I’m sure as sugar that someone will be offended by the term “rummy,” especially some Al-Anon witch who would take up the gavel against anyone who defames people such as her/his “beloved other” that just drove through an elementary school playground.

This Bud’s for you.

I am honestly a MUCH sweeter guy when I put on the superhero costume and do the Doctor Thang.  But here, it’s an opportunity to tell the truth.  When someone’s in my office who’s genuinely suffering, I give them a lot of sympathy, I really do…

But When Immaturity Collides With Alzheimer’s – there are no survivors.

Okay, this guy – and his wife and the li’l hostages – came in to see me, he was a week out after a MONTH of inpatient detox, and if you have to burn off a MONTH in detox, you’ve been busier than the average bear.  It made me believe his story that he was in the Half-Gallon Club.

The first annoying thing was that he wanted specialty workup of some serious medical problems that he had, immediately.

He wanted a repeat ultrasound of his liver, to see if it had shrunk from its previously enlarged state.  I would have told him that his Liver was like the Hindenburg, in Size & Flammability, and that unless he feels a sudden sharp burning abdominal pain, it ain’t going to get smaller all of a sudden.

He had occasional palpitations when he drank.  Which was always.  I said we’d get to it.

He needed to see a Hematologist for macrocytosis.  I might have opined that the erythropoeitic stem-cell line in the bone marrow was kinda like the old Soviet Factories – when all the workers are drunk, the quality control turns to shit.  Embalming is tough on the body.

That much, I could have handled.  But, thanks to the New New Medicine, he had spent some time reading his inpatient chart (!!) and had some corrections that had to be made.

One was that the admitting diagnosis stated drugs and alcohol.  He was greatly offended.  I hope he sees a lawyer.  He does not do drugs, and it was libelous to write in the chart that he does drugs, in his opinion.  There’s plenty of lawyers in bars at 10:30 in the morning – go seek counsel, m’man.

I was preoccupied with admiration for the neuron, to have simmered for so long in pure ethanol, and still keep sparking at all, not to mention at a high level of functioning.

The other was MY NEW HIPAA RULE.  Since patients can now edit, critique and complain about anything written in the chart, I will avoid writing anything about a patient in the chart that differs from the norm.  “Habitual” alcohol use?  That’s pretty judgmental, wouldn’t you say?  Yep!  Sorry!  Social History Unremarkable!

No more scoldies from me to the patient who had chest pain, didn’t take a nitro, didn’t go to the ER and watched the rest of the game – not me!  That’s unique patient information.  Instead, out comes the certified handout, CX-201216 on Chest Pain, and a note in the chart how I reviewed it with the patient.

I’m figuring that within two (2) years, the Patient Encounter will be videotaped from start to finish, all six minutes of it, so we’d best get used to being On The Tube for any attorney to grill.  Practice your platitudes.

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