Roberta: Let's start out with how you (whoever you are) started out writing the MC MD comics in the first place. Actually, before we get to that, let me just ask you why you make such a big deal about remaining anonymous? Isn't it a little pretentious?
MC MD: Oh, I don't know. There's something kind of wild and exciting about being shrouded in mystery. But, to be truthful, I do part-time administrative work and one of the things most prized by businesses (and managed care is business) is loyalty. You know, you're not supposed to frag your commander. There is precious little self-awareness that some of the things we do and say in managed care are really kind of silly. Everyone takes themselves so seriously! We deal with pain and death on a daily basis -- that's serious stuff, not the precise wording of a practice guideline that no one looks at or the verbal gymnastics we go through with straight faces to convince our patients that the cheaper, four-times-a-day antibiotic which frequently causes nausea is as good as the more expensive but better-tolerated once-a-day kind. Anyway, I have a wife and kids to feed (oops -- some personal info) and I need this job. And so far no one seems interested in paying me to be a comic artist.
Roberta: Can you at least tell us where you practice and what kind of doctor you are?
MC MD: I practice somewhere in California as an internal medicine sub-specialist. Our group was recently purchased by a large MSO. I have a degree in Literature and I can't draw.
Roberta: So, how did you start writing your comics?
MC MD: When we were bought out there were some changes. Some big changes. All of the sudden we were responsible to shareholders rather than to our patients. There was new management -- just as arbitrary and inept as the old, but somehow two orders of magnitude more intrusive and arrogant. Dilbert cartoons started appearing everywhere and all of a sudden I found I was understanding them. I began spending my 1/2-hour drive to and from work full of freeway furor, engaged in philippics regarding the latest atrocity coming from admininstration. In one of those rare insightful moments we all have, I realized, computer geek that I am, that I could better channel my energies into a Web-based comic. And it felt much better. Ten hours every two weeks on the road is a lot of time in which to compose a comic. It's just a matter of focusing one's bitterness -- what used to be a miserable drive became fun. And I found there was ample grist for my satire.
Roberta: Where do you get your material?
MC MD: My material comes occasionally from serious pieces in journals like the New England Journal of Medicine, but mostly from comments and complaints made around the coffee pot. And personal experience, of course. My e-mail suggests that at least some of the things I make fun of are not unique to my own organization.
Roberta: Any hate mail?
MC MD: Not much mail at all, unfortunately (it can get a little lonely writing the comics and not knowing if anyone is actually reading them). Sometimes I'll get a letter saying that a particular comic has been circulated around a hospital and has generated a lot of controversy -- I've been warned to expect hate mail, but it never comes. Interestingly, I get a fair amount of mail from UM nurses. They write such nice things that I have vowed never to give them a hard time in my comics (at least not too hard a time).
Roberta: What about the movies? Do you have a secret life as a movie critic?
MC MD: Does it pay better than comic artist? I love movies. I don't get to see a lot of them, unfortunately. My wife (who knows a lot more about movies than I ever will) sees just about every movie that comes out and feeds me the ones she thinks are worth seeing. We subscribe to just about every cable movie channel there is, so I'm able to find the trashy B-movies on my own. The first comics didn't have movie pages. Round about the third or fourth one, I thought it would be funny to reference a movie title. It worked out so well, I went back and added them to the first few comics. Now, of course, I can't imagine writing a comic without them. They allow me to add another dimension to each comic and, to be honest, give me a chance to preach from a soapbox. I do try to carefully screen each comic for pretentiousness, but (may the god of satire forgive me) with varying success.
Roberta: Have you really seen all of the movies you mention?
MC MD: No (do I get points for honesty?) Like I said, I majored in Literature and quickly found that you didn't need to have read entire books to be able to converse intelligently about them. Likewise, I use books, CD's and Web sources to fill in the gaps in my movie knowledge. That's just between me and you, of course.
Roberta: Don't you get a little bored of just drawing stethoscopes all the time? Don't you yearn to add a little variety to your comics?
MC MD: Again, like I said, I can't draw. But I'm really good at cutting and pasting. Think of it as haiku - simple on the surface, but complex in allusion. Maybe I'll buy a scanner some day and branch out. You can't imagine how long it took me to draw the original, primordial stethoscope with my mouse. I was exhausted for weeks afterwards.
Roberta: Do you really hate managed care as much as your comics imply?
MC MD: I'm really not as anti-managed care as I appear. I really do believe in practicing evidence-based medicine using practice guidelines, in accumulating, analyzing, and acting upon outcomes data, and integrating providers, pharmacists, and nurses into a patient care team. It's when these ideals are co-opted and used in name only for the sole purpose of turning a profit at the expense of taking care of patients that I plug in my mouse and get ready for the next comic.
Roberta: How long do you think you'll be writing the comics?
MC MD: Roberta, as long as there is disease state management, I'll be there. As long as there are economically-motivated practice guidelines, I'll be there. As long as there are physician administrators who forget they are first and foremost doctors, I'll be there. As long as AOL gives me server space, and my kids let me on the computer, I'll be there. For the forseeable future, it would appear.
Roberta: Any last words?
MC MD: Not really. I would like to thank you for your encouragement and for letting your readers know about my site. Good luck with yours (you can let everyone know what I previously wrote about your site - "You have a marvelous site. Very impressive. Complex, but friendly. Good enough for one-stop shopping. Well worth a bookmark, and a reason not to sort them." - and that I wasn't sucking up just to get a link.)
Visit the MCMD Web Site at http://members.aol.com/mcmdcomic/index.htm