December 4, 2012 – I came upon this Blog Post late last night when a respected Patient Advocate Colleague of mine, Casey Quinlan, had re-tweeted it with the added commentary that, “it’s only Monday but here’s my pick for Douche of the week.” First off, I apologize to those who are offended by the “salty” language but please hold off on any judgment until you read what this Rheumatologist, Dr. Larry Greenbaum, wrote in his Blog. Secondly, I have come to know Casey Quinlan as a strong, respectful and articulate woman who is ALWAYS on the right side of a debate so when she uses such language to emphasize a point, there must be a good reason.
Judge for yourself, as pasted directly above is the Blog Post made by Dr. Greenbaum, dated November 30, 2012, entitled, “Kiss my …” After reading it and my email response to Dr. Greenbaum below, you will understand why this Blog post SO repulses chronic patients like Casey and me and why it prompted me to write to Dr. Greenbaum below. In that regard, PLEASE feel free to comment on THIS Blog Post and/or to send Dr. Greenbaum an email of your own as he posts his email address on the Blog as firstname.lastname@example.org. Finally, for what it’s worth, I think Casey Quinlan was onto something by crowning Dr. Greenbaum “Douche of the Week,” but after closer inspection of his Blog post, I hereby nominate him for “Worst Doc of the YEAR!!!” What do you think?
December 4, 2012
Dear Dr. Greenbaum:
The Patient Perspective
I do not have a medical practice like yours. In fact, I’m not even a doctor but I’ve been battling the autoimmune and incurable illness, Crohn’s Disease, for the past 30 years so I am somewhat of a “Professional Patient.” With that experienced perspective, I read your 6-paragraph Blog post dated November 30, 2012, entitled “Kiss My …” and I was repulsed by your utter disrespect and lack of professionalism, compassion and patience for your 75-year-old patient. Your behavior is unacceptable in ANY medical specialty but especially so in Rheumatology because that medical specialty is usually one of last resort for patients with chronic and/or inexplicable pain or conditions which other medical specialties are not able to identify. As a result, they refer these patients to doctors like you who then assume the great responsibility of often being the last bastion of hope for these long-suffering patients. But to learn that you vilify certain patients who merely “hassle you” in a written, GLOBAL forum, for all the world to read, for the rest of time, is disheartening at best and “creepy” or even criminal at worst, in terms of your compliance with HIPAA requirements and possibly even Billing Fraud, depending upon your actual billing practices in the event you accept Medicare and Medicaid patients and payments.
HIPAA & Patient Privacy
More specifically, I believe your November 30, 2012 Blog post about this 75-year-old’s patient’s medical ailments and complaints is an egregious violation of at least the spirit of the “HIPAA” law which was enacted to require Providers to follow procedures that ensure the protection and confidential handling of protected health information such as ‘personally identifiable health information’ held or disclosed in any form including orally, written and electronically. The HIPAA laws are simultaneously general and specific and often difficult to abide by or enforce, except if you follow a simple logical rule. That is, treat ALL patients’ privacy and records with the same conscientious care you’d use in handling the medical records of a beloved family member. While you did not disclose this 75-year-old’s name, you may have disclosed enough information in this Blog post that he, his family members and his former physicians, might be able to figure out exactly whom you were talking to, and about, in the Blog post. Accordingly, and applying the aforementioned rule of logic (and compassion), if that was your 75-year-old mother, would you want a fellow physician to talk about her like that to a GLOBAL audience via a written Blog post?
The following passage is the 1st paragraph of your Blog post:
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 super-bill, 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.
Billing Annoying Patients More than other Patients
As a chronic patient with voluminous medical records, I can surely understand your policy of charging a patient more if he or she requires a significant additional amount of your time than the typical patient. That said, and I do this with my doctors, if a patient comes in for a consult and clearly demonstrates that he or she organized their medical records in a succinct and logical fashion out of respect for your time, there should be no additional charge. After all, in such a situation you are merely doing your job but in a more diligent manner due to the rigors associated with the complexities of a particular case. Regardless, I guess doctors could disagree about billing practices in such situations but YOUR credibility is lost when you stated you’d charge more for “patients who take an inordinate amount of time, or patients who annoy me in some other extraordinary fashion.”
Who is to judge if a patient is taking an “inordinate amount of time?” Maybe they are handicapped, disabled or simply nervous about telling you their story after being disappointed or intimidated by so many doctors on their journey to simply being diagnosed? Maybe their underlying illness causes a condition which affects their ability to act in a “normal” fashion? Have these possibilities ever crossed your mind when you devised your God-like billing practices which I am sure run afoul of Medicare Billing Practices? What about the patients who “annoy [you] in some other extraordinary fashion?” I am quite familiar with the “Current Procedural Terminology” billing codes or “CPT” codes and I have never come across a CPT code for charging a patient more simply because they are a pain in the ass. How do you justify that? Don’t you realize that by admitting you do that, you are possibly committing billing fraud? Again, have you ever stopped to think that these “difficult” patients are merely scared from having fought through the arduous bureaucratic healthcare system in the United States? If that’s the case, do you really think it is fair to force them to, in essence, pay a “tax” for having put up with pain, disappointment and frustration? If life were fair, these courageous folks would get a DISCOUNT for all their troubles!
In Paragraph 2 of your Blog post, you state:
I charged him level 5 for taking so much of my time, for bad-mouthing his previous doctors, and for incessant whining. Although he had developed RA only about a year and a half ago, he gave a long and ruminating description of his treatment, or mistreatment, as he saw it. (Underline and Bold Emphasis Added.)
You Charge Extra for Whining Patients?
So, you charged this 75-year-old man a higher patient fee than usual because he was bad-mouthing previous doctors, whining about his situation and providing you with a boring patient history? As a person trained to be a medical doctor, what type of “telepathic” training enables you to make these decisions? Perhaps the patient wasn’t “bad-mouthing” his previous physicians and just trying to tell you the truth about how he was treated by previous physicians? Or, are you of the belief that physicians can never be wrong nor can they ever mistreat a patient? We both know that the truth is probably somewhere in the middle but you seem to classify anything a patient says as “suspect” simply based on its source.
Then you cited him for “incessant whining” as if you knew exactly what it felt like to go through all he had to in order to get to see you, such that you knew what to differentiate as “whining” from what was simply the articulation of chief medical, physical or emotional complaints. How arrogant are you? I suspect the only pain, disappointment and frustration you feel is when the new Mercedes Class of cars comes out and your present lease is not yet expired. Do you have any idea what it is like to do battle with the pervasive effects of an incurable, painful chronic illness like Rheumatoid Arthritis (“RA”)?
What do you know about suffering from Rheumatoid Arthritis?
Do you have any idea about the physical, medical, mental, financial, emotional, professional, psychological, social and familial effects a chronic, inflammatory, autoimmune disease like Rheumatoid Arthritis can have on a patient? You obviously DO NOT as demonstrated by you classifying this troubled 75-year-old patient as one prone to inappropriate “incessant whining” and writing that in a Blog for the whole world to read as if THAT will educate people about RA and help them cope with the horrific disease. What’s worse is that you used these observations to justify charging this poor patient more than usual when it is this type of RA patient who needs a doctor willing to show some compassion and understanding and spend an extra few minutes with him. Based on your “golf club bedside manner” and “scale of annoyance billing practices,” you should be barred from treating patients with chronic diseases like RA which have such serious pervasive effects. Moreover, based on this Blog post, I wouldn’t trust you cutting my dog’s toenails, and I’m not even through the 2nd paragraph!
Do you discount bills when YOU Whine to Patients?
Then, before the 2nd paragraph ends, you WHINE about the apparent thorough Patient History you were given by this 75-year old. Following your example, should this patient then get some type of refund for the amount of whining you did during the consultation? You tempered this “Patient History” with the phrase, “as he saw it.” From what other perspective was this patient supposed to give you a Patient History? Do you put ANY stock in the words of patients? Have you forgotten that your most effective tool in medicine is your ability to LISTEN? Then you included very specific patient notes in this Blog post about the patient’s response to Prednisone. I reiterate that such a specific notation could help identify the patient and then cause a HIPAA violation. I am only commenting on this Blog post because YOU made it public and I want to make sure you don’t do this again with another patient.
A 75 year-old just being 75
In Paragraph 4 you reveal one of your trade secrets: “If all else fails, examine the patient.” Apparently, it was a very long patient interview because the man is 75 YEARS OLD and that logical concept seemed to escape the grasp of your narrow mind. While examining him you added that “[j]ust for good measure, he spent some more time bad-mouthing his previous foot-doctor.” Dr. Greenbaum, this man is 75-years-old and “talking” is what a person of his age does. But that does NOT give you license to broadcast his “issues” on a Blog for the entire world to read especially in such a negative light whether he has a little Dementia, he had valid issues regarding his previous foot doctor or he was just being 75. In Paragraph 5 you indicate he had a “bunch of other chronic medical problems including neuropathy.” Was was it then a surprise to you as to why he had such a long Patient History? Maybe he was recently widowed and didn’t know how to organize his medical records or thoughts properly. Did you ever think of that or do you simply look at test results or use you telepathic skills to diagnose and treat a patient?
You have the sincerity of a 3-Card Monty Con Artist
In Paragraphs 5 and 6 you indicate that you and he exchanged banter about you knowing his neurologist. You indicate at the beginning of Paragraph 6 that “I always think patients feel a little more confident when their doctors know one another.” However, you prefaced this logic saying “i[t] was a throwaway comment on my part….” What does that mean? Do you really want to make a “connection” with a patient and make them feel comfortable or are you doing the least amount of connecting as possible just so the patient doesn’t out you for the jackass that you are? Then you explained the weird response you had elicited from this 75-year-old but, even by your account, it seemed like the patient was “playing” with you and trying to make some sort of “connection,” albeit a strange or unorthodox one, just as you claim you sought out to do by indicating you knew his neurologist. Observing the situation you wrote: “He didn’t seem demented or hateful, just weird.”
You Have the Bedside Manner of a Handball
Dr. Greenbaum, by your OWN ACCOUNT, the only person who seemed weird in the encounter you chronicle in this Blog post is YOU. What does “hateful” have to do with anything in a physical medical examination, especially one in which you couldn’t care less (and didn’t ask) about any stressful situations in his life affecting his medical condition? The fact that you wrote this all down and included it in a Blog post seems indicative of your instability as a person and possible incompetence as a physician. You’ve potentially violated a patient’s privacy and simultaneously revealed how you go about treating and billing a patient. You have the bedside manner of a handball and if there is a place in medicine for you, it is either in research or radiology, where your training can serve you and others well, and you will not have to interact with any live patients.
Become a Radiologist or Live up to your Responsibility
Lastly, if this 75-year-old man was your Father or Grandfather and you came across this Blog post on the Web, how would you feel? You, as a Rheumatologist, are the source of last hope for many chronically ill patients and they deserve to be treated with more compassion and dignity. I think your Blog post is disgusting and extremely troubling and I only hope that my informing others about this Blog post helps you take an honest look at how you are treating patients who, for whatever reason, rely upon you greatly. PLEASE try and live up to that responsibility.
Michael A. Weiss