Friday, January 30, 2015

Celebrity fail

Dr. Grumpy: "The neck MRI didn't show anything serious, so he should be okay:"

Dr. Hospital: "Good. He had a bad fall, and I was worried he'd be paralyzed. You know, like the Superman guy Steve Reeves."

"Or was it Keanu, or Dan, or Martha... maybe there isn't an 'S'..."

Thursday, January 29, 2015

Open season

In the last month, 2 doctors have been shot & killed, on the job, here in America.

I'm not going to say medicine is more dangerous than, say, police, fire, or military work. But it's certainly not safe, either. Both of the doctors who were killed were in hospitals at the time. One shot by a disgruntled patient, another by the upset son of a patient.

2 doctors in a month may be only a drop in the bucket in a country where 82 people are murdered with guns every single day, but it still scares the crap out of anyone trying to help patients, not to mention the affects on our families.

Do I get threatened? Yes. Sadly, all doctors and nurses do. People want to feel better. Or be cured of something. Or want more narcotics. Or are unhappy with my telephone system. So they yell and scream, and sometimes threaten. Most of them simply change doctors and a few may post a shitty review of me online. Generally that's as far as it goes.

But that doesn't mean it might end there. All it takes is one person who goes over the edge. And, here in the land of the gun, firearms are easily obtainable by anyone. Even those who hear voices telling them to kill people. Or have a history of violence with a restraining order against them. Or have committed felonies. Even for a doctor, it's hard to tell who is or isn't crazy enough to actually carry through on their threats.

The ER docs and nurses are the front-line in medicine. I don't know anyone who works in ER who hasn't been threatened or struck by a patient. Does that surprise you? Then go hang out in any decent sized ER in America and see what really goes on there. I was a 19 year old volunteer the first time I did that, and on my second shift got punched in the mouth by a junkie while I was taking her blood pressure.

Violence against health care workers is so common it's not reported most of the time. Only the fatalities make the news.

There's no easy answer, either. Put guns on ER staff? A lot of what they do is lean over patients, so it would be pretty easy for one, or a family member, to grab it off their belt. And don't ask about hospital security. Well-intentioned, sure, but at many hospitals the security guards are septuagenarian retirees with pepper spray. You think that's going to deter a delusional schizophrenic with a Glock?

That doesn't mean we aren't armed, too. I know plenty of docs who keep guns in their desks. Not automatic rifles with armor piercing bullets and high capacity magazines, just basic handguns. We all hope to never have to reach for it. That said, it won't do us any good, either, if a distraught and armed patient catches us up front reviewing lab reports. Or talking to a drug rep. Or heading down to our car.

Dr. Pissy has carried a Beretta under his white coat for as long as I can remember. If you don't think your doctor would keep a firearm in his or her office, think again. Like lawyers and university professors, we have our share of the irrationally angry, and we're easily accessible. Those "gun free zone" signs in front of hospitals and schools don't intimidate anyone determined to wreak havoc. And the laws your state might pass making it a felony to assault a healthcare worker aren't going to bother those who are most likely to do so.

For the record, I have plenty of patients who carry guns to the office (including a police officer who accidentally left it on my exam table overnight and I still give him shit about it). It doesn't bother me, either. They're responsible people (except for you, Officer JT) who happen to carry a gun with them and today have a doctor's appointment, as opposed to someone who brings the gun to the doctor's meaning to use it.

Would it protect me and my staff if Pissy and I had obviously displayed sidearms? Maybe... But on the other hand, a key part of medicine is putting the patient at ease, so you can gain their trust and help them. Plenty of people are not going to open up under that circumstance, which defeats the whole point of the visit. Not to mention all the people who let their rugrats run amok in our office and play with whatever they find

Some are going to take this post as saying I'm a gun nut, who thinks everyone should carry a piece. I didn't say that at all.

Others will take it to mean I'm an anti-gun person, who wants them all banned. I didn't say that either.

My point is this: your doctors, nurses, and pharmacists, regardless of where they work, are doing a damn dangerous job. All it takes is one irrational person with an easily-acquired weapon. And there's no easy way to prevent it, either.

Doctors, unfortunately, are easy targets. We're vulnerable, because what we do best - helping others - means that we're also putting our trust in them not to harm us, too. Trust goes both ways. To get you to confide in us, so we can examine you and figure out your problem, means you have to trust us. At the same time we assume that we can trust you in return. This arrangement works out well, tens of thousands of times a day around the world.

But in the last month 2 good doctors did their best to help and trust others. And paid for it with their lives.

Wednesday, January 28, 2015

Is it covered by Medicare?

Seen in a hospital chart:

For my non-medical readers:

QD: Once a day
BID: Twice a day
TID: Three times a day
PRN: As needed

Tuesday, January 27, 2015


Mrs. Newage: "I'm not happy with my current psychic, so I'm changing. She didn't warn me about the car accident."

Dr. Grumpy: "What happened with..."

Mrs. Newage: "One of my friends recommended Char L'tan. But she's booked out for the next 3 months."

Dr. Grumpy: "I had no idea."

Mrs. Newage: "Yeah, the girl there said they didn't realize how busy it would be this year."

Monday, January 26, 2015

Skool Nerse Time

Ms. Ged: "Thank you for calling the CrapCare Insurance pharmacy line. How may I help you?"

Mrs. Grumpy: "Hi, I got a letter saying my son Frank's pills won't be covered starting next month unless I submit an appeal form. It said to call this number to get the form. So I'm calling."

Ms. Ged: "That letter just went out last week."

Mrs. Grumpy: "Yeah, it came in today's mail. That's why I'm calling."

Ms. Ged: "We... don't even have the appeal form ready yet. You weren't supposed to call so soon after getting the letter."

Mrs. Grumpy: "Well, it didn't say that.  It said to call, and I am. When will the form be ready?"

Ms. Ged: "Next month. We weren't expecting anyone to call this quickly."

Mrs. Grumpy: "So the form to continue the medication won't be ready until after we've already run out of medication?"

Ms. Ged: "Yeah. I mean, that's when most of our patients call, anyway."

Saturday, January 24, 2015

Love thy neighbor

Friday, January 23, 2015


I'm going to assume the confirmatory phone call is also entertaining.

Thank you, Lee!

Thursday, January 22, 2015


Mary interrupts me while I'm with a patient. Never a good thing.

Mary: "There's a doctor on the phone, says he needs to talk to you right now."

She hands me a piece of paper. I pick up the phone. It's a guy I've never heard of.

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

Dr. Interruptus: "Hi, this is Cody Interruptus, I work over at the Local Hospital clinic, and I've got a guy here... 27 years old... anyway, he has Flehner-Lathrop Syndrome, and I think he needs to see a neurologist soon, if you could work him in."

Dr. Grumpy: "That's pretty uncommon, and I've never seen a case. Have you called Ivory Tower Neurology? They have a lady who specializes in it."

Dr. Interruptus: "No. I mean, I'm part of the Local Hospital clinic, and would like to keep the patient here, seeing other docs who work out of Local Hospital. In this day and age we all need to work together and support each other in the community. I'd appreciate it if you could help me out. I mean, you can refer him to Ivory Tower afterwards if you need to."

Dr. Grumpy (feeling guilty): Okay... I'll work him in over lunch tomorrow."

Dr. Interruptus: "Thank you."

Dr. Grumpy: "Let me get his info... Looks like Mary wrote most of it down... What insurance does he have?"

Dr. Interruptus: "Sickness & Wealth HMO."

Dr. Grumpy: "Oh... I'm sorry, I'm not contracted with S&W. I never have been. Two of my call partners, Drs. Brain & Nerve, are, let me give you their number..."

Dr. Interruptus: "But this is LOCAL HOSPITAL. Those two work out of OTHER HOSPITAL. You need to help support us and the Local Hospital community. Can't you just see him for free?"

Dr. Grumpy: "He has insurance. This is not a charity issue. I do plenty of charity work for the uninsured. I'm not going to see him for free when there are plenty of docs who take his insurance around."

Dr. Interruptus: "You should be loyal to the hospital. That should be your first priority."

Dr. Grumpy: "I..."

Dr. Interruptus: "Thanks for nothing."


Wednesday, January 21, 2015

Mary is FIRED!... again.

Recently, who knows why, the twins have become obsessed with the 1984 Lionel Richie song "Hello."

And by obsessed, I mean singing it to the dogs, to each other, in the car, playing it on their phones, playing it on their band instruments... pretty much UNTIL I WANT TO KILL THEM.


The other day I was bitching about it to Mary, and how damn sick I was of hearing it.

The next morning I was in a room examining a patient, and afterwards walked back to my office. When I sat down to type up some notes, my mouse wouldn't track. It had been working fine earlier.

After a minute I turned it over to see what was wrong, to find this taped to the bottom:

Tuesday, January 20, 2015

Mary's desk, January 19, 2015

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

Mr. Ecgonine: "I need to get checked out by the doctor right away!"

Mary: "Okay, we have an opening Thursday at..."

Mr. Ecgonine: "No! This is an emergency! I was snorting cocaine this morning, and my eyes started twitching. It must have made me catch cerebral palsy or Down Syndrome or something like that, and I need to get screened for all of those things."

Mary: "Well, I..."

Mr. Ecgonine: "Not only that, but I think I have some sort of cancer. Like lung cancer, or leukemia, or brain cancer, that kind of stuff, and I need to get screened for all of those, too."

Mary: "Okay, but..."

Mr. Ecgonine: "Hey! My dog just peed in the kitchen!"

The line went dead.

Monday, January 19, 2015


Seen in a medical market research survey last week:

Saturday, January 17, 2015

Weekend reruns

The phones were really ringing today, and so a few calls went to voice mail. Annie had me listen to this one:

"Hi, this is Suzy Frazzled. I'm a social worker involved in the medical case of Kathy Smith. I'm calling to see if you have any records on her. You probably don't, because none of the other doctors on the list she gave me have ever heard of her, either, and I'm on my last damn nerve dealing with her. Anyway, she's blaming every freaking illness she has on a piece of cotton that was left in her ear 2 years ago after she had a glob of wax taken out. Thinks she's won the freaking lottery, apparently. What? No Bob, I don't have that info here. I've been working on Mrs. Smith all damn morning. How come you don't get these cases? The boss gives me all this shit, and it's not fair. Where the hell do these people come from and why do they always end up on my desk? Why can't I get normal cases? Oh, sorry, hello? Anyway, please call me back and let me know if you've ever heard of this lady."

Friday, January 16, 2015


Dr. Grumpy: "Which orthopedist did you see?"

Mr. Vague: "He works over on the south side. It was a Dr. Hansen, or Martin. Maybe it was Stevens or Smith. It could have started with an 'S', but I'm not sure. You know who I'm talking about, right?"

Thursday, January 15, 2015


A long, long, long, time ago, during my college years... I was a volunteer working in an ER.

It was a fairly small ER, and I was allowed to do A LOT of things that volunteers today aren't. It was nice, because my help was genuinely appreciated, and I was made to feel like part of the staff.

Anyway, one day an elderly lady came in with trouble breathing. While the doctor examined Mrs. Gasping, the nurse and I hooked her up to some oxygen. She went to turn on the O2, handed me the oxygen mask, and asked me to put it on the patient.

So I was placing it on the lady's face when the elastic band snapped over, pulling the plastic mask to the side.

To my horror, her whole nose flew off. We hadn't been told she had a prosthetic nose to replace one lost to skin cancer.

The nose clattered over the gurney and onto the floor. I screamed, thinking I'd somehow accidentally torn her nose off. The nurse shrieked. The doctor jumped back. I saw my entire dream of a medical career vanish.

Her husband started laughing, picked up the nose, put it in her purse, and set the oxygen mask on correctly.

I hid in the bathroom for a while.

Wednesday, January 14, 2015

Better living through pharmacology

Tuesday, January 13, 2015

2:28 a.m.

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

Mrs. Insomnia: "Hi, my husband sees Dr. Cortex for epilepsy."

Dr. Grumpy: "Is he having a seizure?"

Mrs. Insomnia: "Oh, no. He's fine. He takes Felbacetam."

Dr. Grumpy: "Okay, so why are you calling? Is he out?"

Mrs. Insomnia: "No, we have about 3 weeks left. But it requires an annual authorization from the insurance company to continue, and Dr. Cortex's nurse put the request in last week. Do you know if they've heard anything back yet?"

Dr. Grumpy: "No. Why don't you call his office when they open in the morning and ask?"

Mrs. Insomnia: "That's a good idea. Thank you, doctor. Have a great night."

Monday, January 12, 2015

A rose by any other name

Karen writes in:

"Dr. Grumpy, I've worked at different doctor's offices for over 20 years. But was still surprised when an infusion pharmacy rep came by recently and left his card and company information."

I'm going to have to agree with you, Karen. That's a TERRIBLE name for a pharmacy. Or pretty much any business (I wouldn't have dinner at DikPizza). Unless it's a sex shop.

According to the website, Dik is the owner's last name. And I respect that. Putting your name on a business is pretty universal. It's his name, and he's proud of it. But still, I think you have to take meanings into account, too. If your last name is Shithole or Fukme, you wouldn't want that on your cards. I think, in this case, going with your initials, or first name, or pretty much anything else, would sound better.

It also kind of distracts you from what the business does. I see "DikDrug" and I immediately assume they specialize in Viagra, Cialis, and Levitra "Here's a sample, why don't you see if it works? There's some magazines in the lobby bathroom."

Even more chilling (at least for a guy) is that DikDrug is an INFUSION pharmacy. This brings to mind painful images of Caverject and long needles being stuck in my winkie... I better cross my legs and end the post here.

Thank you, Karen!

Friday, January 9, 2015

Quote du jour

"I'm less aware of forgetting what I can't remember."

Thursday, January 8, 2015


Last night I was watching a live CME presentation online. The discussion was about ways to measure stroke recovery by using a hand-grip dynamometer.

At one point the speaker said:

"The affected arm will be tested using a grip dynamometer for hand-jobs. Uh, I mean hand strength."

This led to a brief delay while the online panel composed themselves.

Wednesday, January 7, 2015


Drug company advertising is, well, advertising. They're trying to get me to prescribe something.

I see drug ads all the time as I flip through journals. I ignore them. Most are meaningless collections of graphics, charts, and small print. But occasionally one will catch my eye.

A few years back Novartis ran a campaign for their Alzheimer's medication. Normally I'd have ignored it and turned the page, but the pictures were powerful and I stopped.

They've since moved on to more typical campaigns, but this one shouldn't be forgotten, so I'm going to share it here today.

Think of how you treat the elderly. Because someday it will be you on the other side of the mirror. Your newborns and toddlers and teenagers will be there someday, too. And the fragile old man/woman in front of you today was once you.

Tuesday, January 6, 2015

Overheard in the ER

Nurse: "I thought you were leaving AMA?"

Ms. Eword: "I am. You people here don't treat me right. I'm suffering, and in horrible pain, and you won't give me any Dilaudid. I'm never coming back to this dump."

Nurse: "So... why are you still here?"

Ms. Eword: "I want to finish my coffee."

Monday, January 5, 2015

Round & Round

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

Mrs. Feather: "I've been trying to reach you people all week. Why don't you return my calls?"

Annie: "It... looks like I've called you back 4 times. There was no answer, but I left messages each time."

Mrs. Feather: "I haven't gotten any of them. What number did you call?"

Annie: "The one you wrote on your info sheet, 867-5309."

Mrs. Feather: "That's my home number. I never answer that or check the messages. I only use that for outgoing calls."

Annie: "Well, it's the contact info you gave us. Is there a better number to reach you at?"

Mrs. Feather: "I use my cell phone for incoming calls. It's the only one I answer. It's the number my family tries to reach me on, but I don't give it out because I know you people sell phone numbers to telemarketers."

Annie: "No, ma'am, we don't sell or give out your personal information. So what's the cell phone number, so I can reach you next time?"

Mrs. Feather: "I'm not giving that out. It's only for family to reach me on, and no one else."

Annie: "Okay, but then how am I supposed to return your calls?"

Mrs. Feather: "You can call my home number."

Annie: "But you just told me you never answer that line."

Mrs. Feather: "Yes, but you can leave a message."

Thursday, January 1, 2015

New Year's Day

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