and cell phone numbers?"

Mr. Allegro: "I don't know. They..."

Mom 2: "You don't know? Do you know anything about him? Does he have a police record? Is he in good health?"

Mr. Allegro: "Well, I have to assume..."

Mom 2: "You mean he might not be? THIS IS THE PERSON RESPONSIBLE FOR MY DAUGHTER'S LIFE AND YOU DON'T KNOW ANYTHING ABOUT HIM? I'd like to see his medical records before the trip. Have them sent to my home fax. Get his name so I can Google him, too."

At this point a parent wandered in late and asked a few questions that had already been answered during the initial presentation, visibly annoying everyone

Mom 3: "What about the bus? Is it new? Old? Have a history of accidents?"

Mr. Allegro: "The company supplies the bus, and I don't know which one we'll..."

Mom 3: "So for all we know it was recently in a major accident and has shitty brakes. That's SO reassuring. Can we review its maintenance records in advance?"

Mr. Allegro: "Uh, you'll have to call Pinto Lines."

School janitor walks in, is surprised to see people in the room, apologizes, leaves.

Mom 4: "What is the closest hospital and emergency room to the camp?"

Mr. Allegro: "Uh..." (grabs a notebook) "West State Regional Hospital."

Mom 4: "Is it a Level I Trauma center?"

Mr. Allegro: "It has an emergency room. What does 'Level I Trauma' mean? I'm just the music teacher!"

Mom 5: "Do you know if it has board-certified physicians? Michael is always falling off roofs."

Mr. Allegro: "The kids aren't going to be on the roof. They're not allowed there."

Mom 5: "That won't stop Michael. Where there's a roof to fall off of, he'll find a way."

Mom 6: "It says here the kids aren't allowed to bring firearms, tobacco, alcohol, or illegal drugs?"

Mr. Allegro: "Correct. Those will be provided there."

Me and the cardiologist crack up, the others glare at us. Mr. Allegro regrets having tried to joke.

Mom 7: "Why can't they have their phones on the bus at least? It's a 4 hour drive"

Mr. Allegro: "Because we don't want them brought at all. The bus has TV screens, like on planes, and we're taking movies to watch."

Another parent comes in late, asks the same questions that had already been answered during the initial presentation and for the first late parent, further annoying everyone.

Mom 3: "What are the movies rated?"

Mr. Allegro: "G and PG. I think we have 'Wreck-It Ralph,' 'Frozen,' 'Monsters University,' and "Despicable Me 2.' "

Mom 3: "Doesn't 'Wreck-It Ralph' promote violence? I think I read that in Crazyfuck Parent Today."

Mom 2: "No, it doesn't. Besides, from the way your daughter treats mine I'm pretty sure she's used to violence."

School janitor walks in again, is still surprised to see people in the room, apologizes, leaves.

Mom 7: "I don't want Cindy to see 'Frozen' again. She'll come home singing that stupid song that makes me want to slit my wrists."

Mr. Allegro: "You're certainly welcome to send any DVD's of G and PG movies you want, and I can let the kids vote on it."

Mom 4: "These kids are only 12. They're not old enough to make decisions like that."

The cardiologist takes 2 chocolate bars out of her purse, offers me one. A lady behind us says "you're doctors and you eat that shit? Remind me to never come to you." We both ignore her.

Mom 8: "Susan gets headaches a lot, so I want to send her with a bottle of Tylenol. Is that okay?"

Mr. Allegro: "Sure, just fill out the medication form that was in your packet. There's a full-time nurse at camp, too."

The cardiologist whispers to me "Rachel takes Adderall. I thought about writing on the form that the teacher should give it rectally to see what they'd do, but Rachel would never speak to my again." We both snicker, other parents glare.

Mom 5: "How do we know it's really Tylenol, and your daughter isn't selling something?"

Mom 8: "Really, Beth? You should pay better attention to your own son's issues."

Yet another parent comes in late, asks the same questions that had already been answered during the initial presentation and 1st & 2nd late parents, further annoying everyone.

Mom 9: "Is the camp nut-free?"

Mr. Allegro: "Yes. Please don't send snacks with your kids, they'll be provided for them."

Mom 3: "Is your son allergic to nuts?"

Mom 9: "Not that I know of, but I keep them out of the house anyway in case he becomes allergic."

Janitor walks in again, is still surprised to see people in the room, apologizes, leaves. Cardiologist whispers "Is he one of your dementia patients?" Lady in front of us turns around and goes "Shhhh!"

Mom 10: "What about gluten free?"

Mr. Allegro: "No, but we can make arrangements. Does your daughter have Celiac disease?"

Mom: 10: "No, she tested negative, but I still won't let her have gluten. I read that it's being put into foods as part of the government's secret eugenics program."

The cardiologist grabs and squeezes my forearm so hard that she draws blood, I kick her under the table. Lady next to us thinks we're playing footsy and looks disapprovingly. I briefly consider pretending the twins are Kosher just to liven up the party.

Mom 11: "Will you guys be in tents?"

Mr. Allegro: "No, it's a dormitory with 2 wings, girls on one side, boys on the other. The adults will be in the hallway between them."

Mom 1: "Does it have fire sprinklers?"

Mr. Allegro: "Uh, I think so..."

Mom 1: "Are the safety inspection certificates online, where I can see them?"

(School janitor walks in again, is still surprised to see people in the room, apologizes, starts to leave. Cardiologist grabs my arm, drags me out after the janitor).

Janitor: "Can I help you?"

Dr. Cardio: "No, we just needed to get out of there."

Dr. Grumpy: "I think you broke my arm."

Dr. Cardio. "I don't care. I couldn't take it anymore. And you couldn't, either."

Dr. Grumpy: "No shit."

Janitor: "Moms today get crazy at these meetings. They'll be there all damn night."

Wednesday, May 14, 2014

Click

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

Ms. Cell: "I've tried calling your office 5 times today, and the calls keep getting dropped."

Mary: "I'm sorry. What can I help you with?"

Mrs. Cell: "You could get your phones fixed so they don't keep dropping my calls!"

Mary: "Ma'am, usually that's not at our end..."

Mrs. Cell: "Of course it is! I call your office from my cell phone, and the call gets dropped. You think that's a coincidence?"

Mary: "Have you tried calling from a land line?"

Mrs. Cell: "So now you're saying it's MY fault? Is that it?"

Mary: "No, but..."

Mrs. Cell: "Look, I need to..."

(silence)

Tuesday, May 13, 2014

Gender pronouns

Seen in another doctor's note:



Before you write in - the patient hasn't had gender reassignment. Simply a doctor who doesn't proofread.

Monday, May 12, 2014

Overheard in the living room

Craig: "Did the girls have a sex ed lecture today?"

Marie: "Yeah, in the classroom at the back of the library."

Craig: "We were in the cafeteria classroom. Ours showed all these disgusting pictures of sex diseases."

Marie: "Yeah, the nurse made us look at those. They were gross. One thing looked like a vagina with an eyeball on one side."

Craig: "We had this one picture. I thought it was, like, a really burned and infected tongue, but then Mr. Cooper said it was a diseased penis. It was so gross. Jacob Myers ran outside and threw up in the grass."

Marie: "Was that near the back door of the cafeteria?"

Craig: "Yeah, why?"

Marie: "The nurse stepped in it when we were going back to our classrooms, and began swearing."

Craig: "That's gross, too."

Marie: "Her shoe was all covered with barf."

Craig: "Yuck."

Marie: "Cindy put a picture of it on FaceBook."

Saturday, May 10, 2014

Friday, May 9, 2014

Great attending quotes from training

"If a patient demands to have daily office appointments with you, let them. They're the ones paying for it, and you have to be there anyway. They'll get bored and stop after 1-2 weeks. This is a war of attrition, and you'll always win."

Thursday, May 8, 2014

Free

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

Mr. Gratis: "Hi, I need to see the doctor."

Mary: "Okay... We have an opening tomorrow at 2:30. What insurance do you have?"

Mr. Gratis: "I don't have insurance."

Mary: "All right, our cash prices are..."

Mr. Gratis: "Oh, there's no charge for the visit. I was referred by Boondock Hospital."

Mary: "What?"

Mr. Gratis: "I was seen in the ER at Boondock Hospital last week, and they told me I should see a neurologist. Your name was on the list they gave me."

Mary: "Yes, but we still charge for the visit."

Mr. Gratis: "It's supposed to be free. A hospital referred me!"

Mary: "I understand that, but it doesn't mean we don't bill for our services."

Mr. Gratis: "I can give you the name of the doctor there. Can you bill her? Or the hospital?"

Wednesday, May 7, 2014

Wonder powers activate!

Medikidz is a company that sells medical comic books for kids.

I get it. I was a kid once, and loved comic books. In fact, I think there were educational ones at my pediatrician's cave office then, so I'm glad they're still using them today. (I just wish there'd been a good one for biochemistry during med school).

These are the Medikidz superheroes:




I haven't read the comics, but it looks like they fly around on a giant red corpuscle. Being a neurologist I kind of like the knobby-kneed brain in the background. I'm not sure what to make of the guy in front, as generally I prefer my superheroes to wear pants. There's also the guy behind him on the left, who's carrying eating utensils in his belt. This is not standard JLA equipment.

Anyway, the reason I'm even on this subject is that recently the annual Neurology meetings were held in Philadelphia, and my top field agent, SMOD, was there.

Like many companies, Medikidz had a booth on the exhibit floor. I've seen my share of these. Pleasant sales reps in professional attire extolling the virtues of whatever they're selling.

But not Medikidz. To SMOD's horror, their reps were wearing the superhero outfits:



"For this I got a college degree."


They look kind of lonely. It's good to have a job, but still pretty humiliating to have to be at an adult medical convention wearing spandex and a cape. Normally you only see this kind of outfit on Halloween, when shopping at Walmart, or in the personals section of Craigslist.

Dear Medikidz: if you want to attract neurologists, you should wear Star Trek costumes.

Tuesday, May 6, 2014

Relevance

On the fax machine yesterday morning was a note from Dr. Intern's office, about a lady who has an appointment tomorrow.

It said: "Please evaluate Flora Betapir for Alzheimer's disease. Records attached."

The attached records were:

Right hand x-rays from 1999

A mammogram report from 2002

and a Pap smear report from 2005

Sigh.

Monday, May 5, 2014

True colors

Last week, for those of you who missed it, Los Angeles Clippers owner Donald Sterling temporarily became the most hated man in America. This is actually pretty impressive, as it involves leapfrogging over politicians, television pundits, lawyers, doctors, and the barista who can never get your order right.

Mr. Sterling's downfall came because of overtly racist statements. This rapidly brought him condemnation from politicians, celebrities, and pretty much anyone with a microphone or Twitter account. People lined up around the block to announce they would boycott Clippers games if he wasn't removed, and team sponsors jumped ship fast.

So, guess who can't boycott Mr. Sterling? I can't. Or anyone in the healthcare field.

Sure, I can refuse to go to his games, or live in one of his buildings. But if he shows up in my office or hospital, I wouldn't turn him away. And neither should any doctor or nurse.

This is one of the hardest things in medicine. Regardless of how we may feel about a person, or disagree with their beliefs, we still have to do our best to help them when they need us. I've taken care of neo-nazi white supremacists, militant black supremacists, dirtballs who shoot police or kill innocent people just because they don't like them... the list goes on. Sterling's condescending boardroom racism is minor league compared to these guys.

It's part of the job. Whether they come to you in the office, or you're seeing them in the hospital, you have to set aside your personal feelings and do your best to help. Dr. Samuel Mudd spent 4 years in prison for providing medical care to John Wilkes Booth - a conviction yet to be overturned.

I never discuss politics with patients, as it's bad for the relationship. But that doesn't stop some from bringing it up, sometimes expressing blatantly racist or antisemitic views. I've had people tell me all blacks should be shipped to Africa, or Jews or homosexuals killed. Do I agree with this? Hell no. But I also believe that part of being a doctor is caring for anyone who seeks my help, regardless of personal feelings for them.

In hospitals they have it even worse. Nurses and doctors there have to deal with people who are drunk, high, verbally abusive, and sometimes violent. And, again, they do their best to help those no one would want to. As professionally as possible.

Like most people these days I don't support or like Mr. Sterling. But that wouldn't stop me, or any number of doctors, nurses, or paramedics from doing our best to help him if he needed us. Because that's what we do.

Friday, May 2, 2014

Overheard in ER

Dr. Urgent: "What brings you to ER today?"

Mr. Couth: "I got a big, huge, ball of shit in my ass and it fucking hurts."


Attention medical students: we at Dr. Grumpy, Inc., will not be held responsible for your grades if you use the above quote when presenting a case to your attending.

Thursday, May 1, 2014

Wednesday afternoon

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

Dr. Equine: "Hi, thanks for calling me back. I'm a horse veterinarian at Grumpyville Racetrack. Do you have a patient named Mr. Adipose?"

Dr. Grumpy: "Uh, yeah... I just saw him this morning."

Dr. Equine: "You ordered an MRI on him?"

Dr. Grumpy: "Um... What does this have to do with the racetrack?"

Dr. Equine: "I'm going to guess he's a large fellow."

Dr. Grumpy: "Why..."

Dr. Equine: "He just called my office to see if we had an MRI for horses he could use."

Wednesday, April 30, 2014

Hey, it's for a good cause

Previously I've featured such tasteful fundraisers as:

The Alzheimer's Association "Night to Remember" ball

and

A Parkinson's support group's "Shaken, not Stirred" happy hour.


Now, thanks to a reader submission, I've found:




Thank you, M!


Tuesday, April 29, 2014

Fly me to the moon

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

Ms. Pisces: "Hi, I need to get in to see Dr. Grumpy right away!"

Mary: "Well, you're in luck. We just had a cancellation, and he can see you this afternoon..."

Ms. Pisces: "Oh, no. It will have to be next week. My astrologer says the horoscope doesn't favor an appointment this week."

Monday, April 28, 2014

Groundhog Day

A few weeks ago I wrote about the recent disclosure of Medicare payment data to the public. I finally got around to running my own numbers from it, and found my total take was around $70,000.

Now, normally I don't care how much other docs are getting. I try not to pay attention to those things, as it's none of my business. But, due to a recent news story, I decided to look up the stats on another doctor.

The doctor in question is an interventional cardiologist, practicing in the northeast. His father is also a cardiologist, and they work together. Sounds nice huh? A family-run medical group.

Anyway, per the 2012 Medicare data, that year Uncle Sam paid this gentleman $313,375.23. DISCLOSURE: I suck at math. Really. So this number could be completely wrong since I had trouble making sense of which column was which, and then I had to multiply across, then add.

Now, like I previously pointed out this is gross, not net. Like all of us out there, I'm sure the good doctor has insane office overhead to cover. This guy is in a field, unlike mine, where you truly are saving lives, and you can't put a price on that. And I'm also not in the business of telling other people how to spend their money. After all, I blow most of my immense fortune on a Diet Coke habit.

So what does this successful cardiologist spend it on? Well, he supports local businesses by spending $135,000 at a strip bar.

I am not making this up.


"I need it all in singles. Don't ask why."

Granted, this wasn't all at once. It took him 4 visits over 10 days last November at Scores Gentlemans Club to reach that amount, averaging $33,750 per visit. It was a cold winter, and I think we all needed to warm up (at the Grumpy household we cranked the heater up and got out extra blankets). Perhaps it was national "Support your local strip bar week" (if it was, I missed the memo).

I haven't been to a strip bar since a bachelor party in residency, but don't think I could spend that much on drinks, tips, and lap dances if I tried (although I haven't tried, either). Maybe I wasn't going to the right bars.

But it gets better. The good doctor (Zyad Younan, M.D.) put the charges on he & his dad's business credit card. Can you imagine how proud the elder doctor Younan felt when the AMEX statement came in? "EKG supplies, ultrasound gel...  $135,000 at The Boob Palace? ZYAD!!!"




Regrettably, daddy's reaction to his prodigy's spending habits hasn't been in the news. He probably grounded him and took away the car. These things don't look very good on IRS audits.

I'm really not sure how Dr. Younan, Jr. was planning to claim this as a business expense. Granted, he's a heart doctor, and the heart is located in the chest, and I'm sure there are a lot of chests displayed at Scores. Perhaps it was a research project he was working on ("I want to put my stent in your vessel"). He could also have been recruiting a new partner, though not necessarily for the practice.

"You say it's a study to repeatedly check my femoral artery pulse?"


So, to recap thus far: a successful cardiologist blew $135,000 in 4 visits at a strip bar, using his business AMEX.

But wait, that's not all!

As anyone who owns a credit card knows, sooner or later the card company wants to get paid (they're funny like that) and sent a bill to Dr. Younan. Like any honest, law-abiding, boob-ogling, dad-fearing cardiologist, he should pay it, right? And, if he had, none of this would even have made the newspapers.

But he didn't.

Instead, he claimed that he didn't have to pay because he was drugged. EACH TIME (I assume he means something beyond alcohol) and therefore has no recollection of being there.

Now, this, in my opinion, is pretty far-fetched. Okay, maybe once is semi-believable. I mean, stranger things have happened. One minute you're walking out to the doctor's lot, the next you're waking up and finding out you spent a fortune at a strip club. Maybe it was aliens. Or terrorists. Or your ex.

BUT 4 TIMES? I mean, that's one seriously good drugging job. If I'd blown that kind of money in a strip bar, I'd at least like to remember what I got for it. But not this unfortunate fellow. Whatever they used to drug him must have been pretty strong to make him not only forget, but to return to the same place 3 more times. Holy déjà vu, Batman!


"It's February 2nd, and I've been drugged by a stripper. Again."

The good doctor's refusal to pay is so steadfast that Scores has filed suit against him for the amount. They claim to have video of him in their fine establishment, acting, I assume, somewhat coherently. To date I haven't seen it listed on Youtube.

So, in summary:

1. No matter what Medicare actually pays your doctor, IT'S NOT WHAT THEY'RE TAKING HOME. The overhead for a medical practice is higher than you think. Probably much higher.

2. Don't let that hair-netted lady who puts out the bagels in the doctors lounge slip something into your coffee. You never know where you'll end up, sometimes repeatedly.

3. If you want to go to a strip bar, more power to you. But trying to charge it to your dad's business AMEX card may not be a good idea.

4. What you do with your hard-earned money is up to you, but remember to pay the bill. Because if you do, they won't sue you to get their money, and this sort of thing won't end up in the news.

5. $135,000 is a helluva lot of money to blow at a strip bar. I think my record was $50 for my share of the bachelor party.

Saturday, April 26, 2014

Weekend reruns

From 2009:


Today ended with me doing a telephone and internet conference with 15 other neurologists across the country to review data on a drug that's in development.

The meeting took place after we were all home. So you'd hear the occasional sounds of home life. A kid yelling, a dog barking, somebody laughing in the background, etc.

Usually these things go fairly smoothly. Tonight's, however, had 2 noteworthy interruptions:

Interruption #1:

The "click" of a receiver being picked up, and suddenly a young female voice cuts off the moderator:

Young female: "Daddy! My boyfriend is supposed to call tonight! Why are you on the phone?"

Neurologist X: "Britney! Get off the phone NOW! I'm in a meeting!"

Young female: "Daddy! This isn't just any boy! This is TREVOR!!!!!!!!!!!!" (click)



Interruption #2

The moderator was asking a few questions. He was interrupted when a neurologist with a New York accent apparently had an interruption at home, and loudly said:

"What? Tell him to fuck off! I'm on the phone!"

Thursday, April 24, 2014

Seen in a hospital chart.

No. I have no idea what #4 means.



Wednesday, April 23, 2014

Striptease

Mr. Larsson is sitting in the lobby, reading old issues of People, during his wife's appointment. Suddenly he walks up to Mary's desk, holding a small plastic box.

Mary: "Can I help you, sir?"

Mr. Larsson: "Do you have a land-line?"

Mary: "Yes."

Mr. Larsson: "I need to make a call, and can't use a cell phone."

Mary: "Okay, that's fine, just come around the counter there."

He sets the plastic box on the counter, comes over to the desk, and starts unbuttoning his shirt.

Mary: "What are you doing?"

Mr. Larsson: "I need to send a pacemaker report to my cardiologist's office, and we don't have a land-line at home."

He tosses his shirt on a chair and starts attaching clips from the box to his chest. 


"Wanna see the scar?"

Mary: "Um, I don't know how to send a pacemaker report..."

Mr. Larsson: "Can you unplug one of your phone lines and hand me the cord?"

Mrs. Larsson and I finish her appointment. She opens my office door and walks up front.

Mrs. Larsson: "ARNE! PUT YOUR SHIRT ON!"

Mr. Larsson: "But I need to..."

Mrs. Larsson: "NO! I told you, we'll stop at Dr. Senning's office tomorrow, and you can do it directly. You don't need to do this today!"

Mr. Larsson: "But Dr. Grumpy has a land-line!"

Mrs. Larsson: "So does Dr. Senning! Here's your shirt! I'm sorry, Mary, he's just very obsessive about this."

They leave. The door closes. Mary and I stare blankly at each other for about 10 seconds. Then collapse in hysterics.

Tuesday, April 22, 2014

Monday afternoon

I had a nice elderly couple in. She had mild-moderate dementia, and I was looking over her previous test results.


Dr. Grumpy: "It looks like your internist did a pretty decent work-up. Unfortunately, I have to agree with him that she has Alzheimer's disease."

Mr. Amyloid: "Yeah, that's what her daughter and I both figured. What about..."

Lady Amyloid: "We just got married!"

Dr. Grumpy: "Really?"

Mr. Amyloid: "Yep. We've been together for 10 years, but got married last week."

Dr. Grumpy: "Congratulations!"

Mr. Amyloid: "We weren't ever planning on it, but after Dr. Intern told us the news I decided we should while she still knew how much I love her."


After 15 years in this job, it takes a lot to get to me. That did.

Monday, April 21, 2014

Think

For those of you who haven't seen it, this excellent piece was on KevinMD today.

For those of you who don't believe this is what American medicine has come to... you should. I've felt the same things other docs have more times than I can count.

For those of you looking to a career in medicine... I repeat what I said last Thursday: GET OUT NOW.

Weekend on call

This past Saturday morning I was dragged in kicking and screaming consulted at the hospital to see an elderly gentleman. He'd fainted while playing bingo at the Mishwauketomee casino the previous night.


Dr. Grumpy: "What happened, sir?"

Mr. Bingo: "I just wanted to get out and do something. Ever since my wife died all I've done is stay at home endlessly and stare at the walls. I just couldn't take it anymore, and wanted to get out. So I went over to the casino."

Dr. Grumpy: "I'm sorry sir. How long ago did your wife die?"

Mr. Bingo: "Yesterday morning."

Friday, April 18, 2014

Sigh

Mrs. Diopter: "My husband sees things now."

Dr. Grumpy: "When did he start hallucinating?"

Mrs. Diopter: "Oh, not that. He just got new glasses."

Thursday, April 17, 2014

Holy shit! I'm rich!

Last week, for those of you who are keeping score, the government released its list of how much Medicare pays doctors. The total for 2012 was...

(drumroll)

$77 billlion dollars.

If you like zeroes, that's $77,000,000,000.


"Are you sure? That's a lot of zeroes."

Now, there are roughly 850,000 docs out there who take Medicare. Which means (on average) each of us is getting $90,588.24 from Uncle Sam (this is ONLY Medicare, not other insurance companies).

Of course, that isn't even close to the truth. The released data also shows that 2% of the doctors out there are getting 25% of the take. So for those 2%, they're each getting $4,529,411.76.

As I'd expect, none of those guys are neurologists. And the last number (as big as it is) is peanuts compared to what your average insurance company or hospital CEO got as a Christmas bonus alone.



"My kid found these. We didn't know what else to do with them."


So which docs are getting the big Medicare money here?

1. Hematology/Oncology

2. Radiation Oncology

3. Ophthalmology

4. Rheumatology.

WOW! Those guys must be rich!

Nope, that's not it either.

Figures are misleading. While I believe in transparency, the raw numbers can be manipulated easily to make them show pretty much what anyone (usually a politician) wants.

That giant government payout is, in large part, what they're getting for supplies. These specialties have a few things in common:

1. They're primarily office based.

2. They have high overhead costs.

3. The first three are at high risk of being sued.

4. The first 2 are dealing with horribly sick patients, which cost more money to take care of.

I'm sure you're saying "why isn't neurosurgery on the list?" The office-based cost is the main reason. Most of their good work is in a hospital, and the facility supplies the medical equipment, drugs, staff, and operating room. The surgeon, like me*, shows up and brings her expertise (and the charges for it) with her, but the rest of the costs (and billing for them) get paid to someone else. 

*That noise you hear is the horrified inhalation of neurosurgeons because I just mentioned them in the same sentence as neurologists.






So, okay, the oncologists must be rich.

Of course they are! They're part of the secret government-medical conspiracy that's making you smoke tobacco and eat horribly unhealthy food against your will, causing you to get cancer and need their services.

Get real. Yes, they're getting reimbursed a decent chunk of change. But that's gross, not net. Most oncology practices have an office infusion suite to do chemotherapy. This is done there because it's more convenient for the patient, and a helluva lot cheaper for the insurance, to do it in an office than a hospital. But cheaper is a relative term.

Let's look at drugs. One commonly used for breast cancer is Herceptin. This is given once a week, and the list price is $3344 per vial. Another one, Neupogen, is $310 a pop. There's a lot of them like that.

Yeah, but the doctor must charge, like, 2 or 3 times that amount, right? That's why they're rich!

Keep dreaming. You can charge whatever the fuck you want. Medicare will only pay you 106% of the MSRP. Which means, for that $3344 vial of Herceptin, you'll get roughly $3544 back.

So? The doctor is still getting a $200 profit on each vial! That's a lot, you greedy bastards!

Stuff it. Consider the following:

Infusion nurse: $40/hour + benefits.

Infusion chairs: $1500 each.

Mayo stand (a metal table, has nothing to do with condiments): $110 each.

Code cart fully loaded (because disasters happen): $1800 (and it's $1400 to reload it each time it gets used).

Cardiac defibillator (same reason): $1200

IV poles: $70 each

TV set and cable subscription (the patients need something to watch for a few hours)

Wheeled medical stool: $50 each

Then you get into bags of saline, IV tubing, needles, phlebotomy equipment, band-aids, gauze, other medications (Zofran, Benedryl, Phenergan)... you get the idea.

And all of that comes out of the Medicare payments. Of course, the raw number doesn't mention that key point at all.


"And another thing..."

Another point: like many docs these days, the oncologist may have an NP or PA seeing patients. Of course, that person is likely working under the doctor's billing ID (called an NPI). So if both of them get, say, $100,000 back from Medicare, it's listed as money that ONLY went to the doc. And what you're seeing doesn't take into account the salary, benefits, and malpractice coverage for the NP, not to mention all the office supplies and support staff.

Wait, so you mean the money meant for 2 or more people can show up in the Medicare data as being all paid to one doc? Exactly. Doesn't give you a clear picture, does it?

The other fields are similar. Radiation oncology? A radiation machine will easily set you back a few million bucks. Not quite the same as say, a sofa from Penny's. But it's necessary in this line of work, because you can't practice without it (trying to irradiate tumors with the stuff you scraped off your kids glow-in-the-dark Halloween costume isn't helpful).

Then you need trained techs to operate it. Federal licenses and certifications to handle radioactive equipment. And a company that supplies/disposes of used isotopes (selling them to Al-Qaeda is frowned upon).





Ophthalmology? Have you ever been to one's office? They don't have something as simple as my Queens Square reflex hammer ($14 on Amazon). The gadgets they use are big, and to fully outfit a decent ophthalmology office will run you $100,000 to $200,000  - before you can even start seeing patients. Having your cataracts done? Each lens costs the doctor from $1000 to $3000 depending on what you need, not including all the other supplies needed for surgery. So a lot of the money is going to cover those expenses, too.

Rheumatology, like oncology, deals with some pricey drugs. Remicade, for example, is $915 a vial from the company.

Then, for ALL doctors, you have to figure in the other office expenses: computers, printers, chart system, staff, office furniture, office machines, paper, pens, coffee maker....

Yeah, but you guys get most of your office supplies free from drug reps! Sorry, Charlie. That practice was banned in 2008. Now the only thing reps can give us is samples, patient education brochures (which I throw away), and a hurried lunch of tuna sandwiches.

Office space alone can eat you alive. Between Pissy and I we have 2100 square feet. And we're paying $5100 a month for that. That's likely more than your mortgage payment for a house of similar size. And our office doesn't have a pool or wet bar.

Malpractice insurance? For non-surgical fields it's anywhere from $30,000 to $100,000 per year (or more). Surgeons? $100,000 to $300,000 (and up) per year depending on the field. That comes out of your share of the $77 billion, too.

Then, when you finally collect your money, a billing company will get 5% to 10% of it.

So, this is not exactly a high-profit-margin field (medical students: GET OUT NOW). A pretty big chunk of the Medicare money goes to cover just the overhead. Running a medical practice is not something you want to do by cutting corners. When things go wrong, they can go VERY wrong.

I'm not looking for sympathy. I'm just trying to make the point that numbers like this are misleading, and can be twisted to mean whatever anyone wants them to. But when you see how much your doctor is getting for taking care of you, that's not all going in his/her personal pocketbook.

Far from it.

But that doesn't stop me, and most of us, from doing our best to care for you, every single day.



Wednesday, April 16, 2014

"Ommmmmmmm..."

Seen in an ER doc's note:



Tuesday, April 15, 2014

This is a good thing

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

Miss Poppy: "Hi, I need to make an appointment with Dr. Grumpy."

Mary: "Okay, we can see you..."

Miss Poppy: "Wait, first, I need to know if you guys are connected to that big database where you can see which of your patients are getting narcotics from other doctors and when and how many and all that stuff."

Mary: "You mean the state monitoring program? Yes, we are."

Miss Poppy: "Never mind."

click

Monday, April 14, 2014

How ya doin'?

"It's been a busy year. I had to have all kind of treatments from the eye doctor. A few months ago I had this weird feeling in my eye, and had my friend Jan look at it. She's a librarian at the kids school, so I figured she reads all kinds of stuff. She thought maybe I had a fungus in my eye, and I'd once heard of a guy that happened to on the news, so it seemed like I should treat it. My oldest boy is on the high school football team - they were in the state playoffs last year if you remember - and is always having jock itch with burning and red stuff in his crotch. He has these tubes of fungus cream for it in his bathroom, so I rubbed it in my eye for a few days, but that only made things worse. So I went to the eye doctor and he said the cream wasn't supposed to go in my eye because it damaged something and I had to have all kinds of treatments for it. It really ticked me off because you'd think Jan should know better."

Friday, April 11, 2014

1 in 206

Dr. Grumpy: "Do you have any other medical issues?"

Mr. Methuselah: "They said I had arthritis on a bone somewhere. Do you know which one it would have been?"

Thursday, April 10, 2014

That's some pen

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

Mr. Waterman: "I need your help. The pharmacy is refusing to give me my seizure medicine! They claim you didn't order it. I know that's a lie, because I saw the doctor do it."

Annie: "Okay, let me look in your chart."

Mr. Waterman: "I'm all out, too."

Annie: "It looks like he wrote a prescription at your visit. Did you give it to them?"

Mr. Waterman: "Did I give what to them?"

Annie: "The prescription he wrote."

Mr. Waterman: "He didn't give me one! He sent it to them."

Annie: "But... In your chart it shows he gave you a handwritten script. What did you do with it?"

Mr. Waterman: "My copy? I tossed it. I didn't think I needed it."

Annie: "That was the prescription! Why did you throw it away?"

Mr. Waterman: "I figured it was sent from his pen as he was writing it."
 
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