Remember to stroke the physicians frequently and vigorously. They have low self-esteem and are easily flattered.
Create the illusion that the problem is always on the front burner (when you forgot what the problem really was).
Take fake notes when they offer complaints and criticisms (never tilt the pad down in case they are looking).
Talk incessantly as doctors have a very short attention span and after awhile you will drive them crazy enough to agree to anything.
Claim ignorance on a particular topic or situation but say you will get right on top of it.
When you find that you are getting in too deep on some topic, use diversionary topics in order to confuse the overwhelmed physician.
Use examples of other organizations in order to bore your listeners to tears.
Make up data to support your point knowing that no one will ever challenge it.
Pledge to create a committee or action group or task force and then find reasons why it never meets.
In my day, men were men. I treated males for real problems like a limb hanging off or neuritis. We didn't have all these problems you have now. Now you have male athletes promoting this stuff. Athletes?! In my time, the football players didn't even have face masks much less athletic supporters or cups. If they were kicked or bitten on the testicles they would just kick or bite their opponents back.
Now male patients need coddling. They come in for erectile dysfunction. They don't even call it impotence anymore! Most of these men already have had kids so I can't figure out what the problem is. These new-fangled questionnaires talk about maintaining erections, stiffness, and arousal ability. Excuse me? We didn't care about that back yonder. I had better things to do as a physician than to talk to a patient about the stiffness quality of his Johnson.
I would tell him to get a Popsicle stick
and some duct tape and get the hell out of
my office.
Now they want endurance for their erections. Endurance! What do they care about endurance? Just get in and get out. These youngsters should care less about quality and more about getting finished. The point is that men these days are thinking more about their penis than ever before. Instead of letting it whither on the vine, patients want their maleness to stand at attention at a moment's notice.
Even worse, they want their
doctors to be the accomplices
m to this unnatural ritual.
I say no! Let your men suffer like we did. Let them sit in their rocking chairs and whittle their sticks (no pun intended) reminiscing about the days when their penises actually worked. When Grandpa maintains the ability to have an erection like a 20-year-old, he is not only a danger to himself but Grandma as well. And trust me, you would much rather deal with him than her.
Primary Care Monthly Pathoclinicosocial
Mental Mastubatory Exercises
BILL LEFRANCE, M.D
Internship-trained General Practitioner
CORNELIUS PARODY, M. D.
Clinical Professor, Placebo University,
Researcher Extraordinaire, and
self-described smart guy
Dr. W. SCOTT WINNIPER, M.D.
General Adult Psychiatry, subspecializes
in familial MOCUS
Dr. Annie Schmeckl, M. D.Family Practitioner for over 40 years
Case 11-2002
PRESENTATION OF CASE
A 51-year-old man was seen in the office for recurrent fatigue. The patient had been well up until age 12. He has had progressive feelings of “just not doing well” to the point where he now demands “something be done.” Symptoms includes dyspnea which are significant enough that it has made it very hard for him to smoke three packs of cigarettes a day. His dietary habits have changed in that he no longer can eat a full pizza due to early satiety. He now only eats around seven slices. No weight loss has been found. In fact, he has gone up an average of three pants sizes per year since college.
The patient has a constellation of symptoms which include testicular tenderness, a rash under his pannus (folds of abdominal fat) and debilitating backaches (which prevent gainful employment). He also describes abdominal pain which occurs once every four months, lasts up to two full seconds, and makes him feel “funny afterwards.” This is usually alleviated with foul-smelling flatulence
Our patient is a father of seven and divorced thrice. Most of his medical work-up has occurred while in prison and included all procedures that end in –oscopy (cystocopy, endoscopy, colonoscopy, bronchoscopy, arthroscopy). All the patient's labs, except those things that we have no idea what they are, were normal. All review of systems was positive.
On physical exam, the patient appeared well. No abnormalities, as hard as we looked, were found.
DIAGNOSIS DISCUSSION
DR. BILL LEFRANCE – May we review the studies or procedures?
DR. CORNELIUS PARODY – No.
DR. LEFRANCE – Why not?
DR. PARODY – Because we don't have them. They are still at the prison.
DR. LEFRANCE– Well that's a bunch of sh#t!
DR. PARODY – Hey, if you don't like it, you can go …
DR. ANNIE SCHMECKL – Dr. Parody!
DR. PARODY – Sorry. Anyone else with some thoughts?
DR. W. SCOTT WINNIPER – Obviously, there is a lot less here than meets the eye. I think this is an obvious case of SLS (Shitty Life Syndrome). No treatment is possible.
DR. SCMECKL – I agree.
DR. LEFRANCE – Well that's good enough for me. Anyone up for lunch then? There are some bagels here.
DR. WINNIPER – These bagels suck. They are also stale. How about some Thai food? There's a restaurant around the corner.
DR. SCHMECKL – I'm in.
DR. PARODY – Me too. Let's make Lefrance pay. That cheap bastard never reaches into his wallet.
DR. LEFRANCE – One more word out of you Parody and I am seriously going to kick your ass.
DR. ANGUS BLACK (suddenly awakens ten minutes later) – Hey, where did everyone go?
From coast to coast, thousands of hopefuls are gathering to
get the chance to compete for the crown of the sickest man
or woman in America.
Finally, they can prove how ill they are and now,
on live TV, someone may believe them.
Talent, real disease, and strategy are not allowed; just a deep personal belief that you really feel like sh*t. Now TV viewers get their chance to vote on the Sick Zone. Watch participants from each region sweat, faint, or cry as they face a celebrity panel of experts.
Crisscrossing America for casting calls in many cities and pouring over medical records, the producers divided the country into “Sick Zones” that included every state. Watch this summer as we'll learn who America chooses as really being sick. The process of elimination will continue each week until one breathless man and one aching woman are crowned as …
1 Don't try a new drug on a patient until it has been on the market for one year. For your family, wait five years.
2 A test was unnecessary if it turns out normal. But are you going to complain?
3 Some people have a condition called “your number is up.”
4 A therapeutic test means that if the treatment works, then maybe you had the right diagnosis, unless, of course, it was some other diagnosis.
5 If the placebo works almost as well as the therapy, then the therapy is not better than the placebo no matter what any statistician says.
6 I challenge anyone to tell when a sore throat is caused by a virus and not a bacterial colony without doing 14 days of tests at the Centers for Disease Control. That's why we older docs give antibiotics. That's also why we don't see cases of acute rheumatic fever anymore.
7 The Physicians Desk Reference now has 3,500 pages of 8-point type. I know all the drugs in there in minutest detail except for the one you just asked about.
8 We were taught in medical school to learn only about 20 drugs, but le
arn them well. Now the doctor should know 500 but he might barely know the names of most of them. Don't tell anybody I said that.
9 I liked better what they said in 1890 when my great grandmother died in childbirth at home. It was God's will. Better than it's the doctor's fault and let's sue.
10 Want to know what to do for grief or depression? Get up every morning, say a blessing that you are still breathing, and go to work.
11 I am just as perplexed about the here-before as I am about the here-after.
12 Socrates had a theory that the soul knew everything before it was born, then forgot; his job was to ask questions of people till they remembered what they had always known.
13 I'm trying to learn everything there is to know and I am almost finished.
14 Osler, the great physician, was not incensed when someone failed to follow his instructions. He said, now we will find out which one of us is wrong.
15 Fifty years ago we dispensed a lot of placebos. There were green and pink pills, pink and chocolate aspirins, and Caripeptic liquid which smelled and looked like tar. Now I don't know any doctor who dispenses or uses placebos. Now you can get all the quack medicines you want at the health food store.
16 There were and are pure placebos and impure placebos. Sugar is a pure placebo. Aspirin is an impure placebo because it actually does something.
17I once asked a health food store owner if the whole bran she was selling was pasteurized and if she knew how many rat droppings or mouse hairs the FDA allowed in that product. She thought a minute, then proudly replied that any rat or mouse that was eating that stuff was therefore healthy and not to worry.
18 I don't know if you know this, but doctors joke around a lot while they are operating on you. We once had an anesthesiologist who used to say “this patient is ruined; get me a new one.” People like their doctors to have a sense of humor.
19 Or how about this: what should the doctor do if the patient walks out of the office and drops dead in the hallway? Call 911? No. First he should turn the patient around so it looks as if he had been coming in. Sorry; I can't resist sick jokes.
20 Are you sure you want a complete checkup? In the old days, a complete physical examination included an exploratory abdominal operation, burring holes in your head, a spinal tap, bronchoscopy, sigmoidoscopy, and gastroscopy. A complete exam was fatal.
She was pure as snow. As she entered the exam room, it was if she was floating on air. My angelic 80-year-old patient was one of my all-time favorite customers. She was sweet and kind. She reminded me of the sweet little old lady in the Sylvester and Tweety bird cartoons. Little did I know the evil that lurked inside.
The exam went smooth as silk. I dealt with her issues professionally and expeditiously. She was alert and enjoyable to talk to. Her mind was sharp as a tack. As she left, I thought to myself, “I wish I had more patients like Meg.”
That is when all hell broke loose.
Meg decided to turn left into the bathroom near my exit sign. No one knew she was in there. We did know, however, when she left. The rest of the story can only be explained in military terms.
It was as if a weapon of mass destruction had been unleashed. By the time we all noticed, Meg was long gone. I ran out of my office and began questioning my people. Assessment of damage is always the first protocol. “Lisa, what the hell is that smell!!!”
Even with our brains a little foggy, we figured it out quite quickly. Ground Zero was my bathroom. Immediately, I shouted out orders to my troops (just like in real battles, 6 the generals never go near the front).
Coincidentally, I just finished watching my favorite war series of all time, Band of Brothers, for the second time. Subsequently, my orders were eerily similar to those of Captain Winters. I would say things like, “Get in there!!” or “Go, go, go” or “Hang tough” or “Keep shooting (the disinfectant spray)! Don't let up!”
When I felt the enemy was neutralized, I walked into the bathroom to inspect the results. Just like the general who walks onto the battlefield after the battle is over, I looked things over as my staff beamed with pride.
That is when I saw it.
On the floor was a brown streak.
Dear God, we had a contamination breach!! I looked at Lisa with horror as I scrambled to save myself (leaving everyone else behind). My staff could hear me bark orders as I ran away (again just like a real general would).
Luckily, Lisa came into my office and informed me that is was just remnants of dirt from Meg's shoe. The war was over. We could finally rest. Meg is home now and probably laughing to herself about her misgivings. For us, we will live on. We will go on knowing that some battles will always be fought because there never will be a winner. We are fighting ourselves and that struggle is a microcosm of…Sorry, it got away from me. Battle fatigue, you know.
Let me sum this up by saying,
DUCT TAPE
While providing care in the Family Practice Clinic at a North Carolina Marine Corps Base Naval Hospital, Mrs. LeJeune Grunt, a female in her late 50s, presented with complaints of nocturnal pruritis ani (rectal itching) for several weeks. She lived in a somewhat rural area with her husband and various other animals and I surmised that she probably had enterobius (parasitic) infestation. However, not seeing any midday laggers in the anal verge or in the crypts, I was curious as to what might be found on a “Scotch tape” prep. I gave her a paper bag containing three of four glass slides and advised her about using cellophane tape at the time of the actual “itching” and returning at least two “good slide specimens” to me on a walk-in basis.
Two days later, the clinic nurse notified me that there was a “lady with a paper bag for me to check.” I replied that I knew who it was and that she should give me the bag and let the patient have a seat. I took the bag into our procedure room to view the slides under a microscope. It was difficult to stifle a loud guffaw (I was unsuccessful). You see, inside the bag, were two slides covered with silver duct tape, several pubic hairs protruding and a note which read, “My husband couldn't find any Scotch tape last night, so he used this. I hope it will be okay.” I debated as to whether or not to ask her to redo this procedure, but then thought, if her itching was so intense she could endure this “take home lab test” then she must have pinworms and had earned her treatment. After 100 mg of mebendazole and a follow up one week later, she was symptom free. I am not sure if it was the antihelminthic or the duct tape treatment which effected the cure, but I will keep the duct tape in mind if antihelminthics do not prove successful.
Diary of a New Pharmaceutical Representative (aka Drug Rep)
WEEK ONE I can't believe that right out of college, a Fortune 500 company has hired me! My I major in Biology and minor in Elizabethan Poetry sure must have helped. I think the fact that I was the head cheerleader in college proved my abundance of team spirit. To be making $50,000 a year at age 23 isn't i too shabby. And I get a new car, too!
WEEK TWO My bosses seem really nice. I haven't met anyone else out in the field yet. Got a lot of information to study before training starts. There is a lot to know about hypertension, I'll tell you that. It is so interesting to learn how each mechanism of how our drug works. I wonder why they even need sales reps when it is obvious that our ACE inhibitor is the best. The information they have given me to look at shows how it so superior to the competitors. This job is going to be a piece of cake! I bet the doctors are going to love seeing me come their way.
WEEK FOUR Boy, those tests were hard, but I passed all of them. Going to Florida for a big company meeting. This is awesome. A free trip to Orlando. Theme parks. Meeting other reps from around the country. There are a lot of other pharmaceutical reps that were cheerleaders. That's weird.
WEEK FIVE The meetings were inspiring! There were thousands of us chanting our company name! The lectures on our products just proved I picked the best team to join. There is no question we possess the most effective and unique products available. I can see myself working for this company f
orever. Nothing is going to stop me from climbing their ladder to a higher administrative level.
WEEK SEVEN Another field rep had me shadow him for a day. He seemed a little down when I met him; however, he seemed to perk up once he saw me. I am sure it is a pick-me-up for him to mentor someone i£0 new He kept asking me why I would pick this job. Then he asked if I can handle personal rejection. Of course I can handle rejection. I remember when I didn't get picked for junior prom queen. I cried for weeks but I eventually got over it and became stronger in the long run. Most of our day was spent on the road talking or trying to get into different medical offices. We only got to meet two doctors. Boy were they in a rush! I don't think the field rep did such a great job. Our product is so good, he needs to get right in those doctors’ faces! I can't wait until it is my turn.
WEEK EIGHT First day by myself. Met Dr. Smith. He must be stressed because he cut me off in the middle of my sentence and walked away. He must have forgotten I was there because he never came back. Dr. Johnson was just the opposite. It was great. It seemed he wouldn't stop talking to me. In fact, he wanted to meet me for dinner to just talk about my drug. What was really funny is that he forgot what drug I even had but promised he would use it no matter what is is. I am one hell of a salesperson!
MONTH THREE I am not sure why some doctors won't even meet with me. They want some samples but that is all. Had a lunch with a group of internists. They didn't even show up and I spent $200 on lunch for their staff. They weren't even that thankful either. That was kind of rude.
MONTH FOUR Still having trouble getting in to see some doctors. Dr. Ryan told me off and was extremely irritable. He said I was too forceful. I sat in my car and cried for a half-hour. I know I can do better at this. I think our drug is pretty good. I just need to be more assertive.
The Placebo Chronicles: Strange but True Tales From the Doctors' Lounge Page 20