Saturday, April 22, 2017

Last day

Today is the last day to buy a copy of Brain Damage for only 99 cents!

Also, I want to thank everyone who has bought a copy of 11 out of 10 over the last two years.  I just donated another $150 to Deworm the World for last month's revenue, and have been able to give nearly $10,000 from profits.  Please consider donating to this charity, which is one of the few highlighted by Givewell.  There are children in developing countries who can't afford medicine that costs pennies to treat parasitic infections causing illness and blindness.... this is the most bang for your donated buck.

Friday, April 21, 2017

Nurses week

I think the nurses I work with are really awesome.

They have a really hard job.  I think every single one of the nurses I work with does a really great job and is incredibly kind and considerate.

So here's my dilemma....

Nurses week is coming up and I don't know what to do.

In an ideal world, I'd get every nurse I work with a nice present or little gift bag and that would be enough.  However, I work with a LOT of nurses.  There are probably eight or nine regulars, then a few more nurse supervisors, then a bunch of nurses' aides that I also wouldn't want to leave out.  And then there are nurses that don't usually work with me but sometimes do.  All told, this could be thirty people.  And I suspect if I do individual gifts, no matter how hard I try, I'm going to leave somebody out.  And as somebody who has gotten left out in these situations, I know that's the worst possible thing.

Another dilemma is that each nurse only does three shifts per week.  So if I, say, bring in bagels or pizza one day, only half the nurses will get to partake.

In the past, I've bought two big cakes and done it two days in a row on days that as many of our regular nurses are around as possible.  I guess I could do that again.  I don't know... I just want to make sure I'm appreciating the nurses enough.  Because they deserve it.

Wednesday, April 19, 2017

Men at Work

The sign indicating work being done in my town reads "Men at Work."

I know this is a standard sign.  And also it's an Australian band that has one good song (that manages to mention vegemite).  Still, when I'm driving around with two little girls in the car, it bothers me.  Why men at work?  I feel like I'm being told, "There are men doing important things here.  You women should stay away."

Granted, I've never actually seen a woman in one of these work crews.  Still.  I figure if women are going to have to sign up for the draft now, we should be included in the work signs.

Sunday, April 16, 2017

Brain Damage

Happy Easter Sunday!

In honor of the holiday (or else just totally coincidentally), Brain Damage is on sale for only a dollar!

Pick up a copy today!

Thursday, April 13, 2017


I am not a hugger.

I have some friends who will hug me (and sometimes kiss me) every time we meet up.  I have friends that I have literally never hugged.  I don't mind hugging my friends who want this, but my personal preference is that none of us ever touch each other except possibly by accident.

That probably makes me sound like a terrible person.

I love to hug and kiss my kids, and probably am more or at least as affectionate with them as most parents.  I love to hug and kiss my husband.  I like physical affection, but only with certain people.

Lately in my book club, we've all started hugging at the end of the club.  Now I like all these women very much, but I don't know some of them very well.  Some of them I've only met a few times and I just feel weird hugging them!  Is that wrong?

Ditto with patients.  I've had a handful of patient that I bonded with who want to hug me when they're discharged, and while I always oblige, I feel that it's uncomfortable for me and I'm never sure it's appropriate.

Why can't we all just fist bump?

Monday, April 10, 2017


We live in one of the freak towns that doesn't have fluoride in the water.

My kids have both already had cavities, so I want to make sure to follow our pediatrician/dentist recommendation to get them fluoride pills, but it hasn't been so easy.  So we don't have to wait in line at the pharmacy every month, we had been getting our pills from Express Scripts, but we changed insurance, so now we can only use Walgreens online pharmacy.  This has proved to be quite the challenge.

Walgreens would not allow me to add the kids to my pharmacy account until I placed an order with physical pharmacy, so I did this first.

The local pharmacy would not fill the medication because they covered only drops but not pills unless they got "extra info" from our pediatrician.  After a week, this was not received. Our giant peds practice did not know somehow that this info was being requested.  Finally, we just paid $11 each out of pocket for the month's worth of pills.

I was still unable to add the kids online to the pharmacy and had to call to do it.

I then asked the pediatrician to call in the pills to Walgreens online.  They assumed that was the same as Express Scripts and called it in there.  I assure you, they are not the same.

I called the pediatrician's office again and convinced them that Walgreens and Express Scripts were not the same.  I gave them the fax number for Walmart, and they said they had to look it up themselves.  I suggested calling the adult branch of their practice, which I know uses Walmart online.  They said they weren't allowed to do this.

A week later, I got a letter from Walgreens saying that our prescription plan would not cover the 1 mg fluoride pills.  So they would not fill it.

I called my health insurance.  They said the reason they wouldn't cover it was because they only covered 0.5 mg pills but not 1 mg pills.  So I needed to call the pediatrician to ask them to write for 0.5 mg pills and they would cover that.  And the cost would be $25 for a month, and $60 for a 90-day supply from Walgreens online.

I was like, "WTF?  It was $11 to pay out of pocket for the pills!  How could it be more expensive if the insurance is paying for it???"

It took me a while to wrap my head around this one.  The copay for any med is $25, so I have to pay that no matter what, even if the drug is cheaper than that.  Insurance is quite a racket.

Finally, I called Walgreens and asked how much it would be if I paid out of pocket for the 90 day supply.  It would be $13 apparently.  So I said I'd just pay for the fluoride myself.

To date, I still don't have the fluoride.  I don't know what other hurdles I will have to go through to get fluoride.  I can't even imagine the hurdles people who are on like ten meds have to go through.

Thank God it's only fluoride.  If it were a real med, they'd be dead by now.

Me: "Fluoride pills should just be over the counter."

Mr. McFizz; "No!  It's not safe to sell over the counter!  It's only safe to dump in the drinking water."

Thursday, April 6, 2017

Are you a flirt?

It's a fact that if a patient likes your personality, they're going to like you, almost regardless of how smart you are or the sort of care you provide.  And I've noticed that a few of the male doctors I work with actively flirt with their patients.

I'm not saying they're doing it in a bad way.  I don't think they legitimately want to get with 80-year-old Mrs. Rosenberg.  But there's a flirtatious air that they put on with female patients that I think earns them lots of brownie points. Trust me.  

Do I flirt?  I don't know.  I don't think I'm naturally that flirtatious a person, but I've actually been making more of an effort to be flirty and friendly with both male and female patients, if they give me cues that's what they want.  But sometimes I do worry that since it's not as natural to me, I'll do it wrong and end up with some old man falling in love with me.

Monday, April 3, 2017

Fist bump

I used to have a bit of an obsession with fist bumps. When I was in residency, there were these two residents I worked with who were constantly fist bumping each other and I developed fist bump jealousy. I wanted a fist bump.

Ever since, any time I say something that warrants a guy reaching out to fist bump me, I get super excited.  When my boss gave me a fist bump, I almost died of joy.

Last year, we had a young male patient on our unit who has a severe brain injury. He couldn't really speak, but the one thing he really, really loved to do was fist bumps. We parked his wheelchair in the hallway and every time anyone passed him, he wanted to fist bump them. So I got the most fist bumps I ever had in my life.

He was on the unit for two months.  And I never got sick of it.

Thursday, March 30, 2017

Book recommendation

My newest medical lit recommendation is Nerve Damage by Tom Combs:

I really liked this one.  It was a medical thriller that hooked me immediately. The protagonist is an ER doc and it's written by an ER doc, so it's very authentic.  If you read the first chapter, you won't be able to stop reading.  Really enjoyed.

By the way, just wondering if these book recommendations are appreciated?  I was considering trying to do one a month, but I could also not do any at all if nobody is interested in my recommendations.

Monday, March 27, 2017

Worst bowl evah

A little while ago, in an attempt to get my kids to eat healthier, I decided to purchase a fruit bowl.  I figured that if the fruit was right in their faces, there was a tiny chance they might eat it.  They'd be like, "Hey! Oranges!  I'll have one of those!"

I use Amazon for most of my online purchases, so I typed "fruit bowl" into Amazon and I purchased a wooden bowl on the first page of results that looked nice.

A few days later, the bowl arrived.  It was about the size of my hand.  I could probably fit a single orange in it.  Calling it a fruit bowl would be laughable.  Well, unless "fruit" was in the singular.  So I returned it. And I wrote an angry one-star review saying that the bowl was deceptively small.

Now I've written maybe a hundred Amazon reviews in my time.  Some of been good and some have been bad.  The review of this bowl certainly wasn't my first bad review.  But it's the only review I've ever written that's ever received comments.  And in fact, it received THREE comments.  One told me that I was clueless and didn't bother to look at the bowl's dimensions (7 inches) and I should have measured my current bowls, to which I responded that I shouldn't have to get out a ruler to know that tiny bowl wasn't a fruit bowl. (The description of the bowl actually said it was "generously sized.") And then most recently, I got this comment:

"You apparently don't know what "serving" means. Serving is when you bring food to a person, to serve them a meal or food. It is not a fruit bowl. It is a bowl that can be used to serve a side of fruit or salad. You generally don't serve 5 pieces of fruit in a bowl at dinner. You shouldn't need a ruler to know what 7 inches looks like. The product isn't deceptive or misleading, you're just a moron."

Um, WTF?  This is a bowl.  Why are people getting so angry over my review of a ten-dollar bowl.  What is going on here?  Usually when I don't agree with the review of a product, I just downvote it... I don't call the person names.  Especially if it's just a bowl.

My question was: Are these people sellers of the bowl?  Are they trolls?  Or are they people who just really love bowls?

I looked at some of the other bad reviews and the majority of them were complaining that the bowl was smaller than they expected (although only one of them got a comment).  So clearly this was an issue a lot of people had, and my review probably kept people from purchasing the product who would have returned it or given it another bad review.

Anyway, in case you're curious, I bought a normal-sized fruit bowl after that.  But the kids still won't eat their fruit.  (Now it's a "fruit fly" bowl.)

Thursday, March 23, 2017

Why I don't wear scrubs

Some of the nurses at work were talking about a sale on scrubs.  I was listening in, because I only have one pair of scrubs that I wear on call and they're awful.  The top is so big that it could be a dress on me.

Nurse: "Actually, I've never seen you in scrubs, Dr. McFizz.  You never wear them!"

They pointed out that a few of the other doctors do sometimes wear scrubs during 9-5 business hours, but some of us don't.  Here's why I don't:

When I was an intern, I worked at a county hospital, serving a very poor population.  Intern year is hard, and I wanted nothing more than to live my life in scrubs--basically, nonstop pajamas.  But our program director said to us, "You know, these patients may be very poor and not speak English, but they should be treated with respect. And that means they deserve a doctor who is well dressed."

Some of the other interns wore scrubs every day anyway, but I didn't.  On non-call days, I wore "nice" clothes. Those words really stuck with me, even now, over ten years later.  I feel like it's more respectful to dress in nice clothes when I see patients.

Monday, March 20, 2017

Conversations with my 10-year-old with the radio on

Daughter: "Who sings this?"

Me: "Elton John."

Daughter: "Seriously?  It sounds like a woman."

Me: "No, it's a man."

Daughter: "Are you sure?"

Me: "Yes."

Younger daughter: "What's a tiny dancer?"

Me: "I have no idea."

Next song...

Daughter: "I like Pink."

Me: "Me too.  Well, I like all her songs, but I never bought any of her albums."

Daughter: "What's an album?"

Me: "!!!"

Next song...

Daughter: "Who sings this?"

Me: "Whitney Houston."

Daughter: "Is she from Texas?"

Thursday, March 16, 2017

Should you tell?

Here's a question:

If you overheard your colleague Mary saying something negative about your friend and colleague John, should you tell John?  Or if you hear from someone that Mary has been saying negative things about John, should you let him know?

My answer is no.  Always, no.

I've been in a situation like this before, where I was tempted to say something, but I always decided that it was none of my damn business.  Partially because I've been Mary before, and things I've said were misrepresented and taken completely out of context (I don't want to get into that story at the moment).  But this is my favorite example of why you shouldn't do that:

In residency, there was an attending at my program named Dr. Lee.  I worked with Dr. Lee and I liked her.  I thought it was mutual.

About a month after I came back from maternity leave, I was informed by a co-resident that some other residents had been complaining about a certain female resident (not me) who had been calling in sick a lot on Fridays and being irresponsible.  Dr. Lee quickly chimed in, "I know who you're talking about!  It's Fizzy, isn't it?"

I was so upset over the fact that Dr. Lee would think the worst of me, and assume I was the irresponsible resident when I never missed a day when she and I worked together.  For a while, I was very angry at Dr. Lee.

Several months later, I talked to one of the residents who was involved in that conversation.  He informed me that:

1) The attending involved in the conversation was not Dr. Lee at all, but was Dr. Green.

2) Dr. Green did think they were talking about me, but chimed in to *defend* me because I'd just had a baby and thought they should cut me some slack.

So basically, the story was wrong AND the person involved was wrong.  I wasted way too much energy being pissed off over that.  And all because a well-meaning person felt like he should give me a "heads up."

Monday, March 13, 2017

The three little neurologists

So I was recently talking to an inpatient about his back pain management, and trying to make sure he had outpatient follow-up.  I soon discovered that he was seeing THREE neurologists.

One neurologist was to monitor the size of a brain aneurysm.

One neurologist was for management of migraine headaches.

One neurologist was giving him his back pain medications.

Me: "Oh!  So the neurologist you're seeing for your pain meds can take over the care for your back pain!"

Patient: "No.  This neurologist only does sleep medicine, but just agreed to dispense the pain meds.  But she can't manage them."

I feel like sub-specialization may have gone too far.

Thursday, March 9, 2017

Book recommendation

Every once in a while, I recommend a book to you guys.  I don't read a lot of medical thrillers these days, but one of the better ones I've read recently is The Gina Mazzio series, starting with Bone Dry.  I was looking for a female medical author whose books were suspenseful without being too technical and hard to read, and this really fit the bill.

Check it out!

Monday, March 6, 2017

Dragon makes me sound racist

I'm not sure if anyone is familiar with the dictation program Dragon.  It dictates everything you say in real time, which is good because you can correct errors as you go, but bad because the only one reading your notes to make sure they're correct is yourself.

Now I always read over my notes.  But I'm a human being and mistakes can be missed.  One of the more annoying mistakes that Dragon makes with horrifying frequency is:

Patient --> Asian

So instead of my note saying, "Patient is feeling well," the note says, "Asian is feeling well."  Which is a mistake that I really don't appreciate.  Especially if the patient is Asian.

It also sometimes dictates "patient" as "Haitian."

Sunday, March 5, 2017

beta reader request

I've mentioned a couple of times that in spite of swearing I'd never write another book, I wrote another book.  Proving that I'm obviously full of it.

This book is a sequel to The Devil Wears Scrubs.  It takes place about 12 years after the original, when a married-with-kids Jane reconnects with Sexy Surgeon. Just as the original was autobiographical of my life in residency, this is more autobiographical of my life now-ish.

I've been having some struggles with the book, and I would love to get an opinion of someone who is a fan of my books and would be interested in reading a book like I described.

If you are interested in reading a beta version of the book, and giving me your honest opinion and suggestions, please email me at  However:

1) You must be able to read the book quickly.... like within a few days to a week tops.

2) I want more of an opinion than "I like it" or "I didn't like it but I don't know why."  I want someone who is able to read somewhat critically and express their thoughts.  I can take criticism, but the above just frustrates me.

3) If I email you a follow-up question, you can't have disappeared from the internet forever.  That has happened to me so many times. Please be willing to have a brief discussion with me.

Would love to get one or two people's opinions!  But don't feel pressured to do this just because you like my blog.  Only do it if it's something you truly feel that you want to do and can do well.

Thanks in advance!

Thursday, March 2, 2017

By any other name

I don't feel comfortable with patients calling me by my first name.

I'm fine with nursing, therapy, or other staff calling me whatever they want.  But when it comes to patients, I think they should call me Dr. McFizz out of respect.  After all, I would never consider calling them by their first name without being invited.  And sometimes I even have to be reminded several times by patients to call them by their first name, because I usually default to the last name.

I was discussing this with a physician colleague recently:

Me: "One thing that bugs me is when patients call me by my first name."

Him: "Patient call you by your first name?  Really?"

Me: "Yeah!  It happens all the time.  That never happens to you?"

Him: "No.  Never."

Me: "Wow."

Him: "Well, I always introduce myself when I walk into the room as Dr. Soandso."

Me: "So do I."

Him: "How do they know your first name then?"

Me: "They read it off my badge."

Him: "Well, maybe that's the problem.  You shouldn't have your first name on your badge."

Me: "YOUR first name is on your badge."

Him: "Maybe it's because I wear a tie."

Hmm. Or maybe it's the Y chromosome?

One of my hypotheses was that patients forget that I'm a doctor during the course of our conversation, and assume I must be a nurse or therapist.  But right after this, I was with a patient's family member where I had a long conversation about medical care, and she said she was so appreciative to get information from a doctor.  Then when I left, she said, "Bye, Fizzy!"

Monday, February 27, 2017


With the help of the blogger peanut gallery, I got my mother to buy a fire alarm to keep her from dying.  I've got another one for you.

My mother is a retired 70 year old woman.  She lives in a large apartment building, and her upstairs neighbor is doing renovations to her apartment for three months.  From 9 to 5 every single weekday, there is constant drilling, hammering, etc.

Obviously, these hours were chosen because most people are at work.  But my mother is retired.  And she has trouble sleeping at night, so she often sleeps during the day, except now she can't.  It got so bad that she stayed at a hotel for a few days which costs a million dollars a day in Manhattan.  She ended up coming down with a bad cold due to the stress of it.

And there are still two months left.

Is there anything she can do about this?

Tuesday, February 21, 2017

You are being recorded

A few years ago, I had the following conversation with a patient:

Patient's mother: "My daughter told me you told her X and Y."

Me: "Hmm.  Well, I'm not sure I said that to her.  Maybe she misunderstood."

Patient's mother: "You did! And I know you did, because she recorded you talking to her and played it for me!"

Me: "..."

So that was horrifying.  I don't know how many patients are actually secretly recording me, but it's not something I had ever considered before.  I'm pretty sure it's illegal without my consent, a fact that I decided it was best not to bring up in this conversation.

Later, the patient apologized to me for recording me and was very embarrassed.  She said she can't remember conversations unless she records them, so she records all doctors' conversations.  Which is fine, but shouldn't she ask permission first???

Friday, February 17, 2017

Mystery package

I live in an apartment complex... one of those places that's made up of dozens of little two-story buildings that have about 3-4 apartments each.  I live on the first floor and we have a little enclosed patio that opens through glass doors off our living room.  I haven't been out there recently due to cold/snow.

Yesterday, my daughter was looking through the glass doors and said, "Hey, there's a package on our patio!"

Me: "No, there isn't."

Her: "There is."

Me: "It's just an empty box."

Her: "No, it's a package."

So I looked, and sure enough, there was what appeared to be an unopened package on our patio.  We retrieved it, and discovered that it was an Amazon box, and that it was addressed to our neighbors.  It was postmarked about a week earlier.

I have to say, I am 100% baffled as to how our neighbor's package got on our patio, which is nowhere near our front door or ANYONE's front door (it's in the back).  There is also no apartment number on the patio, so nobody would know which patio belonged to which apartment.  The delivery people from Amazon may not always be stellar and sometimes packages get delivered to the wrong door, but I have to believe that Amazon wouldn't just throw a package onto a random patio.  

Has this ever happened to anyone here?  Any thoughts?

Monday, February 13, 2017

HIPAA violations

I don't understand HIPAA.  I mean, I do understand it, but I don't always understand why one thing violates it while and other doesn't. For example, when I go to the doctors office and they call out my entire name in the waiting room, isn't that a violation?

I was in the middle of a phone call yesterday that somebody at work claimed was a violation, but I'm sure that it was not. I was calling the daughter of a patient of mine per her request, and even though there was no voicemail message, I left the following message:

"Hi, this is Dr. Fizzy.  I'm calling about your mother. She's doing great, but I just wanted to touch base with you about her care. Please call me back at 555-5555."

I can't for the life of me figure out how this violates HIPAA, but feel free to educate me.

Thursday, February 9, 2017

Flexible spending update

So I made a post recently about how the payroll place gave me such a hard time about getting back the $5,000 I set aside for childcare.  I wanted to give you an update:

I was sent a check in the mail.  For $4,999.80.

I don't understand this.  What happened to that extra 20 cents?  I clearly spent over $5,000.  Why did they deduct that 20 cents?  I went to the website and it just said the 20 cents were "pending."

Obviously, I don't care about 20 cents.  But I find it perplexing.  Why didn't they give me that 20 cents.  Is this some sort of scam where they take 20 cents from every client and it ends up somehow adding up to millions and skip off to another country?

Monday, February 6, 2017

An expensive trip

Recently, I went with my family to the aquarium. I did the best I could to save money on the excursion.

Since tickets to the aquarium cost nearly $30, I got the discount passes from the library for ONLY $10 each.  So I congratulated myself on spending only $40 instead of $120 on the tickets.  But then the parking cost $40.  And even though I made sandwiches for myself and one of my daughters, lunch in the cafeteria for my husband and other daughter (a cafeteria-grade burger and pizza) cost $25.  So in spite of some efforts, we still spent over a hundred dollars on the trip.

We don't really need to save money--it's just instinctual for me after growing up with a single mom.  But the thing is, we have more money than most people.  Yet I could see that most people were paying full price for the tickets.  And the cafeteria was so packed with people buying food, you couldn't even get a table.  And the parking garage was nearly completely full of people willing to pay $40 for parking.

Granted some of these people could have been tourists taking a yearly trip.  But it's hard to believe that the aquarium was packed to the brim (there was a line to enter after the line for buying the tickets) with people who were so excited to go to a not that great aquarium in the dead of winter.  It seriously wasn't that special. It's just fish. We all agreed after two hours that we were totally bored.

Why are there so many people willing to spend close to $200 for a day at the aquarium?  Who are these people?

Thursday, February 2, 2017


As some of you know, I've got a few books for sale on Amazon. At the end of the year, I get a tax statement telling me how much income I earned from these books. I'm awaiting my UK statement, but I got the US statement last night and was personally happy with the number I saw.  So I decided to share with my older daughter, who wants to be an author herself.

Me: "Guess how much money your mom earned selling the books I wrote on Amazon?"

Daughter: "Ummmm..... 700?"

Me: "700 dollars?"

Daughter: "No, um.... 700 THOUSAND dollars."

Me: "700 THOUSAND dollars!!!!"

Daughter: "No, I mean... one... thousand.  One thousand dollars."

Me: "I earned $24,000."

Daughter: [disappointed] "Oh."

Fine.  I didn't earn $700,000 last year.  But hey, $24,000 isn't bad. (I did donate a chunk of that money to charity, but that's my choice.) A lot of people rag on me about how self-publishing isn't legit and I should submit my book to a real publisher, but all in all, self-publishing has been good to me.  I've probably made maybe $60K total since I started in 2013.  And I've given away hundreds of thousands of free copies of my books, which makes me feel like I would never get this kind of visibility if I'd used a traditional publisher.

With all that in mind, I've written a sequel to The Devil Wears Scrubs.  Await publication in the spring.

Monday, January 30, 2017

Flexible spending

I could rant for a long time about flexible spending.

Excuse me if I misspeak on any of this because it's not something I entirely understand.  So every year, I'm allowed a $5,000 flexible spending account for childcare, which means that $5,000 is taken out of my paycheck before taxes and I can then get this money back in full at the end of the year.

Let me just say that $5,000 is a laughable amount of money for childcare for a family with two working parents.  At the maximum, I was paying $40,000/year to our daycare.  Now I've got two kids in public school, and I STILL pay about $15,000 for afterschool and summer camp.  But fine.  $5,000 is what they allow so I guess I'll take it.

But what I really resent is that every single year they make me fight for it.  Without exception, they have rejected every single one of my initial claims.  This is MY MONEY.  I just am trying to get my own $5,000 that was taken out of my paycheck back.  Do they think if they make it hard enough, that I'll just give up and say I don't want my $5,000?

Examples of why they rejected my claims:

Last year they ignored one page of my receipts.  They looked at the first page, calculated $3,500 in care, then said that was all they would give me.  When I called and said WTF, it turned out that they HAD the other sheet and just decided not to look at it for unknown reasons.  I mean, it was only two pages.  It wasn't like it was 10,000 pages and they missed one page.

This year, when I was filling it out, there was a section that it said you didn't have to fill out if you had receipts.  So I just wrote "see attached" in that part.  Then yesterday morning, I found out I was rejected because I didn't fill out that part.  The part it said not to fill out.

Why?  What's the point of all this?  They're going to give me the money eventually... does it really pay off for them to waste everyone's time?

Monday, January 23, 2017


Can somebody explain to me the deal with Eliquis?

Eliquis is one of the new anticoagulants that is starting to take the place of Coumadin.  It's a wonderful thing, because Coumadin has to be monitored so carefully with blood tests and interacts with everything. The newer anticoagulants don't need to be monitored in the same way and have lower risk of bleeding.  Win-win, right?

Except the problem with Eliquis is that it's not reversible.  If you're on Coumadin and you have a big bleed in your head or GI tract, they can give you Vitamin K to reverse it and hopefully stop bleeding.  If you're on Eliquis, you just have to wait for it to get out of your system.

I could accept this risk because of the benefits of Eliquis except that there are other newer anticoagulants such as Pradaxa that have lower risk of bleeding, don't need to be monitored, and they are reversible.

I can't figure out why people keep prescribing Eliquis instead of a reversible alternative.  It's the most prescribed of the newer anticoagulants, yet I've never heard a physician give a really good reason why they would pick that over something reversible.  I casually looked up the literature and I don't see anything compelling there either.

I don't get it.  Can somebody please explain this to me?

Thursday, January 19, 2017


I was picking up my five-year-old the other day, and I saw that she was working on a drawing that looked like this:

Maybe it's just me, but I got worried that my daughter was drawing what appeared to be... a giant bladder with a penis coming out of it?  I asked her what it was and she said, "I'm not done!"  Then she added this:

And I was like, this isn't better!

Thank God, it did eventually turn into something non-phallic:

Monday, January 16, 2017


I know everyone hates Obamacare, but there's this thing called the Affordable Care Act that's actually pretty good, and I hope it sticks around.

Seriously though, I would say that I'm a fan of ACA and I think it will be a mistake to repeal it with no replacement in mind.  Some stuff about ACA that is really great:

--No denials for pre-existing conditions.

--Free preventive services for women

--No copays on birth control -- something that's actually CUT BACK on abortions

--Premium equality that keeps insurance companies from charging exorbitant amounts just because you're over 50 or a woman

--End of lifetime caps on medical spending.

Just to name a few things.

One thing that some people argue about is the mandate to purchase insurance.  For the record, I read that Republicans were in favor of this mandate prior to it becoming a staple of ACA.  Anyway, there SHOULD be a mandate to have health insurance.  Because hospitals have a mandate to treat people who are having an emergency, which is something that you don't have in any other industry.  You can walk into an ER and be treated without any proof that you can pay.  Where else can you do this?  You can't walk into a car dealership and get a car without proof you can pay for it.  You can't walk into a supermarket and buy a candy bar without proof you can pay! Yet you can easily wrack up tens of thousands of dollars in hospital bills without any money in the bank or health insurance.

So until we start saying that hospitals can turn away people from the ER (which obviously, would be horrible), then there NEEDS to be a mandate that people should have health insurance.

Everyone needs health insurance.

But if there are any better ideas out there than ACA that Paul Ryan is keeping secret from us, I'd certainly be open to listen to it.  God knows, the ACA isn't perfect.  But it's just better than taking away health insurance from 20 million people.

Monday, January 9, 2017

Don't worry, cashiers

I read an article recently about how self-checkout will eliminate cashier jobs, so it's a bad things.  But that seems slightly hard to believe.  First of all, about 80% of the times I've done self-checkout, there's been some error that required someone to come over and assist me. Like I don't put my item in the bag fast enough and the whole thing crashes.  And I'm relatively checkout savvy.

But today I realized that as long as there are old people, cashiers will always have jobs.  Today when I was at the supermarket, there was an elderly woman ahead of me who was attempting to do self-checkout, but completely defeating the purpose of self-checkout.  She needed help with every single item she scanned in.  She didn't know how to scan fruits or vegetables.  She didn't know what to do when she didn't bag her item fast enough.  After three different clerks came over to help her at different points, I went over and helped her through the rest of the scanning process.

Then she was unable to figure out how to pay.

The best thing I can say is that she didn't try to pay with a check or scan in a dozen coupons.  But it was an excellent demonstration of why cashiers are needed.

Tuesday, January 3, 2017

Most Useless Family History EVAH

There was another post I made where I said a patient had given the most useless family history I'd ever heard.  And it was.  Until yesterday:

Me: "Do you have any family members who have had a stroke?"

Patient: "My dog had a stroke."

Is this going to be a new thing?  Do I now need to specify human family members when I ask that question?