Friday, June 29, 2012


I'm with a patient when Mary interrupts me. Dr. Intern is on the phone, and says it's urgent.

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

Dr. Intern: "HI! I just ran a Depakote level on Mrs. Seizure, and it's ZERO! I just spoke to her. She hasn't had any seizures, but I told her she needs to get in to see you ASAP!"

Dr. Grumpy: "Hang on... She isn't on Depakote. I changed her seizure meds in 2010, and she hasn't taken it since then. So I'd expect it to be zero."

Dr. Intern: "Why doesn't anyone tell me these things?"

Dr. Grumpy: "Well, it was noted in the letters I sent you. Don't you read them? Or check a medication list at each visit?"

Dr. Intern: "Who has time for that?"


Anonymous said...

sounds like my internist, unfortunately.

Francine said...


Packer said...

Can't wait for the additional 30 million persons without healthcare to come into system (with no additional health care providers) Think you don't have time now, just wait Doc.

Moose said...

Sweet Zombie Jeebus! There's nothing I love more than people who have been privileged to have what should be a basic human right whining because they have to share it with those who have been historically underprivileged.

It's a sad, sad statement on humanity to see people's reactions like this. "Those filthy, lazy poor people, they shouldn't have any right to health care or to get treated for their filthy lazy diseases. After all, if they weren't so lazy and had jobs they'd be able to afford their cancer treatment!"

(The answer is: Apparently very.)

I also love the idea that private practice doctors are suddenly going to decide to take on heaps more patients because "they're out there." Because every doctor takes every new patient all the time.


The US is the only 1st world country ON THE PLANET who has historically treated health care as something for only the privileged. It's long past time we join the rest of the human race.

Anonymous said...

Just another small example of the problems caused by the lack of unified medical records.

If even basic information, such as active Rx, lab results etc was avaialable to any practitioner a significant saving of time and money would result.

Of course that is not happening any time soon due to (justified) paranoia about mis-use of medical data.

Packer said...

@Moose---you completely missed my point. We are moving to a universal health care system,but we have not accelerated the movement to provide the service providers. If you add 10% more consumers , then you must add 10% more physicians or redesign the delivery system. That is the point, and it completely avoided (with forethought) the political debate surrounding the law. We are there now, but we are not adding care givers. Every Doctor I talk to says they are full up.

Margaret said...

But he had time to waste yours.

Moose said...

@Packer, I did not miss your point, because I addressed what you said. More people needing more doctors is not the same as doctors getting overflowing with patients.

You said, "Think you don't have time now, just wait." Doctor Grumpy, like most other doctors, is and will be (under ObamaCare) under no obligation to add more patients to his practice. He may get more requests from new patients, but nothing obligates him to accept more patients than he feels he can handle.

Steeny Lou said...

That gives a new meaning to "dictated, but not read".

Just Me said...

Moose et al...The fact is that if an insurance system is being flooded with requests for more patient visits - they will make doctors see more patients. That's what happened in Mass.

RehabRN said...

Too bad the almighty JC doesn't visit Dr. Intern, then he'd get his med lists.

BTW my internist has the one of the nurses get the med rec done EVERY time I go.

Moose said...

Doctors in Massachussets have not been forced to see more patients. It's true that it's harder to get in as a new patient to a doctor.

Anonymous said...

With or without Obama Care, with the aging Baby Boomers, it's going to become more difficult for doctors anyway. There are simply too many of us.

Some medical schools in Ohio are trying to entice more students to go into primary care, rather than specialize. This is being done in the hopes of offsetting a doctor shortage around the country.

I marvel that doctors do not read correspondence from other docs or from therapists, but often, they don't.

Anonymous said...

What a doofus, caught with his pants down in his obligation to his patients. With an attitude like that it's no wonder that patients are just ignorant flies on the wall in their own advocacy.

I would just loooooovvvvvveeee some standardization of health care in the model of physicians such as Dr. G. provides his patients; an honest patient-care provider relationship, with a sense of humor, intelligence, and follow-up and follow-through.

Correct, accurate and complete information on a reconciliation records indicating allergies, and a current list of medications, doses, and directions should be standard. Patients should know what it is and docs should use it. Like currency in a monetary system.

I work in a very, very small hospital. Pretty near 1/3 of the patients AT MOST provide a complete list of their current regimen, what they take the meds for, correct allergy information and what chronic illnesses they have.

Acquiring up-to-date knowledge does not stop after 8th grade, high school diploma or a college education. We know more about how many marriages so and so in Hollywood had than we do about our own bouts of health, and it's personal stuff, like things that happen to us individually. Knowing useful and keeping informed about directly applicable processes should be obligatory, and this kind of knowledge is not a prerogative of the deciders, but the very people who should use the information for proper patient assessment, and those who should be making informed choices.

Anonymous said...

Dr. Intern should have been charged for this test, not the insurance company, and certainly not the patient.

If you don't do the basics of your job, there should be financial consequences.

Anonymous said...

That's why medical schools need to teach all new docs to utilize the pharmacist. It also wouldn't be a bad idea if all current docs would get on board with that as well. Pharmacists are medication experts and are trained to spot problems like this.For those of you who don't know, pharmacist do more than just count pills at the drug store. All major hospitals have pharmacists on staff for just this purpose but they are under utilized and there advice is often ignored.

SuzOH said...

This has got to be below some standard of care. My mother has to bring all her meds with her to see her cardiologist on every visit. And all my parents' doctors require them to update a list of medications they take at every visit, even the ophthalmologist. I've set up a Word document I can print out for each visit rather than try to write it out each time.

Roni said...

I had a doctor like this. He prescribed me with a drug which I am allergic to and if not for the pharmacy catching it, I'd be DEAD! He called it by a name I was unfamiliar with and I didn't realize it was the one I can't take. OH and it WAS right in my record. I make sure my meds & allergies are up to date each visit.

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