The flu shot

Who got their flu shot?

This year, I’m hearing the flu shot was only 10 percent effective. Not too great. I’ve already had some patients with the flu who were especially bummed because they got the shot.

I still personally always get it. But there is still a faction of physicians I work with who refuse, even if it means they are pressured to wear a mask in patient areas.

What do you think? Do you get the flu shot each year?

Mailbag: Smelly doctor

Sometimes I get emails from readers asking me questions.  This was one that the reader asked if I could post, so here it goes:

Dear Fizzy,

I was hoping I could get advice from your readers on a problem I'm having!

My problem is, quite simply, one of the doctors I work with smells really bad.  I'm not talking about coffee breath either.  I'm talking about a stink that's noticeable from three or four feet away.  If I see her charting in a room, I will try to leave the room.  When we have a conversation, I breathe through my mouth.

I'm not the only person who notices this.  I've heard other people comment, "Do you think Dr. K knows about her BO?"

Unfortunately, Dr. K is a pretty important person at our hospital.  She's been working there much, much longer than I have.  Furthermore, she's a consultant who is not employed by the hospital, so she doesn't answer to our HR.

I don't know what to do, if anything!  I can't tell her she smells!  But I feel like someone should do something, right?  If I smelled bad, I'd want to know about it.

Thanks in advance!

The good stuff

I've been struggling with sinus issues on and off for the last few months.  I took Sudafed a few times and it didn't help much, which is generally the case with Sudafed these days.

Then a friend of mine pointed out to me that I could get the "good" Sudafed (pseudoephedrine) at the pharmacy without a prescription if I show my ID.  So I did.  And poof..... the haze I've been in was finally lifted!

While I was happy to feel better, I'm also pissed off.  Sudafed (phenylephrine) is essentially USELESS.  I've taken it multiple times and it does NOTHING.  Why bother even selling it?  Pseudoephedrine is so much better!

Stupid drug addicts ruin everything.  Patients can't even get neurontin anymore without being made to feel like a criminal.  Neurontin?  Seriously??  That stuff is practically a sugar pill.  How do you get high off that??

Likability

Because Press-Ganey is such a big deal lately, I've been trying my best to be more likable to my patients.

I've been mostly trying to be an attentive doctor, because I think that's the right way to be likable.  But I think there's an element of charisma that adds to likability, in spite of any medical care you provide.  That's not something that comes natural to me. 

So I've been trying to be as NICE as I can.  I've been trying to smile a lot... I literally am constantly aware of whether there's a smile on my face, and if there isn't one, I try to put one there, unless we're talking about something sad, in which case, I furrow my brow attentively.  I feel like a freaking saleslady.

Tips? Tricks? Advice?  How do I get people to like me? 

(Story of my life...)

THC

I've been hearing more and more lately about THC.

A friend of mine is on chronic pain meds and has started taking a mix of THC and cannabis to relieve pain, and has found it significantly cuts back on his narcotic use.  And the formulation with minimal THC doesn't really even get you high at all.

In a time when opioid abuse is at epidemic levels and death from overdose is out of control, I don't understand why we can't explore THC/cannabis as a serious treatment for chronic pain.  Yet right now, insurance won't pay for medical marijuana and they won't even pay for visits to doctors who are prescribing it.

Although this is talking from the perspective of being in a place where recreational use is not legal.  Maybe in states where recreational use is legal, it's more acceptable to use this as a treatment?

Creepy Halloween Guy

So the other night, I was trick or treating with my kids and a friend of my daughter.  When we got to one of the houses, which was lavishly decorated for the holiday, a man opened the door holding his phone.

"Before I give you candy," the man said to the kids, "can I take your picture?"

So he took a photo of my kids while I waited on the curb, feeling extremely uncomfortable about the whole thing.  Then they took candy from him and left.

Later, the mom of my daughter's friend whispered to me that man always takes photos of the trick or treaters, and she finds it really creepy, but never says anything.  My husband said he wanted to tell the guy not to do it, but it all happened so fast and the kids were already running ahead to the next house.

I still don't know what to make of the whole thing.  Doesn't the guy realize how creepy it is that he's taking photos of random kids?  But then again, they're all wearing masks or costumes... it's not like they were in bathing suits.  But somehow it just seems like someone should tell him to STOP. 

I'm glad I don't live in that guy's neighborhood.

George HW Bush

I have to say, I'm irritated by the accusations coming out against George H. W. Bush that he groped women while posing for photos.

It's great that women are more comfortable going public with their sexual assault allegations against rich and powerful men.  That's a major step for women. 

It's different with Bush though. 

First of all, he's 93 years old.  He suffers from vascular Parkinson's and is on medications for that.  The chances that he doesn't suffer from at least some degree of dementia are slim.  He's probably sexually disinhibited.  I see patients like that all the time, and yes, they do sexually inappropriate things sometimes. Lucky for them though, it doesn't land them in the newspaper to be humiliated in front of the whole country.

I really don't think Bush would make a David Cop-a-feel joke if he were all there.  The proof is that even with all these women coming forward about the photo op harassment, nobody has made any accusations about non-demented Bush from years ago.  Now would be a perfect time to do it, but nobody has.  Which makes me think this is new behavior from his dementia.

Is it right that Bush grabbed those women?  No.  Do they have a right to come forward?  Yes, absolutely.  Is it Bush's fault this happened? I don't think so.  Is it somebody's fault?  Yes. Somebody around him who was aware of this behavior should have warned the women or not put him in a situation where this was likely to happen.  I mean, at least if the women were warned, they could be prepared and know it's not meant in a predatory way. 

I guess my point is I feel there's something wrong with tarnishing Bush's reputation because of things he does while demented. Hate him for Desert Storm, don't hate him for this. The finger-pointing should at least be directed at the right people.

Medical slang

From a discharge summary: "Patient went to the ER with sinusitis, and was treated and street'd."

Aside from the fact that I've never used or heard anyone actually use the term "treated and street'd" in real life... honestly, is that really the language you want in a medical document? 

Not that this is the equivalent, but I was reading a story about a doctor who had entered “TTFO" (this apparently means "told to f*ck off") on a patient’s chart. When he was asked about it later, the practitioner said that the initials stood for “to take fluids orally."

Proposal

Me: "Do you have any other questions for me?"

Patient: "Yes. Will you marry me?"

Me: [laughs]

Patient: "I'm sorry.  I put you in an awkward position.  You don't want to marry me, but you don't want to upset me by saying no."

Me: "I'm already married."

It would have been a lot more flattering if the patient weren't ninety years old.  And mostly blind. 

Still, it's nice to know I have options!

Food boredom

I am officially bored of everything I cook.

Worse, my family is bored of it.  I've started bringing home food for my daughter from the hospital cafeteria because she was so bored of everything I made for her.  You know things are bad when the hospital cafeteria is a treat.

Any easy meal ideas?  I have about 20 minutes to make dinner before I turn into a pumpkin.  (Seriously though, I don't cook anything that takes much longer than 20 minutes.)

Antibiotic overuse

I went to med school in a place where Lyme disease was endemic.  So when I was on my Medicine rotation and one of my co-students complained about feeling tired and achy for a few days, our attending immediately said to him, "Get tested for Lyme disease."

The student was reluctant.  He didn't have a rash.  Our student health plan was crappy with a huge deductible, so he would have had to pay for the test out of pocket.  Also, I pointed out (from a personal Lyme scare) that he could get a false negative this early on.

"Well, if you don't want to get the test," the attending said, "I'll write you a prescription for doxycycline and you can just treat it."

And then we saw another attending, who totally agreed with this.

Even years later, I still find this offensive.  The course of treatment for Lyme is 10-21 days of antibiotics.  Would you really give someone up to THREE WEEKS of antibiotics because they were tired and achy a few days?  I took doxycycline and it made me throw up... not something I'd personally be excited to take for weeks for no reason.  And... hello, antibiotic resistance?

I'd like to believe that the attendings were just overtreating because it was a colleague and not something they recommend to all their patients.

Goodbye, Cyndi Lauper

When I first started practicing, any time a patient would have brain surgery, the surgeon would inevitably shave half their head to do the surgery.

I found this practice ridiculous.  The patient would come out of the surgery looking like Cyndi Lauper at her worst.  I have never witnessed anyone who looked good with half their head shaved. (Including Cyndi.)  I always felt like it then fell to us to deal with the remaining hair.

More recently, the trend has changed.  Instead of shaving the whole head, the surgeon will just shave a teeny area at the incision site.  So instead of rocking Cyndi Lauper, the patient looks pretty normal post-surgery.

From a perspective of compassion for people's vanity, I think this is awesome.  I love it.  It's bad enough you have to have brain surgery without losing all your hair and changing your entire appearance.  So I'm glad about this change.

But from the perspective of the doc who has to monitor these incisions, it's so.  Annoying.  Half the time, I have to do a search for several minutes to find the damn incision.  If it started looking worse, it would be really hard to tell.  And digging staples out that are caked in both dried blood and hair is not a fun task.  Shouldn't we put patient safety above hair?

I'm really torn on it, honestly.

What day is it?

Me: "What is today's date?"

Patient: "Well, it's the day after yesterday!"

I'm going to have to remember that one for when I'm old and confused.

The Pediatrician's Dilemma

A friend of mine who is a pediatrician told me the following story.

He has a patient who is a little girl with some chronic medical issues.  The girl's mother had some legitimate issues with the nursing care that the girl was receiving while hospitalized as an inpatient.  Although this was not the pediatrician's fault, the mother apparently laid into him, screaming at him publicly for a good five minutes.

Of course, the girl is still hospitalized and he's the pediatrician on the inpatient service right now.  So now he has this awkward situation with the patient's mom.  He said that if this girl had been one of his clinic patients and he'd been treated that way, he would have requested she find a new doctor.  But since the girl is hospitalized and probably will be for another week or so, he's stuck.

"I just have to suck it up," he told me.

That's a rough situation though.  Even though the mom screamed at him, she didn't fire him so he's still allowed to see her daughter.  Is there really no alternative to treating a person whose family was verbally abusive to you?

Back to school

For my soon to be fifth grader, this was the list of supplies she needed for school:

2  binders

4 single subject notebooks (multicolored)

5 folders (different colors to coordinate with notebooks)

Scissors

Colored pencils

Multicolored pens

Notecards

Pencils: 2 boxes

1 package eraser tops

2 Glue sticks

1 box of markers

1 box CRAYOLA crayons

Post-it notes

1 Highlighter

1 Box of tissues

1 canister Clorox/Lysol wipes

1 Roll of paper towel

I got it all at CVS for $60, which felt a little ridiculous.  Why SO MUCH stuff?  Especially since I guarantee after one month, all of these things will be lost in the recesses of her bag.  If I ask her for a single pen from her bag in November, she can't find one.

Also, a roll of paper towels??  She really needs to carry an entire roll of paper towels AND a canister of Lysol?  Seriously?  How dirty do they expect things to be getting over there?  

And this is why I have back problems.  Because I spent my entire childhood lugging around THAT.

WTF abbreviations

These are three more abbreviations I saw in a single discharge summary yesterday that I couldn't figure out without google:

WBXRT

CRAO

PSC

I really do think there should be a list of standard abbreviations that are acceptable and everything else should be spelled out.

Woman docs

It seems like I can't book an appointment with a doctor anymore without being asked if I'm okay with seeing a man.

OK, they didn't ask me when I booked an eye doctor appointment.  But when I recently scheduled an urgent care visit for a stomach bug that was taking a long time to clear up, they asked me.  And the OB/GYN office always asks.

Personally, my first pap was done by a man, and I really liked him.  My second regular ob/gyn was also a man and also great.  Yes, I'm a little more uncomfortable being examined down there by a man, but honestly, it's uncomfortable either way.  It depends on the doctor more than it depends on the gender of the doctor.  It's only a recent thing that there are enough female doctors that patients can even get a choice.

What bothers is me is that when they specifically ask me, it makes me feel like maybe I *should* request a woman.  Why can't they just mention the doctor's name and see if I protest?

Also, has a man *ever* been asked if he was okay with the gender of his doctor?

At work, I have also been put in positions from time to time where I was pressured to see a patient for no other reason than they had "woman problems," when I believed another doctor was better trained to treat their issues.  I'd have no problem with it if the woman had specifically requested a female physician, but that was never the case.  It was always decided that "she'd probably prefer a woman."  Sometimes I feel embarrassed to march in, knowing that I'm only there because of my XX chromosomes.

Badge reversal

We recently got an influx of new nurses at work, and I'm awful with names, so I've been struggling to keep it all straight.  I pride myself in knowing everyone's names, so I hate it when I have to ask for something from a nurse whose name I don't know.

Anyway, yesterday I was asking a nurse a question during a meeting, and I couldn't remember her name.  I checked her badge, but her badge was flipped over so I couldn't read it.

Then I looked around the room and discovered that with only a couple of exceptions, every single person in the room had their badge flipped over so you couldn't read their name.  (You'd think just by chance, half would be correct.)

There's something about that which really bothers me.  Badges are required at work for a reason.  Whatever that reason is, I'm sure 80% of badges being flipped the wrong way is not in the spirit of the reason.

I've got some good news...

I don't actually have news, good or bad.  But when you read the subject of this email, did you think I was about to announce I was pregnant?  Because if you did, congratulations, you're exactly like me.

I have literally had three conversations with women in the last week where they told me they had big news and I immediately thought they were pregnant.  And they were pregnant in NONE of those cases.

Friend: "I have some good news!"

Me: "!!!"

Friend: "I'm not pregnant."

Me: "Oh!  Um, I have to admit, I did sort of think..."

Friend: "You know I had my tubes tied."

Me: "Yes.  I did know that."

I find it aggravating that I am apparently so sexist that the only good news I can imagine a woman having is that she's pregnant.

Pee

Doctor dictating next to me: "The patient complained of frequent urination.  She said she woke up multiple times during the night to urinate.  However, during the day, she only urinated a smaller amount.  She is not on any medications that would cause her to urinate more frequently."

Me: "You're saying 'urinate' a lot."

I don't know why, but the word "urinate" just seems weird to me.  I always say "void" in my job and at home, I say "pee." Actually, at work I say "pee" a lot too when I'm talking to patients.  Anything I can do to avoid saying "urinate."

Worse than Ben Carson

I tend to think of neurosurgeons as incredibly hard-working individuals--definitely up there as the most dedicated and intelligent and diligent physicians out there.  But there's one neurosurgery practice we deal with that repeatedly baffles me.

Our unit coordinator: "We'd like to schedule a follow up visit for Mr. Johnson."

Neurosurgery practice receptionist: "Hmm.  Well, he had a motorcycle accident.  We don't see people who were in motorcycle accidents."

Us: "What???"

Them: "Sorry."

Us: "But you saw him at the hospital."

Them: "Well... that's true.  But why does he need to be seen by us again?"

Us: "Um, because you removed half his skull?"

Honestly, call me old fashioned, but I really believe that once you take off someone's skull, you owe them at least one follow-up appointment.  Just sayin'.

The perils of being in medicine

When I was a med student, I went to the student health clinic for my annual women's exam.  This was something that I'd done many times before, and there was nothing significant about the exam.

Except for the fact that one week later, I was assigned to work with the male attending who had been up in my lady parts.

We were both totally professional about it, but it was hard not to think about.  A friend of mine had a GI problem requiring her to go to a colorectal surgery, and not long after, had to scrub with the surgeon who did her proctoscopy.  I'm not sure which one of us had it worse.

But what can you do?  I went to med school in a small community.  I didn't even have a car for part of the time.  Student health was the best option.

One thing that really amazed me though was that when I was on my OB/GYN rotation, the chief resident came on our L&D service to deliver her baby.  She chose that.  She was okay with letting med students who had been on her service do her exam.  Am I crazy or is that something nobody in their right minds should ever want to do?

Bathroom inequity

Recently, I took a trip to NYC and had the opportunity to see the musical Wicked.  I had been wanting to see it for like a decade and we didn't cheap out on tickets.  Like, I'm talking over a hundred dollars each.

By the intermission, I really had to pee, as did my daughter.  We got to the bathroom as quickly as we could, but the line went across the room FOUR TIMES.  The line for the men's room went around the room half a time.

I knew we only had 15 minutes for intermission, but I didn't have a sense of how large the bathroom was.  I assumed that since the show played every single night, they wouldn't create a situation where women couldn't go to the bathroom.

I was wrong.

With three minutes left, we weren't anywhere close to the bathroom.  I had to go very badly and was nearly hysterical.  After paying over a hundred dollars for a seat, I wasn't even able to go to the bathroom during the intermission???

What finally happened is they let us go to the men's room with supervision.  We had 30 seconds left at that point before they locked us out of the show.  We didn't even have time to wash our hands.  My daughter was nearly in tears.

I've talked on here before about the horrible inequity in toilets.  This happens EVERY TIME. Women have smaller bladders, they take the children, and they can't use urinals, so the line for women is always orders of magnitude longer.  Why is this never compensated for???  This was especially disappointing though, since we had waited so long for this show, paid so much money, and we weren't even allowed the basic necessity of a bathroom.

Stress Reduction

My new goal in life is stress reduction.

Correction: There's no way to actually reduce stress.  Life is stressful.  In my line of work, I see people every day who are dealing with much more stressful situations than me.  I could say that once my kids are a little older, things will be easier, but there's no guarantee of that.  From everything I've heard, dealing with teenagers isn't a walk in the park.  The job I took that was supposed to be part time and low stress has evolved into something that's not really part time and somewhat stressful.

So my goal is to improve the way I deal with stress.

A little background:

I'm someone who tends to somaticize my stress.  This has manifested itself in many different ways throughout my life.  In my mid thirties, it's mostly been musculoskeletal.  For a while, I was doing well, but a recent big stress caused everything to get worse. Lately, I've had constant tightness in my upper traps that I can't seem to get rid of. When I'm feeling good, I can ignore a little muscle tightness, but when I start focusing on it, it becomes this terrible pain that takes over my whole life.  As a physiatrist, I know and use every modality there is, but I recognize that a large part of it is psychological.

My problem is that I'm not a spiritual person.  The idea of sitting and meditating is very, very hard for me.  I've tried countless times with little success.

How can I achieve my goal of stress reduction? Has anyone been successful with this? I'm determined to do this, because I see myself going down a path that frightens me.

Firefighters

I'm going to go out on a limb here and say that I think firefighters are heroes.

I recently was trying to fill out some disability paperwork for a firefighter who was injured in the course of his job.  It was a specific form just for firefighters.  Unfortunately, one of the most important Yes/No questions about how the injury pertained to the job was The Most Confusingly Worded Question Ever.  I think it had a triple negative.

I wanted to help the firefighter by getting him the disability benefits he deserved, but I could not figure out how to answer this question in his favor.  I showed the question to three other physicians and NONE of us could figure it out.  I finally picked one, because I had to.

It turned out to be the wrong answer.  (We were able to redo it, fortunately.)

I'd just like to thank whoever developed that paperwork to help deprive heroes of the benefits they deserve.  I hope you sleep very well at night.

The Hard Questions

I get asked questions in the course of my day that can be hard to answer.

"Will I ever be able to walk again?"

"Will I have another stroke?"

"Can you fix my back pain?"

So sometimes it can be a relief to hear a medical question that I absolutely can answer:

"Mommy, since you're a doctor, can you tell me.... is a thumb a finger?"

"YES.  It is."

"Mommy says it is!!  I told you so!"

My dear friend

Does anyone else refer to patients as "friends"?

I'm not saying that you are actually friends.  I'm not suggesting anyone takes their ICU patient out for a beer.  But I feel like I hear things like this:

Nurse: "Our friend in room 305 is asking for more morphine again."

In writing this post, I'm realizing that we tend to use the word "friend" to refer more to difficult patients.

With that in mind, it worries me a little that the teachers at my kids' daycare refer to all the kids as "friends."

Glitter is worse than herpes

I’ve got a terrible case of glitter today.

Don’t laugh. Glitter is a very real affliction. More people’s lives are affected by glitter than by stroke and heart disease combined.

Glitter is just like herpes. It’s not dangerous or deadly, but it’s super annoying. You think it’s just in one place, but then it spreads to other places. Most of the time, you’re not even sure where it came from. But once you’ve got it, it’s nearly impossible to get rid of. And you can give it to anyone you have contact with. Even if you just touch them. So really, it’s worse than herpes.

I mean, not that I’ve ever had herpes or anything. But I’ve heard stories. You know.

With a little girl in the house, we’re always in danger of a glitter attack. On one occasion, Leah must have stuffed some glitter in one of her pockets, because when I did the laundry, all of our clothing was covered in glitter. I remember my husband holding up one of his white dress shirts for work with a horrified look on his face when he saw it was covered in shiny specks. I can’t go to work dressed like Beyonce!

This morning, I know exactly how I contracted my case of glitter. Leah brought home a baggie of glitter from preschool, and she decided to do a project with it in the wee hours of the morning. By the time I discovered what was going on, there was glitter all over the floor of her room. I attempted to clean it up, but I was already dressed for work, so not only did I barely make a dent in our glitter infestation, I ended up catching glitter.

So during my entire drive to work, I’m busy brushing glitter off my slacks. To the point where I nearly crash my car dealing with this stupid glitter. Seriously, it is freaking everywhere. This is the worst.

When I get into the elevator, I give George the Elevator Guy an enthusiastic hello. George nods in my direction, looking critically at my glitter-stained clothing. I should have changed my clothes while I still had a chance.

As we approach the sixth floor, George looks down at the ground where I was standing. He frowns at me. “You got glitter all over the floor.”

I look down. He’s right. There must have been a glitter pocket trapped in the sole of my shoe, because there’s now glitter all over the floor of the elevator. I’m telling you—worse than herpes.

“Sorry,” I mumble.

He raises his eyebrows at me. “Aren’t you going to clean that up?”

We reach the sixth floor and the doors to the elevator open up. This is my floor, but George is still staring at me expectantly. Does he really think I’m going to clean the floor of the elevator? I mean, I don’t want to sound like a diva or anything, but is he kidding me? I work here as a doctor.

Maybe George doesn’t realize I’m a doctor. Even though I do walk around with an ID badge that says “PHYSICIAN” in big black block letters. Maybe he thinks I have some sort of housekeeping job at the hospital.

“You know, I’m a doctor,” I tell him.

George just keeps glaring at me. I don’t think I made the situation better.

I’m not cleaning up this glitter. Even if I wanted to clean it up, I’m not even sure how I’d do it. Does he expect me to find a janitor and borrow a mop?

Maybe he does.

“Sorry,” I say quickly. “I actually have a patient right now, but… I can call housekeeping, okay?”

George frowns at me.

“Is that okay?” I say again, more timidly.

“I guess it’ll have to be,” he says with a shrug.

I practically run out of the elevator. As the doors close, I check the soles of my shoes, which are absolutely covered in glitter. Oh God, it’s probably all over the floor of my car. Worse—I probably tracked it into the daycare and now Mila’s never going to let me hear the end of it. And the worst part is that it’s still all over my clothing.

I walk into Primary Care C, where Dr. Kirschstein is standing there in his white coat with a patient chart in hand. He looks down at the floor where I’m still somehow depositing glitter everywhere I walk.

“Sorry, Dr. Kirschstein,” I mumble. “My daughter… there was glitter in her room and…”

He frowns at me. I’m scared that I really am somehow going to get court marshaled for this. “I’m bringing you my wife’s book on child management,” he says.

“Oh,” I say. “Um, thanks.”

“This time I won’t forget,” he says. “I think you could benefit from it, Doctor.”

I stand by my original assertion—glitter is worse than herpes.

(But it’s better than play-doh.)

This was an excerpt from my new book, The Devil You Know.  Buy a copy on Amazon today for only $2.99!

New Book!!!!

It's been nearly four years.

Four years ago, I published my first novel, The Devil Wears Scrubs.  Now, after four years, here is the sequel, which takes place about 12 years after the original, when Dr. Jane McGill is married with a kid:

Buy it now on Amazon on the Kindle or Paperback!

Dr. Jane McGill is in heaven.

She’s got a great job at a VA Hospital, an adorable daughter, and a loving husband. Granted, it would be wonderful if her preschooler wouldn’t wake her up at three in the morning, and it would be a miracle if her husband would change the toilet paper roll once every millennium. Still, in most ways, she has the ideal life she’d always imagined.

Then Jane discovers that Dr. Ryan Reilly is the VA’s newest vascular surgeon. Dr. Ryan Reilly, a.k.a. Sexy Surgeon, a.k.a. the biggest jerk she ever loved.

A decade ago, Jane broke up with the Sexy Surgeon to marry the Nice Software Engineer, but as cracks and crevices appear in her marriage, she can’t help but wonder what life would have been like if she’d made a different choice. Or if it isn’t too late to change her mind…

Buy it now on Amazon on the Kindle or Paperback!

Or read an excerpt first!

My census

At the end of my first month of intern year, I kept a pile of signout cards with all my patients' diagnoses on it.  This was my list of diagnoses for a month at a county hospital:

1) new onset DM
2) Trisomy 18 with aspiration pna
3) pancreatitis
4) alcoholic cirrhosis
5) inflammatory colitis
6) ascites and alcoholic cirrhosis
7) CP/SOB
8) abscesses
9) pyelonephritis
10) UGIB
11) cardiomyopathy
12) gangrenous finger
13) CAD, here for PTCA
14) SOB/CP
15) diplopia
16) GB cancer
17) SOB
18) TIA
19) LLL pneumonia and UTI
20) CP and melena
21) pancreatitis
22) CP
23) CHF exacerbation
24) TIA and gout attack
25) UC exacerbation
26) gastroenteritis
27) N/V
28) herpes zoster. 

(Note that no non-standard abbreviations are used above :)

4 days

During my Medicine rotations during med school and also during my Medicine intern year, we had four days off per month.  I believe that's the minimum that residencies are forced to provide.

Maybe this makes me a delicate little snowflake, but I think 4 days off per month is nowhere near enough.  Especially when the other 26-27 days of the month, you are waking up super early, leaving super late, and sometimes spending the night in the hospital.  I remember one resident said she got a simple cold and it lasted for two months because she was so overworked that she couldn't shake it.

Is it any wonder residents are so burned out?

There was one month during internship when I was feeling really depressed and burned out, and I was going into a stretch of working nearly two weeks nonstop with two overnights wedged in there.  I asked my lovely (not) senior resident if there was any way I could have even a half day off in there.  In retrospect, I'm embarrassed I asked because the answer was so obviously no.  She let me have it: "If you get a day off, that means someone else has to cover for you!"  

The solution, in my mind, is that we need to train more physicians so the ones we have aren't so overworked and miserable.  Yet I doubt that the four days off per month policy will ever change.

Abbreviations

One of the hard things about going from my pre-clinical years in med school to working on the wards was getting used to all the freaking abbreviations.  I remember my first medicine signout sheet looked like gibberish to me.

These days, I'd like to think I know MOST medical abbreviations.  But sometimes I'll get a discharge summary on a patient that makes me think that whoever dictated it got a little too abbreviation-happy.

These are all from a recent discharge summary:

ECD

DDKT

LTBI

I literally had no idea what any of these things meant.  Is it just me?

Dictation errors

From a recent dictation:

"He hasn't had a left thigh laceration which were featured by ophthalmology."

Really?  I understand that Dragon isn't the greatest, but if you're going to produce notes that say things like that, what's the point of even writing a note?

The literal price of health care

Recently my daughter sprained her ankle. Because she's a bit of a drama queen, I took her to urgent care after she refused to put weight on it for a day. The x-ray didn't show a fracture and they gave her a crutch and an Aircast, which she used for exactly one day before she was better.

 A couple of months later, I got a bill for $150 for the crutch and aircast that we barely used.

Because of large deductibles and other reasons, we end up paying a lot of our outpatient healthcare expenses out of pocket. But the problem with that is that you have no idea what you're going to pay until the bill actually arrives. If they had told me it was going to be $150 for that stuff, I never would've taken it.

Think about how crazy it is. You would never go to a furniture store, buy a sofa, and just wait a few months until the bill comes to see how much you ended up paying for it. But that's what I'm constantly doing with my healthcare bills.

I can give multiple other examples. Recently, my own doctor ordered a lab test which I didn't think was entirely necessary, but I decided to let them get it anyway. The test ended up costing a shocking $300. I never ever would've approved it if I had any idea it would cost that much. And the clinician has no idea what these things cost, so no help there.

Fortunately for me, $300 won't break me. But there are plenty of families out there for whom $300 is a substantial chunk of money. They may go to the doctor and blindly accept any recommendations and then end up with a gigantic bill.

The solution? I'm not sure. We don't want people to forgo important task because they're expensive. But I also think that people have a right to know what they're paying before the bill comes in the mail.

Kids and internet privacy

With a child reaching her tween years, my husband and I have been worrying more and more about what to do about monitoring internet and phone use.

I have friends who say they have passwords for all their kids' Facebook/email/whatever accounts and check them either nightly or at least periodically.  But my husband feels that this is an invasion of privacy and she'll find a way to circumvent it.  We should just educate and trust her.

I'm not sure.  I feel like there are a lot of creeps out there on the internet.  But at the same time, it seems impossible to be able to monitor everything.

What do you think?

What's a buttnose for?

I was listening to another doctor dictate a physical exam yesterday and I heard the following:

Doctor: "Patient has..." (mumbling) "butt nose..." (more mumbling)

Me: "did you just dictate that the patient has a butt nose??"

Doctor: "No. I said the patient didn't know the year, but knows the month."

Me: "Oh."

I thought it was this.

My two pens

When you have kids in your house, especially ones who can reach higher shelves, your stuff is not your own.

I have become irate in more than one occasion because I couldn't find tape when I needed it.  The kids can go through a roll of tape in an hour, then when I've got a present to wrap, I am tapeless.  So I keep one roll on a really high shelf (which they can still reach) and am very strict about anyone using that tape.

Pens are the other thing that drive me crazy.  I can never find a pen when I need one.  I used to keep them in my bookcase, but the kids would just take them.  They have a million crayons, markers, pens of their own, but somehow mine always get taken.  So again, I put two pens on the top shelf of my bookcase and said no one is allowed to touch them.  This is difficult to maintain though.

My daughter: "Can I use one of your pens?  I want to draw."

Me: "You have a million markers and crayons!"

Daughter: "No, I don't."

Me: "You do!"

Daughter: "Can I just borrow one of them?"

Me: "No."

Daughter: "Why not?"

Me: "You won't return it."

Daughter: "Why do you need two?"

Me: "In case one breaks." (or in case someone "borrows" one of them)

Daughter: "Ugh, fine!" [stomps off to her room and returns one minute later with gigantic bucket filled with ten thousand pens]

And don't even get me started on food.  Last week, I brought home an entire chocolate cake, and a day later it was simply gone.

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.

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.

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.

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!

hugs

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?

Fluoride

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."

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.

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.

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.

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.)

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.

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?"

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."

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.

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!

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."

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 fizzziatrist@gmail.com.  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!

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!"

Renovations

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?

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???

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?

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.

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?

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?

Revenue

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.

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?

Eliquis

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?

Drawing

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:

Obamacare

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.

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.

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?

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