Do Not Kiss Me
Do not kiss me because I have a suppressed immune system…
In “Kiss My…” a physician blog in Rheumatology News, Dr. Larry Greenbaum wrote, “I charged him level 5 for taking so much of my time, for bad-mouthing his previous doctors, and for incessant whining.”
Noontime Monday I clicked into the Facebook (FB) feed for the RA Warrior account. There are several pages I’ve “Liked” and supported, passing on numerous fans. According to FB, 66 of my personal friends “Like” the Rheumatology News page and I’m sure there are many more Warrior “Fans,” too.
I noticed the headline posted Friday “Kiss My…”
Reading the post, there was a sad familiar tone: dismissive, derisive, and callous. I sighed, but this is what I hear about from patients every day, so it’s not news. Back at work on my document, I had a second thought: “I wonder what others think of this? Do they see this rheumatologist the way I do from my unique position?” I really did not want to put the link on my Facebook page where 18,500 fans could see it and it could possibly cause uproar. I didn’t want to post it on Twitter where the patients in the community might be furious while the doctors they tweet with could become defensive.
If you know me well, you’re laughing now. That’s Kelly: strong convictions, but not wanting to instigate any turmoil.
I chose my private FB page which is mostly family, friends, and some patients I talk to frequently. The immediate response of another blogger, Afternoon Napper, loudly confirmed I was not alone in my opinion of the article.
Throughout the day I was trading emails with a doctor who’s a patient and I passed on the link. Here is part of a response I received: “It’s like he’s just trying to find holes in the poor fellow’s story. It is so sad the percentage of patients who get treated like complainers or psychosomatics because the doc doesn’t get it, or hasn’t ever had to depend on someone’s compassion and support as he tries to bravely face a scary diagnosis that can feel so disempowering which takes away more and more of all those autonomous tasks he used to be able to do without a second thought…” Wow.
FB privacy is relative; there are 500 friends on my personal page and there were 48 comments in all. The outrage seemed unanimous. Most commenters were rheumatology patients including those who work in the medical field, science, and law. They found Greenbaum’s piece “insulting, horrible, deplorable, arrogant, and condescending” and had concerns about him giving good rheumatologists a bad name.
Last night while the Redskins were clobbering the Giants during Monday Night Football, I was following this discussion and working on an important RPF document. I work very long days, mostly on RPF business or doing research, but when a hurting person comes to me for help I try to be there for them. Whether it’s one of my sons or a fellow warrior, I cannot imagine treating a fellow human soul in the stony way that Greenbaum does.
Let’s not lose sight of the care of this patient
- The bottom line is that the patient in this case received poor care.
- The doctor in this case seemed grossly unaware of that fact.
- Many patients were dismayed by the article, but well-educated rheumatology patients who read it also recognized how poor the care was and why.
Unfortunately Greenbaum is a typical rheumatologist in many ways. Like some other patients said, I feel like I’ve met him more than once. I’m not as knowledgeable of other specialties so the readers will have to inform me about that.
What are those archetypical traits?
- He cannot connect with his patient because he disrespects him.
- He doubts the gravity or dismisses the severity of his patient’s symptoms.
- He lacks a thorough understanding of his patient’s disease.
Because of these things, Greenbaum does not understand this dear man’s afflictions, missing clues that are obvious to me even through his jaded eyes. For example, I suspect the patient has had the disease much longer than he has been diagnosed and treated for it.
How are such unhelpful, and even noxious attitudes passed on to new doctors? One doctor, Scott Conley, wrote about how a rheumatologist mentor did that here, “AAFP Resident and Student Voice Deep Waters.” (My blog about this article is here.)
The account by Conley and those of other doctors and nurses with whom I’ve discussed Greenbaum’s piece prove that this is not an argument between doctors and patients. It is an argument about what is good and bad medicine.
- What is an acceptable way to treat fellow human beings?
- What are the limits of HIPAA? of Medicare billing?
- What conduct is acceptable in social media?
This afternoon, I saw numerous people had written to Greenbaum or Rheumatology News. If I were to speak to him, I might say this: “If it is so annoying to hear about a man’s circumstance living with Rheumatoid Disease, imagine how terrible it must be to actually live with it in your body 24 hours a day, 365 days a year.”
What should be the response?
- Physicians should publicly denounce what Greenbaum did.
- I call on good rheumatologists to publicly state the wrongness Greenbaum’s attitudes and behavior.
- Where are the comments? All rheumatologists and readers of Rheumatology News ought to insist they post the cancelled comments or remove the offensive article.
If your comment from the article was removed, I hope you took a screenshot of it. If you did, please feel free to post that image on my public FB page here. Another place you might re-post your comment is the post for the Greenbaum article on the Rheumatology News FB page here.
Recommended reading
- Yale Medical School Graduation Address: a Patient Centered Approach
- ACR REF Rheum Research & Courage That Won’t Back Down
- Some Rheumatologists Don’t Understand How Much It Hurts
- Dr. Dolittle and the Rheumatoid Arthritis Specialist
Some other blogs posting about the Rheumatology News blog by Dr. Greenbaum:
Hospital Patient
The Rheumatoid Rebel
Afternoon Nap Society
About.com Patient Empowerment Guide
The Lupine Butterfly
The Doctor Weighs In
Wow!! What more is there to say?!
And if it is medicare he billed like that (well if any insurance company can pinpoint who it is he is talking about) he has a bigger problem on his hands.
It’s like he said, “Yes, I am an ***hole and I’m proud of it. I bill illegally. Here I am publicly admitting it. Oh, and here is my name so that you know not to go to me or if you do, you should look for a new doctor.”
Deleting people’s comments? I guess free speech is only for doctors. Oh, wait. That will bite them where it hurts too.
Pingback: Kiss your @$$?? « The Rheumatoid Rebel
Holy Crap! Sic Em Kelly, there is no excuse for that guys post. People with that view get away with it because no one takes them to task. That dr isn’t worth a dime of what he gets paid. Just because you go to medical school doesn’t make you a doctor. Can’t believe that publication would let that get posted, leads me to believe this is how a lot of rheumatologists talk to each other behind closed doors. I get it, I worked in retail for a while, and everyone complained about troublesome customers. But then again, my job was to sell things and be polite. His job is to understand and listen to patients, and still be polite. Clearly, he is not being polite and understanding, and in a public forum no less. Sounds like the man was being a typical 75 year old silly man. How arrogant and rude and cocky this doctor is. May he rot in ____. I have no patience for people like this anymore in life. You can find them both inside the medical profession, and in many other professions. Also, sounds like fraud to me, medicaid ought to examine his billing office.
This reminds me of why my wife of 31 years and I are getting divorced. When she said no sex without you wearing a condom (scared of “catching” my autoimmune disease), I realized I was living with someone that didn’t have a clue what I was dealing with. This is the same attitude many have towards those of us dealing with an inflammatory arthritis. this doctor should have been a mortician instead of a physician.
Kelly, I went to that article you talk about. I wanted to comment, send the doc an email but I didn’t. His arrogance is so evident in his post. It is so sad….I pray his eyes are opened.
Their parents must have been SO proud to have TWO Doctors in the family! Funny how the last name of my Doc is different though… but obviously cut from the same cloth. I want to shake my Doctor like a rag rug. Does he REALLY think that I WANT to be there either? HE chose this profession– I did NOT choose to be a patient. Derisive, dismissive, arrogant, ignorant, AND in power over the well-being of a human!? Sometimes, I think the only way to get a decent Doc is to get them right out of Med School– when they still have compassion, professional curiosity and have yet to be jaded by the realities of the field they have chosen.
Have you read about Dr Tylenol, Phyllis? This is a brand new doc, just out of school. And we (my daughter and my friend) thought I was the very first person this doc had ever seen with Rheumatoid. I was afraid that time too – of what people would think of me for judging a doc. So, I sat down and just wrote out exactly what the doc said and left it up to the readers to decide whether that is adequate. https://www.rawarrior.com/keeper-or-loser-im-not-giving-up-but-what-do-you-think/
It is the training as Dr. Conley writes – and I hope my friend Dr. Bob West will be able to comment (So far he has tweeted about this post) – He also tells me, as a professor at a medical school, that it depends on who trains them.
I read the article when it originally came out, and was disgusted, and sadly familiar with what was said. I appreciate that this doctors time is limited, and that some can be frustrated with patients. But his calling is to help people, his skill is supposed to be LISTENING to the client, using scientific information and putting the two together to diagnose and treat. He failed this man in a huge way.
My first rheumy doc was also very dismissive of my complaints. He rarely ordered labs, and even more infrequently addressed my physical symptoms. Rheumatologists are scarce where I live, so I stuck with this doc for years. He charged me $500 to write a narrative for Soc. Sec. Disabilty in 1996! Imagine what he’d charge today! Sometimes I think people go into medicine ‘cos they have a good memory, and just want the respect and the big bucks.
The medical school that educated this doctor should be ashamed. And so should his parents! Did he not realize that doctors actually treat people? His lack of empathy and knowledge is frightening. It’s very unkind of me, but I think if he came down with RA it would be the perfect ‘educational’ experience. He should go into research immediately where he will not be inflicted on any patients.
Colleen, let’s not inflict this guy on the research end of things either! It’s so clear that he is not able to consider the validity (or not) of his interpretation of events, which is the absolutely wrong way to go about either research OR patient care. People like this guy need to go into a completely different field, just ditch digging, where they cannot screw things up with their arrogance and overweening and unwarranted self-confidence. Or, if they do screw up, they only bury themselves and not their patients!
I feel like crying as I read this…not just because of the heartbreaking horrible behavior of a fellow medical practitioner but because I am in so much pain this morning. Having spent yesterday nauseated from my methotrexate and awakened this morning with horrible wrist and shoulder pain. I am a recently certified nurse practitioner and I am looking for a way to serve the RA community and assist other practitioners to understand how we feel. Please pray for me in my search and I am open to any suggestions. Where can I best serve?
Mary Jo, is it ok if I email you? I do have an idea for you.
Yes, Kelly, please do.
Mary Jo, have you tried salted corn chips? I first tried fritos on Kelly’s suggestion, but now I get the salted corn chips from Whole Foods. Just a couple, with some water, really helps. Ginger is another idea. Hope you feel better.
This guy sounds similar to the rheumy I saw for almost a year, and this kind of callous arrogance isn’t limited to male doctors as the rheumy I saw was a woman! Had to beg for plaquenil….wouldn’t give me salagen or evoxac for th severe dry mouth, which is why I had to get some cavities filled. Tried to convince me I had fallen arches and fibromyalgia. Didn’t do any monitoring of blood work when I saw her, no imagining. Told her how much pain I was in and she wrote me off every time. The only good things is I’ve never gotten any bill from her, so my insurance must have covered everything.
Thankfully my new rheumy is different, and am now on mtx and evoxac. Says what I have is more sjogrens than RA, but keep having more RA symptoms.
Kelly,
I sent an email today as this article was very offending. Below is what I told him and thank you for sharing the article.
Mr Greenbaum,
As someone with RA your article was just plain offending. You can never know what a patient goes through every day, unless you have this disease. How can you call yourself a doctor when you have no sympathy for your patient? While there are times when a patient may take a little more of “your time” than you would like, but really is it not the patient’s time since they are paying you for it?? Saying he was “taking too much of your time” is just telling those of us who suffer this disease how little you care for your patients. How can a doctor say “patient who annoy me in some other extraordinary fashion”? You sir should give back your license as you have no business being a doctor.
Rosie Docherty
I don’t think this is even his “worst” blog post. The “squirrely” post where he takes an anxious/depressed patient off her meds to get rid of her alopecia?! She had every right to complain that he didn’t tell her how to tapper! Why wasn’t her psychiatrist consulted?! He could have easily swapped her SSRI with an SNRI and kept her anxiety under control…maybe even help with her pain a little.
Also, where are the blogs by the second blogger (there is a link to “meet our bloggers”). The whole section is garbage…what passes for journalism these days…puffffft!
The problem with some doctors is they have never been truly sick so they can not relate to what the patient is feeling. They are educated in the technical terms and may be competent but if they can not pigeon hole a patient to fit the textbook they are unable to relate.
oh, and for kicks, try reading the older blog posts by that guy, they all reek of the same “i’m smarter and better than my patients” attitude. He ought to spend more time reading research on his chosen profession than writing pompous blog posts, and solving problems. Have some integrity dr. His bio says “he blogs to explore the humor” or something like that. So, “superman” and “hit by a truck” is so freaking humorous? How the $u@k else are we going to explain our frustruations and experience to the dr? Of course that is everyones experience with prednisone taper usually, is it so humorous?? Rude. I feel for his patients.
Looks like this guy’s prior blogs have been taken off the site! In fact, when looking at the “Meet Our Bloggers” page, there is only one – a pleasant-looking young Asian woman. They must have taken a lot of heat! I don’t have enough money to become a “premium” member and comment on the site, so I didn’t. And, and anyway, I’m too much of a lady to share what I REALLY think of this person! Himself, after reading that blog, said, “This guy is weird and kinda arrogant. I don’t think I’d want to go to him.” That’s all that I can put here because the rest is censored and nasty! He did say that if a doc treated me that way he’d have to “get in his face” about it!
Kelly, I accidentally tacked this comment on the wrong post (blush, was rereading some of your related links) but am reposting here.
Part of me is glad he reveals what he thinks because it shows how far we have to go. Unspoken attitudes are more difficult to address, even if common. I too am dismayed by the writer’s attitude and tone. It’s also unethical to bill patients (and thereby often insurance or taxpayers as well as the patient) more because you don’t like them. That’s the doctor’s personal issue to deal with. It’s sad when doctors are so burned out that the extra time some patients require cause them to lose patience and compassion.
It’s up to the doctor to listen empathetically but to redirect if time is running short and to set a couple of concrete goals that are most important to the patient before the end of the appointment, whether that’s evaluation of new symptoms, pain control, investigation of DMARDs, etc. It sounds to me like one of the patient’s primary goals for the appointment was finding an empathetic rheumatologist, and that’s important for a first appointment. That the patient joked and that the doctor did not get the joke, even if they don’t share the same sense of humor, indicates a fundamental lack of connection.
For those doctors want to practice more compassion, it seems like it should come more easily. Connect with us and for those who do, stop objectifying us. Let go of the disdain you show as we describe our symptoms or pain and try to attribute the causes for them. We’re all the same–we’re people first, both doctors and patients. Degrees and status don’t make one person better than another, than the patient or the person who bags your groceries or mows your lawn. Of course, a certain percent of people will never have compassion; they don’t want to have it. We probably have to write them off.
Oh, MY what a horse’s patoot ! How can that doc have the stones to actually publish an article about his bad behavior ? Why won’t anyone hold him accountable ? I have seen this type of behavior with Obstetricians as well. I am so grateful for a kind rheumatologist !
How dare this “doctor” punish a patient financially because he “whined’ to much. Who the hell does he think he is? This man should be reprimanded in some severe manner by the AMA. Maybe he needs to go back to school or better yet, change profession completley.
Thanks, Kelly!I feel better just going to the fb page and posting my thoughts on this “doctor”.
My comment is directed to those rheumatologists who seem to have trouble understanding why some patients don’t always have a smile on their face, and who sometimes post blogs that are “negative” in tone. And who tell us we need to try a little harder to not be so negative, because apparently we are scaring their other patients and making it so much harder for the doctors to explain to their patients about how everything is not all doom and gloom. And who also imply that perhaps we are not as bad off as we think we are, and negative thinking leads to negative results.
If we are “negative,” it’s usually for two valid reasons.
First, we are the patients who are not getting better, despite all of your claims that so many of us will go into remission, and we are both frustrated and sad about it.
And second, we have dealt with one or more Dr. Greenbaums in our lives. And our spirits are crushed because we think to ourselves, how are we ever going to get better when our physicians are so cruel, insensitive, and dismissive.
So please stop judging us.
Yes, everyone who tries to comment on that post should DEFINITELY copy & paste it before clicking SUBMIT. Perhaps the set of disallowed comments can be posted somewhere, shining further light on what this doctor didn’t want to hear.
Or maybe not! I try not to jump to conclusions until the evidence is in.
Superb post, Kelly – one of the best I’ve ever seen you write. You are SO perceptive, and SUCH a good teacher.
Thank you, Dave. It always means double to me coming from you!
I hope people do document their cancelled comments. So far their FB is still up & people are posting there. Not sure if it’s moderated.
I am very surprised Rheumatology News allowed this to be published. It’s bad for rheumatologists as a whole, casts a dubious shade over even the good docs. I really like my rheumatologist, he’s not perfect but he is very kind, listens, and is always positive even when I am down. But this article has far reaching consequences… It made me doubt my own rheumatologist. Does he think I’m a whiner? Is he annoyed with me… Irritated that I haven’t responded to treatment? This article will undercut some patients’ confidence in their own doctor, and prevent proper communication.
good points, Kryssie. This is not the only article like this on that blog – there are quite a few. And patients have been discussing other rheumatology posts in social media (blogs, facebook, twitter, etc.) that have this dismissive, minimizing tone. You make a great point about how it undermines communication in general. Like I wrote in the post, it can give a bad name to good rheumatologists. Everyone in the profession should be concerned about this attitude and whether it’s allowed to continue to increase or a change is made.
I’m also a former medical coder and he can’t charge for a level 5 consult based on face to face time or review of records. I wonder if there is a phone number to call to report something like this. I am sure Medicare and other large insurance companies would find an audit very fruitful.
Yes, Kryssie, I heard from a couple of other coders already and someone in hospital administration who said it was not legal what he did.
I’m sure that there are numbers to report the activity to Medicare and his state.
I have RA but I am lucky.
I felt like something was wrong with my hands for 3 years. Each time I went to my family doctor for a physical or anything else I would mention the pain and swelling in my hands. Each time he would just tell me they were “working hands.” The second year physical, I asked for an RA specialist referral. The family doctor ordered a blood test. It came back negative. I let it go, but I knew that it was more than “working hands.” The third year physical I asked again for a referral and got one. Dr. Mike Malloy (Tulsa) listened to me, took one look at my hands and said he thought I had RA and that it doesn’t always show up in blood tests or X-rays. He ordered X-rays of my hands which didn’t show any arthritis. That was about 3 years ago. I’ve tried Methotrexate, Humera, Enbrel and they all either elevated my liver numbers or I couldn’t tolerate the side effects. Now I am taking Orencia home injections. It has slowed the progression but not stopped it. I now have started having pain in my feet. But I feel lucky when I see other RA patients bent over a cane or walker with deformed hands. Other than constantly swollen hands no one would guess that anything is wrong with me. I feel lucky that I’m not in the shape some of those other patients are. And with a caring doctor maybe I won’t get like that. I ‘m lucky that my RA doctor does care about me and my treatment.
Dear karen:
Thank you for the very thoughtfilled comment on your experiences with Doctor Greenbaum. Your first hand experience is very helpful to hear about. All doctors should have to be recertified each year in some way and it would seem reasonable that they should go each year for some sort of refresher course that would help them deal with burnout. God forbid he hasn’t always been that calous. What with the internet and mass communication worldwide I see no reason why a national data bank couldn’t be set up where patients could rate their doctor by using a provider number or something after each visit or once a year or what ever. I frequently look up doctors before I seek them out and read what other patients have to say.
apparently the consumer rating sites all have very low ratings for this doctor as well.
OMG. This was my doctor last year. I found him in the phone book and decided to try him after going to my first RA doc, we called doc#1 doctor death. Lol he thought you should just deal with your RA. So, off to dr Greenbaum. He was very cold, very distant. He would say I know you’re in pain, but I don’t deal with narcotics. Oh I see some joint damage, let’s just stay on the prednisone and see where it goes. Honestly, he was in the room 3-5 minutes, maybe not that long. My husband and I are new to this. I was diagnosed with severe RA in December of 09. There were weeks where all I did was cry, because I hurt so bad and felt so hopeless.
I have a new RA doctor now. He is almost 2 hours away, but worth every mile. He actually looks me in the eye! Sits and talks to me, together WE made a plan of attack for me. Wow. What a difference he has made in my life.
You know, I thought it was me. There’s something wrong with me. I felt like the rest of my life was a long grey dismal existence. I can’t believe dr Greenbaum thinks its ok to treat his patients this way.
Why would a doctor choose to be in a field he has no compassion for? I pray ALL his current patients get to read his article.
Kelly,
As you know, a book could be written about the very topic in your reply I am replying to.
Briefly, two changes in physicians seem to occur simultaneously as they age: they become more knowledgeable, and they become more jaded (and less empathic). Dr. Tylenol, newly-minted, appears to be the exception to the rule, in lacking both. How can a new doc lack empathy? The recruitment process is rigorous, but with 160 new students per year, a large fraction of phonies (i.e. they don’t want to “help patients”, they want to “help themselves”) will gain acceptance into med school, after which they are home-free (one-way traffic, essentially). Is there not a weeding out process along the way? Yes, a very feeble one. How could a new doc lack fundamental knowledge after 4 years of med school and 5 years of post-graduate education (residency and fellowship)? I’m not sure since, in part, I’ve not been directly exposed to residency training. But it’s always important to keep in mind that fully HALF of doctors graduating with an MD degree are worse than average (eye wink) and the lowest ranking student in each class of 160 students is still called “doctor”.
We’re all looking for the rare doctor who has increased knowledge and wisdom with advancing years who simultaneously refuses to become jaded, unlike the majority. It’s THESE doctors that patients feel are what med schools should be graduating exclusively, but unfortunately, that’s a pipe dream. Admissions committees do the best they can, and faculty try to apply strict rules, but it’s not a perfect system, and unfortunately patients pay the price.
Again, a book could be written on this topic. I’m sure there’s many gaps in my reply that will lead to additional questions…
– Bob
Possibly so. And yet, the perspective you provide is still invaluable to patients who often wonder simple things like “why can’t I find relief for my suffering, a doctor who cares to try and who believes me?” etc. It is hard for us to imagine all the details involved. So thank you so much for taking time. And no doubt in the midst of finals when you must be swamped. Thanks, Bob.
Karen,
> I pray ALL his current patients get to read his article.
And that’s why I hope social media helps collect feedback like this.
Any of you who’ve known him, are you familiar with HealthGrades? He only has ten patient ratings there http://www.healthgrades.com/physician/dr-larry-greenbaum-2lmt4/patient-ratings but in every category he’s below average, especially the ones about listening to patients, helping them understand, spending enough time with them.
On Vitals.com http://www.vitals.com/doctors/Dr_Larry_Greenbaum.html he has 1.5 out of 4 stars – about the same proportion. But that’s based on only two people.
Information like this can truly help drive the new era of consumer-driven medicine. I wonder if that poor 75 year old would have gone there if he’d seen this.
(And you who do have great doctors, have you given them thumbs-up on HealthGrades?? Let’s help the best ones get recognized!)
Great points, Dave! The RPF is recognizing good doctors with a special program to make sure the good ones get recognized and can be easily found. And we’ve done some of that already via social media through RAW. But we can only do that if patients speak up about their great doctors and let us know so other patients will know where to turn for good care. The program will be made public on the rheum4us.org site asap.
I can think of only 3 other posts like this on this site – out of 700 – where we talked about how a doctor failed to provide decent care (without naming names) – and each time, we’ve asked patients to send in names of good doctors that we can consider for the RPF listing. I wish that at 2am when I posted this, I would’ve remembered to do so. I truly agree that it’s the only way to solve this problem & the approach we have always taken.
IF YOU KNOW A GOOD RHEUMATOLOGIST WHO GIVES YOU (or your loved ones) GOOD CARE, PLEASE SEND HIS/HER NAME TO KELLY AT RHEUM4US.ORG ! THANK YOU!!
That speaks volumns! I have checked those sites for a new doctor and often the number of ratings are small, but I don’t think I have ever seen ratings that low!
Something to remember – for the most part, only unhappy people fill out those forms. Those who are basically happy with their care and their relationship with their doc don’t go to the sites much less fill out the survey. I’d trust my own eyes and my medical/nursing knowledge to judge offices and staff over a disgruntled patient whom I do not know.
What an ugly man. The patient has one ruined finger and one ruined toe from medical treatments gone awry, and saying this out loud is seen as whining? He used metaphors to describe how he felt with higher and lower doses of prednisone, and the doctor doesn’t like that? From the description, the patient sounds like a sweet and somewhat courtly older gentleman, and for this he gets charged as much as possible? The patient deserves better, and the doctor deserves plagues of locusts, boils, and rats.
So well said Anne. Exactly right: “The patient has one ruined finger and one ruined toe from medical treatments gone awry, and saying this out loud is seen as whining?”
Hi, here is a copy of my e-mail sent to DrGreenbaum
Dr Greenbaum you need to return the money you billed this patient and apologize for providing no care. This man came to you and expected to be treated with respect. As soon as you labeled him with “incessant whining” you started to cause him harm. He is a 75 yr old man whose life has been totally turned around by this “Arthritis” and he is in pain. Bad mouthing ( and here I want to insert you pompous Moron) is him telling you how he feels that he has been let down by his previous providers. If they were as dismissive as you he has just cause to feel betrayed.
All you had to do was look this man in the eye and say I am sorry this has happened to you. Then you had to actually listened to him. Because , you see, he pays for your so precious time. An assessment without prejudice would have been the next step. Because, you see, that is what you are supposed to do.
A little background. I am a RN,CCRN,CMS of over 20 years. I have had the honor of working with knowledgeable and caring providers. I am also a person with RA. I went from a person who was referred to as ” a phenomenal nurse” to some one who could barely perform basic ADLs. I had one Rheumatologist that should have retired 10 years prior to treating me. My other Rheumatologists are awesome, caring providers who are not too full of their own importance to listen and understand what patients are trying today.
You may be a decent person but, that is not indicated in your Kiss My… .Please step back and take an honest look at yourself. If this is not possible, ask someone to question your patients and coworkers anonymously. At the bare minimum, pause before entering an exam room and try to realize that this patient trusts you to be knowledgeable and caring.
We don’t know for sure that he wasn’t being facetious about the billing, especially since it was an initial consult that would likely be long. I read some of the back posts and it seems to me that he’s being tongue-in-cheek about some matters rather than mean; with the lady with the antidepressant tapering, the office did try to reach her. However, I haven’t read them all and may be missing something.
I don’t know him, but I would like to give Greenbaum the benefit of the doubt if he hears about these concerns that he takes them to heart. ACR and its members need to know more about patient experiences and how attitudes affect so many of us.
I stand by my statement that the blog post is too disdainful, but I don’t feel from what he’s written in other posts that he wouldn’t listen to patients. But I also worry about the effect our approach can have on an individual, especially one who may be willing to discuss with us and learn from us.
Thank you Frida for asking us to think deeply about this. And I am.
At least two of his patients have posted about his poor care, as well as numerous others on rating websites who all rated him much lower than average.
I think perhaps you’re right that he thinks what he wrote is funny. However, it doesn’t seem too many others agree. I too read several of his other blog posts, and found his tone dismissive and callous.
A woman on anti-depressants could be changed to another if there were side effects, but only with the advice of her psychiatrist who prescribed them – just withdrawing them unilaterally seems poor judgment in my opinion.
Regardless of any of that, many leaders in healthcare communications for social media have agreed that the manner in which he speaks of patients publicly is unacceptable. And my point was that it clearly reveals his dislike for them, making it too hard for him to respect them and treat them.
You’re right that the prescribing physician should have been consulted with an anti-depressant; my friend’s brother committed suicide after a few days after he changed anti-depressants. That’s a high risk period for many patients.
Reading through your other posts, I know that you really want to change the attitudes of health care professionals towards patients and their pain. I do too. Sometimes I don’t know what will work; even grabbing them by the lapel and whispering in a gravely voice, “listen to us” wouldn’t work. I like that more students are shadowing patients in medical school and are taking classes in medical humanities or medical storytelling. But it depends on what’s offered there–often the stories aren’t diverse or are from the perspective of a patient who’s a doctor. I think only then are patients believed–when a doctor is a patient.
funny you’d say that! as you see, I quoted one in this blog post & I have other plans I can’t really share, but I’m open to all strategies. And pressure from the public is another one…
and no, I never thought the lapel thing would work, but it would make a great ad. lol. I so agree arguing w/ them is useless that I”ve never even told one dr that I think they are wrong – they just make it so obvious that they are completely closed off to the possibility of input of any kind from a patient. Can we imagine if the old man in the story stood up and said, Doc lemme tell you why you’re not right about this foot surgeon..
No, in a way, I think the man DID try to explain it, but it was dismissed. A closed mind is a closed door. And this docs mind seems closed to me.
Kelly This Doctor is in violation of HIPPA! He has given enough of a discription of the patient for him to possibly be identified. This is very serious and can carry high legal ramifications. Not to mention that poor patient could sue his pompous butt for defamation of character.
Oh, this is all so sad, but thank you so much Kelly, for all you have done. We are such smarter patients now. I’m lucky,
I have a good rheumatologist, but I know I wouldn’t have the care I get from him had I not been able to have such informed conversations with him. I’m armed with the info from you and everyone here at each visit.
I was devastated 2 years ago when first diagnosed, but now feel like a warrior. Such a great choice of names for the site Kelly. perfect.
I’ll add my doctor to toRHEUM4US .ORG
Thanks so much
He’s definately in the wrong profession ..sounds like he should have been a food critic of MacDonalds and wasted all those years in med school !I hate to say it ..but I find with this type of personallity ..he still wont get it anyways ? Sadly there are many out there like this..I don’t know if there is much we can do about it ..except ..remember that Doctors are not gods..and you are in control of your body and care of it ..interview your doctors ..and if they are not satisfying your needs medically or otherwise ..fire them ..and look for another one. Talk to patients who are very satisfied with their Doctors and go from there..Doctors provide us a service that we pay for ..if you are not satisfied ..or you find them incompetent ..cold ..or ignorant ..like this man ..move on ..we are never bound to these people ! I’d have to guess this man has absolutely zero respect in his facility , practice and from his patients. He can’t stay in business if he has no patients ..hopefully by publically showing his disgust for his patients that will help in keeping RA patients away from him ..and giving him what he wants ..not to be bothered by …ahhh …his patient?
Here is a copy of the email I sent to Dr. Greenbaum. I doubt he’ll read it, but it made me feel better 🙂
Dr. Greenbaum,
It was with a considerable amount of dismay that I read your comments of November 30, 2012 in Rheumatology News online. As a career prosecutor who has sat through many, many meetings with crime victims over the years, I am familiar with compassion fatigue and the resulting need to vent to someone. Without even the consolation of being able to bill at all for sitting through such meetings, much less at an enhanced “consult level 5” rate, I have always been able to confine my complaints to a moment or two of grumbling to my co-counsel or secretary. It is my hope for the sake of your other patients that your publicly posted comments, which to my ears sounded much like the incessant whining you attributed to your patient, were the ill-considered expression of momentary frustration and not a reflection of your daily outlook.
As a patient suffering from rheumatoid arthritis at what seems to me a young age, and with the benefit of a passable education, I still occasionally struggle with knowing what information is helpful to share with my rheumatologist. Furthermore, striking a balance between truthfully answering the questions “How are you feeling? How are your meds working?” while trying to strike a positive note is difficult. Over-sharing, from an elderly patient diagnosed relatively recently, doesn’t seem terribly unexpected.
What troubles me most about your comments is that I failed to note even the slightest sign of compassion for your patient. Even at thirty-plus years younger than this gentleman, my experience with rheumatoid arthritis has been that it is a disease I wouldn’t wish on my worst enemy. I feel certain that given the choice, your patient would happily have traded his symptoms for the opportunity to merely hear someone else talk about them.
Undoubtedly my comments are not the only ones you have received in reaction to your article. It is my sincere hope, both for you and your patients, that through those or some other source you receive a different perspective on your work. Your knowledge and experience enable you to affect positive change in your patients’ lives and that is a privilege not extended to many people. I wish you all the best in your efforts.
Suzanne Owen
This is what I sent to Rheumatology News: rhnews@elsevier.com
Hello,
On behalf of thousands of patients with Rheumatoid Disease I cannot begin to express my deep regret that this post has been allowed to stand in your publication. Many of us with RA have experienced this type of treatment which is a disservice to the profession of rheumatology, to the pursuit of badly needed research on aspects of the disease that are not yet understood, and to the humanity of us all. I would ask that you please print an editorial that clearly addresses that such attitudes are unacceptable and retracts this article altogether.
I’d also like to know why we cannot comment on the site to the post?
Thank you,
Helen
Helen, please take a screen capture or even a digital photograph of your comment that is not being posted on their site. You could email that to me if you do. Thanks, Kelly
Hi Kelly,
Thank you for your reply. I sent the email to rhnews@elsevier.com just as I posted it here because the Rheumatology News site would not allow a comment to be posted. I also could not see any other comments.
Kelly, I expressed to you privately a very devastating experience I had, as well. You have said that you are open to all suggestions. I suggest that a letter of complaint be written to the American College of Rheumatology – c.c’d to the licensing board in his state, and to the Editors of Rheumatology News by either or both the Rheumatoid Patient Foundation Board and RA Warrior. If you’d like to start a petition, I’d be willing to sign. You have done TREMENDOUS work to help de-mystify and end the stigma of Rheumatoid Disease. Because the disease is not well understood, there can be a tendency to blame or dismiss the patients’ concerns. We cannot tolerate patient abuse. There have to be consequences to Rheumatologists violating ethical treatment of patients. When we are alone and enduring patient abuse, it is very very difficult to have any effective voice but a collective voice can and will be heard. You are the master of diplomacy, highly intelligent, and well-respected. I will support whatever decision you make in this incredibly offensive situation but please let us know what action will be taken.
IMO, this doctor is committing fraud by overbilling so I sent a Medicare fraud tip, it’s simple to do – just go to:
http://www.stopmedicarefraud.gov/
and look for “Report Medicare Fraud Now”.
Hi. I’ve done some searching about Dr. Larry Greenbaum. He is not listed with the Indiana State Medical Association. Indiana State Medical Association http://www.ismanet.org/directory/index.htm
He is listed as a member of the American College of Rheumatology. This college has a code of ethics for the professional conduct of Rheumatologists and a complaint process.http://www.rheumatology.org/about/governance/code_ethics.asp
Here is his contact information:
Larry M. Greenbaum, MD
Member Type: ACR Fellow Member
Indiana Internal Medicine Consultants
701 E County Line Rd Ste 101
Indianapolis, IN 46143-1070
Ofc: 317-885-2860
Fax: 317-885-3789
Time Spent: Patient Care, Teaching
Disciplines: Adult Rheumatology, Internal Medicine
For complaints about Doctors in Indiana, the Attorney General’s Consumer Complaint must be completed: http://www.indianaconsumer.com/filecomplaint.asp
so today I had my 3 month rheum visit. I see a fellow, with various attending doc over the last 3 years. It is due to my crummy health ins, but I’m actually happy to do it. The fellow was quite kind and listened, and took her time. The attending doc… in a hurry and somewhat dismissive. Especially since I had a low level of pain, and I’m not “typical” (stiffness at night, not morning, gasp! and very migratory) Anyhow, they seem reluctant to believe me sometimes when I come with no pain or swelling, thank god my rf factor and ccp test initially was very high. Anyhow, my point is this, I had a lot better interaction with the fellow than the attending doc, and after I was asked to fill out a review and questionaire on the fellow. I made sure to give glowing reviews and comments on her ability to listen, in hopes that maybe she will remember that in the coming years of her practice. The questionaire was pretty good, many questions pertaining to the doctor and their level of empathy and understanding. Hopefully they do something with the info that they collect…
So…as a former patient of Larry Greenbaum, after reading this disgusting blog post, I have reported him to the Indiana State Medical Licensing Board, the Johnson County Sheriff’s Department for insurance fraud. I also reported him to the AMA.
I am tempted to print out his blog post to hand out to people walking into his office so they can see what he thinks of his patients.
@Sally…The site you listed isn’t the actual state licensing board and therefore not all doctors have to register with them. The Medical Licensing Board of Indiana is the official government site. http://www.in.gov/pla/medical.htm
Thanks Delana. I appreciate the correct information : )))
No worries Sally. Since I live here and my hubby is an attorney, I kind of had the “4-1-1” on what to do. 🙂
Re: Dr. Scott Conley’s article.
I was having trouble figuring out what bothered me about Dr. Conley’s reaction to the RA patient who was labeled as “crazy” by the attending Rheumatologist. Although I appreciate that Dr. Conley had a more humane view of the woman, his interpretation that the woman was taking meticulous notes to gain a sense of control over a situation that is horrendously out of control only provides a PARTIALLY accurate picture.
The “patient” might actually be just as smart or smarter than the doctor providing care. She just might be taking meticulous notes because she sees herself as an “equal partner” in her own health care. She might be taking meticulous notes because often doctors don’t have the luxury of time to be as thorough as we can be logging our own histories. We have all experienced the consequences on our treatment when inaccurate or incomplete information is acted upon.
So, this is why I had a niggling feeling that there was still a tiny bit of condescension in Dr. Conley’s reply. We don’t want to be pitied. We ARE equal partners in our health care.
Pingback: The Rheumatologist's Rant - The Doctor Weighs In | The Doctor Weighs In
December 7th sent to: http://www.thedoctorweighsin.com/the-rheumatologists-rant/
Hello,
Thank you Dr. Salber for highlighting the most offensive article I’ve seen written about a person suffering from the ravages of rheumatoid arthritis. Dr. Drummond? You would characterize this article as “a little politically incorrect”? Have you read the code of ethics for members of the American College of Rheumatology? I am a professional member of several health care colleges / associations. I would never dream of thinking of or writing about clients / patients / people in the manner Dr. Greenbaum did. Perhaps your awareness of severe cases of compassion fatigue has dampened your ability to judge how truly horrendous any type of condescending attitudes are when inflicted upon people under doctors’ care. There is no place for anything but the highest regard for the humanity of all people among health care practitioners. We should expect nothing less and should press for standards of practice that reflect this basic ethic. Dr. Salber, thank you for offering to pass along to the Editors of Rheumatoid News our comments. Here is what I emailed to rhnews@elsevier.com:
Hello,
On behalf of thousands of patients with Rheumatoid Disease I cannot begin to express my deep regret that this post has been allowed to stand in your publication. Many of us with RA have experienced this type of treatment which is a disservice to the profession of rheumatology, to the pursuit of badly needed research on aspects of the disease that are not yet understood, and to the humanity of us all. I would ask that you please print an editorial that clearly addresses that such attitudes are unacceptable and retracts this article altogether.
I’d also like to know why we cannot comment on the site to the post?
Thank you,
During the high holy days of Rosh HaShanah Yom Kippur and now Hanukkah I think that Dr. Greenbaum needs some deep reflection in his choice of professions and maybe needs to step away.
So sad to have a doctor treating patients with his mind not at all involved.
I think they feel like they have been raked over the coals because I was unable to post a comment.
Their comments have not posted from day one. I do not know how they feel, but I think a lot of people tried to comment and were not posted. Also, there were people complaining on FB that some FB posts were also deleted. If a company wants to gain readers by using social media, then they are open to possibility of commenting. Feedback is part of social media (ie: blogging).
Sad.
No words to react to such a blogpost in rheumatology news…….
This doctor’s blog has spread like wildfire throughout the RA community. Thankfully we are so connected and now most know to avoid this doctor. We all deal with difficult or annoying people in our lives, whether it be at work or every day life…for him to feel entitled to more money because he had to deal with (in his opinion) an annoying patient is absurd. So much for having compassion for your patients…
And more importantly, it shows patients that this is unacceptable and they do not have to settle for being mistreated. We spend so much time talking about what good care looks like, but many have not had that yet and feel stuck or alone. The world must reject this callous dismissive behavior.
Hello,
I am new here. Is there any information shared on this blog or internet in general for recommendations of good Rheumy doctors from patients that like their doctors?
Thanks in advance,
Kristina
The first doctor I saw when I developed RA, but didn’t know what was wrong treated me terrible. She said I had to grow up and accept pain. Then she wanted to talk about all the pain she had. I have never been back to her. I am now seeing a wonderful doctor, and while he helps so much I still have pain…don’t we all. Shame on a doctor that would treat a patient so disrespectful.
Wellllll, here’s the next episode in Dr. Greenbaum. It appears he’s a little concerned about how insensitive OTHER doctors can be. (I’m not making this up.)
First, CAUTION: You can never know who’s actually doing what online – somebody could be playing some sick cat-and-mouse game, trying to evoke some excess reaction that they can tell to others, or report to someone, or whatever. So although this post of his might provoke flames, try to follow Kelly’s exemplary model – be clear and factual, as well as firm.
Having said that:
Out of curiosity I explored the archive of his other posts. The current one, A tale of two neurosurgeons, starts thus:
“I hope the surgeons reading this article don’t take offense, but some of you guys need to polish your bedside manner.”
Really! Has someone been schooling Dr. G in compassion?
“The surgeon wasn’t very personable, to put it mildly. He reluctantly emerged from behind his desk, did a token 30-second neurologic examination but didn’t examine her back. He told my patient that her problems were not amenable to surgery. She was put off by his cursory exam, but to add insult to injury, he made a dismissive wave of his hand.”
Perhaps he has been schooled!
“I could have warned this surgeon that there are days when clinic just doesn’t go smoothly.”
Really!
“Many times, when I debrief my patients after their encounters with my surgical colleagues, they are upset that the surgeon didn’t seem to spend any time with them or pay attention to their complaints.”
Really?? A doctor who doesn’t pay attention to the patient’s complaints?? How cruel.
But soon we find out why this bothers Dr. G:
“It isn’t fair, because invariably this ends up consuming my time.”
Yes, fans, it’s all about Larry. “The surgeon saves 5 minutes by rushing off to see the next patient, but I lose 10 minutes trying to explain the surgeon’s brusque manner.”
Then he drives his 4×4 into another HIPAA mud ditch:
“Ironically, this patient’s specialty is corporate communication, and she couldn’t believe that a neurosurgeon could be so devoid of interpersonal skills. … he was talking to an overweight, middle-aged woman …”
Okay! How many overweight middle-aged female RA patients in corporate communication do we have in Dr. G’s territory? Show of hands?
On page 2 of the post, he moves on to another specialist’s flaws – an orthopedist:
“After multiple dislocations, the orthopedist’s mental anguish reached a crescendo, and he yelled at the patient in his waiting room, ‘I don’t know what you’re doing wrong! I’ve done everything right!’ It must be hell to be so perfect.”
He closes with another anecdote he witnessed in his younger years, again about a surgeon who failed to be kind:
“She probably would have appreciated a few words of explanation, but none was forthcoming. The surgeon continued to jot his notes, and the patient started to cry. The startled neurosurgeon spun around and said, ‘You wanted help, and you’re going to get it!’ His tone was a bit nasty, and he seemed to imply that she would have to bear the responsibility of taking up his valuable time with her complaints.”
I’m starting to wonder if this guy actually has some kind of personality disorder, to be so arrogant himself AND think others are, not himself. (I mean that seriously. Anyone know such traits?) Maybe it’s just RIWHOAD – Really Impressed With His Own Amazingness Disorder.
I wouldn’t have believed this if I hadn’t read it myself – that’s why I say, always watch out for the possibility that someone’s gaming you. In any case, what he WROTE is ludicrous in comparison to the one we’ve complained about here, and it appears to be another likely HIPAA slip.
I really can’t believe that almost everyone here can not ‘read between the lines’ and see that Dr. Greenbaum was trying to be funny. The article seems to be written more for colleges rather than patients.
There are bad/obnoxious patients! I worked in Healthcare for over 20 years. I have an Associate of Science degree in Ophthalmic Technology. (I know it’s not a four year degree so I’m sure some of you are discounting my comments immediately.) I did go to college for two years before this degree. Beside the point…
To me, you all sound like you’ve been treated like I have been by previous doctors. Doctors who tell me, “This is non-productive” when I try to talk about my pain or that my feet are swollen! Do you think this could have tainted your view or account for no sense of humor. (Putting on flame retardant suit)
I bet Dr. Greenbaum is not a Doctor who overbills or dismisses every patient. He spent an hour with this patient!! He spent an hour with me! Below is my review, not included in the ratings yet, at Vitals.com
______________________________________________________
I’ve seen many specialists and rare few spend more than 15 minutes on their examination or consultation. Dr. Greenbaum spent more time than any previous Doctor had. He spent a lot of time reading my chart/history. He actually looked at and manipulated my joints…Gasp! More than all of this, he believed me, let me repeat that, he believed me, when I told him about my pain. He prescribed medication (DMARD) right away. When he told me the diagnosis he looked me right in the eye. When he told me the side effects of the medication, he made sure I was paying attention, again looking me in the eye. He was talking and listening to me…a patient. I’m so glad I found Dr. Greenbaum.
Make that colleagues not colleges!!