Search Our Site by Key Words

Why We Should Stick Together:
A Parable

Two psychiatrists, one a Hopkins psychopharmacologist and the other a Shepherd Pratt psychoanalyst, lived on adjacent farms in a rural section of Baltimore County. The area had a lot of trees and open spaces, so the two peacefully ignored each other for years.  All this ended when a tornado passed through the area, damaging their barns and fences.  Several of their cows wandered off, so each went out to round up his own cows. They both came upon a particular cow and each claimed her as his own.  As the disagreement began to heat up, one began to pull on the cow's head and the other started pulling the cow's tail in the other direction. They paused for breath and heard a sloshing noise. They looked under the cow and saw an executive from Magellan* who had just finished milking the cow.

*Magellan is the result of the recent merger of several managed care companies.

_________________________

After they had dropped off the CEO, Saint Peter flew with the televangelist until they arrived at a crowded street lined with narrow row houses. They alighted near a clean but unremarkable row home. "That's it?" he exclaimed, "How come I only get this when that managed care guy got a mansion?"

Roughly 50 percent of Americans-through no fault of their own-do not possess the talent necessary to carve out a meaningful role for themselves in society," continued Gingrich, a longtime ANA supporter. "Their lives are futile hamster-wheel existences of unrewarding, dead-end busywork: Xeroxing documents written by others, fulfilling mail-in rebates for unscented diaper wipes, and processing bureaucratic forms that nobody will ever see. Sadly, for these millions of nonabled Americans, the American dream of working hard and moving up through the ranks is simply not a reality."

Under the Americans With No Abilities Act, more than 25 million  well-compensated managed health care administrative positions will be created in the white-collar sector for nonabled persons, providing them with an illusory sense of purpose and ability. Mandatory, non-performance-based raises and promotions will also be offered to create a sense of upward mobility for even the most unremarkable, utterly replaceable employees. The legislation also gives health care corporations  incentives to hire nonabled physicians, nurses and social workers. It is hoped that this will provide these professionals with enough of a sense of power to save their self-esteem.

Finally, the Americans With No Abilities Act also contains tough new measures to prevent discrimination against the nonabled by banning prospective employers from asking such job-interview questions as, "What can you bring to this organization?" and "Do you have any special skills that would make you an asset to this company?"

"As a nonabled person, I frequently find myself unable to keep up with co-workers who have something going for them," said Melinda Smith, who lost her position as an unessential filing clerk at a Baltimore wallpaper wholesaler last month because of her lack of notable skills. "This new law should really help people like me." With the passage of the Americans With No Abilities Act, Smith and millions of other untalented, inessential citizens can finally see a light at the end of the tunnel. Pennsylvania physician Dr. Henry Q. Bookman also lauded the program. "Since I'm a nonabled physician, all of my patients kept leaving my practice. It gave me such a low self-esteem. The new ANA initiative has placed me in this wonderful managed care job! I don't have to worry about patients anymore. And this new sense of power . . . I haven't felt this good in years."

"No," said the doctor, "but have you got any brass lawyers?"

_________________

Emergency Telephone Screening Reduces Wasteful ER Visits:

Patient: (To HMO Screening Nurse) Help, I have chest pain! Call me an ambulance!
HMO Screening Nurse: Okay, sir, you're an ambulance.

________________

A hospital bed is a parked taxi with the meter running.
Groucho Marx

_________________

June 28, 1998

A pediatrician, a surgeon and a managed care physician were playing their usual Wednesday round of golf, and started discussing how much of their capitated income was actually spent on patient care.

Specifically, they started to compare how they decided what portion of the collection to keep for themselves and what portion to use on their respective patients.

The pediatrician explains: "I draw a circle around myself and toss the money in the air. Whatever lands in the circle I keep for myself. What ever lands outside the circle, I use for the patients."

The surgeon then adds: "I use a similar method, except that whatever lands in the circle I use for patient care, and whatever lands outside the circle I keep for my personal needs."

The managed care executive said, "Well, I'm a religious man. When I toss the money in the air, I figure that any money God wants the patients to have, He can take."

________________

Mary: I just signed up with a managed care company that believes in preventative medicine.
Jane: That sounds great. Why are you so grumpy?
Mary: It turns out that preventative medicine means their prescription plan prevents me from getting my medicine.

June 20, 1998

A Code Of Ethical Behavior For Patients

1. Do not expect your doctor to share your discomfort. Involvement with the patient's suffering might cause him to lose valuable scientific objectivity.
2. Be cheerful at all times. Your doctor leads a busy and trying life and requires all the gentleness and reassurance he can get
3. Try to suffer from the disease for which you are being treated. Remember that your doctor has a professional reputation to uphold.
4. Do not complain if the treatment fails to bring relief. You must believe that your doctor has achieved a deep insight into the true nature of your illness, which transcends any mere permanent disability you may have experienced.
5. Never ask your doctor to explain what he is doing or why he is doing it. It is presumptuous to assume that such profound matters could be explained in terms that you would understand.
6. Pay your medical bills promptly and willingly. You should consider it a privilege to contribute, however modestly, to the well-being of physicians, health care managers and other humanitarians
7. Do not suffer from ailments not covered by your health care plan. It is a waste of resources to contract illnesses that are beyond your means.
8. Never reveal any of the shortcomings that have come to light in the course of treatment by your doctor. The patient-doctor relationship is a privileged one and you have a sacred duty to protect him from exposure.
9. Never die while in your doctor's presence or under his direct care. This will only cause him needless inconvenience and embarrassment

June 1, 1998

After a hostile corporate takeover, the CEOs of two managed care companies faced each other in court.
"You are a cheat!" shouted one.
"And you're a liar!" bellowed the second executive to his opponent.
Banging his gavel loudly, the judge interrupted, "All right, now that both parties have been identified, let's get on with this case."

_______________

Four medical interns, a pediatrician, a psychiatrist, a surgeon and an ob/gyn, were friends. Once, when watching a football game, they made an extravagant wager. The pediatric intern won. Each of the others owed her a thousand dollars.

She laughed and said, "I know none of us has that kind of money now, but I'm sure it will be small change when we're out in private practice. You don't have to pay me now, but if I die before you, I expect each of you to throw a thousand dollars in my coffin."

As it happened, she did indeed precede the other three to her eternal reward. The others greeted each other at the funeral. The psychiatrist and the ob/gyn each had a successful private practice. The surgeon had left clinical care to become the medical director of a managed care company. They remembered their bet long ago. The psychiatrist and the ob/gyn each tossed a thousand dollars cash into the coffin. The managed care physician then removed the cash and put in a check for three thousand dollars.

__________________

Q: What is the ideal weight of a retrospective claims reviewer?
A: About three pounds, including the urn.

Serenity Prayer for Hassled Managed Care Executives

Grant me the serenity
to accept the things I
cannot change.
The courage to change the
things I cannot accept,
and the wisdom to hide
the bodies of those people
I had to kill today
because
they pissed me off
and also,
help me to be careful of
the toes I step on today,
as they may be connected
to the (hand) that I may
have to kiss
tomorrow.

In the Beginning....

Interview for  HMO Physician Panel

Diabetes Update! Managed Care revolutionizes management of Type II Diabetes

The new diet is as follows:

As we all know, it takes 1 calorie to heat 1 gram of water 1 degree
centigrade. Translated in to meaningful terms, this means that if you
eat a very cold dessert (generally consisting of water in large part),
the natural processes which raise the consumed dessert to body
temperature during the digestive cycle literally suck the calories out
of the only available source, your body fat.
For example, a dessert served and eaten at near 0 degrees (32 degrees
F) will in a short time be raised to the normal body temperature of 37
degrees C (98.6 degrees F). For each gram of dessert eaten, that
process takes approximately 37 calories as stated above. The average
dessert portion is 6 ounces, or 168 grams. Therefore, by operation of
thermodynamic law, 6,216 calories (1 cal./gm/degree x 37 deg. x 168 g)
are extracted from the body fat as the dessert's temperature is
normalized. Allowing for the 1,200 latent calories in the dessert, the
net calorie loss is proximately 5,000 calories. Obviously, the more cold
dessert you eat, the better off you are and the faster you will lose
weight, if that is your goal.

Great moments in paperwork: How to fill out care review forms

1. Make sure you give a complete history of current and past presenting complaints:

The patient has been depressed ever since she began seeing me in 1988. She is tearful and crying constantly. She also appears to be depressed. . She has no past history of suicides.

2. Document whether you are ordering laboratory studies.

Patient has left her white blood cells at her primary care doctor's office.

3. Document discharge condition and planned disposition.

The patient is ready to leave the hospital. She is feeling much better except for her original complaints.

Discharge status: Alive but without permission. The patient will need disposition, and therefore we will get the outpatient psychiatrist to dispose of her."

__________________

Psychiatric Consultations are expensive: Be sure your medicine and surgery colleagues document the reason for the consultation

Because she can't get pregnant with her husband, I thought you might like to work her up.

Patient has chest pains if she lies on her left side for over a year.

By the time she was admitted to the hospital, her rapid heart beat had stopped and she was feeling much better.

Healthy appearing, decrepit 69 year old female, mentally alert, but forgetful.

Patient was seen in consultation by the physician, who felt we should sit tight on the abdomen and I agreed.

If he squeezes the back of his neck for 4 or 5 years, it comes and goes.

__________________

Three professionals were sitting outside the gates of heaven waiting for judgment. They began to argue about which of their trades represented the oldest profession.
 

The Doctor said, "Well, the Bible says that God took a rib out of Adam to make woman. Since that clearly required surgery, then the oldest profession is surely medicine."

The Engineer shook his head and replied, "I don't think so. The Bible also says that God created the world out of void and chaos. To do that, God must surely have been an engineer. Therefore, Engineering is the oldest profession."

The Managed Care Executive grinned in triumph. "Ah," he said,"but who do you think created the Chaos?"

______________________

Memorandum
To: All Hospital Employees
From: Administration

Effective immediately, this hospital will no longer provide security.
Each Charge Nurse will be issued with a .38 caliber revolver and 12 rounds of ammunition. An additional 12 rounds will be stored in the pharmacy. In addition to routine nursing duties, Charge Nurses will patrol the hospital grounds 3 times each shift. In light of the similarity of monitoring equipment, the Critical Care Units will now be resume security surveillance duties. The unit secretary will be responsible for watching cardiac and security monitors, as well as continuing previous secretarial duties.

Food service will be discontinued. Patients wishing to be fed will need to let their families know to bring them something, or make arrangements with Subway, Dominos, Wendy's, or another outside food preparation facility, prior to mealtime. Coin-operated telephones will be available in the patient rooms for this purpose, as well as for calls the patient may wish to make.

Housekeeping and Physical Therapy are being combined. Mops will be issued to those patients who are ambulatory, thus providing range of motion exercise, as well as a clean environment. Families and ambulatory patients may also register to clean the room of non-ambulatory patients for discounts on their bill. Timecards will be provided to those registered.

Administration is assuming the grounds keeping duties. If an administrator cannot be reached by phone or beeper, it is suggested to listen for the sound of the lawnmower, weedeater, or leaf blower.

Engineering will also be eliminated. The Hospital has subscribed to the Time-Life series of "How to..." maintenance books. These books may be checked out from Administration. Also, a toolbox of standard equipment will be issued to all Nursing Units. We will be receiving the volumes at a rate of one per month, and have received the volume on basic wiring. If a non-electrical problem occurs, please try to repair it as best as possible until that particular volume arrives.

Cutbacks in Phlebotomy staff will be accommodated by only performing blood-related laboratory studies on patients already bleeding.

Physicians will be informed that they may order no more than two (2) X-rays per patient per stay. This is due to the turn-around time required by the local Eckerds. (Drug and Convenience Store) Two prints will be provided for the price of one and physicians are encouraged to clip coupons from the Sunday paper if more prints are desired. Eckerds will also honor competitors coupons for one-hour processing in an emergency. If employees come across any coupons, they are encouraged to clip them and send them to the Emergency Room.

In light of the extremely hot summer temperatures, the local Electric Company has been asked to install individual meters in each patient room so that electrical consumption can be monitored and appropriately billed. Fans may be rented or purchased in the Gift Shop.

In addition to the current recycling programs, a bin for the collection of unused fruit and bread will soon be provided on each floor. Families, patients and the few remaining staff are encouraged to contribute discarded produce. The resulting moldy compost will be utilized by the pharmacy for nosocomial production of antibiotics. These antibiotics will be available for purchase though the hospital pharmacy, and will, coincidentally, soon be the only antibiotics listed in the HMO's Formulary.

Although these cutbacks and changes may appear drastic on the surface, the Administration feels that over time we will all benefit from this latest Health Care Reform.

 unknown  (Contributed by an anonymous colleague)

___________________

Strategic Development of Health Care Policy

In the beginning was The Plan

And then came the Assumptions
And the assumptions were without form
And the Plan was without substance
And darkness was upon the face of the Workers
And they spoke among themselves, saying, "It is a crock of shit and it stinketh."

And the Workers went unto their Supervisors and said, "It is a pail of dung, and none may abide the odor thereof."

And the Supervisors went unto their Directors, saying, "It is a container of excrement, and it is very strong, such that none may abide by it."

And the Managers went unto their Directors saying, "It is a vessel of fertilizer, and none may abide its strength."

And the Directors spoke among themselves, saying one to another, "It contains that which aids plant growth, and it is very strong."

And the Directors then went unto the Vice Presidents, saying unto them, "It promotes growth and it is very powerful."

And the Vice Presidents went unto the President, saying unto him, "This new plan will actively promote the growth and vigor of our industry sector, with powerful effects."

And the President looked upon The Plan and saw that it was good.

And The Plan became Policy.

This is how "Shit Happens."

From the "Bad News Page" http://home.earthlink.net/~austintxmd/Pages/bad0298a.html

1. Develop a chemical sensitivity to doughnuts and pizza.
2. Insist that they build an accurate 3-dimensional model of a benzodiazepine receptor out of pick-up-sticks and playdough (most child psychiatrists will have these materials on hand)
3. Establish a strict office dress code. Tell your office manager not to admit anyone wearing tailored skirt suits or highly polished shoes.
4. Tell them that you mostly treat children and ask them how many of their products have been specifically recommended for children. (except for Solvay…see next item)
5. Tell the Solvay rep not to come back until he can bring you a detailed report of the hourly wages and working conditions of the workers who manufactured the 1996 AACAP book bags.
6. Be sure to return all of your phone calls while the rep is waiting to see you.
7. Hire a pharmacology graduate student to help out in your front office. The drug rep may not see you until the student has finished quizzing him on the chemical properties of all of his products.
8. Schedule four of them at the same time and only see the one who emerges from your waiting room alive.
9. Ask them whether their company has underwritten psychologists' efforts to get prescribing privileges.
10. Take the drug rep back to your office and confidentially tell him that you have had a bit of a problem with your DEA license. Could he provide you with lots of free samples?
11. Get your information about psychopharmacology from talking to colleagues, attending seminars, and reading journals.

Copyright 1998 Carol Watkins, MD