Doctor Grumpy in the House

English is an odd language. Being a native speaker, it seems pretty easy to me. But I'm generally lousy at other languages. I took 2 years of Spanish in high school and 4 in college, and I still can't speak it worth crap.

As you guys know, I moonlight doing medical market research interviews. Some are over the internet, some are in person, and some are by phone.

Some of the phone meetings have been outsourced overseas, so occasionally I find myself chatting with someone who speaks English, but with a non-American accent. Occasionally it's someone to whom English is a second language, though usually they're still quite good at it. And that's the situation I found myself in yesterday morning.

The study was on my interactions with drug reps, given by a lady with a mild, nonspecific, accent, but her English was still quite good and understandable. Unfortunately, it was also very old-style, and oddly formal, with phrases and words that aren't used much among modern English speakers. Understandable words, just a little odd.

Most of them were minor, but one was an issue. She used the old word for personal interaction.

Which is "intercourse".

Yes, I know it can mean ANY kind of personal interaction, and the technical phrase for sex is "sexual intercourse". But it's been shortened over time, to where now intercourse just means you're doing the wild thing.

And I'm a veteran of crazy patients, and having to keep a straight face. And I freaking lost it here, (thank heavens for the phone mute button) and at one point had to run to the john to keep from peeing myself (I told her I was going for a Diet Coke).

Here are some of the questions:



"How many times a day do you have intercourse with drug reps?"

My inner voice: It's variable, depending on the time left after I have intercourse with patients.



"If a drug rep provides lunch for your office, are you more likely to have intercourse with them?"

My inner voice: My standards aren't that high. If she's hot, I don't care if she brings prime rib or Taco Bell.



"Do any of your staff members also have intercourse with drug reps?"

My inner voice: Oh yeah, we have a non-stop orgy here. Nowadays I just wear a silk robe to work.



"During intercourse, did the rep provide you with insurance formulary information?"

My inner voice: If she did, I was too preoccupied to notice.



"Following intercourse, did the rep provide you with medication samples?"

My inner voice: No, but we shared a cigarette.



Wait until Mary and Annie find out I had intercourse with a marketing person yesterday. Of course, then I'll be having intercourse with them, too.

Marie: "See? Here's a picture. I told you it looked like this."

Craig: "Well figgle my newtons!"

Marie: "What does that mean?"

Craig: "I don't know."

Whatever happened to the good old "What's your sign?" or "Do you come here often?"

Apparently this guy needed to try his own method.

Mrs. Tech: "The headache is over the entire right side of my head, I get horrible nausea, and I can't stand light or noise."

Dr. Grumpy: "That's a migraine."

Mrs. Tech: "No, it's absolutely NOT a migraine! You should know better!"

Dr. Grumpy: "Why are you so sure it's not a migraine?"

Mrs. Tech: "The iPhone app says so."

Dr. Grumpy: "Anything else I can do for you?"

Mr. Bozo: "Yes, I need you to write a letter to the state, to get my 13 year old son a driver's license."

Dr. Grumpy: "The state driving age is 16, and your son isn't my patient."

Mr. Bozo: "I know, but you're treating my back pain, and when it really hurts I'm not comfortable driving. My son is the only one who's available."

Dr. Grumpy: "But he's not old enough to drive."

Mr. Bozo: "He drives those motor cart things all the time at the fun park. He does fine. Can't you just send the state a letter to get him a license?"

Dr. Grumpy: "I can't do that."

Mr. Bozo: "Why can't you be reasonable?"

I found this in a hospital chart today.

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Dr. Grumpy has lost his neurology mojo over time.

Actually, I shouldn't say I've lost it, as much as it's been worn down by red tape.

Yesterday I turned away a good hospital case, and told them to find someone else.

The patient was insured. The patient was interesting. Not some run of the mill chronic back pain case.

28 year old guy admitted for abdominal pain and weight loss. Large mass found (possibly lymphoma). Within 2 days of admission he developed 2 separate cranial nerve palsies, on opposite sides.

Now, I know you residents and medical students are out there, holding up your hands and yelling "Oooh! Oooh! Mr. Kotter! He could have meningeal lymphomatosis with cranial nerve palsies! He needs an MRI and spinal tap."

Hell, you think I didn't know that? Like I said, these are the interesting cases that make the job fun.

So why did I tell them to find another neurologist?

Here's why:

The patient had seen another neurologist (who didn't come to my hospital) about a week before. He'd had an MRI done as an outpatient. He'd had a spinal tap done as an outpatient.

And yet, no one, including the patient and his family, had ANY FREAKIN' IDEA about which neurologist he saw (beyond "his office was on the west side"), or where the MRI was done, or where the spinal fluid had been sent for tests.

I don't care that someone else had already done the key parts of the work-up. I'm not looking to stand up as the great Grumpy, solver of the unsolvable. Any competent neurologist would know what to do.

And getting results is reasonably easy IF you know where to fax a release.

But in order to get the answer here I'd have had to try to track down a neurologist, an MRI facility, and a laboratory. And there are no shortage of any in Grumpyville.

And from personal experience (particularly involving tracking down labs) I knew it could easily take an hour or more of phone time to do this. I've found that when you want something specific, delegating it to an order in a chart ("please get outside labs from Planet Phlebotomy") will often get you nowhere, or some results you didn't want. So I'd likely be doing the calling, and getting transferred between departments, and then cut off, and having to call back... you get the idea.

When you have a full-time office practice, and a family of 5, adding an extra hour or two to the day isn't something you want to do. Especially when you're going to get paid the same amount for the consult no matter how much work you put into trying to track the results down.

And so I quietly told them to call another neurologist.

I still like what I do. But the realities of time, money, and frustration can dull the scientific curiosity of anyone. Even me.

No matter how easy surgery looks on your favorite TV show, it should only be done by trained professionals.

Also, it is not recommended that you try to staunch blood loss with a lit cigarette.

Like this guy.

Thank you, Lee!

Dr. Grumpy: "Do have your MRI report here?"

Mr. Lumbar: "No, but it said I have disks in my back."

Dr. Grumpy: "Everyone does. Did it say anything more specific?"

Mr. Lumbar: "Um, it mentioned bones, too."

Wild times with hallucinogens.

"I know the waiters there spit in my food, because they don't like people who just eat salads. I told the waiter that I had special powder I'd sprinkle in my salad to show traces of saliva, so he better not try it. But now I'm afraid to go anywhere else, because the food servers throughout the country are conspiring against me. They've hired a chemist to find ways to make it so that their spit doesn't show up with my special powder, and my powder doesn't work now. I know they're still secretly spitting in all my food, so I need to hire someone to make me a new powder that will detect their invisible saliva. Does Dr. Grumpy do this sort of thing? Please call me back in the morning."

The brain that would not die...

In 2005 I took care of a patient with Jakob-Creutzfeld disease (or Creutzfeld-Jakob, depending on where you trained). This an uncommon, rapidly progressive, neurological disease.

My patient's family got in touch with a research program at the NIH, where they were collecting brains from these patients for further studies. So after he died later that year, his brain was sent off to their research center.

To this day, once a year, around the time he died, I get a letter from the NIH, asking how the patient is doing.

I used to write back pointing out that THEY had his brain, and to ask him. Now I just toss them.

One of my friends was recently on a trip to China, and sent back a few pics.

This one shows the location of a party school. I suspect there's a big difference between the American and Chinese definitions of "party school".

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In his hotel room, among the usual amenities, was a box of condoms. Obviously, these people take their birth control seriously.

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This last one, which I'm not going to comment on (that's your job) he says was taken in a generic shopping mall, in a store that featured local crafts.

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It was pointed out to me that the entry for IRNA, the Iranian government's news agency, lists their website as having started in 1981.



This is very impressive. In 1981 I was in high school. My computer at the time was a TRS-80 (top-of-the-line model, with 16K of RAM!) and in spite of all that technical saavy I'd never heard of webpages. I didn't learn about such things until the mid-90's, during my residency.