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.
Placebo Journal is replete with what Farrago acknowledges is a "sophomoric" brand of pre-pubescent, toilet bowl humor, often with sexual innuendo not that much unlike that found in Mad Magazine in the 1960s. On the surface, some features don't seem like they would have an appeal to the health profession.
For example, there's a regular parody on medical advertising, such as one fictitious ad for Spermo, a dating service for doctors, a spoof of the physician online group Sermo. And another ad promotes Sexapro, the only drug that treats both depression and erectile dysfunction.
But there are other features that resonate with experiences physicians frequently encounter, like the feature on one practitioner's "Favorite Munchausen."
Among the "Top 10 Things You Don't Want to Hear in the OR" is the line, "Should we just throw these two units of blood on the floor or should we run it through the patient first?"
For each issue, Farrago includes real radiology films depicting glass in the gluteus or a bottle of Tabasco sauce unfortunately lodged in someone's groin.
"A lot of what we have in the PJ is what doctors are thinking, but not saying. And they tell us they feel good that someone knows, and someone else is laughing with them," Farrago says.
Farrago accepts no advertising, but supports his 5,000 to 10,000 circulation with a $28 subscription fee.
For example, there's a feature on a head injury patient with cortical blindness, who after eight years, received a letter denying him disability because of a determination that he could actually see.
But Farrago says that he is careful about what he uses. All the stories are supplied by real doctors, nurses and patients, he says. That is, if Farrago, or his three writers don't contribute original material.
Is he making any money? Not much, Farrago says. "But I will say this, all the money it makes goes to a good cause: Me."