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  • Avatar Dilaudidopenia 
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    Status: Physician
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    Joined: 05/22/2016

    A good way to answer questions on stuff like this from patients (ESA’s, fitness for duty) is to say the lawyer in your legal department told you not to do it.  “Sorry, policy.”  Patients may not like it but not much they can do to argue with it.

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    This sounds like the same thing docs want when it comes to opiates. “Can we get a policy so we can blame that when patients ask me to do something I don’t want to do?”

    Get a spine. Tell patients “I’m not writing you that excuse because it’s the wrong thing to do” or “I’m not writing you for more percocet because my medical judgment is that it is a bad idea for you.”

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    Yeah that works until you get a complaint letter and admin throws you under the bus.

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    You need new admin and/or a different job. There’s a difference between a real complaint and a complaint like this. I’m glad because I don’t think I’ve ever seen a complaint like this get back to a doc where I work.

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    Oh I agree. I haven’t faced a complaint like this either.  I’m just saying hypothetically.  In any case, I’m not sure why there would be resistance from admin to create common sense clinical policies against abuses like this (work notes, pain medications).  Just seems like good institutional medicine, no?

    #209158 Reply
    Liked by CordMcNally
    Avatar RocDoc 
    Participant
    Status: Physician, Small Business Owner
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    Joined: 06/20/2016

    Yeah that works until you get a complaint letter and admin throws you under the bus.

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    And Press Gainey is my master unfortunately.

    #209159 Reply
    Avatar Dilaudidopenia 
    Participant
    Status: Physician
    Posts: 187
    Joined: 05/22/2016
    easier

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    Would love to meet the patient that says “Wow doc, you’re so right!” after I explain that they don’t need opiates.

    #209161 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2504
    Joined: 01/03/2017
    Just seems like good institutional medicine, no?

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    It is but at the same time I try not to hide behind a policy when discussing my decisions with a patient/family.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #209184 Reply
    Liked by Tim
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 1067
    Joined: 11/07/2017

    Serving on a jury is on my bucket list. I’ve never been summoned, and my lawyer friends tell me they usually dismiss people anyway when they find out they are doctors. Maybe someday when I’m one of those retirees.

    #209186 Reply
    Liked by Tim
    Avatar hightower 
    Participant
    Status: Physician
    Posts: 1450
    Joined: 12/07/2016

    I got summoned about a year ago. I was honest and told them I was an ED physician and me having to miss work at the last minute would cause undue hardship on the group and possibly leave an ED understaffed or even unstaffed depending on the facility I was working at. It finally worked but I didn’t get cut until towards the end. There were sooooo many more obviously false and ridiculous excuses that I was sure I would get cut in the first round. Nope, but the ridiculous excuse people got cut early. I say, the more ridiculous excuse, the better!

     

    I will say that there were quite a few “older” retired people that I could tell wanted to do it. My potential case was pretty boring, though, it was a son suing his father over something stupid. My wife got summoned several years ago and her case was about an injury in a car wreck. She’s a physical therapist and she got cut pretty much on the spot.

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    I was able to do the same thing as a hospitalist to get out of it.  Our medical director sent a letter.  They gladly dropped me.

    #209199 Reply
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
    Posts: 4394
    Joined: 05/13/2011
    easier 

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    Would love to meet the patient that says “Wow doc, you’re so right!” after I explain that they don’t need opiates.

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    Would you settle for “I understand”?

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #209279 Reply
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
    Posts: 4394
    Joined: 05/13/2011

    Yeah that works until you get a complaint letter and admin throws you under the bus.

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    And Press Gainey is my master unfortunately.

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    Studies show no correlation between press-gainey scores and how much of a candyman you are. It has far more to do with how much you sit down and talk to the patient. Same with antibiotics. Don’t fool yourself that practicing bad medicine will somehow raise your scores.

    https://www.annemergmed.com/article/S0196-0644(14)00120-6/abstract

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #209280 Reply
    Liked by childay
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
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    Joined: 05/13/2011

    A good way to answer questions on stuff like this from patients (ESA’s, fitness for duty) is to say the lawyer in your legal department told you not to do it.  “Sorry, policy.”  Patients may not like it but not much they can do to argue with it.

    Click to expand…

    This sounds like the same thing docs want when it comes to opiates. “Can we get a policy so we can blame that when patients ask me to do something I don’t want to do?”

    Get a spine. Tell patients “I’m not writing you that excuse because it’s the wrong thing to do” or “I’m not writing you for more percocet because my medical judgment is that it is a bad idea for you.”

    Click to expand…

    If you have the energy and time to argue with patients who won’t take no for an answer, have at it.  I don’t blame anyone who takes the path of least resistance when they have 15 minutes with the patient and 6 pages of forms to chart.

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    I guess I view it as patient care (helping them understand what the best thing for their medical condition is) rather than arguing. If it’s clear they aren’t going to understand, I simply tell them I have other patients to see and won’t be prescribing them opiates or filling out whatever form or whatever and walk out.

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    It is not just forms and opiates.  It is also non indicated test patients want.  Antibiotics.  Low T.  Diagnoses to support disability.

    Arguing with people about what is right is the correct thing to do but it takes time.  I m one that still has a lot of fight in me.  I am also willing to let people be mad at me and I can shrug off complaints and press ganey nonsense.  Not all docs can.  And some take the easier path of just giving in.  I do not agree with it but it happens.

    Sounds like you still have some fight in you too.  Keep up the good work.

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    I agree it takes time and effort to do the right thing.

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #209282 Reply
    Liked by hatton1, Lordosis
    Avatar AR 
    Participant
    Status: Physician
    Posts: 790
    Joined: 03/10/2016
    This sounds like the same thing docs want when it comes to opiates. “Can we get a policy so we can blame that when patients ask me to do something I don’t want to do?” Get a spine. Tell patients “I’m not writing you that excuse because it’s the wrong thing to do” or “I’m not writing you for more percocet because my medical judgment is that it is a bad idea for you.”

    Click to expand…

    It may sound like the same thing, but it’s not the same at all. With opiates you are talking about a decision that can harm them and it is important for the patient to understand that (if possible).

    Participating in jury duty or not is not a health decision (with rare exceptions).  Writing the letter is never going to harm the patient.

    So it is entirely reasonable to desire to appeal to policy (or take some other shortcut) for something that doesn’t really affect health (in most cases) but at the same time desire to have frank discussions about why you don’t think a patient needs oxycodone.

    #209647 Reply
    Liked by Tim
    Avatar GPGP 
    Participant
    Status: Physician
    Posts: 163
    Joined: 05/02/2017

    I’ve been summoned in two states over time. Both times I simply called, explained that I was a busy physician, and would have to reschedule patients, impacting patient safety and quality of care. Make it about the patients, not you. Be respectful and polite. Both times, they put me back in the pool – eg my number will come up again, but they didn’t require that I serve then, nor that I reschedule for xyz day 3 months from now. Ymmv. I do think docs are often dismissed from jury duty. Then again, a colleague (MD) was on a jury for a vertebral dissection after Chiro for a 35 year old woman.

    #209652 Reply
    Liked by Tim
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2504
    Joined: 01/03/2017
    Then again, a colleague (MD) was on a jury for a vertebral dissection after Chiro for a 35 year old woman.

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    I’m surprised the lawyers (especially the defendant’s lawyer) let that happen.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #209656 Reply
    Liked by Hank
    Avatar Tim 
    Participant
    Status: Accountant
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    Joined: 09/18/2018
    Earnest refinancing bonus

    “I’m surprised the lawyers (especially the defendant’s lawyer) let that happen.”

    Possible that case was got a bad back, go to the Chiro, make him gimme some money. A medical opinion might have been a blessing.

    #209657 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
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    Joined: 01/03/2017

    Possible that case was got a bad back, go to the Chiro, make him gimme some money. A medical opinion might have been a blessing.

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    In my experience (of my n=1 of jury selection), if a lawyer as an objection to a potential juror then they get tossed. That worked for either lawyer team. I find it hard to believe the defendant’s lawyer thought having a physician on the jury would be a blessing for their case. In fact, the blessing would be for the plaintiff.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #209702 Reply
    Liked by Tim
    Avatar GPGP 
    Participant
    Status: Physician
    Posts: 163
    Joined: 05/02/2017

    I agree – I’m surprised she wasn’t tossed off the jury.  Maybe they’d used up their objections already? The jury found for the plaintiff.  She did say that she felt this was an example of very rare complications happen.  The chiro didn’t do anything wrong, seemed like he was “in his lane,” doing musculoskeletal work in an accepted way on an appropriate patient.  It’s different if you’ve got some yahoo manipulating an osteoporotic 85 year old’s cancer.  The primary issue came down to informed consent and documentation as well as local statute, from what she said.  So it’s possible the plaintiff’s lawyer felt like she’d explain to the jury that rare complications happen, and sometimes that’s not malpractice.

    #209705 Reply
    Liked by CM, Tim

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