by Patricia Salber

Pat Salber, MD, MBA, Host of The Doctor Weighs In & CEO, Health Tech Hatch

Thanks to @kimwhit @rawarrior @AfternoonNapper for tweeting about this.  Not being a rheumatologist, I don’t routinely (or ever) read Rheumatology News so I would have missed what I consider to be one of the more offensive pieces I have ever seen written by a physician.  Titled “Kiss My….” , the article starts out with this statement:

“If your practice is like mine, you probably don’t bill for “consult level 5″ very often. That is the most expensive level of care on our office superbill, and I usually reserve it for patients with huge volumes of records, patients who take an inordinate amount of time, or patients who annoy me in some other extraordinary fashion.”

The author, Dr. Larry Greenbaum, a rheumatologist who practices in Greenwood, Indiana, goes on to describe an office visit he had with a 75-year-old man with rheumatoid arthritis (RA).

[He] didn’t bring many records, but I spent a very memorable hour with him. I charged him level 5 for taking so much of my time, for bad-mouthing his previous doctors, and for incessant whining.”

Dr. Larry Greenbaum, author of “Kiss my…”

What??? First of all, I am pretty sure that bad-mouthing and whining are not criteria to bill a level 5.  Second of all, RA is a pretty miserable disease.  Third, and most important, why on earth would Dr. Greenbaum think that his fellow specialists would have anything but disdain for his pompous, disparaging remarks about one of his patients?

As far as I can tell, this guy could compete for the prize of “Most Obnoxious Doctor” from the Society for Participatory Medicine – if only they had such a prize.  It is one thing to think these thoughts – and I bet most docs can conjur up the memories of some patients that annoyed the heck out of them – I know I can remember a patient or two who got me riled up.  But, we are doctors and it is our job to take care of people who are sick, in pain, not tolerating their circumstances well, and not taking care of themselves the way we wished they would  - whether or not they disparage other doctors or even whine.

Greenbaum goes on to say,

“When his treatment commenced with 20 mg of prednisone a day, he felt like “Superman,” but by the time he was down to 2 mg a day, he felt as if he had been “hit by a truck.” He claimed that an arthrocentesis by his first rheumatologist caused his left index finger MCP joint to permanently dislocate the day after the procedure. “He took too much out,” he complained. He was on methotrexate, but he was dreadfully worried about dire side effects. A recent string of sinus infections were clearly due to his medications, in his opinion.” 

I have a close friend who was treated with prednisone and methotrexate for presumed RA.  Greenbaum’s patient’s description pretty much mirrors how she told me she felt during the treatment.  Why make fun of this?  And, BTW, patient’s should worry about side effects of their medications if they have a doctor like Greenbaum, because he may not.

And, here it is – the “blame the patient” line:

“He didn’t think that his long history of smoking could possibly have contributed to his problems.”

At the end of the article, Greenbaum tells the patient he knows his neurologist:

It was a throwaway comment on my part, but I always think that patients feel a little more confident when their doctors know one another. He gave me a goofy look and he elaborated, “She’s a beautiful young woman with black hair. I kissed her hand.” He was seated on the exam table and I was standing directly in front of him. He looked me in the eye and added, “But I’m not going to kiss your hand.” He didn’t seem demented or hateful, just weird. I assured him that I’d be fine without his kiss, and I wondered quietly if his neurologist had gotten over this moment of chivalry.I wasn’t the least bit insulted. It was just another day in clinic.

My takeaway from reading this is that this is a doctor in distress.  Is it burnout?  Is it boredom?  Are there problems outside of the exam room that are bumming him out?  Perhaps he needs a vacation or a nap or good night’s sleep.  Perhaps he needs some patients to kiss his hand. This is not my area of expertise….Dr. Cary?  Dr. Drummond, Mr. Diamond, please weigh in here.

One thing I do know is that Greenbaum’s fellow specialists should let him know how they feel by commenting on his post (it is interesting that are are no comments, suggesting to me that someone may be screening them.) Certainly, this article has gotten some people angry as noted by the 59 comments on Dr. Kelly Young’s Rheumatoid Arthritis Warrior blog.

I would love to know what you think?  Post a comment and I will provide a link to the editors over at Rheumatology News.  (In the age of the internet, you really can’t hide.  Hmmmm…I wonder what what will happen when the folks at CMS read this?)
According to the article, “Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. You may reach him at [email protected]