Sunday, September 21, 2008

Munchausens' by Attorney

When a new patient comes to the office, we are required by insurnace and CMS to get all kinds of information from them. This is all the family history and past medical history stuff that takes so long. We just had a patient that came in the past medical history was seven pages long. It was filled with a list of things like irritable bowel, interstitial cystitis, fibromyalgia, chronic pain, depression, etc. All the things that are in the medical neverland that can not be proven to be real or non-real. When I looked at the form, I was amazed as she included in her Review of Symptoms, those that would support her diagnosis except that they were listed in alphabetical order and not the way they were listed above on the form. (we ask the patients to actually list their symptoms rather than just checking boxes because people would otherwise check everything. None of the symptoms related to why we were seeing her.

I couldn't resist so I ask our Front desk receptionist. She is really the one who runs the practice, she sees all and knows all, and in fact does it all. She told me that this patient had one of those handouts from an attorney that tells them what to list and how to list it so that later the medical records can be requested used for disability or for whatever they have planned. I was shocked, I asked her how often this happens, and her answer was that it was all the time, she said she did not want to tell me for fear I would spend too much time in the office banging my head into the wall. Then she goes, "here, you might like this!". When the patient was filling out the forms, she asked if she could photocopy it, and sure enough, I now had the attorney's handout in my hands. It was a cut and paste breakdowm of each of the "questionable diagnosis" and list of symptoms and where to put them on the forms. There was no attorney's name on the form however.

Three days later, the requests for the medical records came, it was of course from a local disability attorney. I made sure that the photocopy of the attorney's handout was included in the records.


SeaSpray said...

Clever title! :)

I guess if this is what they do most of the time then they develop an efficient system to facilitate the process. Interesting.

I think it is great that you recognize the value of your front desk receptionist! She sounds like a good one and believe me not all receptionists should be out front representing the docs and practices I've been in and would be better suited away from the patients.

Sorry...I guess I am more aware than most because I basically did that with other responsibilities at the hospital for 20 years. I can not stand to see a patient ignored or treated rudely in any degree for any reason. They choose to come to that doctor because they are concerned, possibly afraid something is wrong and they should be made to feel as appreciated and comfortable as possible. AND the patient can just as easily choose to go elsewhere.

Then again...I have never worked in a doctor's office so perhaps I am off base saying that since I don't know all the dynamics that go on behind the scenes. Just seems logical though.

I always thought of my self as a diplomat you said...we do see and know all. I have seen staff say the most horrible things about patients if they were annoyed and then the ED staff attitude would turn negative and I decided long ago I would not do that.

You know those hellacious nights or in your case days where you barely have time for peeing..never mind eating? And people start getting a bit testy? Well when pts expressed their anger and wanted things from the staff...I never used the pt's words but would convey the message in a more positive the staff wouldn't get totally irritated. Ha...they had their own comments a flyin too. :) And when staff said the things you know an ED staff can say behind the scenes...I would go back to the patients and family and put a positive spin on what they said. I KNOW I helped to keep things going more smoothly and settled the ruffled feathers. And obviously..I told it just like it was when it was important. I'm not a nurse but I could triage with the best of em and they do count on us because we are the first ones to see the patients.

I guess this has gone off topic a bit, but your receptionist not bothering you with something she knew might bug you is understandable because you have more important things to think about. I think when you become familiar working with know just how to handle things for them.

When I was 24 and thinking I might not be able to have that time I was thinking I wanted to be Consuela, the nurse/receptionist on Marcus Welby, MD because I love helping people and I liked the interactions she had with the doctors and patients and thought it would be fun. I also thought then someday I'd work in a hospital when I got enough experience in a doctor's office. But I worked at the hospital first and so even though intellectually I know I could easily transition into a physicians's office...I feel a bit shy about it.

What do you or your colleagues look for in a receptionist? What kinds of things does your receptionist do? I know different doctors might have different requirements.

I have been vacillating between doctor's office or working in the hospitals. I have to say the economy must be affecting job availability because few are advertised in the hospitals now. people are staying in their jobs.

I hope you don't mind that I am asking but I really am curious...what does a doctor look for in a receptionist? And do receptionists only do reception or are they given other tasks as well?

I guess that depends on staff size and individual office requirements... but I really am curious to know what doctors want in a receptionist.

Sorry to bother you with this..just on my mind a lot right now. I'd appreciate any insights you have to offer...but...I know you are busy...but if you can... :)

So...did you end up banging your head against the wall after reading the lawyers handout or was mailing a copy sufficient? ;)

SeaSpray said...
This comment has been removed by the author.
SeaSpray said...

I just heard this on the radio earlier and thought you might appreciate it given your fondness for disability claims. ;)

The NY Times recently reported on the Long Island Railroad having a 9 out of 10 disability approval rate for people going out on retirement. So these people have an additional 3000.00 tacked on to their retirement pension. The show host said probably for things like jiggling the kidneys on the tracks all those years. He was being facetious of course. Actually arthritis and I don't recall what else.
here is an excerpt of something I googled about it: "The L.I.R.R.’s disability rate has been three to four times that of the average railroad in recent years, and far outstrips Metro-North, which serves commuters north of New York City and has a work force of about the same size. For example, from 2001 through 2007, Metro-North had 32 cases of disabilities resulting from arthritis and rheumatism, compared with 753 at the L.I.R.R.

The disability problem has been compounded by labor contracts that allow longtime workers to retire with a pension as early as age 50 and by a tangle of negotiated rules that allow workers to reap four days of pay for a single day’s work. Such rules allowed eight senior train engineers to earn from $215,000 to $277,000 in 2006.

Financial stuff is so discouraging lately! Seems like people have no problem milking the system for self gain without any regard to consequences. Consequences be damned because I am more important must be their motto! In the meantime... we the tax payers have to kick in for all these things.

Maybe I am dating myself...but what ever happened to working for your money and giving back vs take, take and take? then again the days of the counted on gold watch with a corporation are long gone.

Everything is all about the money. And I understand that-people need to earn a living and there is nothing wrong with making a profit, or why be in business? But something is so different from how it seemingly used to be.

It is colder and more impersonal. Corporations merger, the new controlling companies don't feel loyalty to the existing employees, they mismanage funds (understatement given recent news), there's multiple buy outs in one company sometimes,downsizing pares down staff compromising quality and efficiency..yet all the while they want excellence and efficiency. Products are smaller or inferior compared to what they used to be, and often sent over seas for cheaper labor. Then we get the toxic toys from China (That really burns me-so unnecessary and WRONG!),toothpaste, makeup..all tainted. Products aren't made to last anymore. ( I do have a sears dryer still going strong from 1991)

What is wrong that people seem to matter so little in the equation?

That's a rhetorical question, although if you have an answer/opinion...I would be most interested.

mercydoc said...

Arrrgghhhhh!!!! This takes the cake! There has GOT to be a law against this! Can't someone investigate and sue the lawyer(s) that are coaching people to commit fraud??? I would love to see someone from 60 minutes or a similar show do a hidden camera story on how sleazy these lawyers are!!! And then have the joy of seeing them stripped of their license to practice on nationwide TV...sigh. Instead I'll have to watch Ted Turner share about "His life, Loves, Personal Struggles and Business". On the other hand I could just turn the stupid thing off!

Paulo McManus said...

Every disability lawyer must learn from this. Beinn sure and confident of what you are trying to prove is a mark of a great lawyer.