Never mind

I'm walking a forgetful elderly lady up front after an appointment, and notice on the info sheet that today is her birthday.

Dr. Grumpy: "Happy birthday!"

Mrs. Taubeta: "Oh, is it someone's birthday?"

Dr. Grumpy: "It's your birthday."

Mrs. Taubeta: "I have a birthday coming up, too!" (looks at Mary) "Well, have a happy one!"

Mary: "It's your birthday."

Mrs. Taubeta: "Really? My birthday is next week, too! What a coincidence."

Dr. Grumpy (giving up): "Well, I hope you have a happy one."

Mrs. Taubeta: "Thank you. And to you, too. I'm sorry you have to work on your birthday."

Soap Opera

Dr. Grumpy: "Any seizures recently?"

Miss Scorned: "I don't think you've had any?"

Mr. Ictal: "Yeah, about 2 weeks ago. Remember? I was sleeping, and pissed the bed."

Miss Scorned: "I don't remember... YOU BASTARD! YOU'VE BEEN SLEEPING AT DIANA'S AGAIN!!!"

Mr. Ictal: "No! I mean, I must have been on a, uh, business trip or something..."

Miss Scorned: "YOU'RE A FUCKING GARDENER! YOU DON'T GO ON BUSINESS TRIPS!"

Mr. Ictal: "You're right, I..."

Miss Scorned: "I AM SO OUT OF HERE!" (grabs purse, leaves)

Long pause

Mr. Ictal: "So, anyway, I had one seizure, about 2 weeks ago. Hey, can you download a bus schedule? I'm going to need a ride home."

Dining out

This past Friday night Mrs. Grumpy was out with a friend. So, in the tradition of single dads everywhere, I took the kids out for a gourmet meal at Costco.

This is a surprisingly complex task that involves juggling orders for hot dogs, pizza, chicken bakes, ice cream, churros, and drinks in your head, while sending the kids on a seek-and-destroy mission to find an open table and hope they don't kill an old man eating a hot dog and hide his body under a 50 lbs. bag of dog food in the process.

I found myself in line behind a lady who was torturing the poor 16 year-old kid working the counter, and got to hear this:

Ms. Food: "I can't decide between the pizza or a hot dog."

Counter Guy: "Okay, do you want someone to go ahead of you?"

Ms. Food: "No... Which one has more calories?"

Counter Guy: "Um, not sure... I can look it up."

Ms. Food: "Well, I want something low-calorie."

Counter Guy: "Well, the salad has fewer than either of them."

Ms. Food: "Okay... I'll take a hot dog, with a piece of cheese pizza."

Happy New Year!

Wishing all a happy Rosh Hashanah.

Patient quote of the day

"When it's really dark outside, and I've closed all the window shades, and all the lights are out, then things look really dark to me. Especially if I close my eyes."

Today's criminal tip

When trying to use a stolen credit card, don't hand it to the guy you just stole it from.

Thank you, Don!

Behavior

The twins, for whatever reason, are both running for student council this year. Elections are next week.

Last night they had to attend a mandatory "election rules" class. So, while Mrs. Grumpy picked up Frank from jail the bus stop, I took Craig and Marie to the meeting.

(There were some touchy issues. Craig's Hair, his running mate, had threatened to leave the ticket in a dispute over the newest member of his entourage, Craig's Cast, recently receiving more attention. The situation was defused by an agreement that Craig's Cast will be removed in 4 weeks. Craig's hair has now agreed to stay onboard for another 20 years, after which it will have the option of leaving at its own discretion and be replaced by Craig's Cheap Rug.)

Anyway, all kids were required to shake hands with the people they're running against, and then the following points were covered:

1. Keep it positive.

2. No negative statements. Give people a reason to vote for you, NOT a reason to vote against your opponent.

3. Don't make promises you know you can't keep.

4. Stick to the real issues (I have no idea what "real issues" there are in student council).

5. Be honest.

6. No screaming, blaming, or finger-pointing.

7. Be a good sport.

8. All campaign posters must be removed by the end of the day after the election.


I know I've touched on this before. And listening to the talk, I wonder: Why can't we do this on a national level? What the hell kind of world is it where grown-ups behave worse than kids? Aren't we supposed to be the ones setting a good example?

I still like my idea of a reality show called "Modern Sandbox:" Politicians who espouse screaming and yelling at the opposition will be dropped into a desert with an equal number of equally stubborn people from the other side, under circumstances where their mutual survival depends on finding ways to work together and be polite. Advertising revenue and T-shirt sales will go toward the national debt.

Serious WTF*ckery

Words fail me.

Dedication

Dr. Grumpy: "How you doing? You look tired."

Mrs. Colostrum: "It was a long night."

Dr. Grumpy: "Aren't you supposed to have your baby soon?"

Mrs. Colostrum: "Yeah, I delivered her this morning."

Dr. Grumpy: "THIS MORNING?"

Mrs. Colostrum: "Yeah, at Local Hospital next door."

Dr. Grumpy: "And they discharged you already?!!!"

Mrs. Colostrum: "Oh, no." (opens jacket, shows hospital gown underneath) "I just hate to miss scheduled appointments, so I walked over to your office. They think I'm at the gift shop."

Today's contest

Okay, folks, since Dr. Killpatient gave me the idea...

A catalog pushing Halloween-themed nursing scrubs was lying around the hospital yesterday, with this picture on the cover:

So let's see what captions you guys can come up with. I'll toss out a few:


"Dr. Grumpy is sending a patient to the ER!"

"Dr. No Bullshit is on vacation again!"

"Shipping charges on Halloween scrubs are how much?!!!"

Mary's desk

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

Mr. Bling: "Yeah, this is Mr. Bling, and I need to make an appointment to see Dr. Grumpy."

Mary: "Mr. Bling, you sent us a letter 2 weeks ago saying you were firing Dr. Grumpy, and wrote a number of unkind things about him."

Mr. Bling: "Yeah, I know. But I decided it's too much of a pain to find another neurologist."

Mary: "I'm sorry, sir, but our policy is that once a patient has dismissed us, we won't take them back. It's just not good for the doctor-patient relationship after that."

Mr. Bling: "That's bullshit! I need a neurologist, and you're refusing to see me! I don't have time to find another one."

Mary: "Sir, you should have thought of that before you fired Dr. Grumpy."

Mr. Bling: "See, it's reasons like this that I fired you guys in the first place."

Hangs up.

Saturday at the park

Dr. Grumpy: "What's going on? Why are you fighting?"

Craig: "FRANK ATE ALL THE BROWNIES!!!

Marie: "YEAH! I PACKED 3 BROWNIES FOR US TO HAVE AS SNACKS AND HE ATE ALL OF THEM!"

Dr. Grumpy: "Frank, did you eat all the brownies?"

Frank (with chocolate all over his face) "Mmmph. Yeah, but I had to."

Dr. Grumpy: "Why?"

Frank: "Because! Look at this wrapper! They all expired last month, so it wasn't safe for them to eat! I did it to make sure they'd be okay."

Nudge nudge, wink wink, say no more

Dr. Grumpy: "Anything that makes the symptoms worse?"

Miss Carpal. "Um... I'd say the hand falls asleep whenever I'm holding long, slender, objects."

Rebuttal

In late July I re-ran my "Dr. Worthless" post, about the (alleged) migraine specialist who didn't do shit for one of my patients.

On August 28, nearly a month after I put it up, the following comment was posted:

"Dr Worthless: Pretty much every neurologist in my metropolitan area. I am sick and tired of managing issues that fall into the realm of neurology because of the laziness of your specialty. I really miss the days when a neurologist could actually make a diagnosis without an MRI."

Here is my rebuttal:

Dear Dr. Whoever You Are:

Thank you for kindly painting all neurologists with the same brush.

I'm sorry some in your area aren't up to your personal standards in work ethics. By a similar definition I know some "lazy" internists who seem to feel that I should be treating bladder infections, sinus problems, or foot ulcers simply on the grounds that the patients also have a neurological disorder, and therefore tell them to call me for their general medicine needs. So I suppose I could say I'm sick and tired of managing issues that fall into the realm of general medicine because of the laziness of your specialty.

But I won't do that. To make generalizations based on 1 or 2 people is what leads to idiotic stereotypes. I'm sorry you feel that way based on the few neurologists you've encountered. So stop referring to them and find others.

Please try to keep in mind that medicine is a team sport. When you view other doctors (or nurses, or whatever) as the opposition, the only person who really loses is the patient.

Diagnosing people without an MRI is fairly easy. I (and many other hard-working neurologists) do it every day. Bear in mind that many neurological conditions (migraines, Parkinson's disease, epilepsy, Bell's palsy, and Alzheimer's disease, to name a few) are clinical diagnoses. This means they're based on what the doctor thinks after taking a history and doing an exam. The purpose of MRI's (which, I admit, are often overused) is usually to exclude other causes, rather than confirm the diagnosis.

MRI's, like all forms of technology, are like genies. You can't put them back in the bottle. If you don't like it, perhaps you should consider going back to the days when an internist could actually make a diagnosis without a CBC. Or CMP. Or stethoscope (after all, in 1840 the flexible binaural stethoscope was cutting edge). MRI's may be overused, but I find them to be more effective at excluding/confirming serious neurological disorders than sacrificing chickens over the patient and dancing naked under the moon.

I'm going to guess that you've never been sued (I have). Nowadays you can get legally reamed out for NOT ordering tests, regardless of any guidelines that say it's fine not to do them. You can tell me that I'm practicing defensive medicine, and guess what? I don't care. If doing everything I can to protect my family and my livelihood is being lazy, than so be it.

Ordering a test often has more to do with CYA than diagnostics in ANY branch of medicine. If you have some magic power that exempts you from legal action and allows you to make 100% accurate diagnoses without using that newfangled stuff, than you have my respect for being a better physician than little old me.

Yours truly,

Ibee Grumpy, M.D.