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In Times Like These, Take One Dose of Laughter

Cheryl Clark, for HealthLeaders Media, August 18, 2009

Doug Farrago MD doesn't just rail against insurance plan denials, Joint Commission rules, hospital, doctor and patient stupidity, health reform arguments, or drug marketing ridiculousness.

He ridicules and satirizes it. All of it.

For the last nine years, he has lampooned it and tweaked its nose like the Three Stooges routine he believes the trenches of medicine too often imitate.

The 44-year-old family doctor in the small town of Auburn, ME is the founder and publisher of Placebo Journal, "idiopathic wit and wisdom," a kind of "Mad Magazine" for practitioners.

With his colorfully cartooned, 40-page issue published once every two months, Farrago hopes to help providers use humor to better cope with the infuriating obstacles they encounter trying to help their patients.

"Humor itself can't make the situation improve. But maybe poking fun of the stupidity in some of the situations, even some of the serious stuff, can alleviate some of the anxiety and stress we all feel," Farrago says. "If you don't have a sense of humor today, you'll become a robo-doc."

He is not at a loss for material. With the health reform debates, hysteria over H1N1, the increase in Joint Commission regulations, and the decline in physician reimbursement, Farrago says, "It's insane. Finding humor in everyday practice is like shooting fish in a barrel."

There's a feature story on "How to torture a managed care executive," and another on his pompous doctor colleague whose toupee was blown off by a patient who coughed hard, right in the middle of a code.

"In Memorium, Stupid Pharmaceutical Tricks. 2001-2009" spoofs the censure on pharmaceutical gifts to physicians. The display includes a fishing lure labeled "hydrocodone combinations," a toy bathtub labeled Cialis, tiny plastic Mr. and Mrs. Mucus for Mucinex and a plastic bottle of ordinary water labeled "Lipitor."

"Malingerers Say the Darndest Things," trots out whacky excuses real patients used to try to falsify Workers Compensation Insurance claims.

The Joint Commission and insurance companies are regular targets, Farrago says. "We always rip the Joint Commission any chance we get" because of their rules, like the one that prohibits him from taping Christmas cards on his office door. Fire hazard, he says. "Where's the evidence on that?"

A feature in a recent issue asks the question "What if managed care companies were honest" in the letters they send doctors.

"Dear Doctor ____. We recently received a medical claim on your patient, _______and we are trying to figure out a way not to pay it. One method to accomplish this task would be to determine if you think that _____in any way had a pre-existing condition that would exclude him from these services..."

Subscriber Kevin Pho who blogs as KevinMD, says he corresponds with Farrago frequently. Farrago, he says, is "a sharp wit." And his journal serves an important function especially now during the whipsaw of contradicting opinions on health reform.

"Doctors are dispensing news that's not always that good. And in the health reform debate, doctors are especially worried about reimbursement. A recent Annals of Internal Medicine report says half of doctors are burned out," says Pho.

"Practicing medicine can be intense high pressure activity. Without an outlet to share and laugh with other doctors, it will become unbearable," Pho says.

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