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Curbside Consult with Dr. Jayne 3/28/11

March 28, 2011 Dr. Jayne 1 Comment

Dr. Jayne interviews Doug Farrago, MD

Earlier this month on HIStalk Practice, I posted a piece called “Meaningful Use: 15 Things Your Practice Can (and Should) Do Now.” I jokingly included an Item 16, which was a suggestion to immediately identify a CMHO for the organization – a Chief Medical Humor Officer.

CMHOs are hard to come by, so I wanted to introduce you to the self-proclaimed King of Medicine, Doug Farrago. Doug is editor and publisher of the Placebo Journal, often cited as “the Mad Magazine of medical humor.” Since starting the Placebo Journal in 2001, he has also published a compilation of stories, The Placebo Chronicles, as well as penning the Placebo Gazette e-newsletter and the Placebo Journal Blog. A man of many faces, he also stars in Placebo Television.

According to his website, “Dr. Farrago has risen to national prominence in the publishing world by providing a humorous outlet for physicians while fighting back against the medical axis of evil (pharma, lawyers, insurance, and a whole lot more.)”

I’ve been reading Placebo Journal since issue #2 and have also been a contributor, so I’m a bit biased. But given the sheer bulk of guidelines, regulations, mandates, programs, requirements, and dictates that most of us in healthcare IT deal with on a daily basis, being able to draw humor from all of it is a rare talent.

USNews.com once called Placebo Journal “raunchy, adolescent, and very funny.” When creating it, what was your objective?

The goal was to make people laugh. Plain and simple. The magazine is intended to distract docs from the crap we have to deal with. The stories we tell, like in the old doctor’s lounge, are what keeps us going. It enables us to commiserate.

How did you become King of Medicine?

Initially, I had posted an editorial in the Boston Globe about something ridiculous about our healthcare system that they wrote about. I wanted to piss off the ivory tower docs down there that pontificate on everything as if they are experts, but yet haven’t seen a patient in years. I made the point that maybe I should decide everything and should be named King of Medicine. It just stuck as I continued with the Placebo Journal.

You’ve also been an inventor and entrepreneur. How have those experiences impacted your ability to continue delivering quality medical care in a changing healthcare environment?

Absolutely … not. This is a job that is continually being bastardized by the idiots who have are trying to game the system. More and more people are jumping in the mix getting between the patient and the doctor. The only way to fix that is to get creative and go cash pay. I haven’t made the jump yet as I am owned by a hospital. It is really tough to get off the stripper pole.

How has technology impacted your practice in the last 10 years?

There have been some great advances with the ability to get information in real time. It has, unfortunately, opened up some bad stuff as well. We are entering a world of “industrialized medicine.” Mooooooo……

Do you use an electronic health record (EHR)? How has it changed the way you practice medicine?

EMRs are great for many things. The positive part is that I have info at my fingertips that was tough to get to in the old days. It is the never ending f#cking clicks and boxes that I can do without.

What’s your funniest EHR story?

I don’t remember one in particular. In general, I have been using an EMR for four years. During that time, I have lost the ability to make eye contact with people. Is that a new disease?

You’ve been fighting the establishment for some time. I understand you were once asked to leave the American Academy of Family Physicians annual meeting after covertly handing out copies of the Placebo Journal. The next year, you appeared in the exhibit hall in lederhosen. What’s next?

Unfortunately, our organizations have sold us all out. I am older and maybe a little wiser now. At this point, I just want to get people to lighten up a little and make a point in the process. Or just screw with their heads a little.

You used to work with professional boxers. Based on that experience, do you have any advice for physicians and their staff members as they try to navigate the CMS program for Meaningful Use?


As an employed physician, are you required to participate in the Meaningful Use program or are you able to opt out?

Right now, I am playing the game. My goal is to opt out of this garbage as soon as I can. Then I am going to wear a t-shirt that says, “I got your Meaningful Use right here” to the next big conference.

Although the Placebo Journal has always been a print publication, you recently made the decision to go strictly digital. I understand the unreasonable costs of utilizing a government-run agency had something to do with that. Although it was just the US Postal Service in this case, can you draw any parallels to what’s going on with other government forays into healthcare?

There are 82 federal programs dealing with teacher quality in this country. How is that working out for us? The same will happen with medicine. It is all bloat.

The local people at the USPS are great, but the fact is, no one mails letters anymore. Why are stamps so expensive? Why were there tons of people not getting my journal via snail mail every month? Too much government does not equal better service. Sorry, folks. The less middlemen in the healthcare system, the better.

You also do public speaking. Have you ever spoken on healthcare information technology topics? Any key thoughts you’d like to share with HIStalk’s readers?

I have not spoken on HIT, but my talks would still work as I can easily poke fun at what technology is doing to us. Besides, it would make you folks stop and think for a while. Maybe, just maybe, too much technology is bad. There is a human component to patient care, you know. An EMR can’t do a rectal exam … yet.

E-mail Dr. Jayne.

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