Friday, September 30, 2011

Consult This!

Me:  "So I'm being consulted for pre-op clearance on my own patient by the surgeon who I consulted to perform surgery?"

Ward clerk:  "Yes.  He also said to make you hurry up and do it."

Me:  "Has he even seen the patient?"

Ward clerk:  "No."

Me:  "Tell him I'm consulting him to get off his ass and read the chart before he ever consults me again."


Thursday, September 29, 2011

Legend of the Seeker, part 2.

Patient:  "Normally, I wouldn't tell you how to do your job, but there's only one thing I like that works for my depression."

Intern:  "What's that, sir?"

Patient:  "Dilaudid." (very strong painkiller for non-medical people).

Intern:  "Sir, that can actually cause depression."

Patient:  "Like I said, not trying to tell you how to do your job, but it works well for me.  Might be my chemistry is different."


Wednesday, September 28, 2011

The price is wrong...

Patients are kind of like children, they rely on us to keep them out of danger.  The problem is, they often have their own ideas about what is dangerous and, unlike a child, you can't just drag them by the ear and tell them "No."

A patient was recently admitted to our hospital for difficulty walking, our initial workup showed that he had a massive stroke.  We began our initial protocol:  scan the neck for blockage in the arteries, get physical therapy involved, that sort of thing.  In the midst of all of this, the patient suddenly demanded to be transferred from our facility to a specialty hospital....a specialty hospital that focused exclusively on heart-related issues (and yes, I know there are certain strokes that are caused by heart problems...this isn't one of them).  We tried to explain to the man multiple times that the facility was not equipped to handle his problems as they did not have a neurologist on staff there.  Additionally, the hospital would be under no obligation to accept him in transfer as they did not have a specialty that we did not already have.  He was adamant, however, ultimately stating "No price is too great when it comes to my life!"  (he kinda slurred this...stroke patient, remember?)

To my amazement, the hospitalist at the other facility accepted the patient.  The head of my group would have killed me if I pulled that.


Tuesday, September 27, 2011

Working for the weekend...

There is a misconception that doctors are rich and that we just sit back and have buckets of money thrown at us while we do absolutely nothing, as evidenced by the conversation my partner had with a patient the other day.  Side note:  I'm not sure I should be using the word "partner" after yesterday's post.

Patient (while being examined):  "Must be nice to be a rich doctor."

My partner:  "I'm not rich.  My student loan payments are more than my mortgage every month.  I also work more than 80 hours a week.  How much do you work?"

Patient: "..."

My partner:  "That's what I thought."


Monday, September 26, 2011

Freudian outing...

So that I won't come across holier-than-thou, I thought I should point out that I also say stupid crap.  Here is a conversation I had with a friend the other day:

Friend:  "How's that cappuccino? (I know, I'm so white)"

Me:  "Not bad, but it could use some more semen."

Friend: "What?"

Me:  "Cinnamon....I meant cinnammon."

Friend:  "Sure you did, stud."

Me:  "Damnit....helluva way to out myself."

Friend:  "Does your wife know?"


Sunday, September 25, 2011

Sunday, Sunday, $und@y...

Since I've biked roughly 100 miles this week, I figured this is a good Sunday post.  I have a feeling this guy will show up in an ER near me soon.

Saturday, September 24, 2011

Toxic cleanse...

Doctor: "ok, you'll have to be on meds daily to control your bipolar disorder."

Patient: "No, I don't want to put any poisons in my body."

Doctor: "Sir, you use cocaine..."


Friday, September 23, 2011

Big Macs vs Cancer sticks

People are often oblivious to their own addictions and don't like having them pointed out, often dismissing any harm they're doing as nonsense.  Sometimes, the damage is more subtle and has very little to do with health risks, as in the following:

Patient:  "I just don't know what I'm going to do.  I can't afford to feed my kids or pay for repairs on our house."

Me:  "Ma'am, how many packs of cigarettes are you smoking a day?"

Patient:  "Three...what does that have to do with this?"


Thursday, September 22, 2011

No brainer...

Overheard while I was leaving the optometrist (picking up wife's prescription):

Elderly woman, entering building:  "Oh my goodness, they have glasses here!"


Wednesday, September 21, 2011

Lazy day + Facebook = today's lesson

I'm busy trying to figure out how to use the new Facebook today so I'll just upload you some pics from my phone.

I have to give friends advice over Facebook all the time, I find you get less requests when you give advice like this:

A similar tactic works when dealing with my wife, also:

In summary, make yourself an imbecile and you get less work requested of you.

The last pic is of me getting an ace in disc golf yesterday, it's just there because I want it to be.

The Gears of War hat augments my uselessness.

Tuesday, September 20, 2011

Pronounce it...

Family:  "You want him better chair?"

Me: "What?"

Family:  "Better chair?"

Me:  "Sir, I don't think we have a better chair."

Family (enunciating):  "Do you want him in the bed or chair?"


Monday, September 19, 2011

Not a problem...

Me:  "What happened when I sent you to the gynecological oncologist?"

Patient:  "They said the cancer wasn't a problem?"

Me:  "Why would they say that?"

Patient:  "I guess if you're dead it's not a problem anymore."


Saturday, September 17, 2011

Write it down...

People who are intubated are often at least somewhat awake.  They try to communicate with us by mouthing words, but it is almost impossible to read lips with nothing in the way, much less with a tube extruding from their mouth.  One afternoon I was talking to an intubated patient who was becoming very frustrated with trying to communicate with me.  One of our specialists had just left and must have been in a hurry because the patient was visibly upset at something.  I found a pen and pad for them to write with and put it in their hands.  They scribbled furiously for about 30 seconds, writing what I thought was a question or a request for something before turning the paper over to show me what they had jotted down.  In all caps, written over the entire page was a single question:   "THAT OTHER DOCTOR WAS AN A**HOLE!  ARE YOU ONE, TOO?"


Friday, September 16, 2011

Two nurses, one bedpan...

Nurse:  "I need an enema."

Me:  "I've seen enough of the internet to know how this goes."

Nurse:  "That didn't come out right."

Me:  "Want me to buy you a drink first?"


Thursday, September 15, 2011

For a very important date...

Family member, to nurse at desk:  "That doctor said he would be here at 11 a.m.!"

Nurse:  "Ma'am, it's 11:01 and he's standing behind you."

Family member, turning to me:  "You're late!"


Wednesday, September 14, 2011

Pretty Zebra...

One of the terms you may hear doctors say sometime is "chasing zebras."  This term refers to the tendency of some of us to look for the weirdest diagnosis that could explain the symptoms the patient is having rather than look at the obvious (in other words, it's much more likely to be a horse rather than a zebra).  Patient families do this quite often, especially when we give them a reason for something they don't want to hear.

Family:  "We think the reason she's like this (severely demented, all extremities contracted) is because of undiagnosed Lyme disease.  She had a tick bite 15 years ago that looked funny."

Me:  "I think it probably has much more to do with the fact that she's 98 years old."

Family:  "No, I don't think so."


Tuesday, September 13, 2011

Dude looks like a lady...

Part of our duties in the hospital involve doing medical history and physicals on the patients admitted to our inpatient geriatric behavioral unit.  One afternoon, I was doing a fairly simple H&P on a gentleman who was admitted for inappropriate sexual behavior (toward women).  As I neared the end of my exam he leaned back and glanced me over before saying, "You're almost as pretty as a woman."  I ended the exam and left the room rather quickly.


Monday, September 12, 2011

Out of work...

I recently had a patient complain about the cost of her medications (this is common).  We had switched her to generics of everything we could, but one of her meds was name-brand only and there was nothing to substitute it with.  Her reasons for wanting the cheaper meds were obvious, but she continued to regale me with stories about how she spent all day at home, couldn't find a job, expenses piling up, etc...  I turned it over to one of the secretaries, who helped her fill out an assistance form for the medication.  She listed herself as unemployed, gave her total monthly income, that sort of thing.

Medical Assistant:  "Ok, this part the doctor needs to fill out and we'll be able to fax it to the drug company."

Patient:  "Oh, well I don't have time to wait right now, I'll just pick it up on my way home from work this afternoon."


Sunday, September 11, 2011

Saturday, September 10, 2011

Can I get a real doctor over here?

I work as a hospitalist.  For those of you who don't know what that is, I am the person who takes care of your primary care physician's patients when they are admitted to the hospital.  For certain reasons, not all of the PCPs in the area use our service and they will come in to admit their own patients.  I got called down to the ER one night to admit a patient and as I was talking to her she happened to mention that one of the doctors who did this was her PCP.  I apologized for the mix-up and told her I'd go out and call him so he could admit her.  At this point she became somewhat frightened and grabbed my arm as I turned to leave.

Patient:  "But, I only go to him for small things, I need a real doctor to take care of me in here."


Friday, September 9, 2011

Hang it up...

One thing that really irks me when I'm talking to a patient is cell phone use.  I can count the number of times on one hand that I have had to take a phone call while talking to a patient.  They were true emergencies:  ICU calling about a patient I'd been watching, call from another hospital about a transfer, that sort of thing.  Whenever it has happened I have apologized profusely and walked out of the room to take the phone call.

One afternoon, as I was making my rounds, I walked into the room of man admitted for pancreatitis.   He began his conversation with me about his progress and we were discussing his treatment when his phone rang.  He immediately picked up the phone and started talking on it, like I wasn't even there.  I continued to ask him questions, which he would answer very curtly and with single-word answers.  I finally got sick of it and walked out of the room.  About 30 minutes later, I got a call from nursing about the man.

Nurse: "Mr. Cell Phone forgot to ask you for something, he wanted to know if we could increase his pain meds."

Me:  "Tell him I have to take a phone call and I'll think about it."

I never called back.


Thursday, September 8, 2011

Buttered side up...

Today's names have been changed slightly to impart the same effect while protecting the identity of the really, really stupid.

One of my nurse friends told me a story about a patient she took care of in training.  The guy was evidently a chain-smoker who had decided to crawl up on top of an abandoned oil tank with a buddy to light one up.  When the tanker inevitably blew up it incinerated his friend and lit everything for an acre on fire.  He managed to survive and was brought in by ambulance to the burn unit.  As they wheeled him in they ran through his quick history before reading off his name, at which point the entire trauma unit burst out laughing.  The guy's name was "Toast."


Wednesday, September 7, 2011

Perfectly normal...

Patient:  "Doc, I don't think that Viagra you prescribed is working."

Me: "Why do you think that?"

Patient: " d*** hasn't gotten any bigger at all and I've been using it for a month."

Me:  "Do you think they sell pre-made nooses anywhere?"

Patient: "Huh?"

Me:  "Nothing."

At this point I'm reminded of a tip (pun intended) told to me by a urology attending during my senior year of medical school.  He always made a point of saying the phrase "everything looks perfectly normal" whenever he examined a male.  I kinda wondered why he did that until near the end of the rotation he explained, "Guys have this innate fear that there is something wrong down there, especially size-wise.  Simply saying 'everything is normal' puts them at ease and stops a lot of uncomfortable questions."

With that in mind, the true medical definition of "normal" when you're talking about penis size is everything from 3/4 of an inch to "We're ready for you on the set, Mr. Jeremy."


Tuesday, September 6, 2011

Names are important...

Me:  "Do you take any medications, sir?"

Patient:  "Just one, only one I've been on for 25 years."

Me:  "What do you take it for?"

Patient: "..."

Me:  "OK, what's the name of the medication?"

Patient:  "..."

Me:  "Sir, you've been taking the same med for 25 years and you can't tell me the name of it?"

Patient:  "Well, it used to be white, but now it's a pink color"

Me:  "..."


Monday, September 5, 2011

That's one way to fix it...

CDL licenses (truck drivers, etc...) require fairly stringent certification in order to obtain one.  They're easy to do once you know what the qualifications are, but they have some rules that are sometimes arbitrary.  Diabetics pose an interesting problem with them since you have to simultaneously have controlled blood sugars but can't be on anything injectable (insulin) to get them under control.  I had a trucker come in once for his yearly certification.  This required me to check his average blood sugar, called a hemoglobin A1C.  Normal is 7% or below, his was 14% (WAY out of control).  In order for him to be certified I had to have him at the 7% mark, something that would take about 2-3 years of stringent control to get him to that level.  I looked at his med list and noticed that he had been on long-acting insulin (and somehow still got his license).  I asked him if he'd been taking it and he replied, "No, I quit taking that because I knew I couldn't be on it and drive a big rig."


Sunday, September 4, 2011

Saturday, September 3, 2011

I have the Kuru...

I have managed to contract something from one of the snotty kids I saw while moonlighting this week.  I'm thinking it's either Ebola or rickets, either is equally plausible.  Anyway, I'm now armed with orange juice, Metal Gear Solid 4 and a bottle of antibiotics I wrote for my wife several months ago.  She took one then claimed they didn't work...such faith in her husband.

Today I thought I'd show you a blog I found a few days ago, the guy has been doing this for a few years and it tends to be a bit more free-flowing and less rigid a structure than mine, but he has some great patient sayings on it.  Check it out:

Friday, September 2, 2011


I had a man come in recently for a physical.  He wanted everything done...labs, exam, studies, etc.  After all was said and done I went over the results of the labs we had immediately available.  He had several things I thought needed to be worked on.  I told him he was overweight and needed to lose weight and exercise.  He replied, "I'm not doing that."  His blood pressure was up, I told him that the exercise and weight loss would probably help that or he'd have to go on medicine eventually.  His response, "I'm not going to take medicine or exercise."  His cholesterol was up fairly significantly.  I again told him that the exercise and diet would benefit him here or he would have to take cholesterol medicine.  Again, he replied, "I'm not going to take medicine or exercise or diet."  At this point, I was irritated at the guy for having wasted my time with this so I just asked him, "Sir, why did you come here if you weren't going to listen to anything I have to say?"  He responded, "Because I get a discount on my insurance!"


Thursday, September 1, 2011

Debt paid in full...

Medicine is a business.  It is a sad fact, but a necessary one.  Even if you make healthcare "free," medicine will still be a business.  One with enormous overhead, in fact.  It is rare, but we do fire patients for non-payment when it goes to extreme levels.  A few days ago, I saw a patient in the clinic that I thought needed a cardiology evaluation for the swelling in her feet.  I suggested a local cardiologist, only to be told that no, she can't see that one because she owes their office money and they wouldn't see her.  I suggested another, same story.  Another one, same story.  At this point I was down the last one I knew locally off-hand.  I suggested that one and asked if she owed him money as well.  She replied, "No....the bankruptcy I filed last year took care of the money I owed him."


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