Doctor Grumpy, MD
Doctor Grumpy is a neurologist.
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Physician voices
Compassion. Once upon a time, I had a lot of it. I guess I still do, or I wouldn't be at this desk. I think most medical students start out that way. We want to help the sick, heal the…
Compassion. Once upon a time, I had a lot of it. I guess I still do, or I wouldn’t be at this desk.
I think most medical students start out that way. We want to help the sick, heal the wounded, decrease suffering. All that stuff we once wrote in the “personal statement” section of the universal med school application. And believed.
A friend …
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Medicine can suck the compassion out of you. But I still give it my best shot.
Physician voices
Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5 per visit. He doesn't take insurance. This led to several online threads featuring comments such as "Finally! A doctor…
Recently there was a news story about Dr. Russell Dohner, of Illinois. He charges all patients a flat fee of $5 per visit. He doesn’t take insurance.
This led to several online threads featuring comments such as “Finally! A doctor who cares!”
Apparently, this means that doctors like me, who charge more than practically nothing, are evil and don’t care.
I respect …
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Charging $5 per visit is easy if you’re independently wealthy
Drugs and prescribing
The Israeli-Palestinian conflict is obviously a hot-button issue. And I'm not taking sides, nor am I proposing a solution. But here's where it affects me. There's a Parkinson's Disease medication called Azilect. It has some unique properties, and there's no…
The Israeli-Palestinian conflict is obviously a hot-button issue. And I’m not taking sides, nor am I proposing a solution. But here’s where it affects me.
There’s a Parkinson’s Disease medication called Azilect. It has some unique properties, and there’s no generic, or direct competitors, currently available. It’s manufactured by Teva, a company that does most of their business in generic drugs. It’s the world’s largest generic drug manufacturer, and if you’ve …
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Would you refuse drugs from an Israeli drug company?
Physician voices
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…
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). …
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Why a neurologist turned down an interesting hospital case
Physician voices
Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much. There are no easy answers. We're caught between doing what's best, without putting the patient through too much, and doing what's needed to…
Medicine is never an easy field. People accuse doctors of not doing enough, or doing too much.
There are no easy answers. We’re caught between doing what’s best, without putting the patient through too much, and doing what’s needed to protect ourselves from legal action.
Let’s take Mrs. Summer. She’s a nice 78 year-old lady I saw in the office last week.
Earlier this month she hurt her back. So she saw …
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People accuse doctors of not doing enough, or doing too much
Patient voices
The World Health Organization recently announced that cell phones "may possibly" cause cancer. Now, I'm neither a researcher or statistician, and personally think the jury is still out on this one. I'm not going to take sides. But here is…
The World Health Organization recently announced that cell phones “may possibly” cause cancer.
Now, I’m neither a researcher or statistician, and personally think the jury is still out on this one. I’m not going to take sides.
But here is what I am pissed off about. Notice that the story said “may possibly” cause cancer. But the way we think, it somehow becomes “does cause cancer,” and so we panic, and hold …
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The nightmare of medical research in the lay press
Drugs and prescribing
Pharmaceuticals are amazing stuff. You can bitch and moan about their costs, side effects, or the number of them you're taking, but what they've done to extend life and improve its quality is truly remarkable. And for all the bad…
Pharmaceuticals are amazing stuff. You can bitch and moan about their costs, side effects, or the number of them you’re taking, but what they’ve done to extend life and improve its quality is truly remarkable.
And for all the bad raps they get, I salute the pharmaceutical industry, and those who work anonymously in labs around the world, to bring us these miracles.
But …
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The trend from drugs of value to medications of convenience
Patient voices
I mentioned having a migraine this past weekend, and was somewhat surprised by how many people commented and wrote to me, surprised that a doctor, let alone a neurologist, would actually get migraines. What's up with that? I know this…
I mentioned having a migraine this past weekend, and was somewhat surprised by how many people commented and wrote to me, surprised that a doctor, let alone a neurologist, would actually get migraines.
What’s up with that?
I know this may be hard to believe, but we get health problems too.
I see this odd view surprisingly often. People who somehow expect us to be beyond the health concerns of non-doctors.
We may be …
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Your doctor isn’t superhuman and is allowed to call in sick
Conditions and diseases
B12. Sounds simple, huh? 1 letter, 2 numbers. One of the B vitamins. It's important in a number of body functions, particularly the nervous system and blood cell production. It's in pretty much all meats and vegetables, and multivitamins you…
B12.
Sounds simple, huh?
1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.
To me, it’s also a good example of what’s wrong in health care.
Let’s take Mrs. Olde.
She goes to her internist, and is complaining of feeling weak and tired. So he checks …
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Redundant tests waste health care dollars
Patient voices
I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy. So I hate turning business away. But tonight I refused a hospital consult. Why would I do that? Because. The consult…
I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.
So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?
Because.
The consult was for an 88-year old lady with advanced Alzheimer’s Disease. Her sad life was reduced to lying in bed staring at the ceiling. The patient had been seen by 2 other neurologists during …
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Let Grandma go with dignity, and a family’s inability to do so
Conditions and diseases
"Dave" showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck. His internist had already thought of…
“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.
His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.
Here is where the problem began. Everything about Dave’s exam and story pointed …
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Some MRI places have good quality machines, others are obsolete
Physician voices
You've seen it, somewhere. Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a "Best Docs" issue, usually listing 10 doctors from each specialty who they consider the best of…
You’ve seen it, somewhere.
Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a “Best Docs” issue, usually listing 10 doctors from each specialty who they consider the best of the best.
Dr. Grumpy, for the record, is not biased against this. I’ve been named a “Best Doc” in my field several times.
And I know most of the other neurologists on the …
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Best Doc in a magazine, the inside story
Patient voices
"You can't afford to be sick!" I hate these ads. You've seen them. They're in newspapers and regional magazines across the country. Some smiling mom and her cute kid. It's an ad for some local clinic, always with a tagline…
“You can’t afford to be sick!”
I hate these ads.
You’ve seen them. They’re in newspapers and regional magazines across the country. Some smiling mom and her cute kid. It’s an ad for some local clinic, always with a tagline like “You can’t afford to be sick!” or “You don’t have time to be sick!”
And they list things they treat, like headache, sore throat, ankle sprain, runny nose, and skinned knees. They …
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Being sick is not always abnormal
Patient voices
I'm a doctor. We get all the glory. And credit. And guess what? We only deserve part of it. I started out in medicine in the mid-80's, volunteering at an ER. And the biggest shock to me was learning how…
I’m a doctor. We get all the glory. And credit. And guess what? We only deserve part of it.
I started out in medicine in the mid-80’s, volunteering at an ER. And the biggest shock to me was learning how much of what happens in a hospital is nurse territory. Doctors will see you anywhere from 5 to 30 minutes a day, …
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Listening to nurses is key to being a good doctor
Generally, I find my practice works best when I get paid in dollars. They're convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card. But, in a…
Generally, I find my practice works best when I get paid in dollars. They’re convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.
But, in a remarkable effort to win the “Let’s See How Stupid I Can Sound” award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going …
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Bartering and whether doctors should be paid with chickens
Physician voices
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…
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 …
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Futile care has human and financial costs
Conditions and diseases
Before telling this story, I’m going to have to lay some background for my non-medical readers. The most obscene word in English, in my opinion, has three letters and is an acronym. It’s tPA (it stands for Tissue Plasminogen Activator).…
Before telling this story, I’m going to have to lay some background for my non-medical readers.
The most obscene word in English, in my opinion, has three letters and is an acronym. It’s tPA (it stands for Tissue Plasminogen Activator).
This drug gets a lot of press as a “clotbuster.” It has the potential to break down clots and reverse a stroke. That potential, however, has a dark side. By breaking down …
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The drama of using tPA in stroke within the three-hour window
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