The Rheumatologist’s Rant – A Most Obnoxious Doctor

Dr. Larry Greenbaum, author of "Kiss my..."
Patricia Salber, MD, MBA, Host of The Doctor Weighs In
Patricia Salber, MD, MBA, Host of The Doctor Weighs In

As far as I can tell, this guy could compete for the prize of “Most Obnoxious Doctor” from the Society for Participatory Medicine — if only they had such a prize

Thanks to @kimwhit @rawarrior @AfternoonNapper for tweeting about this. Not being a rheumatologist, I don’t routinely (or ever) read Rheumatology News so I would have missed what I consider to be one of the more offensive pieces I have ever seen written by a physician. Titled “Kiss My….”, the article starts out with this statement:

“If your practice is like mine, you probably don’t bill for “consult level 5″ very often. That is the most expensive level of care on our office superbill, and I usually reserve it for patients with huge volumes of records, patients who take an inordinate amount of time, or patients who annoy me in some other extraordinary fashion.”

The author, Dr. Larry Greenbaum, a rheumatologist who practices in Greenwood, Indiana, goes on to describe an office visit he had with a 75-year-old man with rheumatoid arthritis (RA).

[He] didn’t bring many records, but I spent a very memorable hour with him. I charged him level 5 for taking so much of my time, for bad-mouthing his previous doctors, and for incessant whining.”

Dr. Larry Greenbaum, author of “Kiss my…”

What??? First of all, I am pretty sure that bad-mouthing and whining are not criteria to bill a level 5. Second of all, RA is a pretty miserable disease. Third, and most important, why on earth would Dr. Greenbaum think that his fellow specialists would have anything but disdain for his pompous, disparaging remarks about one of his patients?


Most Obnoxious Doctor

As far as I can tell, this guy could compete for the prize of “Most Obnoxious Doctor” from the Society for Participatory Medicine—if only they had such a prize. It is one thing to think these thoughts—and I bet most docs can conjure up the memories of some patients that annoyed the heck out of them—I know I can remember a patient or two who got me riled up. But, we are doctors and it is our job to take care of people who are sick, in pain, not tolerating their circumstances well, and not taking care of themselves the way we wished they would—whether or not they disparage other doctors or even whine.

Greenbaum goes on to say,

“When his treatment commenced with 20 mg of prednisone a day, he felt like “Superman,” but by the time he was down to 2 mg a day, he felt as if he had been “hit by a truck.” He claimed that an arthrocentesis by his first rheumatologist caused his left index finger MCP joint to permanently dislocate the day after the procedure. “He took too much out,” he complained. He was on methotrexate, but he was dreadfully worried about dire side effects. A recent string of sinus infections were clearly due to his medications, in his opinion.” 

I have a close friend who was treated with prednisone and methotrexate for presumed RA. Greenbaum’s patient’s description pretty much mirrors how she told me she felt during the treatment. Why make fun of this? And, btw, patient’s should worry about side effects of their medications if they have a doctor like Greenbaum, because he may not.

And, here it is—the “blame the patient” line:

“He didn’t think that his long history of smoking could possibly have contributed to his problems.”

At the end of the article, Greenbaum tells the patient he knows his neurologist:

It was a throwaway comment on my part, but I always think that patients feel a little more confident when their doctors know one another. He gave me a goofy look and he elaborated, “She’s a beautiful young woman with black hair. I kissed her hand.” He was seated on the exam table and I was standing directly in front of him. He looked me in the eye and added, “But I’m not going to kiss your hand.” He didn’t seem demented or hateful, just weird. I assured him that I’d be fine without his kiss, and I wondered quietly if his neurologist had gotten over this moment of chivalry. I wasn’t the least bit insulted. It was just another day in clinic.


What’s Really Going On?

My takeaway from reading this is that this is a doctor in distress. Is it burnout? Is it boredom? Are there problems outside of the exam room that are bumming him out? Perhaps he needs a vacation or a nap or good night’s sleep. Perhaps he needs some patients to kiss his hand. This is not my area of expertise…Dr. Cary? Dr. Drummond, Mr. Diamond, please weigh in here.

One thing I do know is that Greenbaum’s fellow specialists should let him know how they feel by commenting on his post (it is interesting that are are no comments, suggesting to me that someone may be screening them.) Certainly, this article has gotten some people angry as noted by the 59 comments on Dr. Kelly Young’s Rheumatoid Arthritis Warrior blog.

I would love to know what you think? Post a comment and I will provide a link to the editors over at Rheumatology News. (In the age of the internet, you really can’t hide. Hmmmm…I wonder what what will happen when the folks at CMS read this?)

According to the article, “Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. You may reach him at”


  1. Hey Pat … you don’t spend much time on do you. Let’s talk for a bit about what this article and attitude may or may not mean.

    In men, the first sign of burnout is compassion fatigue. It shows up as a cynical, sarcastic attitude. It is a dysfunctional coping mechanism for stress AND it is incredibly common. And by itself it is NOT enough to be concerned about Dr. Greenbaum being fried at the moment.

    However, when I see a cynical, sarcastic joke or article about patients put up on the web I wonder more … because it shows a lack of judgement on the part of the doctor. Maybe he is emotionally tone deaf – we all know doctors like that – or maybe he is over stressed. I mentioned above … let me give you some examples of burnout splashed all over the web.

    Sermo is a site for physicians to connect behind a secure login page. They verify you are a physician before they let you in and almost all docs on the inside use anonymous user names. It is where doctors go to vent.

    The first time I went to Sermo there was a post about a doctor’s fantasy about using a nail gun to nail a drug seeking patients hand to the exam table … and supportive comments piling in behind about kneecapping and lighting patients on fire and throwing them out the window. That is burnout for sure … and a bunch of good old boys who think VENTING is a good thing … normal and healthy.

    That behavior is pathologic and a sign of severe burnout. However, male physicians are unlikely to notice or do anything about it when the culture supports that type of behavior. BTW, they didn’t like it when I asked if the tone of the conversation might be inappropriate. I was flamed.

    Sermo is where burned out doctors go to vent and there are a LOT of them there. That particular post is part of the reason I launched my burnout prevention coaching website at

    At this point I don’t see a reason to believe that Dr. Greenbaum is being anything other than a little politically incorrect. And here is a link to an article I wrote on recent research showing men and women experience burnout differently. It explains why these cases of compassion fatigue that progresses to homicidal fantasies on the part of the doctor is nearly exclusively MALE behavior.

    My two cents,

    Dike Drummond MD

    • Thanks Dike, that was much more than 2 cents worth! No I don’t spend any time on Sermo and from you description I don’t think I would like it. Geez louise, a nail gun to nail a drug seeking patient’s hand to the exam table? I love your post on differences between male and female physician burnout presentation and all the contributions you are making to help docs deal with their stress and burnout. It’s about time we started talking about it. Pat

  2. You are welcome Pat. BTW, I heard a story this week about an ER nurse who wore a Tshirt that says “I am here to SAVE your Ass … Not KISS it”. Subtle forms of compassion fatigue are everywhere and accepted as normal in healthcare. This is to be expected when burnout rates average 1 in 3 on any given office day,

    Dike Drummond MD

  3. Hello,

    Thank you Dr. Salber for highlighting the most offensive article I’ve seen written about a person suffering from the ravages of rheumatoid arthritis. Dr. Drummond? You would characterize this article as “a little politically incorrect”? Have you read the code of ethics for members of the American College of Rheumatology? I am a professional member of several health care colleges / associations. I would never dream of thinking of or writing about clients / patients / people in the manner Dr. Greenbaum did. Perhaps your awareness of severe cases of compassion fatigue has dampened your ability to judge how truly horrendous any type of condescending attitudes are when inflicted upon people under doctors’ care. There is no place for anything but the highest regard for the humanity of all people among health care practitioners. We should expect nothing less and should press for standards of practice that reflect this basic ethic. Dr. Salber, thank you for offering to pass along to the Editors of Rheumatoid News our comments. Here is what I emailed to


    On behalf of thousands of patients with Rheumatoid Disease I cannot begin to express my deep regret that this post has been allowed to stand in your publication. Many of us with RA have experienced this type of treatment which is a disservice to the profession of rheumatology, to the pursuit of badly needed research on aspects of the disease that are not yet understood, and to the humanity of us all. I would ask that you please print an editorial that clearly addresses that such attitudes are unacceptable and retracts this article altogether.

    I’d also like to know why we cannot comment on the site to the post?

    Thank you,

    • Hey Sally … I understand your outrage and I want you to know that the impossible standards you set for doctor s are a BIG part of the problem here. You are expecting doctors to be saints. They expect themselves to be saints too … and superheros and perfect and all sorts of impossible things that add shovel after shovel of stress to the already heavy burden of taking care of sick people all the time. These unrealistic expectations play a large role in the burnout epidemic.

      Doctors are not SAINTS and neither are you Sally.

      Doctors are humans, they make mistakes, they have bad days and sometimes they get exhausted and then are sarcastic and cynical about their patients. It happens. And I know there are areas of your life where it happens to you too.

      Pat asked me if I thought Dr. Greenbaum was burned out. My answer is you can’t tell from the article because that level of sarcasm is so common in healthcare that in many institutions it is considered normal. Maybe he was just having a bad day.

      He was indeed politically incorrect for taking what may have been a bad day and putting his thoughts out on the internet. I have learned over the years that it is OK to feel that way. It is even OK to write the note … just delete it when you are done.

      One last thing … Sally … your standards are impossible to live up to and no doctor in the history of humanity has ever gone their career in compliance with your expectations. I don’t know what you feel about that … and it is true.

      I hope that Dr. Greenbaum – if he sees our discussion – takes a look at himself and his attitude and if he needs some time off and a break to recharge his batteries before he comes back to seeing patients, that he gets it. That would be the highest and best use of this kerfuffle.

      However – if you have now banished him to the realm of the damned and irredeemable … by your standards … then no one wins.

      My four cents,

      Dike Drummond MD

      • Dr. Drummond,

        Whoa, whoa, whoa.

        I don’t know you, I don’t know Sally, and I also don’t know Dr. Greenbaum, but your response to Sally’s post has prompted me to jump into this discussion because I found it so inappropriate.

        “The impossible standards you set for doctors are a BIG part of the problem here.” All Sally said is that disrespect by a physician should never be tolerated and that Dr. Greenbaum may have violated the ACR Code of Ethics. Asking that a physician not behave in the manner in which Greenbaum behaves is not asking for the *impossible.* He can be as cantankerous or angry or bitter or sarcastic (or whatever he is) that he wants to be, he just shouldn’t be like that in the presence of his patients, nor should he blog about it for all the world to read. As you yourself noted in your comments, he needs to find some other way to cope with his emotions. If an attorney or some other professional was this disrespectful about a client/patient, we wouldn’t tolerate their behavior, either. I suspect we would all want their head(s) on a platter.

        Yes, everyone can have a bad day or two. And they are entitled to them. But we can have an expectation that the way they treat others on those bad days be done in an appropriate manner. Greenbaum’s manner was inappropriate. Doesn’t matter how hard his job is, or how stressed out he was on that day, or whatever. The president of the U.S. doesn’t get a free pass from time to time to insult and disparage other heads of state, even if they are totally infuriating him with their views on hot button, emotional issues. He is a professional, and we expect him to behave that way with those he interacts with in his job. Same goes for physicians. Lawyers. Accountants. And so on.

        “Doctors are not SAINTS and neither are you, Sally.” I don’t think she said anything in her comment that suggested that she feels this way. Why are you attacking her for something she never said or implied?

        “your standards are impossible to live up to and no doctor in the history of humanity has ever gone their career in compliance with your expectations.” Again, what are you talking about? Sally merely objected to the behavior of Greenbaum (which behavior should never be considered acceptable) and the fact that it is, in her view, unethical and improper.

        Finally, one other point. Burnout may or may not be the reason for Dr. Greenbaum’s callousness. None of us know for sure what is drove him to write his post (and by the way, read some of his other ones. They aren’t that much more pleasant for us patients to read). Whatever the reason for his behavior, it is the only the *reason* for the behavior. It is not an *excuse* for it. Because there is no excuse for it.

  4. Hi Dr. Drummond,

    Thank you for your reply. I agree with you that professionals or patients who assume unrealistic expectations plays a role in burnout. There is also the potential to alienate each other and then nobody succeeds in optimal patient care. We see burnout in many professions. I believe there are healthy ways to handle the pressures of any profession that induces extraordinary stress. I think you’ve done a service in outlining some of these strategies. I do not find it tolerable to accept or excuse potentially unethical behavior from professionals and am grateful that professional associations and licensing bodies have ethical standards. I also find it presumptuous to state that I would ever banish anyone to the realm of the damned or consider myself a person without flaws. I’m saddened that accusations that verge on a personal attack without knowing me or how I value all people were included in the reply.

  5. @Dr. Drummond.

    Actually, you missed part of the issue…one that is criminal. The overcharging based upon how annoyed Dr. Greenbaum was with the patient or how much the patient whined instead of it being based upon services rendered. Let’s assume that 75 year old patient was on Medicare…and he billed Medicare for that inflated amount. INSURANCE FRAUD. Which is illegal…and since Medicare would be involved, it could fall under a federal crime at that.

    I am also a former patient of Dr. Greenbaum. Burn out? Maybe. This man has an ego. He refused to listen to concerns raised or answer questions asked. When working with a doctor, it should be a partnership with open communication where as a patient, I can say that I don’t like the risks of a particular medication or treatment and would prefer to try something else. To talk down to or at me and then tell me that I am not smart enough to understand what is going, is insulting and untrue. Many of us are well read in medical journals and current research…why?? Because we want to make INFORMED decisions about our health and healthcare treatments. Because let’s face it, there are some doctors that have to be last in their class…and no one knows everything.

    I do agree that burnout is a factor in many doctors attitudes and it is important that you pointed it out for people to see, but it doesn’t excuse Dr. Greenbaum’s unethical billing practices or his belittling in a public light of a patient and his pain.

    • Dr. Salber,

      The reason there are no comments showing on Rheumatology News is that they turned them off. There were comments and then they suddenly disappeared. I thank you for your wonderful take on what Dr. Greenbaum said.


  6. Wow – a post about a mean doctor where the commenters turn on each other too. Whew! I agree about Sermo; why I stopped visiting that site. I agree about compassion fatigue being common in medicine, and the culture unfortunately supports that. I agree that men reach compassion fatigue faster than women, which is why women are starting to predominate in med school. But if this guy reaches compassion fatigue quickly, then he shouldn’t be in rheumatology, where the diseases never go away and compassion is doubly necessary. It wouldn’t be the first time a doc picked the wrong specialty. Hopefully in the real world it would just mean he would no longer have any patients after awhile.

    • Hello,

      It is my sincere hope that something good will come of all of this- for doctors who face incredible pressures and for people with RA who face a lifetime condition that can be so baffling and disabling. I do believe in the best in people !! I’m proud of the work being done by Kelly Young at on behalf of thousands of people with RA to work for positive change in the field of rheumatoid disease. We all want to find answers cooperatively to end the suffering that results from this condition. I think there can be positive outcomes that come from very unfortunate situations such as the one we are highlighting. I know that the majority of rheumatologists and doctors are compassionate, caring, and do their best. I was sincere in my thanks to Dr. Drummond for his work to address compassion fatigue. I think that when cultural norms of any profession are encouraged to have a re-evaluation and shift, this is healthy. I also appreciated Tracy’s comments because I will always believe in ethical treatment of patients, clients, and all people. I think it is important that this discussion not turn on anybody but we keep the focus on the issue at hand.

  7. Wow … I wish it were possible to have a conversation in email that was able to convey the nuance of emotions and allow an actual discussion. If we had only met over a cup of tea.

    I sincerely apologize if your perceptions of my “tone” in the emails above was that of an attack. It was not meant as such. Both Sally and I have strong opinions on different side of this discussion. Doctors routinely kill themselves over their inability to live up to superhuman expectations … or they simply deal silently with their feelings of guilt and remain chronically burned out.

    And there is no room in the doctor patient relationship for some of the feelings Dr. Greenbaum expressed (what was the editor thinking in publishing this).

    I am certain that if Sally, Bev, Delana and I sat down for a cup of tea … our conversation would have a distinctly different tone than these text posts. AND we would find that we are all pointing at the same issue from different viewpoints. There is no disagreement between us in my opinion … no political parties … no hostility.

    We all want what is best for the patient AND the doctor … I am sure of it.

    Dike Drummond MD

    • Dr. Drummond,

      Let me tell you a little about myself. My RA came on suddenly, literally overnight. It took me nearly three years and I had to see 5 rheumatologists before I finally got my diagnosis of RA. Rheumatologists 1 through 4 were just like Greenbaum. The attitudes of these physicians made my situation all the more unbearable. I suffered my own type of burnout from my experience with those doctors. I thank god every day for rheumatologist number 5. If she had not shown some level of understanding or compassion, I am not sure I would still be here, because I was very close to giving up on everything.

      My “expectation” with each of my doctors was just to show a smidge of empathy, and if they didn’t know how to diagnose my condition, all I wanted was some honesty. If I had been asked, I would have told them that I was perfectly ok with “I don’t know” as their answer to what was wrong with my health. Who expects their doctors to make up a diagnosis if they lack the knowledge to actually figure out what’s going on with their patient?

      I did not go into my appointments with an attitude, nor did I go into my appointments with an expectation that my doctors know everything. I did not go into my appointments with Dr. Google articles, I just answered my physician’s questions and submitted to the exams and tests that they ordered.

      Considering how diplomatic Sally has been in her posts to you, I can only imagine she is the same in her doctor appointments.

      I still do not understand why you would say that a patient who objects to Greenbaum’s behavior is one who sets impossible standards for physicians, and that neither doctors nor patients are saints (in all caps, no less, which is tantamount to shouting when writing on the web).

      While some patients are undoubtedly exactly as you describe, we are not all like that. So please do not assume that every patient contributes to the “superhuman expectations” you refer to.

      I would have explained that to you over your “cup of tea” with the other commenters, but I noticed that I wasn’t invited.

  8. Well said. Thank you. I am hopeful that continued discussions about this very important topic will bring better health and resources for doctors facing the challenges of practice as well as patients being treated ethically and compassionately in public and private. I’m sure each “side” has incredible stories to tell and I have empathy for both. Working toward solutions to improve health care for everyone seems to be a good goal : )

  9. What I don’t want to get lost in the back and forth is the pervasive nature of the epidemic of burnout in physicians in America. Every study done in the last 20 years has shown symptomatic burnout AVERAGES 1 in 3 doctors on any given day. I have seen some research showing rates as high as 87%. And there is no reason to believe that our nursing colleagues or people in administration are any less burned out.

    The very nature of the job and the conditioning we go through as we are trained set us up for burnout to begin even in medical school. Most of the time the physician is just trying to get through the day and is unaware of the impact their burnout has on the team. And it is also important to know that men and women have different burnout symptoms. Here is an article I wrote on research showing these important gender differences.

    This is just the start of the burnout resources I have at my site. Explore and please tweet and share them with your friends in need.

    Dike Drummond MD

  10. At age 24, I have been a patient for 19 years and I have been treated similarly. It’s not right. I actually have an account on the site and tried to leave a comment when the article first came out about how horrid I felt that this doctor was acting towards this patient. However, the website will not allow comments on this page whether you are a member or an anonymous poster!! I emailed this doctor and gave him enough of my mind that by the time I was done I had major brain fog. I still have not heard anything back. Furthermore, there are many who believe that this may violate HIPPA and additionally constitute medicare fraud and are reporting him to the medicare fraud line as well as the AMA board in his area.

  11. Hello all,
    I am still committed to working collaboratively with others suffering from rheumatoid disease and the medical professionals who care for us. There is tremendous value in patients with rheumatoid disease telling our stories. It appears there is an urgent need for more funding for research as it is evident there often is a significant gap between what patients are experiencing, diagnoses, and effective treatment. There is no cure. We’re in this together !!! Please see the thread on rawarrior that addresses the topic of “swelling” and the myriad of symptoms that people with rheumatoid disease experience. It would be fairly easy to take the comments on rawarrior and do a qualitative research analysis of the number of symptoms that appear most frequent as well as the type of symptoms most concerning for people suffering from the disease. It would also be interesting to do a count of the number of times patients’ concerns are completely dismissed when visible swelling isn’t evident among the long list of concerning and debilitating symptoms. There is so much objective, clinical and experimental research that needs to be done to understand so many aspects of this disease to treat or cure the condition.

    Dr. Drummond, I enjoyed the link to your research article on compassion fatigue. A thanks to you too Dr. Salber for your thoughtful overview of the “rheumatologist’s rant”. Thank you.

  12. Kelly Young is not a MD, PHD, RN nor has any medical training. She is self taught. I often wonder how she gives lectures across the country while blogging that she is so sick that she can’t get out of bed. I wonder many times if she is truthful about her RA .

  13. I’ve also had some extremely rude rheumatologists, and the danger of seeing a very rude doctor (He cursed me out for not getting my prescription filled) is that I just stopped going to the doctor, went home and got sicker and sicker and nearly died. My family came and moved me back to my hometown and found me a new doctor. Who, eventually was also mocking and inflexible and fired me for asking questions. But by then I was back on my feet and seeing a complementary doctor (MD who also did alternative medicine) who respected me and listened to my questions and concerns.

    I don’t know- I just have to think that being a rheumatologist has to suck. You can’t ever cure anyone. And then there’s all the paperwork, and being an office manager/ business owner. It can’t be anything like what they imagined being a doctor would be like. And how often do people go to the rheumatologist when they’re feeling fine? I don’t know about you, but me? Never! I practically only go when I’m miserable and need something.

    I don’t excuse the rudeness. That is unacceptable. But somewhere behind it is that doctor’s own pain or insecurity. Of course if he were my Dr., I’d just drop him. But sounds like he needs s hug. From somebody.

    I think it’s horrible that our system is so messed up that doctors are committing suicide and other doctors (or the same doctors?) are harming patients by adding insult to injury. I do blame the system more than the patients or doctors. It’s the problem with health care being a for-profit industry, in my opinion. It’s not about the patients. Or the doctors. It’s about Wall street.

    Anyway, my current rhuem is great. He listens. I tell him about my various things I’m doing to stay well, and he writes it down and doesn’t mock me or challenge me for my choices (acupuncture, diet, supplements, Qi gong, etc.). He doesn’t spend a lot of time with me, but when he’s there, he’s either listening or asking questions, totally present. I’ve moved a lot and was diagnosed 20 years ago, so I’ve seen quite a few doctors. His “bedside” (exam-table-side?) manner is unusually good. He could write a book. Or teach a class. Maybe I should tell him that.

    • I realize this is from some time ago, but I’m sure others will read this too as they searching for answers like I am.
      I have read rawarrior by Kelly often as I am searching for answers to my many questions about RA. Her blog has been so helpful! I have RA and do believe Kellys is as bad as she said! Being new to this it is still hard for me to believe this disease! Often when the pain goes away I start wondering if I just imagined it was ad bad as I remember- then the pain is back! Some days I can do almost anything I want, and other days I can’t get off the couch and just lay moaning in pain- even with pain meds! ( which I am thankful to have after seeing so many that can’t get them because their Dr doesn’t believe it’s that bad & actually it’s probably worse than they are letting on!)
      So yes, some times I think Kelly really suffers because she pushed herself to go to these conferences- because she want to educate people that have no idea how horrible this RA is! And those of us with RA are thankful for the hard work she does, and helping to get information out about this horribly disabling disease helps so much! And if you read her blog she does talk about how much it does take out of her! And like I know myself, some days you can do almost anything you just never know! Some days start out so bad, and then by noon I feel like I could climb mountains. ..
      It is so hard to have your limitations questioned because’ yesterday you had no problem and today…’ and Dr’s tell you the pain can’t be that bad – but we know it is- and refuse to prescribe pain meds! So we suffer, and question ourselves if it’s really that bad! I love the articles by Rhumatoid Dr’s that talk about how they never knew how bad RA was, until they got it! I feel bad for them, I wouldn’t wish this disease on anyone! – but it does help because they are believed & help educate others.

  14. YIKES! I am so thankful I do not live in IN and have to see THIS rheumy. AND I think I am having problems with MINE! It also makes me wonder what all my physicians are saying about me. Hmmmmm…

  15. Same problem. I have had symptoms all my life. I have been only recently diagnosed. Nov. 2014. My rheumatologist has done..nothing. No bone density scans, no mri or cat scan to verify damage. He discusses no results with me. He doesn’t listen to anything I say. He forgets to tell me about made appointments. The office staff LOSES track of payments made by me. They ‘forget’ to do all of the blood work or don’t tell me I have any bloodwork until I am in the elevator to leave. He has no idea how severe my condition is yet he won’t test me to find out. He scratches his head saying “I don’t know why you aren’t responding to meds.” DUH because I have been sick for over 20 years NOT for only 8 months.