Patient quote of the day

"We've been trying to get pregnant for a year, but took a break last month to get married."

Downgraded? Wishful thinking? Fight in my lobby?

From the "Emergency contact" section of a patient information form a woman filled out yesterday:

Mary's desk

Mary: "Okay, so we'll see you next Tuesday at 8:15. Any questions?"

Mr. Letter: "I know your office complex pretty well, but where are you in relationship to the 1st floor post office?"

Mary: "There isn't a post office in our building."

Mr. Letter: "Yes there is. I was just in it last month to mail a package. It's on the west side of the first floor."

Mary: "Sir, I assure you, this is a medical building. There isn't a post office anywhere in here."

Mr. Letter: "They must have closed it. It's across from the elevator. How could you not see it?"

Mary: "We've been in this building for over 10 years, sir. There's no post office here. The nearest one is about 4 miles away."

Pause

Mr. Letter: "Are you sure Dr. Grumpy isn't in the building with the post office?"

Mary: "Yes sir. Do you want me to give you our address? You can see a map on our website..."

Mr. Letter: "Why don't you just cancel the appointment. I need to buy stamps and send a package to my cousin, so I'll just try to find a neurologist closer to a post office."

Negative answers FAIL

Dr. Grumpy: "Do you use caffeine?"

Mr. Negative: "No, except for 2 cups of regular coffee each day."

Dr. Grumpy: "Do you take any medications?"

Mr. Negative: "Nope. Only Coumadin and Metformin."

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Negative: "None, just Penicillin."

Don't just stand there! DO SOMETHING!

I hear that all the time. Apparently, standing by the bedside and giving medications isn't enough for some people.

There's a pervasive idea that a high-priced invasive procedure has to somehow be better than doing something simple and conservative. I suppose this is human nature. Our ancestors gravitated toward human sacrifice on the instinctive belief that a deity that demanded human life has to be more powerful than one who wanted rice.

And I'm not knocking surgery, or surgeons, or other invasive procedures. In many cases they are critically important and life saving.

But let me tell you some stories.

The cardiologists have a remarkable technology called the stent. It's a tiny piece of metal that can help prop open a closing artery to restore blood flow. It's changed a lot of the way heart care is practiced during my career.

So it's only natural to extrapolate this technology to arteries of the brain. Instead of doing surgery, or using ho-hum medicines, we started putting high-tech stents into arteries supplying the brain, too.

Guess what? A study found boring old pills beat snazzy stents!

Here's another example:

For acute strokes, TPA is the big thing (I'm not going to argue about how effective it really is). But there's all kinds of things we can do beyond just plain old TPA. After all, how exciting is it to slowly drip some liquid into an IV line?

(crickets)

But it can be so much more exciting! What if we give TPA by threading a catheter all the way up to the brain and drip it right onto the clot? COOL! Or we could also use REALLY flashy technology ("technology always implies it MUST be good, doesn't it?). There are tiny gadgets we can thread all the way up to the brain, screw them (gently) into the clot, and pull it out (WOW! Like a cork!). Or another gadget we can use to punch a whole in the clot and restore blood flow.

Sounds all science fiction-y, huh? Well, we DO have the technology to do all those things.

But does it work? (Wait, who DARES ask such a question of advanced technology?!!!)

Um, no.

That's it folks. 2 studies (here and here) found that all this advanced stuff was no better than boringly watching TPA drip into an IV line. Ho-hum.

Now, the companies who make the fancy gadgets, and the doctors who use them, will gladly point out all kinds of flaws in the studies, and some of them may be legitimate. But some complaints, like "we need to select patients better," translate simply as "let's stack the deck in our favor."

In medicine we hear the phrase "Do something!" a lot. But usually we already are doing something. The problem is that many people think that unless it involves a lot of razzle-dazzle and medical voodoo, we aren't.

And in some cases that's quite far from the truth.

Yet more pictures from the road

I suppose only a neurologist would notice this guy's T-shirt:

Here we have a fashion statement, albeit for a good cause:

 

I don't understand this:

"I want you to remember this, Clark. The one man who hung you from his radiator grill."

More pictures from the road

This bio-hazard bag rode an elevator at our hotel for roughly 24 hours before disappearing. Maybe they wanted us to think we were aboard the Carnival Triumph.

I assume this bumper sticker's purpose is to confuse readers regardless of political leaning.

Catching up on some reading behind-the-wheel while Mrs. Grumpy was driving, I encountered this strange ad for an epilepsy drug. Apparently, if you don't like turning blue, it's easier to be green.