Monday, October 31, 2011

Scary Halloween Visitors

I'd like to thank my SMOD for submitting this. He works for a drug company, and says this is an actual training video they use.

Return to San Diego, part 2

Our hotel had this thing near the light switch. I have no idea what it was. I tested it a few times, and determined that it wasn't a motion detector or light sensor. I asked everyone at the front desk, the maid, and the maintenance guy. None of them knew what it was, either.

After various family things Craig wanted to go to Sea World.

We were in line for the Sea Lion Halloween show. We actually got there first, followed closely by a deranged woman and her tribe. She immediately accosted the poor teenager standing at the entrance to ask what time we'd be allowed in. The girl said "about 15 minutes."

So, exactly 15 minutes later the woman wanted to argue about it.

Deranged woman: "Why haven't you let us in?"

Teenage girl: "Gates open at 2. It's 1:56, ma'am."

Deranged woman: "Well, at 1:41 you said 'about 15 minutes.' It's been that. I demand you let us in."

Teenage girl: "Sorry, but it has to be at 2:00. My boss will tell me."

Deranged Woman: "This is ridiculous. I demand you refund my park admission RIGHT NOW!"

Teenage Girl: "You'll have to discuss that with the office by the front gate, ma'am."

Deranged Woman turned away to mumble under her breath for about 30 seconds. During that time a park employee came over with an older couple. Both were using walkers, and he clearly had Parkinson's disease. Teenage Girl put them at the front of the line.

Deranged Woman: "What are you doing?"

Teenage Girl: "These people are handicapped, ma'am. Therefore we allow them in early to give them extra time to find seats."

Deranged Woman: "That is grossly unfair! I demand you make them go to the back of the line (which by now was the size of the Queen Mary)."

Teenage Girl: "Sorry ma'am. Our policy is to assist those with disabilities."

Deranged Woman: "That is discrimination against the healthy. When I go for my refund, I'm going to report you."

At this point Deranged Woman noticed my Grumpyville Faceplants cap.

Deranged Woman: "Oh! Grumpyville. My sister lives in Grumpyville. She's a surgeon. Do you know her? Are you a doctor?""

Dr. Grumpy: "I clean fish tanks." (this is true)

She turned away and pretended I was invisible. Obviously aquatic habitat maintenance people were beneath her caste.

Mercifully, Teenage Girl let us in at this point. While we were waiting the guy doing the pre-show, Biff, sprayed Deranged Woman with a squirt gun, and she dragged her kids out of the theater. Apparently she'd had enough.

Over at the Pets Rule show Craig noticed me staring at a fire extinguisher, and asked why. In a true sign of how bad a neurology geek I've become, I realized I was staring at the "In case of emergency break glass" hammer and thinking what a great reflex hammer it would make.

Craig was hungry, and I got him some chicken fingers (which should be dipped in gold for what they charge). I lost my appetite when I looked at the table across from us.

You'd think they could keep the crack dealers out of the park.

After Sea World we went down the street to Belmont Park, a small amusement park by the beach.

Craig loved the place, because he could run amok without interference from his siblings. They have a cool, older, roller coaster there, The Giant Dipper (he called it "Giant Diaper) which he dragged me on 14 times. By the end of the day I thought I'd need a giant diaper myself.

They also have a ride that sends you up in the air and flips you around. I personally DID NOT find it reassuring that they have a large ladder attached to the fence surrounding it.

While we were waiting at the "Beach Blaster" line a homeless guy (wearing nothing but sneakers and spandex shorts) came over, and tried to earn some change by singing the 1980's Kim Wilde song "Kids In America." Unfortunately for him, the 80's were 21 years ago, he had no singing voice, and he only knew the chorus. So he repeatedly belted out:

"We're the kids in America! Wa-ho!
We're the kids in America! Wa-ho!
We're the kids in America! Wa-ho!
We're the kids in America! Wa-ho!
We're the kids in America! Wa-ho!"

Until finally security led him away.

They had some prize games on the midway, where, as usual, you could win stuffed animals. I'd hate to win one of the whales. They were doing a chain hump, and I didn't want to interrupt them.

On the way back to the hotel I stopped for some artisanal Mexican food at Taco Bell, and we sat in the lobby to eat it. While Craig watched TV, I downloaded a few EEG's to my computer to read them. Behind me the front desk phone rang, and I heard the polite clerk have this remarkable discussion.

"Front desk, this is Mike, can I help you? No sir, sorry. We don't have safes in the rooms. We have safety deposit boxes at the front desk, and you can use them at no charge. Just bring down your valuables and... No, there's no way I can move one up to your room, sir. They're built into a concrete wall for security. Um, well, uh, I really have no idea what local companies install safes, especially at 9:15 on a Saturday night. But it's a hotel room, sir. You can't just have someone come up there and install a safe in the wall. Because it's against hotel policy. I am the night manager, sir. I'll be happy to lock up your valuables down here, but there's no way you can install a safe in your room. Okay, sir. Have a good night."

I was impressed. Mary couldn't have done it any better.

Sunday, October 30, 2011

Return to San Diego, part 1

So as everyone knows, Craig, his hair, and I had to fly to San Diego last weekend for various reasons. But, while there, we got to do a few things around town.

Namely, his inexplicably favorite place on Earth, Legoland.

They've done up Lego Miniland with ghost figures for Halloween. Maybe it's just me, but I think they look more like something out of a plastic KKK rally.

Throughout Legoland they were constantly blasting Halloween music: Monster Mash, GhostBusters, and oddly, The Time Warp. Yes, the Time Warp. Because nothing says family entertainment like music from a flick that featured extraterrestrial transvestites, multipartner sex in a pool, an axe murder, and cannibalism.

Like KISS, what was a sign of moral decline in the 1970's is now benign family fare. By the time Craig brings his kids here Jenna Jameson will be on the same pedestal as Carol Brady and Shirley Partridge.

We even saw my MIL at the park.

And, as always, I stopped to marvel at one of my idols, made out of Lego's.

We spent the afternoon there, and as we headed out at closing time, Craig wanted to stop and look around the Lego store near the park's entrance.


As we walked into the store, I thought it was really hot inside, as the air was moving and twisting like a heat mirage. Upon getting closer I realized it wasn't a mirage, but millions of humans, like the entire population of southern California, all crammed into an 8,000 square foot retail store. It looked like people would consume all the oxygen in the room before they could buy anything, but the open doors kept a continuous ocean breeze coming.

Picture this: An amusement park packed with Lego-crazy chidren, many of them in Halloween costumes. And now they're all being funneled to the exit, past the same Lego store. Naturally they're all going to want to stop inside (which is, of course, why the park is designed that way). So the place is insane. It made black Friday and 3rd world bazaars look like peaceful, orderly affairs. The noise was like a packed stadium during 3rd down & long.

As soon as we got in Craig and his hair vanished, disappearing into the mass of humanity, and only reappearing when he had the question "Can I have this?" (which applied to pretty much everything in the store). I felt bad for the staff, who were horribly outnumbered, and who after closing would have to rebuild the shelves from kids randomly moving merchandise from it's original location.

After the vampire at the counter sucked the green corpuscles out of my wallet, we headed to the car. On the way we passed a poster featuring Lego Star Wars characters. And, to my horror, Craig yelled "DAD! LOOK! His head is a penis!!!"

Back at the hotel Craig went swimming while I worked on my computer. They were serving a light dinner, and at one point I went in to get something. Craig wanted some cookies, so took my key-card and went in ahead of me... then let the door close behind him as he disappeared into the serving area.

Leaving me locked outside.

I knocked. No one answered. After a few minutes he showed up, with a plate full of cookies, and asked me why I hadn't come in with him.

Gotta love kids.

Saturday, October 29, 2011

Today's criminal tip

When someone steals your marijuana stash, don't call the police to report it as "stolen jewelry."

Thank you, Nathan!

Artisanal link

It's been a few months since I had time to collect and publish some of the horrifying bullshit artisanal pictures you guys have been sending in, but I promise I'll get around to it.

In the meantime, here is an awesome site by a kindred spirit who hates the word as much as I do.


Thank you, YellerDawg!

Friday, October 28, 2011

Zombies! At my office!

At the start of her appointment today Mrs. Married said her husband was running late, but would be coming to the appointment. So I told Mary to send him back when he got here.

A few minutes later he shows up.

She introduced him as "this is my late husband."


I'd like to thank Dani for sending me this bizarre chest X-ray report.

Thursday, October 27, 2011

Upstanding Gentleman

Who says chivalry is dead?

Thank you, Lee!

Bad reactions

Mr. Singsing: "I'm allergic to Oxycontin."

Dr. Grumpy: "What happens when you take it?"

Mr. Singsing: "I have no idea, but I woke up in jail."

Wednesday, October 26, 2011

Hot date?

I'd like to thank Kate, for sending in this item. It was in the Police Records section of her local paper today.

Patient quote of the day

"Doc, I'm 77 this year. Last year I was 76. Next year I'll be 78."

Mary's Desk

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

Reverend Bully: "Yes, this is Reverend Bully, and I need to make an appointment."

Mary: "Okay, what's your insurance?"

Reverend Bully: "Major Illness HMO."

Mary: "Okay, we'll need a referral from your internist, but let me schedule you... We can see you on Friday, at 11:00."

Reverend Bully: "I need to be worked in today."

Mary: "Okay... we don't have anything today. Did your internist speak to Dr. Grumpy about this?"

Reverend Bully: "No, but God told me I needed to be worked in today."

Mary: "All right, but..."

Reverend Bully: "This is God referring me! You can't say no!"

Mary: "Okay, then have God either fax us a referral or talk to Dr. Grumpy personally."

Tuesday, October 25, 2011

Today's criminal tips

Just remember folks: when burglarizing a store it's always important to sign out of your Facebook page before leaving the scene.

Also: when going door-to-door to show off your winkie, you shouldn't display the goods at the local police chief's house.


Mr. Hedbutt: "Where'd you to go college, doc?"

Dr. Grumpy: "Big State University."

Mr. Hedbutt: "Really?"

Dr. Grumpy: "Yes. Why?"

Mr. Hedbutt: "I'm surprised. Usually Dr. Concierge, my internist, knows better than to refer me to you public school people."

Monday, October 24, 2011

The throne

I'd like to thank my reader, Rose who brought this drug ad to my attention. And Webhill, for her suggestions.

I'm not trying to make light of IBS, or patients with it, but let's face it. This ad could have been done better.

1. This lady is obviously in a public bathroom. So why is she leaving the stall door open?

2. The idea of having her shiny laptop (which looks suspiciously like a MacBook Pro, without the logo) on the skanky bathroom floor is just WRONG. You want to take that stuff back to your desk?

Also, it implies that she's touching it with her hands while on the toilet. A recent British study found that 1 out of every 6 cell phones had fecal material on them, likely from poor handwashing. Adding laptops to this list, given that they often have more than one user, is NOT a good practice.

3. The slogan stinks.

Sunday, October 23, 2011

Weekend reruns

I have a nice young lady in my practice who, as far as I can tell, has only made one major mistake in life. She fell in love with, married, and had kids with Mr. Dumb. He later decided he'd rather be a crackhead, and dumped his family in favor of the excitement of living on the street and smoking crack.

So Miss Nicelady heroically soldiers on, dealing with single Mom stuff. She was awarded child support from Mr. Dumb. Unfortunately, this only gets withheld from his paycheck on the rare occasion he's actually working. So it amounts to $20-$30 once every few months, when he finds temporary work as a dishwasher.

So at her appointment today I asked her how things were going. She paused, and then began laughing.

2 months ago she suddenly began getting steady money from his child support withholding- $100 or so every 2 weeks. She was thrilled, and didn't want to look a gift horse in the mouth.

Until one night, when some guy she'd never heard of called to see why she was stealing HIS money!

Get this:

Mr. Dumb, trying to get crack money, sold his identity (Social Security Card, Driver's License, etc) to Mr. Dumber for $50.

Mr. Dumber, now hiding under Mr. Dumb's ID, went off and got a job.

And so, when Mr. Dumber began getting paychecks, his salary was withheld and sent to my patient.

Basically, Mr. Dumber paid $50 in order to have $200 a month withheld from his paychecks. How inconsiderate of Mr. Dumb not to have mentioned these minor details to his purchaser.

In addition, Mr. Dumber was also angry at my patient (like it's her fault) because he got pulled over one day, and discovered Mr. Dumb's license was suspended 2 years ago.

Miss Nicelady told me the best part of the whole thing was when Mr. Dumber told her he was going to call the police on her.

Friday, October 21, 2011

Crime in America

When armadillos are outlawed, then only outlaws will have armadillos.

Thank you, Helle!

Weekend update

Due to bizarre circumstances, Craig and I are flying to San Diego this weekend on short notice. So my posting will be limited over the weekend. Likely just any news stories that catch my eye.

Annie's desk

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

Mrs. Sig: "Hi, I need a refill to cover me for the holiday weekend."

Annie: "Um, this isn't a holiday weekend."

Mrs. Sig: "Okay, I'll call back another time."


Thursday, October 20, 2011

Weird Science

Apparently alchemy is making a comeback.

Thank you, Jodi!


Mr. Wool: "I'm doing much better. I don't need the walker any more, and am just using a cane."

Dr. Grumpy: "It's a nice cane, too. I like the carved handle."

Mr. Wool: "Thank you. It used to be my grandfather's. It has a big knife hidden in it..." (whips off handle) "that he used for slaughtering sheep."

Wednesday, October 19, 2011

"Do this! Maybe you'll get on Dr. Grumpy's blog!"

Yes, because sometimes being drunk just isn't enough.

Thank you, L.T.!

Things that make me grumpy

I have nothing against doctors making money. Hell, I'm trying to do that myself.

So medical journals are full of ads offering ways for doctors to increase revenue. Some of them practical, some hokey, and some that really piss me off.

Like this one:

(click to enlarge)

I have nothing against doctors who are doing concierge work, or sinking money into tech stuff, or marketing their practice.

But what ticks me off about this ad is that of the 4 things they claim to offer, doing what's best for patients is the very last thing listed.

If I ever reach the point where making money, investing in gadgets, or marketing my practice take precedence over doing what's right for patients, I hope someone tells me it's time to hang it up.

And if you've reached that point and don't see a problem with it, than maybe you've forgotten why you became a doctor.

Tuesday, October 18, 2011

Extreme sports

Yes, just another day in the competitive, gut-wrenching, in-your-face world of professional Scrabble.

Thank you, M!

Mary, call the psychic hotline

I'd like to thank my reader Tony, who says he found this on his fax machine this morning.

(click to enlarge)

Monday, October 17, 2011

Doctor talk

Dr. Grumpy: "Your hands are pretty sweaty. It looks like you have hyperhidrosis."

Mr. Thermo: "Um, no, I'm Italian."

How's the other foot?

Found this in a hospital chart today:

"She has dementia and osteomyelitis in her right foot."

Sunday, October 16, 2011

All Quiet on the Western Front

He stood there, shell shocked, with a thousand yard stare
In the last 48 hours he'd survived unspeakable horrors, but never left his station
Now, I needed to talk to him.
I didn't want to, but only he could answer my question.
I'd rather have left him alone.

He was like you and me until recently
But now front-line combat had turned him into a broken shell
Clothes disheveled, hair uncombed, hands shaking
An unlit cigarette hung from his quivering lips

But he was still a man with job to do
As I began speaking to him he summoned his composure
And softly answered my question
"Sorry, sir," he said "We're all out of the iPhone 4s."

Saturday, October 15, 2011

Crime update

For those of you losing sleep over the marauding bridge thieves I reported on earlier this month, I can now bring you some good news: They've been caught.

Thank you, Moose!

Shameless promo

Because I think Fizzy is absolutely one of the best medical cartoonists (Netter wasn't a cartoonist, people) I'm suggesting you have a look at her new book.

It's a collection of her best cartoons, and is available in both paper and eBook forms.

You can buy it here.

Please note: Dr. Fizzy did not pay me to write this. I just think she's great at capturing the insanity of medical training in her work.


Although I should note November 27 is a Sunday this year, and this may be an old picture. But thank you to everyone who sent it in.

Friday, October 14, 2011


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

Mr. Sofa: "Um, I stopped by my pharmacy on Tuesday to request a refill, and I still don't have it."

Annie: "Hang on... It looks like Dr. Grumpy approved the refill on Tuesday afternoon."

Mr. Sofa: "Well, I still don't have it."

Annie: "Did you call them to see if it's ready?"

Mr. Sofa: "No. I don't have their number. Could you look it up for me?"

Annie: "It's right here. It's 867-"

Mr. Sofa: "Actually, can you call them for me and ask if it's ready?"

Today's criminal tip

When shoplifting, there are some things you shouldn't leave behind.

Thank you, Lee!

Thursday, October 13, 2011

House calls are back in style

And they're free!

Thank you, Lawjok!

Germ theory

Mr. Irritant: "Did you just wash your hands?"

Dr. Grumpy: "Uh, yeah. You watched me."

Mr. Irritant: "That's pretty damn insulting. So you think I'm dirty?"

Dr. Grumpy: "No. I wash my hands after every patient, sir. It's good practice."

Mr. Irritant: "That's bullshit. I didn't come here to be treated like a second-class person."

Wednesday, October 12, 2011

Rescue Heroes!

Yes, yet another busy day for the police department and their K9 corps.

Thank you, Outrider!

Public Service Announcment

Today is World Arthritis Day, and WarmSocks has asked me to help with raising public awareness of Rheumatoid Arthritis.

She wrote in because recently Dr. Phil said on national television and still has it on his web page that obesity is a risk factor for developing rheumatoid arthritis. This is incorrect. Weight is a risk factor for developing osteoarthritis, but not rheumatiod arthritis. These disorders ARE NOT the same.

Her organization is doing a "post your numbers" (or numbers in support of someone else) project Similar to the Facebook "colors" project for breast cancer awareness. They're asking people to post weight/age of onset/current age.

She writes that if you don't know someone with Rheumatoid Arthritis, to please think about "80 pound Lori, diagnosed with juvenile arthritis at age nine. Now fourteen years old, she's lived with arthritis for five years. There is no cure. Please post 80-9-14 as your Facebook status and help raise awareness."

Tuesday, October 11, 2011

Chemistry of Walmart

People of Walmart + Chemistry 101 = Bad Idea.

Mary, bring me a strong drink

Dr. Grumpy: "You haven't had a seizure in years. What happened?"

Mrs. Flake: "I stopped taking my epilepsy medication last week. It was causing all kinds of terrible side effects."

Dr. Grumpy: "But... You've taken ShakeAway for 5 years, and never had a problem with it before."

Mrs. Flake: "Well, I took my pills at bedtime one night, like I normally do. And the next morning I woke up with a fever and sore throat. I was achy all over, and my nose was stuffy. After 2 days of this I realized it was probably from ShakeAway, and stopped it. The next day I was feeling better, so it must have been the drug."

Dr. Grumpy: "Ma'am, it sounds like you just had a cold. That's all. The medicine had nothing to do with it. Let me give you a schedule to restart it."

Mrs. Flake: "That poison! I just told you, it made me sick! Don't you listen? I refuse to start it again."

Monday, October 10, 2011

Today's news

In a new meaning to the phrase "water hazard" an Australian golf course has a family of sharks living in a water trap.

And in Florida, a legislator concerned about the unemployment issues facing people of below-average-height is trying to revive the bizarre sport of dwarf tossing.

Celebrity Endorsement

Craig and his hair were picked to read the morning announcements for 2 weeks on Wingnut School's closed-circuit TV channel

He took this very seriously, so he'd bring the announcements home each night and practice them endlessly for the next day.

Let me tell you, there are very few things that can drive you crazier than a kid re-reading ad infinitum things like "Band practice is at 12:45 on the north field. The chess club will meet in the library at 2:15. There will be a bake sale to support the 6th grade field trip at 3:00 in front of the cafeteria." Over and over and over again.


This past weekend was the annual Boy Scout popcorn sale in front of Local Grocery. So Craig and his hair were out accosting shoppers, when a tween girl stopped in front of the table.

Craig: "Would you like to buy some popcorn?"

Tween Girl: "Hey! You're that kid on school TV!"

Craig: "Yes I am! Would you like an autographed bag of Scout popcorn?"

Tween Girl: "Yeah! And I love your hair!"

In a few hours he sold $600 worth of popcorn

Sunday, October 9, 2011

Attention patients

Leaving the message "Oh my God! Are you fucking kidding me?!!!" On my voicemail at 8:59 p.m., with no other information, will not get you a call back.

Saturday, October 8, 2011

Random pictures

All right, today I'm going to put up some shots you guys have sent in.

First, is an older ad for Viagra. I'm unsure if the image is inspired by the song line "Get your motor running" or the juice commercial tag-line "I could have had a V-8!".

Next, in a sign that the apocalypse is coming, the world has apparently run out of names for wine.

To send email attachments, they now sell internet shipping labels. I had no idea you needed them, and obviously I've been doing email all wrong.

And last is this fortune cookie I got recently. I can only assume it refers to the occasional vegetables I see in my practice.

Friday, October 7, 2011

"Pssst... Hey, you wanna buy a bridge?"

Yes, it actually happened. Police in Pennsylvania are reporting that someone has stolen an entire bridge, 50' by 20'.

So, if you happen to notice that your neighbors have installed a new bridge over their pool, or see someone selling a bridge door-to-door in your neighborhood, please call police immediately.

Thank you, Webhill!

Today's mail

Got a letter from Grumpy National Bank saying they're increasing the fee on all fuel purchases made on my office premises.

Mary, have those gas pumps removed from the lobby. I guess they weren't my best idea. We'll also have to stop selling ziploc bags full of premium unleaded to the patients.


Dr. Grumpy: "Your memory test was fine."

Mr. Bogus: "But I didn't have a memory test!"

Dr. Grumpy: "You did, last week. I have the results here. You did fine."

Mr. Bogus: "That's impossible. I couldn't answer half the questions! And the girl who did the exam was confusing me!"

Dr. Grumpy: "So... you do remember the test?"

Mr. Bogus: "Yes! I mean no! I have terrible memory problems! I can't remember anything! What are we talking about?"

Dr. Grumpy: "Never mind. Hey, when is your disability paperwork due?"

Mr. Bogus: "Next Wednesday, before 5:00 east coast time. The fax number is 867-5309. Do you need the address? I have it in my wallet."

Dr. Grumpy: "How did you remember that?"

Mr. Bogus: "How did I remember what?"

Thursday, October 6, 2011


Dr. Grumpy: "That could have been serious. Why didn't you go to ER?"

Mr. Spacecadet: "I considered it, but the whole ER concept is such an intangible."


Dr. Grumpy: "So we'll see how you do with physical therapy, and then..."

Mr. Cullet: "Hey, doc, who installed your office windows?"

Dr. Grumpy: "I have no idea. I just rent the space, and it was built long before I moved in."

Mr. Cullet: "Well, you could have better windows. I can get you a great deal on new ones."

Dr. Grumpy: "Thanks, but I don't own the building. You'd have to talk to the managing company."

Mr. Cullet: "The new ones would be good quality, all-weather windows, with top-notch energy saving features."

Dr. Grumpy: "Okay, but I can't buy new windows for a building I don't own. Let's focus on your arm pain. So I'll see you back after therapy, and then we'll decide if more studies are needed."

Mr. Cullet: "Okay, doc, but you're missing out on a great deal."

Wednesday, October 5, 2011

Goodbye, Steve

Thank you.


p.s. Stay hungry. Stay foolish.

Mary's desk, October 5, 2011

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

Ms. Newpatient: "Hi, I have an appointment for tomorrow, and have a question."

Mary: "Okay?"

Ms. Newpatient: "On your website it says you use Grumpyville Billing Service."

Mary: "Correct."

Ms. Newpatient: "You need to change that. I refuse to come in unless the doctor fires them immediately. They've turned me into collections for several other doctor's offices, and I'm tired of them doing that."

More reasons I use Rogaine

Dr. Grumpy: "At your last visit you switched to generic Noshakes. How's it been working for you?"

Mr. Ictal: "I need to go back to the brand name. I've had 3 seizures in the last week."

Dr. Grumpy: "That's not good. Let me write you a new prescription."

Mr. Ictal: "Okay. I need one. I ran out of all my pills 2 weeks ago, and haven't taken any since then."

Tuesday, October 4, 2011

Stump the expert

Okay, it's time again for you armchair neurologists out there to help me with a challenging case. Here is, verbatim, the first paragraph of my note. See if you can guess the diagnosis:

"When working outside in the Summer, or inside baking, she becomes warm, sweaty, and lightheaded. The symptoms resolve with drinking cold water and cooling down. They don’t occur if she keeps up on her fluid intake."

Monday, October 3, 2011

The Omen

Dr. Grumpy: "Did someone refer you to me?"

Mr. Damian: "Your name was in the letter I got from Dr. Lastsucker when he fired me."

Sunday, 7:15 p.m.

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

Mr. Albuquerque: "Hi, I want to know if I should be taking Plavix for a stroke."

Dr. Grumpy: "Did I prescribe it for you?"

Mr. Albuquerque: "No, my neurologist did. I've never seen you."

Dr. Grumpy: "Sir, I can't give out medical advice if you're not even my patient. Why don't you call your neurologist?"

Mr. Albuquerque: "I'm calling different parts of the country to get a consensus on if I should or shouldn't take it."

Dr. Grumpy: "You're welcome to make an appointment to see me, and discuss it."

Mr. Albuquerque: "That's ridiculous. I live in New Mexico, and there's no way I can travel that far."

Sunday, October 2, 2011

Sunday reruns

It's been 2 years since I put this up, and I must say that one (but only one) of the insurance companies I deal with has significantly improved in that time.

I'm not taking sides in the health care debate, but I do want to clarify something.

I see people on the news screaming that they don't want "bureaucrats" between them and their doctor, and are afraid that's what government health care will bring.

WTF? THAT'S THE WAY IT IS NOW, PEOPLE!!! I hear my assistant Annie on the phone all day trying to get approval from non-government insurance companies for tests, medications, physical therapy, ANYTHING that I order.

Look at your insurance card. Doesn't it say things like "in-network" and "formulary"? Who the hell do you think came up with those? Not us docs. Dat be dem dere byoo-row-kratz!

Look back at some of my posts (like this, or this). I routinely have medications (both brand name and cheap generics) and tests refused by insurance companies. For an excellent commentary on this from the pharmacy side, this was written by FranticPharmacist.

So if you don't want bureaucrats between you and your doctor- TOO BAD. They've been there for years. THE ONLY PEOPLE WHO DON'T HAVE THIS PROBLEM ARE PAYING CASH FOR EVERYTHING!

In fact, for those of you who don't want the government running this, THEY ARE ACTUALLY ONE OF THE BETTER ONES TO WORK WITH! Just ask Annie. Medicare doesn't question the majority of my tests, or meds. Yes, they don't cover everything, nor should they, but they don't fight with me over stuff like MRI's on stroke patients. Uncle Sam (unlike Aetna, Cigna, Humana, and many others) tends to leave these things to the doctor's discretion. Annie prefers Medicare patients for this very reason - they make her life easier.

So what happens to you the way it works NOW, with your non-government insurance?

You come to me for some neurological issue, which requires further work-up. So I order, say, an MRI and MRA of your head.

Annie gets the order, and calls Bozo Insurance, Inc. (BII) to schedule it. BII refuses, saying they want more information. So they fax us a 5 page "pre-auth" form, which Annie spends 20 minutes filling out and faxes back. Then they say the form wasn't enough, and they also want copies of your office notes, so we send those, too (yup, when you joined BII you agreed that they can read your medical records).

So a few days go by. BII will claim they never got our fax. Or that we filled the form out wrong. Or that they don't cover Capricorns when the moon is in Pisces. A
nd we don't know this until Annie calls back after a few days, because they're hoping we forgot about it.

Eventually they'll deny the whole thing, on the grounds that you don't meet criteria for an MRI and MRA. This decision is usually made by a non-medically trained person with a minimum of a GED. They do this because they want to see just how badly I want the test.

So they tell me I can appeal this via "peer-to-peer" review. Which means I need to personally call their "physician reviewer" to argue with them as to why I want the study.

So, during my insanely busy day at the office I have to call them. I'm promptly put on hold for 10 minutes, before finally reaching the reviewer. This person is a doctor- but NOT necessarily in my specialty. In fact, it's usually something like a retired dermatologist, who hasn't done neurology since medical school in 1938. Or an OB/GYN who hated his job, and is doing this now instead. Or some doctor who immigrated from Lower Swazbodiaczk and can't get a U.S. medical license (but your insurance company hired him to decide what medical care you need). But it's almost NEVER someone actually in my field, who might understand why I want the study.

So after telling your life history to Dr. Denial, one of 2 things will happen. They'll deny both studies, and want you to try medication or physical therapy or psychotherapy or holistic reflexology or whatever, and if you fail that THEN I can try to resubmit a request for the test. OR they will flip a coin and say they will cover the MRI, but not the MRA. Or vice-versa. They'll say that if the first test is fine, THEN I can start over trying to get the other covered. Maybe.

And many of these companies actually pay these "reviewers" bonuses based on HOW MUCH MONEY THEY SAVED THE COMPANY BY DENYING TESTS.

This can at times become comical. One of my patients is a doc who works part-time as one of these insurance company "physician peer reviewers". And when he needed an MRI, guess what? HIS OWN COMPANY DENIED IT! He paid out of pocket for it (and yes, it was abnormal).

So how did I get on this tangent? Because yesterday I was walking by Annie's office, and heard her losing it over the speaker phone. And, as always, she was totally awesome.

Annie: "I'm calling because you people denied an MRI on a stroke patient?"

Pinhead: "Before we discuss this, I have to inform you that this is a recorded line."

"Oh, good, hopefully someone will actually be listening to me then. Thus far it hasn't happened."

Pinhead: "Let me look up the tracking number... Okay. I have to inform you that we are unable to approve this study. Your doctor will need to make a peer-to-peer call."

Annie: "Oh, now THAT's a surprise."

Pinhead: "What do you mean?"

Annie: "Is this line really being recorded?"

Pinhead: "Yes. It's to improve customer satisfaction."

Annie: "Oh, goody, because I'm sure not satisfied, and neither is the doctor, or the patient. Your company, and whoever is listening, never approves anything. In fact I can say that 100% of the time you require peer-to-peer review."

Pinhead: "We do this to save our customers money on unnecessary testing."

Annie: "Okay. Then let's just stop wasting each others time. Forget the intake coordinator, forget you. Since your only job is apparently to tell me that my doctor needs to call your doctor, couldn't your company save money by firing you?"

Pinhead: "Um, I hadn't..."

Annie: "Think about it. You have benefits and a salary, right? I mean you're not doing this as a volunteer job, are you?"

Pinhead: "No, but I..."

Annie: "So wouldn't your company save money by firing you and instead getting a computer that automatically denies every damn test and sends a fax telling us to call for a peer-to-peer review? Then we can just let the doctors talk directly to each other from the beginning, which is what you bozos want anyway. Think of the money saved by cutting all of your jobs."

Pinhead: "Oh, but you can't mean that?"

Annie: "Oh but I do mean that. And I'm glad we're being recorded. Let's consider the current situation. You are basically a worthless automaton. A computer could do your job for far less. And at this point you've incurred the wrath of all the medical professionals in the country as well as the patients. You and all of your superiors ought to be out of a job due to your blatant inefficiency. And don't think we don't save your denial forms, and your names, and document it all in the chart."

Pinhead: "I..."

Annie: "Nothing personal you understand, just a suggestion. I'll have my doctor call your doctor. Have a nice day".

Pinhead: "No, wait! I..."

Annie hung up.

So bottom line here: if you don't think bureaucrats are currently between you and your doctor- THEY ARE! GET REAL! IT'S BEEN THAT WAY FOR THE LAST 10 YEARS OR MORE!

Saturday, October 1, 2011

Lego Scorpion

Last week my kids got some new Lego things, and put them together yesterday.

This is one of them.

It's about a foot long.

And in poor lighting, at 2:00 a.m., silhouetted against white carpeting, it can scare the crap out of you.

I learned this the hard way.
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