The last patient of the day

Following a whine session yesterday with Mary and Annie, I now present our list of issues that always seem to plague the last patient seen each day (especially when on a Friday).


The last patient of the day:

1. Shows up late, and wants to tell you the 10 minute story of why they're late. And/or wants to spend 10 minutes in the bathroom before the appointment starts.

2. Wants to read the required HIPAA privacy form word-for-word and ask questions, even though it's identical to the one every other doctor and hospital in the country use.

3. Has a new insurance card. And forgot to bring it.

4. Forgot to bring the insurance authorization for the visit, and the doctor who issued it closed earlier in the day.

5. Left their (MRI reports/lab reports/small child) in the car, and and has to go back to get them, and has no fucking idea where they parked.

6. Doesn't want to start the appointment until their spouse/child/parent arrives, and has no idea where they are. Or what their cell phone number is.

7. Has a new address, and needs to fill out the forms for it.

8. Needs a shitload of tests ordered.

9. Needs a bunch of prescriptions written, with both 30-day (local pharmacy) and 90-day (mail-in) scripts written for every damn drug.

10. Makes all who have contact with them want to strangle them.

No, just pick somebody else's family. It's more fun.

Dr. Grumpy: "Any major illnesses in the family?"

Mr. Gene: "You mean my family?"

Tuesday night, 9:25 p.m.

"Hi, I have an appointment with Dr. Grumpy tomorrow at 11:15, and I need to know if that's 11:15 our time? Or is that 11:15 in another time zone? I really want to be there, so need to know if it's local time or not. Thank you."

Annie's Desk, April 6, 2010

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

Mrs. Ditz: "My husband is having problems with his medication."

Annie: "Which medication is that?"

Mrs. Ditz: "The one Dr. Grumpy gives him. I don't know the name. He takes it at night."

Annie: "Okay, I'll look it up... What kind of problem is he having?"

Mrs. Ditz: "He says it causes side effects."

Annie: "What kind of side effects?"

Mrs. Ditz: "I don't know. What kind of side effects can it cause?"

Annie: "It depends on what he's taking."

Mrs. Ditz: "I don't know what it is."

Annie: "Why don't you let me talk to your husband?"

Mrs. Ditz: "He's at work. He won't be home until after 6:00."

Annie: "Why isn't he calling himself?"

Mrs. Ditz: "He doesn't know I'm calling. I thought it would save time if I did."

Dear Dr. Astute,

Thank you for seeing my patient, Mrs. Complex. She's a very challenging case, and I'm glad you were willing to provide your expertise.

And you certainly didn't disappoint.

Your impression of her condition, with all of it's details, showed such remarkable deductive reasoning and was so brilliantly detailed, that I realize there was no way I'd ever have come to such a conclusion.





Yes, folks. That's the entirety of his impression and plan. The only thing I took out is the good doctor's name.

Frazzled Farmacy

I had to stop at Local Pharmacy tonight to pick up a Sarcasma prescription for Frank (yes, now my kid is on it, too).


Pharmacy guy: "What's the name?"

Dr. Grumpy: "My son, Frank Grumpy."

Pharmacy guy: "Hang on... Here we are. Okay, has your kid ever taken Flagyl before?"

Dr. Grumpy: "No, but it's not Flagyl, it's Sarcasma."

Pharmacy guy: "No, it's Flagyl, I have it here, and it looks like there's another script for birth control pills. Has she ever been on those, either?"

Dr. Grumpy: "You've got the wrong script."

Pharmacy guy: "Well, it has her name on it."

Dr. Grumpy: "HE! The name is Frank Grumpy!"

Pharmacy: "Wait a sec... Oh, sorry. These are for Fran Grumpay, just sounded alike."


For those of you who didn't see the prescription drug that keeps me under control the last time I put it up...

(click to enlarge)

Tourism 101

Dr. Grumpy: "It's good to see you back. How was your adventure cruise to Antarctica?"

Mrs. South: "It was incredible! Oh my God! Did you know they have Penguins there? Like LOTS of them? It's unbelievable! More than they have at Seaworld!"

Early Monday morning

It was a quiet, relaxing weekend at the Grumpy house. A family gathering. Wii and boardgames with kids. Hot tub. Only one hospital call.

Somehow this always leads me to hope that the office week will start right.

Keep dreaming.

Grabbing my morning pills out of the medicine cabinet and heading for my car, I accidentally chewed through a fish oil capsule, slathering my freshly brushed teeth with the enticing taste of raw cod liver.

I slugged down a Diet Coke on the drive in, which improved things somewhat. I figured making tea would help further.

I keep a bottle of lemon juice at the office, and add a few drops to my water when I make tea.

After I pulled my water out of the microwave, I tossed in some sweetener and a tea bag, and took a gulp a few minutes later. And gagged.

I'd forgotten the water and just microwaved a big mug of straight lemon juice.

It sure as hell covered up the fish oil.

I think I'll stick with another Diet Coke for the time being. And hope like hell there's not a finger or something gross in the can.

I'm old

Marie comes running into my office, dancing wildly with her portable radio. She's crazy with excitement.

"Daddy! Daddy! Listen to this awesome dancing song! It's new! I've never heard it before!"

She jabs an earbud into my right ear.

It was "I Ran".

By A Flock of Seagulls.

From 1982.

Nothing makes you feel older than your kids.

Sunday afternoon, 12:48 p.m.

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

Mrs. Manana: "Yeah, I have an appointment tomorrow, and need to come in today, instead."

Dr. Grumpy: "Today is Sunday. My office is closed."

Mrs. Manana: "Yeah, my appointment is tomorrow. But I just found out I have to work. Can I meet you there today?"

Dr. Grumpy: "No." (looks up schedule) "What about Tuesday or Wednesday, instead? Same time."

Mrs. Manana: "Do you see patients those days?"

Dr. Grumpy: "Um, yes."

Mrs. Manana: "Okay. I'll be in Wednesday."

Sunday Editorial

Quite a few readers have written in asking what I think of the Florida doctor who's told patients that voted for Obama to go find another doctor.

I'm sure it's legal. It's his practice. He can do what he wants.

But I don't think it's professional.

Part of being a doctor means treating people equally. Regardless of who they are. White or black, men or women, gay or straight, Republican or Democrat, Coke or Pepsi.

I don't discuss politics with patients. They ask me what I think of the new health care bill, and I give them a generic "We'll see what happens." Divisive discussions aren't good for a doctor-patient relationship.

Some people can be quite outspoken in their beliefs. I've taken care of a variety of ideologies. White supremacists. American neo-nazis. Socialists. Communists. Right, left, and in-between.

Sometimes it's hard to separate personal dislike from clinical judgment. But I do it, and try my best to treat all equally. And I never discuss my opinions with them.

"Dammit, Jim! I'm a Doctor!"

I am a person. With my own political beliefs. But there's no room for them in medicine. My job is to take care of people, and try to make them better, regardless of what I may think of them.

When President Reagan was shot, he famously quipped "I hope you guys are Republicans" to the surgical team as they were getting ready to operate on him, and the surgeon replied "We're all Republicans today."

Dr. Samuel Mudd went to jail for setting John Booth's broken leg after Booth shot President Lincoln.

The same trauma hospital in Dallas that frantically tried to save President Kennedy after he was shot, worked to save the life of his assassin, Lee Oswald, a few days later.

Caring for people equally, regardless of our personal thoughts about them, is what we do.

And if you don't think you can live up to that, then maybe you should find another profession.

Stupid

Mrs. Old has numb feet. She lives in a nursing home. I've never seen her before.

Today her new nursing home doctor was rounding on her. He saw in her chart that she's had numb feet for over 10 years, but has never seen a neurologist for them. She also has Alzheimer's disease, so can't tell him much.

At 10:45 this morning Dr. Newbie called my office to see if I would see her. Because of transportation issues, they couldn't get her here until next Thursday. So he didn't make an appointment for her.

At 1:45 the hospital called me. Dr. Newbie actually admitted her for 10 years of foot numbness and 5 years of Alzheimer's disease, so she could see me before next Thursday.

I refused the consult. I am NOT going to be a party to such an insane waste of money.

What the hell?

Quitting smoking

Dr. Grumpy: "How are you doing with quitting smoking?"

Mr. Inchworm: "Better. I'm down to 1.25 inches."

Dr. Grumpy: "Inches?"

Mr. Inchworm: "Yes. I have 10 cigs a day. And I measure them past the filter, and cut them off at 1.25 inches."

Dr. Grumpy: "That's not the most common way of quitting."

Mr. Inchworm: "Last week it was 1.5 inches, and next week I'll go to 1 inch."

Dr. Grumpy: "Do you think this is going to work?"

Mr. Inchworm: "Of course! I use a ruler and everything."

Statistics R Us

Doing a research survey this morning. It featured this question:

"What percentage of your migraine patients suffer from migraines? Your answers should add up to 100%."