CEREBROSPINALECTOMYFront desk: "The referral came in by fax." Me: "From where?" Four of these. All of them real. SEND this to whoever fights this queue with you. Front desk: "The referral came in by fax." Me: "From where?" Front desk: "A scanner. It photographed a computer screen." Me: "Showing what?" Front desk: "A PDF you generated in June." Me: "So we are passing my own note back and forth until one of us dies." Patient: "I am calling from my daughter's house." Me: "Where is that?" Patient: "Just over the state line." Me: "Then for the next thirty minutes I am legally not your doctor." Patient: "I will drive back." Me: "Please do not drive. That is the entire reason we are talking." Billing: "The ambulance was out of network." Me: "It was a stroke." Billing: "He didn't choose an in-network ambulance." Me: "He couldn't choose a side of his body." Acute stroke care is time-critical — the treatments that work have hard time windows, and the entire public health message is 'call 911 immediately, do not drive, do not wait.' Any system that then bills the patient for not shopping around is arguing with its own advice. Send this to whoever thinks a stroke is a purchasing decision. Resident: "The AI scribe already wrote the note." Me: "How long is it?" Resident: "Fourteen hundred words." Me: "For a fifteen-minute visit?" Resident: "Six of them are the diagnosis. The rest is the chair."
EXPLAINED (ACCURACY-CHECKED)
(1) Fax remains a widely used channel for referrals and clinical document exchange in US healthcare despite electronic health record interoperability requirements. (2) Telemedicine licensure is generally determined by the patient's physical location at the time of the visit, so crossing a state line can place an established patient outside their physician's licensed jurisdiction. Separately, driving is restricted after seizures under state-specific rules. (3) Acute ischemic stroke treatments are time-dependent and public guidance is to activate emergency medical services immediately rather than arrange transport independently. (4) Ambient AI documentation tools generate substantially longer clinical notes than physician-authored notes, increasing note length without increasing clinical content density.
https://cerebrospinalectomy.com/jokes/front-desk-the-referral-came-in-by-fax/