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Managed Care Jokes
Jokes, cartoons and humor about our evolving health care industry
Please send us your jokes about the managed care industry. Ground rules: Jokes must be “G” or “PG.” No jokes disparaging our patients. No jokes disparaging particular individuals.  Try to credit your source or indicate that the source is unknown. We solicit jokes from patients, providers, and others. In the spirit of fun and fairness, managed care executives and reviewers are urged to send in jokes about themselves, their competition or fee-for-service physicians.
If you use these jokes in your lectures and presentations, please ask permission and reference the source.

Managed Care Jokes of the Month
March 2002
Jokes from Previous Months
Ask Miss Managed Care
Send your questions about the etiquette of dealing with the various social classes within the managed care and provider social order. Miss Managed Care will give her Gentle Readers her expert opinion on their questions of protocol.
Canadian Medical Humor
Links to other sites with managed care humor

Managed Care Jokes
You may reproduce these jokes as long as you reference the source and include the web address.
Jokes of the Month
Baltimore Star
March 11, 2002
Marylanders Misjudge Care First Execs.
Get the whole story before you point fingers,” says Care First Spokesperson.
Care First/Blue Cross Blue Shield of Maryland is is petitioning the Insurance Commissioner and the State Legislature to allow it to sell itself to a profit-making venture in California. Recently the liberal, consumer-coddling Baltimore media reported that the top executives of Maryland Care First will pocket over 33 million dollars if the sale goes through. The citizens of Maryland reacted with outrage.
“This is the usual way these stories get sensationalized,” said Care First spokesperson, Sharon Dalute, “You don’t actually think that our executives intend to keep these bonuses for their own personal use, now do you? Why would they do that? They certainly don’t need the money. We already give them six and seven figure incomes. Actually each senior executive has elected to use his or her bonus to benefit the citizens of Maryland.
“William Jews, our CEO, intends to use his bonus to help waive the high medication and medical equipment co-payments for Care First subscribers with diabetes and other chronic health conditions. Executive Vice-President Sharon Vecchioni intends to use her bonus to reimburse all of the individuals with AD/HD who were denied psychotherapy benefits when Care First mistakenly believed that medication was the only effective treatment for AD/HD. David Wolf, another executive vice president, had never spent much time with  any real Care First patients. He did play golf with some doctors once, so he decided to use his 3.6 million dollar bonus to reimburse physicians for the extra time they and their staff took away from patient care while managing burgeoning Care First paperwork and tracking down slow payments. John Picciotto, the Care First General Counsel, plans to donate his bonus to help a few of the individuals who gave up seeking reimbursement due to the Byzantine complexity of our contracts. He is aware that his 2.8 million bonus will only help a small portion of these individuals, but he hopes that if he takes the “get out of town quick” bonus, he may be able to help a few more.  The other executives have plans to donate their fund to equally needy and equally  underinsured Maryland citizens.”
Politicians and regulators reacted quickly to these revelations. “I was right all along,” declared Sen. Thomas Bromwell, “I hope that all those people who want to turn healthcare back to the non-profit ideas of the 1930s see how wrong they were.”
Insurance Commissioner Steve Larson wiped away a tear as he faced reporters, “All this time I thought that I was trying to educate the public and help the citizens take a critical look at these monumental changes. Now I see how wrong I’ve been. These guys are so caring. and so politically savvy, We should just listen to them and trust that they know what is best for us.”
Two Moons Over New Mexico
Psychologist prescribing.
December 2001
Disability Determination
Claimant: Job (no surname)
Date of Injury: September 26, 2507 B.C.E.
Date of Evaluation: 11/28/2001
The claimant appeared for an independent Medical Evaluation based on his assertion that he has a disability because he has become so depressed that he cannot continue in his usual occupation as a farmer.
Mr. Job notes that on the morning of September 26, 2507 B.C.E, he was feeling fatigued, and had been resting from working in his fields, when a cloud of locusts appeared and began devouring his crops. He ran to the house to get help in flailing away the insects. However on his way to the house, he discovered his cattle all lying on the ground dead. He arrived at his house, only to find it in flames. His wife and seven children were all inside, burned up.
Mr. Job states that he then fell to his knees and prayed to God, only to discover that his entire body was covered with boils. Since then, his neighbors have shunned him.
It is Mr. Job’s claim that he has been so upset by these events that after vainly trying to chase the locusts away, he simply let them eat his crops. He said that he has not been able to return to work since that time.
Assessment: It is clear from his account that the claimant has a history of feeling fatigued in connection with farming work. He admitted that the work-related fatigue began prior to his applying for the disability insurance. It seems quite evident that his so-called depression is an offshoot of this…a psychologically motivated effort to avoid gainful employment. He did show signs of open sores, but these are likely to be self-induced. In my opinion, Mr. Job has a form of Munchhausen Syndrome where he is driven to excoriate his skin, fueled by a covert psychotic disorder. I infer the psychosis from his mutterings about God and the Devil being behind his problems.
In conclusion, I see no basis for compensating this man for an obviously pre-existing condition.
Lou Siffer, M.D.
Psychiatric Consultant
October 2001
Tweezer Pharmaceutical Company


To:     All Pharmaceutical Sales Representatives
From:  District Sales Manager
Re:      Promotional Gifts
It has come to my attention that pens and other promotional trinkets that we have been leaving for physicians’ office staff are no longer having the desired effect.
This is a serious problem, since our ability to penetrate the market depends on advertising. The last thing that we, as a drug company, want to see is the spread of Silly-Pen-Resistant Staff!
Our Research and Development Departments are working feverishly on this serious advertising problem. We can’t allow America’s physicians to develop Sell-Mediated Immunity!
September 2001
News Flash October 2001: All physicians contracted to Kaiser Healthcare have gone out on strike. Kaiser officials say that they will have a statement for the press as soon as they can get a pharmacist out there to read the physicians’ picket signs.
If you work for an HMO, you know their stock is going down the tubes when…
Score to your answer to the following statements:
0 … never true,
1 … rarely true,
2 … sometimes true,
3 … always true.

  1. ___ Board of Directors’ meetings often begin with “Put the gun down, and then we can talk”.
  2. ___ The IRS has your company’s number on speed-dial.
  3. ___ The office plants are on Valium.
  4. ___ The number of jobs held down by directors exceeds the number of HMO providers currently accepting new patients.
  5. ___ No one has time to wait for the microwave to heat their lunches.
  6. ___ Staff outings are often mediated by law enforcement officials.
  7. ___ You have to check your secretary’s Day-Timer to see if he can pencil in time to take out the trash.
  8. ___ Maxwell House gives you preferred provider rates for coffee–but has switched to traditional insurance for their own employees.

24 — a maximum score. Is your resume sent out yet?
16-23 –About right for the usual Medicare HMO. Some companies like to live on the edge.
8-15 — Not too bad, but don’t get sick. Your company must be gouging the providers to be doing this well.
0-7 – Are you sure that you work for an HMO?
Free CME Presentation!*
Differential Diagnosis in Psychiatry: How to Distinguish Paranoid Schizophrenia from Cell Phone Use

  • Social Distance: The individual with schizophrenia will generally retreat to a considerate distance from others when he needs to converse with his voices. The cell phone user will stand right next to you, talk in a loud voice, and gesticulate in your face.
  • Safe Driving Technique: The cell phone user often needs to look at his phone to dial while driving, causing him to drive over yellow lines and endanger others on the road. The individual with schizophrenia does not need to dial, and thus is a much safer driver.
  • Restaurants: The cell phone user is more likely to be talking loudly in a quiet, expensive restaurant. The individual with schizophrenia is less likely to be noticed because he usually has his conversations in eateries where the ambient noise drowns out his conversation.
  • Prognosis: Individuals with schizophrenia often seek help for their difficulties, and are quite responsive to treatment. Cell phone users are remarkable for their lack of insight and resistance to any form of social, medical or legal intervention.

*Funded by generous grants from Pfizer Pharmaceuticals and Verizon Wireless.
Carol Watkins, M.D.
August 2001
Eleven ways to get rid of drug reps–Updated for 2001
Carol Watkins, MD

  1. Develop a chemical sensitivity to doughnuts and pizza.
  2. Ask the Celltech Rep to entertain your pediatric patients by donning his Captain Metadate costume. (The reps really have these duds!)
  3. Insist that they build an accurate 3-dimensional model of the chemical structure of their compound using pick-up-sticks and play dough (most child psychiatrists will have these materials on hand)
  4. Tell your office manager not to admit anyone with a rolling suitcase.
  5. Tell the rep that you are writing an article about ethical interactions with pharmaceutical companies.
  6. Hire a pharmacology graduate student to help out in your front office. The drug rep may not see you until the student has finished quizzing him on the chemical properties of all of his products.
  7. Schedule four of them at the same time and only see the one who emerges from your waiting room alive.
  8. Be sure to return all of your phone calls while the rep is waiting to see you.
  9. Tell the Lilly rep that you really appreciate the email list of the 600 Prozac users that they “outed.” You’ve used it to recruit 8 new patients just this month.
  10. Take the drug rep back to your office and confidentially tell him that you have had a bit of a problem with your DEA license. Could he provide you with LOTS of free samples?
  11. Get your information about psychopharmacology from talking to colleagues, attending seminars, and reading journals.

Copyright 2001 Carol Watkins, MD
Reviewing Managed Care Treatment Plans in a Timely Manner: A Technical Guide for Blue Cross Employees

  • Sit in a straight, comfortable chair in a well lighted place with plenty of freshly sharpened pencils.
  • Check your email.
  • Read over the treatment plan carefully, to make certain you understand it.
  • Walk down to the vending machines and buy some coffee to help you concentrate.
  • Check your email.
  • Stop off at another cubicle on the way back and visit with a colleague. If this person hasn’t started his reviews yet either, you can walk to McDonalds and buy hamburgers to help you concentrate. If your colleague has already finished his quota of reviews, drop him.
  • When you get back to your cubicle, sit in a straight, comfortable chair in a clean, well lighted place with plenty of freshly sharpened pencils.
  • Read over the paper again to make absolutely certain you understand it.
  • Check your email.
  • Set up an instant message account.
  • You know, you haven’t written to your mom in the past year. You’d better write that letter now and get it out of the way so you can concentrate.
  • Look at your teeth in the bathroom mirror.
  • Listen to one side of your favorite tape and that’s it. I mean it. as soon as it’s over you are going to start working on that review.
  • Listen to the other side.
  • Check your email.
  • Add friends, family and colleagues to your Instant Message (IM) list.
  • Rearrange all of your files into alphabetical order.
  • I.M. your friend on the next floor and ask if she has started writing yet. Exchange derogatory remarks about the medical profession, the state of healthcare today, and the world at large.
  • Sit in a straight, comfortable chair. Have a Cherry Lifesaver. Savor its exquisite flavor across your tongue.
  • Check your email.
  • Check the newspaper listings to make sure you aren’t missing something truly worthwhile on TV. Note: If you are only a week behind quota, anything on TV from Masterpiece Theater to reruns of PeeWee’s Playhouse is truly worthwhile.
  • Catch the last half hour of American Bandstand on Channel 46.
  • I.M. your colleague in the third cubicle down to see if he was watching. Discuss the finer points of the plot.
  • Sit down and do some serious thinking about your plans for the future.
  • Check your email.
  • Sit in a straight, comfortable chair in a clean, well lighted place with plenty of freshly sharpened pencils.
  • Read over the treatment plan one more time, just for the heck of it.
  • Lean forward and do that review.
  • Write up your comments, and while you’re at it, check your email.
  • Complain to everyone that you got behind schedule because you couldn’t read the doctor’s lousy handwriting.

June 2001
Scientific Update: Psychotherapy Found to be Useless for AD/HD
Medical research authority Care First-Blue Cross Blue Shield of Maryland has released data that finally lays to rest the debate on AD/HD and psychotherapy. Dr. No, medical director of Care First, revealed that psychotherapy is no longer medically necessary for children or adults with AD/HD.
Dr. No spoke at a press conference, “We are aware that there is a large body of literature purporting to show that multimodal treatment helps people with AD/HD. Well we looked at some of that so-called “research” out there and rejected it. First there’s that Russell Barkely character. He isn’t a real doctor so we’re not going to bother reading his stuff. And don’t get me started about Peter Jensen. Where did that guy learn to write? I would just love to have a word with his high school English teacher. He goes on and on with his big words and boring, repetitive jargon about “methodology” and  “subject selection.” He also needs more imaginative titles for his papers. MTA indeed! Sounds like a bus route.
Since there obviously isn’t any real literature out there on AD/HD and therapy, we did our own study. We recruited 15 of our case review managers. All met our AD/HD criteria: they were lazy, stupid or crazy. In the pretreatment phase, they averaged 6 mistakes per insurance review form. We then subjected each of them to 3 sessions of mandatory “Beratement Therapy” with trained supervisory therapists. Post-treatment studies showed that they only made an average of 2 mistakes per form. The increased speed of claims processing was considered proof that therapy is a bad thing for these people–or at least for us.”
Individuals with AD/HD had mixed reactions to the new research developments.
Families, tired of spending long hours in therapists’ offices cheered the new developments. Said Linda Monkton, mother of a child with AD/HD, “I thought that these family sessions were helping us modify our daughter’s impulsive behavior, but maybe it really was just the pills all along. I’m so excited!  I plan to stop our family therapy sessions, and as soon as I get home, I’m going to double my daughter’s medication dose.”
Other subscribers were not so pleased. “The insurance company told me that they would only cover my therapy if there were another co-existing mental disorder, said Marsha Maple, a 26 year old graphic designer,  “As I left my psychiatrist’s office last week, he announced that now I also have Bipolar Disorder! Can you imagine how awful it is? With my therapy I was finally beginning to cope with my AD/HD. But now for the past week, I’ve been having these awful mood swings. My doctor says that my insurance company is causing my symptoms. And it gets worse. He thinks that I may develop a third diagnosis next week, depending on the appeals process. I can only hope it’s Obsessive-Compulsive Disorder. Maybe then I can clean up this messy house.”
Seriously though, we need to let the Blues know that this is a ridiculous assertion. Subscribers of Care First BC/BS of Maryland may want to call the Maryland insurance commissioner’s office.
May 2001
At long last it’s here...On Beyond Ritalin
March 2001
The Blue Crab Bar was so sure that its bartender was the strongest man around that they offered a standing $1000 bet. The bartender would squeeze a lemon until all the juice ran into a glass, and hand the lemon to a patron. Anyone who could squeeze one more drop of juice out would win the money. Many people had tried over time (weight-lifters, longshoremen, etc.) but nobody could do it.
One day this scrawny little man came into the bar, wearing thick glasses and a pin stripe suit, and said in a tiny squeaky voice ” I’d like to try the bet” After the laughter had died down, the bartender said OK, grabbed a lemon, and squeezed away.
Then he handed the wrinkled remains of the rind to the little man. But the crowd’s laughter turned to total silence as the man clenched his fist around the lemon and six drops fell into the glass. As the crowd cheered, the bartender paid the $1000, and asked the little man “what do you do for a living? Are you a lumberjack, a weight-lifter, or what?”
“Well,” said the little man, “I set fee schedules for an HMO.”

Magellan Behavioral Health Announces Strategic Partnership with Microsoft
Magellan Behavioral Health has consistently led the way in improving the lives of psychiatrists and their patients through innovative strategies.  Like Microsoft, Magellan has used technology to make life easier for physicians and reduce their administrative workload. Today Magellan has announced that it will join with Microsoft in order to use the software giant’s efficient methods on interfacing with the individuals using their services.
Dr. Harry Herbert, CEO, President, Chief Stockholder, and President for Life, stood next to his counterpart, Bill Gates of Microsoft when they made the historic announcement. “We are already using many of these techniques, said Herbert, but a partnership with Microsoft will help us refine our techniques. We are also hoping to benefit from their experience in subverting anti-monopoly laws.
“Harry and the rest of the Magellan executives are already doing a great job applying many of our techniques, said Gates, “This partnership should work out well for both of us. Microsoft and Magellan plan to develop increased usage of our Medical Database ® Lawyers, marketing companies, and the patients themselves will, for a modest fee, be able to access their own medical records and those of their colleagues and neighbors.”
Developments at Magellan include the following:

  • Magellan, as always, announces a list of benefits and participating providers will be mailed the week before a new plan is to take effect in January. However it will follow Microsoft’s example and actually send them in May.
  • Responding to pressure from human resource departments of some large corporations, some early copies of the benefit plan will be released in March. The recipients of these early copies must sign non-disclosure agreements.
  • In June, the benefit brochures will be recalled because the Magellan loses a suit for appropriating some other HMO’s intellectual property.
  • When you move, Magellan will continue to send confidential information to your previous address forevermore, just like Microsoft sends its product upgrade notices.
  • Like Microsoft, when you or your doctor send a preauthorization in late, Magellan will reject it on the grounds that the prior year is no longer supported.
  • The Magellan’s telephone help will remain similar to Microsoft’s, staffed by ill-trained, high-turnover personnel who sometimes give a correct answer, but Magellan will have to discontinue using a toll-free phone number. The patient or provider is responsible for any errors resulting from the erroneous information given by phone line staff.
  • After struggling with reams of dense documentation of complex options and rules, you discover that you will need an extra brochure, with a ten-word-long title, in order to answer (you hope) a single obscure question. Magellan, like Microsoft, will charge a minimum of $50 for that publication.
  • Magellan, like Microsoft, will continue to issue immense volumes of bug fixes, interpretations, and clarifications. Updates should be neither easily searchable nor well-indexed. Lists of participating providers will be at least 12 months out of date.
  • Instead of a single brochure, containing complete lists of benefits and providers, Magellan rules will be promulgated in a haphazard fashion by individual subscribers and providers via BBS, Usenet, and CompuServe. A for- profit-publishing subsidiary would also be nice.
  • Herbert plans to jet around the country giving speeches and granting numerous interviews, but only to sycophantic reporters. Changes to the Magellan procedures will be at the whim of the Dr. Herbert and largely kept secret until they are published.

February 2001
A Historic Breakthrough in Nature and Science!
Millions of Americans are overweight. Obesity is one of the most dangerous—not to mention unattractive—medical crises facing our nation. I am sure that you have tried all the latest pills, diets and massage treatments. There is always the option of regular exercise and a moderate diet—but get real—who has time for that?
Now you don’t have to restrict your favorite foods. You don’t even have to exercise. Go ahead; eat that second piece of cheesecake! With our plan, you can still attain any weight you choose!!
Giardella ® is guaranteed to help you loose 5, 10, 20 pounds—you decide!
Best of all, it’s from nature, so you know it’s safe. Unlike artificial, sterile pharmaceutical factories, nature is in perfect balance. All living things from nature are beneficial for your health.
Here’s how it works. We collect crystal clear water from the Gunpowder River. We wish you could see the source. Overhead, tall sycamore trees sway in the breeze. Just upstream, a family of industrious beavers has built a series of impressive dams. The industry of the beavers imparts a special essence to the waters. This enteric essence cleanses your system in a profound way that you have never experienced.
A day or two after you drink our healing water, you will begin to notice your body cleansing itself. The weight just flows away. Once you have lost as much weight as you want, it is easy to stop. Just page your family doctor—he or she should be available day or night—and ask him to call in a prescription for Flagyl ® After one or two doses, the cleansing process slows down, and your weight will stabilize. That’s all there is to it!
Keep a few extra vials of our crystal clear elixir on hand if those troublesome pounds start to come back. It works over and over.
Note for non-physicians and for physicians who have not kept up with their CME (we know who you are)

Don’t really do this!  Giardiasis  (giardia lamblia) can cause nausea, severe diarrhea, electrolyte imbalance, vomiting, lethargy, seizures, death, foamy stools, nutrient deficiency, and lots lots more! Beavers sometimes are carriers of giardia, so one should be cautious of drinking water near their habitation. P.S. The river in question is the source of Baltimore’s drinking water.
January 2001
This one isn’t about medicine or managed care, but I couldn’t resist….
Bush to be smitten later today
In a stunning development this morning, God invoked the “one nation, under God” clause of the Pledge of Allegiance to overrule last night’s Supreme Court decision that handed the White House to George Bush.
“I’m not sure where the Supreme Court gets off,” God said this morning on  a rare Today Show appearance, “but I’m sure as hell not going to lie back and let Bush get away with this.”
“I’ve watched analysts argue for weeks now that the exact vote count in Florida ‘will never be known.’ Well, I’m God and I DO know exactly who voted for whom. Let’s cut to the chase: Gore won Florida by exactly 20,219 votes.”

Shocking political analysts and pundits, God’s unexpected verdict overrules the official Electoral College tally and awards Florida to Al Gore, giving him a 289-246 victory. The Bush campaign is analyzing God’s Word for possible grounds for appeal.

“God’s ruling is a classic over-reach,” argued Bush campaign strategist Jim Baker. “Clearly, a divine intervention in a U.S. Presidential Election is unprecedented, unjust, and goes against the constitution of the state of Florida.”

“Jim Baker’s a fool,” God responded. “He’s got some surprises ahead of him, let me tell you. HOT ones, if you know what I mean.”

God, who provided the exact vote counts for every Florida precinct, explained that bad balloting machinery and voter confusion were no grounds to give the White House to “an idiot.”

“Look, only 612 people in Palm Beach County voted for Buchanan. Get real!
The rest meant to vote for Gore. Don’t believe me? I’ll name them: Anderson, Pete; Anderson, Sam, Jr.; Arthur, James; Barnhardt, Ron…”

Our Lord then went on to note that he was displeased with George W. Bush’s prideful ways and announced that he would officially smite him today. In an act of wrath unlike any reported since the Book of Job, God has taken all of Bush’s goats and livestock, stripped him of his wealth and possessions, forced the former presidential candidate into hard labor in a salt mine, and afflicted him with deep boils
Dick Cheney will reportedly receive leprosy.
Original source of joke unknown: If it is yours, please let us know so that we can assign proper credit.

December 2000
An attorney for an injured patient was cross-examining the chief surgeon during a malpratice trial – it went like this:

  1. Doctor, did you examine my client the day of his surgery?
    A. No sir, but the description of the abdomen was consistent with an acute inflammation of the appendix.
  2. Doctor, since you did not personally examine the patient that day, who provided you with this description?
    A. My chief resident.
  3. A trainee examined the patient and you operated based on his description. . Do you trust your residents?
    A. Yes sir, with my life.
  4. With your life?  Let me ask you this then doctor – do you have a locker room in the surgical area – a room where you scrub your hands and change your clothes in preparation for surgery?
    A. Yes sir, we do.
  5. And do you have a locker in that room?
    A. Yes sir, I do.
  6. And do you have a lock on your locker?
    A. Yes sir.

Q. Now why is it, doctor, if you trust your residents and staff with your life, that you find it necessary to lock your locker in a room you share with those same doctors?
A. You see sir, we share that locker room with the administrative suite, and sometimes lawyers and administrators have been known to walk through the room.
In the beginning God created the heavens and the Earth. And the Earth was without form, and void, and darkness was upon the face of the deep. And Satan said, “It doesn’t get any better than this.”
And God said, “Let there be light,” and there was light. And God said, “Let the earth bring forth grass, the herb yielding seed, and the fruit tree yielding fruit,” and God saw that it was good.
And Satan said, “There goes the neighborhood.”
And God said, “Let us make Man in our image, after our likeness, and let them have dominion over the fish of the sea, and over the fowl of the air and over the cattle, and over all the Earth, and over every creeping thing that creepeth upon the Earth.”
And so God created Man in his own image; male and female he created them. And God looked upon Man and Woman and saw that they were lean and fit.
And Satan said, “I know how I can get back in this game.”
And God populated the earth with broccoli and cauliflower and spinach, green and yellow vegetables of all kinds, so Man and Woman would live long and healthy lives.
And Satan created McDonald’s. And McDonald’s brought forth the 99-cent double cheeseburger. And Satan said to Man, “You want fries with that?”
And Man said, “Supersize them.” And Man gained 5 pounds.
And God created the healthful yogurt, that woman might keep her figure that man found so fair.
And Satan brought forth chocolate. And Woman gained 5 pounds.
And God said, “Try my crispy fresh salad.”
And Satan brought forth Ben and Jerry’s. And Woman gained 10 pounds.
And God said, “I have sent thee heart-healthy vegetables and olive oil with which to cook them.”
And Satan brought forth chicken-fried steak so big it needed its own platter. And Man gained 10 pounds and his bad cholesterol went through the roof.
And God brought forth running shoes and Man resolved to lose those extra pounds.
And Satan brought forth cable TV with remote control so Man would not have to toil to change channels between ESPN and ESPN2. And Man gained another 20 pounds.
And God said, “You’re running up the score, Devil.” And God brought forth the potato, a vegetable naturally low in fat and brimming with nutrition.
And Satan peeled off the healthful skin and sliced the starchy center into chips and deep-fat fried them. And he created sour cream dip also. And Man clutched his remote control and ate the potato chips swaddled in cholesterol. And Satan saw and said, “It is good.” And Man went into cardiac arrest.
And God sighed and created quadruple bypass surgery.
And Satan created HMO’s………..
Submitted by David M. Elwonger MD.
Original author unknown
A large Baltimore hospital planned to buy up a number of medical practices. As their existing legal staff was already quite busy dealing with lawsuits, the hospital decided to hire a new lawyer to handle the contracts with the medical practices. The top hospital administrator decided to interview some young lawyers.
“I am sure that you are aware that our hospital has acquired a considerable reputation regarding the integrity of its dealings with our physicians.” the administrator began with one of the first applicants, “We require that special person whose integrity matches that of our venerable institution. ” He leaned close to the young lawyer, “Mr. Harper, are you an honest lawyer?”
“Honest?” replied the young applicant,  “My life is the definition of the word honesty. Why, I’m so honest that my parents lent me thirty thousand dollars for law school, and I paid back every last cent the minute I tried my very first case.”
“I’m impressed. What sort of case was it?”
The lawyer looked down at his shoes and admitted, “They sued me for the money.”
The administrator smiled and said, “You’ll fit right in here–You’re hired.”
November 2000
A managed care executive, who had become quite wealthy, was trying to join an exclusive country club. In this particular club, it was important to have civic-minded family connections. The executive’s father had been hanged for cattle rustling. Of course, he did not want to reveal this bit of family history. When asked about his father’s early demise, he told the country club membership committee: “My father died while taking part in a public ceremony when the platform gave way.”
Three professionals were out hunting on the Chesapeake Bay, when their duck blind collapsed. All three became entangled in submerged crab pots and drowned. They arrived at the River Styx, the gateway to the Underworld.
The raft attendant said to the first man, a surgeon, “Let’s see, you’re Dr. Douglas, orthopedic surgeon. Look at this list. Overcharging patients, running around on your wife, Yes, we’ve been expecting you. Please follow me.” The attendant ferried him across the river to a doorway. “This is where you’ll be staying Dr. Douglas,” said the ferryman as he opened the door. Inside was a dark, dank, musty room. Water was dripping from rocky walls where torture equipment hung. A growling pit bull was chained to the center of the floor. Dr. Douglas stepped in, and a loud voice cried out from above, “Dr. Douglas! You have sinned!”
The ferryman poled his raft back to the other side and pointed to Mr. Jordan, an emergency room nurse. The ferryman glanced at his list, “Let’s see….making wise cracks in front of injured patients, insulting the medical staff, flirting with student nurses. Yes, you’ve been on our list for quite a while. Mr. Jordan, please accompany me across the river.” Once across the Styx, he led the nurse to another doorway. Just like the other room, it was dark and dank, water dripping down the walls with horrible torture equipment hung everywhere, and a snarling pit bull chained to the center of the floor.
As Mr. Jordan stepped in, a voice from above cried, “Mr. Jordan! You have sinned!”
The ferryman closed the door, crossed the river again and returned to the last man waiting at the entrance. “Dr. Harbor what are you doing here? This says that you were an idealistic psychiatrist working in the state system,” He scratched his head and looked further down the long printout. “Sorry, I was looking at the 1970s page. Here we are….1980s, 1990s, early 2000…..my, you have quite a list: abandoning your commitment to the poor and needy, founding a lucrative but corrupt managed care system, gobbling up any competitor who dared to set reasonable clinical standards . Yes, we certainly have been waiting for you.” He poled the ferry across the river and a little downstream. When they got to the other side, the ferryman opened a door to reveal another musty, gloomy room with torture equipment hanging from dank, dripping walls. But in the center of the room stood Cindy Crawford. As Dr. Harbor stepped into the room the voice cried out, “Cindy Crawford! You have sinned!”
September 2000
Lilly of the Valley Pharmaceutical Corporation
Physician Education Department
Helping You become the best physician that money can buy

Dear Physician:
Thank you for the courtesy extended to our pharmaceutical sales representative last week. We are enclosing your requested free sample boxes of Prozac, along with the usual boxes of caviar and lobster tails.  Please mail in the following form so that we may send you a $200 “consulting” fee.
Reason for seeing our pharmaceutical representative in your office:
( ) Needed free samples of your fine pharmaceutical products.
( ) The new drug rep looks cute in that tailored skirt.
( ) Front office triage clerk was on vacation.
( ) Office staff was running short on pens and highlighters.
( ) Due to HMO reimbursement cuts, I can no longer afford lunch.
( ) I hadn’t heard of Prozac before, so I needed some unbiased information about how well it works.
What is the most important factor that influences your choice of a first line antidepressant?
( ) Favorable side effect profile.
( ) Saw ad in professional journal.
( ) Saw ad on TV.
( ) Your competitor brings us these cool toys to take home to the kids.
( ) I use whichever drug my HMO has on its formulary.
( ) Your company is funding my favorite charity.
( ) Like….I’m into prescribing herbs this week. Do you make any of those?
How can our pharmaceutical representatives improve their services to you in the future?
( ) Use an electric warmer to keep the pizza hot until it reaches our office.
( ) My office manager says you forgot her birthday this year.
( ) Fund some talks about psychotherapy.
( ) I hear that in Japan, the sales reps will wax your car.
( ) Cut the advertising and pass on the savings to my patients.
( ) I prefer cute Male drug reps in European cut shirts.
( ) Could you get me free samples of some Schedule II Drugs?
Carol E. Watkins, M.D.
Director of Strategic Marketing-IV
Three men sitting on the same row in an airplane found that they were all heading to an orthopedics conference. A managed care executive had the window seat. In the middle was a malpractice lawyer. An orthopedic surgeon the aisle seat. The orthopedist, tired from doing on-call surgery all night, took off his shoes and leaned back to relax. Just then, the managed care exec decided to get up to get a drink.
“No, don’t. Let me get it for you. It’s easier to get up from the aisle seat”,  said the orthopedist. While he was gone, the managed care executive spit in the doctor’s right shoe.
Just as the orthopedist had settled down to relax again, the lawyer said, “My, that drink looks good. I think I’ll go get one myself.”
“Please don’t, you might fall and injure yourself. Let me get it for you.” said the orthopedist. While he was gone, the lawyer spit in the orthopedist’s left shoe.
When the plane landed, the orthopedist put on his shoes and realized what had happened. He looked at them in disgust, “How long must this go on?” he asked. “This fighting between our professions? This hatred? This animosity? This spitting in shoes and peeing in cokes?”
August 2000
Dear _________________ :

Thank you for leaving one [1] tooth under your pillow last night.

While we make every attempt to remit prompt payment, we were unable to process your request for the following reason(s):

the tooth could not be found
it was not a human tooth
we do not think that pieces of chicken bone are very funny
we were unable to approach the tooth due to excessive odor
the tooth has previously been redeemed for cash
the tooth did not originally belong to you
the tooth fairy does not process fingernails
your request has been forwarded to the Nerve Ending Fairy for appropriate action
you were overheard to state that you do not believe in the Tooth Fairy
you are age 12 or older at the time your request was received
the tooth is still in your mouth
the tooth was guarded by a vicious fairy-eating dog at the time of our visit
no night light was on at the time of our visit
the snacks provided for the Tooth Fairy were not satisfactory, or were missing
we discovered evidence of unsafe tooth extraction as follows:
Thank you for your request, and we look forward to serving you in the future.
  “The Tooth Fairy”
The Tooth Fairy Managed Health Care Company, Inc.
Note: The original source of this joke is unknown. If it is yours, please let us know so we can assign proper credit.
July 2000
One summer in a rural church, the pews were packed. As the minister began his sermon, the air conditioner quit. The room became hotter and hotter. Suddenly, lightning flashed and there next to the pulpit, stood Satan! Yes, there he was, horns, tail, hooves and the scent of brimstone.
The minister and parishioners screamed and took to their heels. Satan laughed and cackled as he watched them tumble over each other in their efforts to get away as fast as they could. When the pandemonium ceased, Satan saw, to his surprise, that there remained one lone man, sitting in one of the back pews.
Satan glared down at him, “Do you know who I am?” Satan shouted.
“Oh yes,” said the man.
“Do you realize that I am the embodiment of evil, the destroyer of all that is good, the author of pestilence the source of all chaos? Satan thundered, “I am the pinnacle of all the demons and trolls of hell !!!”
“I know,” said the man.
“Then why are you still sitting here?? Satan demanded.
“I have been appealing my HMO’s denial of services for my wife’s heart surgery. I figured that it would get to your review level sooner or later.”
June 2000
Q: I received from Trigon (Managed Health Care) a paper with the title “Practice Profile.” It asks me to mark my areas of “Clinical Specialization.” It says that I can only designate “three areas of specialization” from their list. Why are they limiting me to just  three?
A: Trigon was named so, Apparently because they are infatuated with the concept of 3, which has its roots in ancient history. I think it has something to do with their mission statement as well, which is why so many MCOs authorize three or less sessions at a time, as well as why MCOs often set a maximum of 30 visits annually. It is why MCOs feel that you must make at least three phone calls for each authorization and spend three hours per month on hold per enrolled patient. It is why 3 out of 10 claims are rejected and why you must wait on average three months for payment of 1/3 of your claims and up to 3 cubed (=27) months for the remainder. It is why it may take MCOs at least three years to drop your name from their promotional materials after you quit (unless you have been in the news for some dastardly deed, for which it takes them just three seconds to disaffiliate from your kind.) And the number one reason is that upper level MCO executives are limited at best to sharing the propensities of a 3 year old and the business scruples of at least 3 centuries ago (recall the Spanish conquest of New Spain.)
I believe that despite Trigon’s demand that you choose only 3 items, one of their 3 secret desires is that you choose at least 27 of them, for a more perfect 3 (it being cubed.) We reserve for another time discussion of their other two secret desires, which have to do with money and hegemony.
Charles E. McDermott, M.D.
May 2000
Question: Why wouldn’t the managed care reviewer take his pet cat to the beach?
Answer: The cat kept trying to bury him with sand.
A rabbit and a snake were both injured in a California earthquake. The impact caused both to become blind and to lose their memories. In an attempt to find out who they each were, they decided to feel each other.
First, the snake felt the rabbit. “Well, you are fuzzy and warm. You have a round cottony tail and two long ears.”  “Hooray!” exclaimed the rabbit, “I must be a bunny.”
Next the blind rabbit felt the snake. He was thoughtful for a moment. “Let’s see–you are long, cold and slimy and you have a little forked tongue.” The snake wailed, “Oh no! I must be a hospital administrator.”
April 2000
The Baltimore Sun
February 10, 2000
Maryland Bar Association Discusses Prescribing Privileges for Attorneys

by Abraham Marcus

(Baltimore) — Lawyers may be the mental health professionals of the future, a spokesman for the Maryland Bar Association said in a press conference today.

John Harbin, a practicing attorney from Towson, Maryland, said in a prepared statement that “We are faced with a critical shortage in two areas: mental health professionals who can communicate effectively, and hard working problem solvers who are willing to listen and take action on people’s problems.”

The remarks were made during a brief break in a three-day conference on Law, Medicine, and Consumer needs. A growing number of attorneys in recent years
have advocated expansion of the scope of their licensure to include privileges ordinarily reserved for physicians. In most of the United States, a professional must possess a medical degree (M.D. or D.O.) and be licensed by a medical examining board in order to treat patients and prescribe medicines.

“That [only letting doctors prescribe] is a patently ridiculous restriction,” Harbin stated, “since no doctor spends as much time with, or gets to know, a patient as well as the patient’s lawyer does.” For patients to have to seek out a physician for something as simple as getting a prescription cold remedy or a sleeping pill “makes about as much sense as having to get a certified mechanic just to put gas in your car.”
We are aware that nurses are working to get certified as primary care medical providers. Lawyers have had many more years of training than nurses.
Proposed legislation first discussed last year at a meeting of the Maryland Trial Lawyers Association would give licensed attorneys only limited prescribing privileges, but would permit them also to admit patients to hospitals in consultation with a licensed physician.

Reaction from organized medicine was predictably swift, and at times harsh.

“This is not just a stupid idea,” said Mark Olanzepine, MD, President of Maryland Med Chi, “it’s what we call in Baltimorean idea not worthy of a steamed hard crab.”

Dr. Olanzepine said that Maryland Med Chi. was not caught unaware, and that rumblings about attorney prescribing had been heard as long ago as 1985, when the Maryland Bar Association unsuccessfully lobbied in Annapolis to permit attorneys to bill for non-legal services such as basic first aid rendered at the scene of an accident.

Dr. Olanzepine was joined in his outspoken opposition by Steve Sharfmann, a primary care physician who is director of the Value Behavior Health HMO. “You may see limited permission given to attorneys to give their clients medication under special circumstances,” Sharfmann said, “but I doubt that you will see it any time soon.”

Both groups promised a spirited fight in Annapolis early next year. Where Governor Glendenning and Lt. Governor Townsend stand on the issue is not quite clear, but it may become a topic in the Presidential debates as interest groups press candidates to take
a stand.
(Source of original version unknown: If it is yours, let us know so we may give proper credit.)
March 2000
Why Did The Chicken Cross the Road?
No one seems to know why the chicken crossed the road, so I looked up my old friend Chicken Little, who was glad to answer the question.
Me: Why did you cross the road?

Chicken Little: The sky was falling.

Me: What do you mean?

Chicken Little: A flock of us free-ranging chickens were pecking around as usual when, suddenly, a hawk swooped down out of the sky and snatched up one of the flock. At first, we didn’t think too much about it,
because that’s life when you’re a free-ranging chicken. But it wasn’t long before more hawks came and carried off more chickens. Soon the sky
was filled with hawks. That’s when I decided the sky was falling.

Me: How awful! How did you escape?

Chicken Little: I couldn’t see any hawks circling in the sky above the other side of a nearby road, so I clucked a signal to the other chickens, and we crossed the road.

Me: And what was it like there?

Chicken Little: This time the hawks were all on the ground. They chased us into a big hen house and locked us in. It wasn’t bad at first. We were warm and dry and got chicken feed. The hawks guarded the place and
left us alone as long as we didn’t try to escape. All we had to do was lay eggs. That’s why they called us providers. We asked what kind of place this was, and we were told it was an HMO, short for Henhouse
Management Organization.

Me: So you lucked out. Who could have guessed it would turn out so well?

Chicken Little: It wasn’t good for long. More and more chickens were jammed in together. Feed became scarce. We were required to lay more and more eggs, with less and less to eat. The hawks made short work of anyone who couldn’t keep up.

Me: How did you deal with it?

Chicken Little: We could see another road, and across that road we could hear a big cock crowing that if only we would cross the road, he’d take care of us. He said that we’d like his single layer system better than the HMO. He sounded so sincere. We thought it couldn’t be worse than what we had, so we made a break for it and crossed the road.

Me: What did you find on the other side?

Chicken Little: You can see for yourself. We had our wings and tails clipped, and we were jammed into tiny coops made of chicken wire, where we can hardly move. The coops are piled in a huge stack with us providers in a single layer on the bottom–that’s why it’s called a single layer system. Above us are layers and layers of chicken coops, filled with administrative chickens scratching out regulations for us to follow. The big cock perches on top of the pile, constantly crowing.

Me: You’ve crossed two roads. Are you happy now?

Chicken Little: Would you be happy? Everything that comes out of the chickens above us, from the cock on down, falls through the holes and lands on our heads. If you were in here with us, wouldn’t you say the sky is falling?
By Gerald D. Klee, M.D.
Previously published in Harvard Medical Alumni Bulletin and The Maryland Psychiatrist 
Reprinted with Permission


The Misunderstood Life of “The Big Bad Wolf” 

“Hello, good sir, er, wolf,” smiled the psychiatrist nervously, “Won’t you sit down and discuss what is bothering you. Oh, by the way, what is your name first?”
“Wolfgang J. Woolf, to be exact. Not that anyone actually calls me that except my mother, though sometimes I wish they did. Instead I am called ‘arooo—yip—grrrrr,’ meaning in wolfish, ‘a young and annoying idiot’ in a rather condescending way. My only friend, Autumnus R. Luppus, is invisible. He calls me Wolfie, which I don’t mind that much after the awful nicknames the other cubs come up with.”
“Mmmmm hmmm. Well then, do begin your story, and explain to me why you are here,” the psychiatrist replied.
I began, “Do not reprimand me for beginning my story the traditional way, sir. It is just that any storybook character must begin that way. You know that, do you not?”
“Of course, of course. All of the three pigs do, when they had to get trauma therapy after they met you on that dreadful occasion, “ he smiled.
I started, “Well first there were the three pigs, then the incident with Peter, you know, Peter and the Wolf, and then, oh forgive me, but there are so many! But recently there has been another incident. Let me begin…”
Once upon a time, there was a little cozy cottage in the woods. I do believe it has since been torn down to build a large set of condominiums and apartments. However, at the time, it was very nice. Within it lived an innocent little girl (I do believe now she is a not-so-innocent corporate lawyer who sues many people per day.) and her mother (who was sued by her daughter for complete negligence of the events to come in my story.) These two were very happy at the time, and one day the mother, Ma Hoode was obliged to visit her lunatic mother with some presents. Since Ma Hoode was not too fond of her mother, she made her daughter, Red Riding Hoode go. Red set off immediately, wasting no time, as she wanted to get the visit over with as soon as possible.
In Red’s path was a large forest that also happened to be the site of my family’s den, not that I am allowed to visit. You see, my parents tried to teach me to hunt, but to no avail, for I felt too sorry for my prey. Eventually I just gave up and became a vegetarian. This caused several problems for me. My pack deserted me, for I could never become a great hunter like them, being a vegetarian. And when I tried to make friends with the smaller animals that were also herbivores, they believed that I was still after them for dinner, so they ran away from me.  I was virtually friendless! But anyway, back to Red’s journey. Well anyway, she was walking along, spooked by the dark forest. She carefully made her way, jumping at every small noise. But this went on for a while, and I tired of watching her, so I paid a visit to her crazy grandmother.
I hid behind a large gooseberry bush, planted next to several pink flamingos and lawn gnomes. Not only was this old woman crazy, she also was tacky and color blind, apparently. The grandmother’s head popped out of a window, and she began gazing lovingly at her lawn gnomes. I decided to leave, but as I tried to leave, my fur got tangled in the thorns of the bush and a loud rustle was audible. The old woman ran out her door and looked around. She saw me, but luckily did not scream. Instead, she walked right up to me and hugged me, saying, “Oh my! My long lost love! My sweet dearie! Oh John! You’ve finally returned, and look! You’ve grown more hair! The last time I saw you, you were bald. Oh dearie, how you’ve grown! My little husband!”  I tried to run, but her arms encircled me in a tight grasp. When I struggled, she only held tighter. This seemingly frail old woman lifted me up and carried me into her house.
She took one of her nightgowns and forced me into it grinning, “Oh John, I saved one of your suits for your return. And look! It fits you perfectly!” I grimaced. All of a sudden, Red could be seen making her way down the path to Grandma’s. She knocked on the door. Grandma pushed me into her bed and ran to hide in the closet, locking the closet door. Red pushed the door open, and seeing me in her grandmother’s bed, she rejoiced, “Oh good wolf! You’ve finally eaten my crazy grandmother! Wait! You’re a wolf! Aaaaa! Not a wolf!” Then she ran out of the house.
I was glad the girl had left; I didn’t like her much at all. A few minutes later, she could be seen again…with a woodcutter! He had an ax, and I know what they like to do. Kill wolves! He bashed through the door shouting, “Where is he? Where is he? Can I kill him? Please? Please? Huh, Huh? Can I kill him?” I did not like the look of the situation. I bolted from the window, running for my life. The wood cutter never even saw me. Then Grandma came out of the closet. Red exclaimed, “There he is, kill him!!!”  The woodcutter chopped Grandma into little cubes in minutes, not realizing it was Grandma.
To this day, I still think that Red knew all along that it wasn’t me. But after the woodcutter killed Grandma Hoode, such a gratuitously violent man was he, he killed himself! Later when Red told the police, she twisted the story around so that it sounded like it was all my fault, and now I am going to jail for the millionth innocent crime I have committed.
“Doctor, help me!” The psychiatrist scribbled a few words onto a pad of paper on the table. I could just make out that they said, “chronic mental disorder: lying. Physician suggests that the patient should be hospitalized in a secure mental institution or a prison-hospital under close supervision. The patient is a menace to society, and should be kept away from the community.” Then he said, “Hmmmm. Interesting story you have there, son. I can’t help you, though. You must face the crimes you commit instead of lying about them to get out of trouble. How could I believe an unrealistic story like that?” Then he dialed the police station, All that I could hear was that I would be “thrown behind bars” and that the psychiatrist would be “greatly rewarded for his troubles.’”
I ended up spending the rest of my life in jail, thanks to the fact that Red Riding Hoode became a corporate lawyer herself with no sense of ethics or morals. I am writing this on the wall of my high-security prison cell with the hopes that someday somebody will read this and realize that I was completely innocent. I did nothing wrong, and do not deserve this cruel and unusual punishment. How could I deserve this if it was just my luck to be stuck in the wrong place at the wrong time? I must end my writing now because the guard has begun to watch me again, and he looks unhappy. Farewell, and remember my sad story the next time you see any house with lawn gnomes all over the grass, for you may be the next one to be imprisoned for life and called a chronic liar.
Written by Nicole, age 12
New Jokes for February 2000
Managed Care Hell 
A concurrent review nurse had used up her allotted three days in heaven.  Purgatory had such a long waiting list that it was no longer taking new admissions. Her benefits exhausted, she was referred directly to hell.
When she arrived at the gates of hell, her personal torment manager greeted her.
“Welcome to hell,” said the demon, “I am here to orient you to our new, streamlined eternity of perdition; we now emphasize efficiency and choice. To that end, we allow each condemned soul their choice of several torture plans. Let me escort you to the open enrollment area so you can make your choice.”
The demon led the nurse down a toasty-warm, brimstone-scented corridor with a line of doors on each side. Managed care hell is down that side, gestured the demon with his clawed hand, “Look inside and see which one appeals to you.” Just then, the demon’s pager went off.  “I’m supposed to get off this #%*&!, shift in 15 minutes, this call better go to the second shift torment manager!” Turning, he said, “I’ll be back in as soon as I turf this call.  Have a look around yourself.” With that, he disappeared in a puff of sulfurous smoke.
The concurrent review nurse opened the first door. Inside she saw a huge noisy room with tiny cubicles and the echoing sound of a thousand blaring speakerphones. Each reviewer sat in a cramped chair in front of a desk covered with mountains of paperwork. One white-coated demon toted a whip and lashed out at any reviewer who wasn’t filling out papers fast enough. Another white-coated demon with a blowtorch applied flames to the toes of any reviewer who made a mistake or misfiled a paper. The nurse reviewer quickly closed the door.
She opened the second door. “Audit!” screamed a blinking neon-red sign. Wailing and moaning filled the room full of cubicles. At one end of the room, frightened people frantically fed papers into a thoroughly jammed shredder. At the other end of the room, demons with law enforcement badges rifled through piles of paper and randomly dragged off individual reviewers for special torture. Perspiring slightly, she closed that door too.
The reviewer then went across the hall and opened another door. She found herself in the staff office of a hospital ward. She watched as a concurrent reviewer marched into the room. Immediately, the attending physician sprang from the most comfortable seat and offered it to that reviewer. The resident physician stood up and offered to fetch the reviewer coffee and doughnuts. The intern brought the reviewer paper, pens and several charts, all carefully opened up to the right page.
Just then the demon returned. “Have you made your decision yet?”
“I think so,” said the reviewer with a little smile. She pointed to the third door.
“Sorry nursey,” smiled the demon, wagging his finger, “That one there is doctors’ hell.”
They’re starting to patent the receptor sites in my brain… 
When the Glaxo ligand attempts a binding to the Smith-Kline receptor on the lateral aspect of the nucleus gratuitous, the reaction may be inhibited by the FTC regulatory system. The powerful binding forces will eventually overtake the relatively weaker, lipophilic regulatory system. The result of the binding may be an increased saturation of the fissure of finance and an increased turnover rate in the drug reps at the Baltimore synapse.
Upon encountering a large spider in the clinic examination room. . .

Administrator: Runs screaming away from the spider. Sends a stat page for the entire medical staff.
– Internist: Kills the spider.
– General Surgeon: Crushes spider with his fist, giggles, and looks for more spiders.
– Utilization Review Coordinator: Ugh! Me See Spider. Me Like Spider. Ouch! Me No Like Spider!
– Radiation Oncologist: Has GPS grid to spider. Couldn’t find spider. Back to lounge for rest and a manicure…
– Pediatrician: Plays with the spider, then eats it.
– Medical Oncologist: Kills spider, but the treatment is so toxic that it kills all the patients in the waiting room. Procedure is considered a great success, and all participants become co-authors of feature article in Oncology Journal.
– Neurologist: Follows the spider from room to room and gets lost.
– Department Chairperson: Guides the spider to the staff lounge.
– Emergency Room Physician: Wounds the spider in first encounter, then feverishly works to save the spider’s life.
– Endocrinologist: Studies spider. Prepares in-depth 20-page article in obscure journal about how to kill spider using hormonal and dietary changes in flies eaten by the spider. Complains that internist sabotaged job because he misunderstood the fifth page of the hormonal protocol.
– Psychiatrist: Makes contact with the spider, develops a climate of trust and mutual understanding, and then teaches it to kill other spiders.
January 2000
A doctor in a bar leans over to the guy next to him and says, ”Wanna hear a managed care joke?”
The guy next to him replies, ”Well, before you tell that joke, you should know something. I’m 6′ tall, 200 lbs, and I’m a managed care lawyer. The guy sitting next to me is 6’2” tall, weighs 225, and he’s a managed care executive.  The fellow next to him is 6’5” tall, weighs 250, and he’s one of our second level reviewers. Now, you still wanna tell that joke?”
The doctor says, ”Nah, I don’t want to have to explain it three times.”
Green Side Up
A managed care executive hired a contractor to repaint the interior of their Columbia facility. The executive walked the contractor through the spacious building and told him what colors he wanted for each room. As they walked through the first room, the executive said, “I think I would like the board room painted a cream color.” The contractor wrote on his clipboard, walked to the window, opened it and yelled out, “Green side up!” He then closed the window and continued following the executive to the next room. The executive looked confused, but proceeded with his tour. “For my office, I was thinking of an off blue.” Again, the contractor wrote this down, went to the window, opened it and yelled out, “Green side up!” This baffled the executive, but he was hesitant to say anything. For the ladies’ restroom, the executive said he would like it painted in a light rose color. Once more, the contractor opened the window and yelled, “Green side up!” Struck with curiosity, the executive mustered up the nerve to ask, “Why do you keep yelling ‘Green side up’ out my window every time I tell you the color I would like the room? “The contractor replied, “Because you asked me to save money by having your reviewers lay the sod on the front lawn.”
20 great slogans for our new managed care organization…..
Rome did not create a great empire by having meetings, they did it by killing all those who opposed them.
If you can stay calm, while all those around you are in chaos… then you probably haven’t completely understood the seriousness of the situation..
Doing the paperwork RIGHT the first time gets the job done. Losing the paperwork fourteen times gives you job security.
Eagles may soar, but weasels don’t get sucked into jet engines.
Artificial Intelligence is no match for Natural Stupidity.
A person who smiles in the face of adversity…probably has a scapegoat.
If at first you don’t succeed, try managed care.
Never put off until tomorrow what you can avoid altogether.
TEAMWORK…means never having to take all the blame yourself.
The beatings will continue until morale improves.
Never underestimate the power of very stupid people in large groups.
(For providers) We waste time, so you don’t have to.
Hang in there, retirement is only thirty years away!
Go the extra mile. It makes your boss look like an incompetent slacker.
INDECISION is the key to FLEXIBILITY. Succeed in spite of management.
A surgeon was on vacation in the depths of Louisiana and he wanted a pair of genuine alligator shoes in the worst way, but didn’t want to pay the high prices the local vendors were asking.
After becoming very frustrated with the ”no haggle” attitude of one of the shopkeepers, the surgeon shouted, ”I’m good with a knife, maybe I’ll just go out and get my own alligator so I can get a pair of shoes made at a reasonable price!”
The vendor said, ”By all means, be my guest. Maybe you’ll run into a couple of managed care physicians who were in here earlier saying the same thing.”
So the surgeon headed into the bayou that same day, and a few hours later came upon two men standing waist deep in the water. He thought, ”those must be the two managed care physicians the guy in town was talking about.” Just then, the surgeon saw a huge gator swimming rapidly underwater towards one of the managed care physicians.
Just as the gator was about to attack, one managed care doc grabbed its neck with both hands and strangled it to death with very little effort. Then both men dragged it on shore and flipped it on its back. Lying nearby were several more of the creatures.
One of them then exclaimed, ‘‘darn, this one doesn’t have any shoes either!”
How do you get a twinkle in a MCO reviewer’s eye?
Shine a flashlight in her ear.
Hear about the managed care reviewer that got an AM radio?
It took him a month to realize he could play it at night.
What happened when a mental health managed care group tried to start a company Ice Hockey Team?
They drowned in Spring Training.
December 1999
A boy and his uncle were visiting the grave of the boy’s grandmother. On the way back to the car, the boy looked at a gravestone and asked his uncle, “Do they sometimes bury two people in one grave?”
“Of course not,” his uncle replied, “Whatever made you think that?”
“Over there–” the boy replied, pointing, “Look at that gravestone. It says, ‘Here lies a hospital administrator and an honest man.”
Three physicians, a Russian, a Cuban and an American were all in the same train compartment heading for an international medical conference. The door opened and a managed care executive came in and sat down. The others politely ignored him and continued their animated conversation.
The Russian took a large bottle of the finest Vodka from his briefcase. He poured a glass for each of them and declared, “My country produces the finest Vodka in the world! Nowhere else will you taste Vodka this good. Not only that, but we have so much of it that we can just throw it away.” With that, he stood up and threw the rest of the bottle out of the window. The other companions were quite impressed.
The Cuban, not to be outdone, pulled a large package of Havana Cigars out of his valise. He handed one to each man and said, “No country in the world produces cigars like we do in Cuba. The finest! Everywhere in my land they are so plentiful that we just open a pack and toss the rest away.”  He then threw the rest of the pack out the train window.  Again, the others were very impressed.
At that point, the American physician, without a word, got up from his seat and tossed the managed care executive out the window.
New Jokes for Jan. 1999
Two little girls were having an argument about which of their daddies was better. “My daddy is better than yours. He is a carpenter and builds houses.”
“That isn’t so great,” said the other girl, “My daddy writes insurance contracts and he makes loopholes.”
Changing HMOs is like changing deck chairs on the Titanic.
A billing clerk for a managed care company proudly told a friend that she had just finished a jigsaw puzzle, “And it only took me five months.” she beamed.
“Five months?” said her friend, “That sounds like an awfully long time to finish a jigsaw puzzle.”
“Not really, ” the clerk explained, “The box says six to twelve years.”
MCO Unveils Innovative Approach to In-Network Provider Shortage
Ever the trend-setter in managed mental health care, Vasco DeGama Health Care Corporation announced its new benefit package for patients with mental illnesses. “We’re really excited about this, said Dr. John Magazine, the company medical director, ” For the first time, we are planning to expand the number of visits authorized.
The new approach was, as usual, a response to another unexpected health care crisis. “The last time we reduced our reimbursement rates, 80% of our mental health providers went out of network,” said Dr. Magazine, “We then noted that the remaining providers were sending in fewer active treatment plans. We thought that they were getting psychoanalytic or something, so we checked up on them. To our surprise, we found them in their empty offices, dead of starvation.
“I had to think of something quick. That weekend I was out walking with my dogs–I’m not much of a people person you know–and I stepped right into it. Dogs!  Why have we been using wasteful human therapists all this time? Dogs are much more understanding, empathetic and accepting than humans. Humans often require years of training to learn empathy and unconditional positive regard, but dogs innately possess this quality.   Dogs clearly express their emotions by barking, howling, licking and whining. This could be a role model for some of our more repressed patients. Instead of years of expensive university training, dogs need only a few weeks of inexpensive lessons at the local PetSmart. Of course there are a few disadvantages. If the dogs do not bathe regularly, they tend to produce olfactory difficulties in small, unventilated therapy rooms.  However, in a small, uncontrolled study, our patients reported a preference for dogs, rather than our in-network providers, in their current state of decomposition. Dogs do not do a very good job for telephone screening or for hotlines. However, we plan to hire vet techs to cover the phones.
“We tossed the ball around at a recent corporation meeting and retrieved some great ideas. At this point, we are able to be much more scientific in assigning specific canine therapists to patients with specific complaints. We plan to assign Dobermans to patients requiring behavior therapy.  Chihuahuas will make excellent Rational-Emotive therapists. We will assign Pit Bulls to those needing aversive therapy and also to those excess cost patients. The border collies, of course, will be in charge of group therapy. At first, we planned not to use Basset Hounds due to their passivity and virtually complete lack of responsiveness. Then someone said they reminded him of a psychoanalyst he knew years ago. So now, even though we think psychoanalysis is a waste of time, we will allow it if done by one of our new in-network providers.
“Although we do not generally recognize the validity of Axis II diagnoses, we are studying the use of feline therapists for individuals with Narcissistic Personality Disorder,” he added.
“Dogs will certainly be added value employees in our corporation. They will work for long periods of time, seven days a week for cheap dog food and a few bones. In the past, we had to throw far too many bones to our human therapists. The best part of the whole deal is the contractual part. Due to recent tightening of the ethics codes in the medical profession, it has been more difficult to purchase psychiatrists outright. This is not a problem with dogs. Just think, we get to OWN their licenses.
Said Dr. Magazine, “The program will start as soon as possible. We’re straining at the leash. We should be quick to scoop up an opportunity when it presents itself in our own backyard.”
Eleven ways to get rid of drug reps
Carol Watkins, MD

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

Copyright 1998 Carol Watkins, MD
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Last modified: October 13, 2007