Saturday, March 6, 2010

Saturday morning, 8:27 a.m.

"Hey, someone told me to call and make an appointment? My friend Sandy said I should see Dr. Grumpy for the problem I'm having. Also, when you call back, could you please let me know what kind of doctor you are? Because if you're a psychiatrist I'm gonna beat the crap out of Sandy."

An opposing viewpoint

"Flaming Lisa" gave a dissenting opinion on my post about death, "Checking out". While I disagree with her, I do believe in fairness. I'm therefore putting up her entire comment verbatim, as an opposing viewpoint.



Hmmmm. It's too bad that the original post had to be all balled up with Killer Kevorkian and Terri Schiavo (2 very different cases).

As a Catholic, food and water are considered ordinary (required) care even if medically assisted--so Terri Schiavo would be alive and her murder would never have happened and perhaps her parents would have been able to care for her as they wished. Wow! How awful is that????

Kevorkian is a murderer and has served jail time for such a crime.

This woman in the original post, however, was trying to die but was subject to her husband's wishes. As much as you "healthcare workers" keep harping that this happens all the time, I have a hard time believing it. I don't see hospitals crammed with people being given every possible test under the sun in these circumstances. It is an exaggeration on your part.

MDKauffman: is it really so hard to administer antibiotics to a woman with a UTI? Where's your compassion you idiot? UTI's don't have to be a dying persons disease--you just don't like old people. Get a new profession.

You've all lost your heart! How cold and hard have you gotten???? I am convinced now that NO ONE should be making these decisions (and especially not you people) for a family except the family. Thank you for clearing that up for me and making me thoroughly distrust the medical establishment.


--Flaming Lisa

Friday, March 5, 2010

Mary, bring me a sword

Dr. Grumpy: "So did the Painbegone help your migraine?"

Mr. Unsure: "I don't know."

Dr. Grumpy: "Did it make the headache better?"

Mr. Unsure: "Ummm... Maybe?"

Dr. Grumpy: "That doesn't sound very convincing."

Mr. Unsure: "I don't remember."

Dr. Grumpy: "Didn't you just take it yesterday?"

Mr. Unsure: "I think so, umm, yeah."

Dr. Grumpy: "So, after taking Painbegone, did the headache get better? Yes or no?"

Mr. Unsure: "A little of both."

Dr. Grumpy: "What does that mean?"

Mr. Unsure: "It got better eventually."

Dr. Grumpy: "Define eventually."

Mr. Unsure: "At some point I didn't have a headache."

Dr. Grumpy: "How long is 'at some point'?"

Mr. Unsure: "One hour, maybe several more. I didn't pay attention."

Dr. Grumpy: "Was it faster than it normally takes your headaches to get better when you don't take medication?"

Mr. Unsure: "What medication are you talking about? The white pill? Or the tan one?"

Dear Dr. Staff,

Thank you for referring Miss Carpaltunnel for "an abnormal MRI" (at least that's what it said on your referral form). Unfortunately, your office didn't send a copy of the MRI report in advance.

Earlier today I called your staff, asking that you fax over her MRI results before the appointment. Your secretary said she'd do it immediately.

One hour later, we faxed over a release, and Mary called again. Your helpful staff said we'd have it soon.

90 minutes later I called again, and someone said she'd "get right on it."

So I was glad when a fax from your office finally showed up.

Unfortunately, it wasn't her MRI report.

It was her chlamydia test. And it was positive. But I didn't have that kind of interaction with her, I swear.




So, if you guys can find the brain MRI report, please send it over.

Thank you.

Thursday, March 4, 2010

I am humbled

I'm absolutely overwhelmed with your positive responses to my previous post, "Checkout time". Thank you. It's my most commented-on post, ever.

I didn't expect so many would see it from my side.

I'm just one doctor. I can't change the world.

But maybe sending a link to the post to others who DON'T see this side of dying will help more people understand. So if any of you want to, go ahead.

Death touches all of us. Thinking about it in advance won't stop that. But it can help us deal with it better when the time comes.

I was so surprised by your responses that I didn't put up any of my usual stories from the medical trenches. We will return to our regular program format of sarcasm and medical practice idiocy tomorrow.

Checkout time

I'm sure I'll get flamed by somebody over this post, but I've been stewing over this for a few weeks, and just want to say it.

I haven't ever saved a life. No doctor has. We may prolong the inevitable, but we don't save anyone.

We aren't immortal, and weren't meant to be. We die. All things do. Plants, animals, even stars.

Death is as much a part of life as birth.

And yet, at times people chase medical science as if we have immortality in all our gadgets and pills.

Why am I writing this?

A few weeks ago I had a hospital consult on a horrible, awful, sad case. Lady in her 60's with advanced cancer. It had spread through every organ of her body. Brain, lungs, bones, liver, intestines. You name it.

She'd had surgery. And radiation. And chemotherapy. Established treatments. Experimental treatments. Alternative treatments. Her husband had taken her to every major cancer center in the U.S. (using YOUR insurance premiums, of course). And every single one told them there was no hope. So he fired them and moved to the next center.

She landed at my hospital, somehow. Sick as shit. Ended up a ventilator. Tubes in every orifice. Comatose from every body system failing. Suffered a bleed into the brain. Seizures. You name it.

We health care people have seen this stuff a million times before. But my readers who aren't in the field may not have. And trust me, this situation happens A LOT. More than you'd ever believe. The media leaps onto cases like Terri Schiavo as if they were rarities, but in reality cases like this are frighteningly frequent, every day, in every hospital in the country. Really.

And of course, her husband is beyond denial. He's not a bad person, just hears only what he wants to. He has the room covered in family pictures and religious symbols. He tells me his family is hoping for a miracle, and knows it will come.

So who is he REALLY doing this for? Not for her. To the sad shell of what was once a beautiful, vibrant woman what he's doing is more likely some form of torture. She's gone, sir. Elvis has left the building. But he won't hear that, no matter how many doctors, in innumerable ways, and many times, tell him.

Ask yourself: How do you want your life to close down?

How many of you said you want to die incapacitated in a hospital bed, with plastic tubes in your urethra and butt, and down your throat? And another one in your nose? And maybe a 5th one in your abdomen, going directly into your stomach? With IV lines going into veins in both arms, the few veins that haven't already collapsed from repeated IV lines in them. And the tube in your throat keeps forcing air in and out. Does that sound like a comfortable way to end your days?

I'm not, by any means, arguing against critical care. Some people end up like the above, with a realistic plan of recovery. And many do. I'm talking about people where this is done with absolutely no goal other than to drag life out for as many seconds as possible.

And so back to my lady. Me and 4 other docs (neurology, cardiology, pulmonary, renal, and oncology) had a 1 hour meeting with husband and his grown kids. We told them this was futile. That what we were doing to her was prolonging her suffering. They all listened. They accused us of being "too negative". The next day they transferred her to another hospital. So I have no idea what happened after that.

Beyond human suffering and reason, let's look at this in the cold hard facts of money. Yeah, I'm sure you Sarah Palin fans will accuse me of putting a price on human life. But hell, your insurance company already does, whether you want to believe that or not.

This woman's care has cost at least a million dollars here, likely a hell of a lot more. I'm pretty sure this family's premiums don't cover that, and I know they aren't wealthy. So the money is coming from their insurance company, which is YOUR premiums.

So let's say futile care for this woman cost $1.5 million dollars. Would that money be better on helping treat people who had a more reasonable chance at recovery and significant quality of life? Maybe several?

Yeah, this is a slippery slope, and there's no easy answer as to where you draw the line. The military deals with this in battlefield or disaster area conditions, where you put your resources to those who are salvageable, and letting those who aren't die. But you can't say that in the polite world of modern medicine.

But for all the controversy over the phrase "death panels", ask yourself this- are they so unreasonable? In a case like this, should, say, a panel of 3-5 certified doctors in oncology, with no ties to the patient or the insurance, objectively review the the data and say "Stop this madness"? Or maybe determine further treatment would be beneficial?.

If they decide it's futile, I'm not saying that treatment should stop, but at that point the insurance company can end it's involvement and the entire financial burden falls on the family. I suspect that when they realize realistically how much futility costs to torture a loved one, they'll let her go.

Money, unfortunately, is a finite resource. You have to pay hospital staff, and drug costs, and facility electric bills, and supply bills. In a perfect world I could support my family and care for patients for free. But I have a mortgage and kids and bills, too. As do the nurses and other hospital staff.

Balanced against this finite resource is human suffering. Which is infinite. And you can't keep paying unlimited need with limited resources. In any situation.

Wednesday, March 3, 2010

Annie's Desk, March 3, 2010

Annie often gets sales pitches. When that happens, she has carte blanche from me to do or say whatever she wants. And she does.


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

Donny Dingo: "Hi! This is Donny Dingo! From FubarMED medical software! Can I speak to your office manager?"

Annie: "You got her. How can I help you?"

Donny Dingo: "No, I'd like to help YOU! With our all-purpose electronic medical records system!"

Annie: "No thanks, but can you help me with your screwed up online prescription service? It's a piece of crap."

Donny Dingo: "Yes, I can direct you to someone who knows about that sort of thing. But first, let me send you a link to try our electronic medical record keeping system FOR FREE! ABSOLUTELY FREE!"

Annie: "We don't need one. Dr. Grumpy wrote his own. But we do use your online e-prescribing service, and I'd like to discuss problems with it because..."

Donny Dingo: "That's great! I'm looking forward to working with you guys! What is your office phone number and fax and email, and I'll send you the link!"

Annie: " You already have our phone number, because you called me. You have no clue about the e-prescribing issues, do you?"

Donny Dingo: "I'll get you this info right away! Thank you! Have a nice day!"

Annie: "Can you at least give me a number for the e-prescribing complaint department? Hello?"

(click)

Okay

Mr. Talk: "My speech was fine when this happened, in all the languages I know."

Dr. Grumpy: "How many languages do you speak?"

Mr. Talk: "Just one."

So there!

I'd like to thank the anonymous reader who sent this to me.


Tuesday, March 2, 2010

I'll get you, my pretties! HAHAHAHAHAHAHA!!!

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

Ms. West: "Yes, I need to make an appointment."

Mary: "Okay, we can see you tomorrow afternoon... What's your insurance?"

Ms. West: "I have Medicare."

Mary: "I'm sorry, we aren't currently taking any new Medicare patients."

Ms. West: "What? Why not?"

Mary: "The new Medicare cuts went into effect this week and..."

Ms. West: "My internist cut me because of this, too. This is ridiculous. I can't find anyone who takes Medicare!

Mary: "I'm sorry, but..."

Ms. West: "I'm putting a hex on your office."

Mary: "Excuse me?"

Ms. West: "I'm serious. I'm a modern witch, and am putting a hex on your office and..."

Mary: "Good bye." (hangs up)


No, I'm not making this up. This was a first for my practice. And that says a lot.

Tuesday morning whatever

Ms. Ictal: "So I had a seizure 2 weeks ago, and you did the episiotomy last week. What were the results?"

Dr. Grumpy: "You mean the EEG?"

Ms. Ictal: "Whatever, the test that started with an "E". What did it show?"

Monday, March 1, 2010

Monday night, 7:05 p.m.

"Hi, this is Mrs. Ramble calling. I need to make an appointment with Dr. Grumpy, who I think I saw once. It's not for the problem he saw me for then, it's for a new problem, but it's been going on for a while, so it's sort of old. Maybe it is the same problem, I'm not sure. But whatever it is, I think I need to see Dr. Grumpy for it, unless it's the problem I had before, in which case he needs to have a new look at it. So can someone please call me back tomorrow?"

Beating my head on the desk

Dr. Grumpy: "How's the tremor doing with the new medication?"

Mr. Shake: "Pretty good. I mean, some days the tremor is still bad, but on most it's okay."

Dr. Grumpy: "Any connection you've noticed on the days when it's worse? Are you more tired those days? Or drink more coffee? Or..."

Mr. Shake: "Mmm... I guess it's worse on the days when I forget to take the pills."

Yes, I'm juvenile

This invitation to a CME (Continuing Medical Education) course showed up in the weekend mail (I have no idea why there is a gray box instead of a picture. I didn't do that).

(click to enlarge)




For other great MD names, please see this post, and the comments that followed.
 
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