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  • CordMcNally CordMcNally 
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    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.

    Click to expand…

    I probably would have let my fellow jury peers know that there’s no good scientific evidence showing benefit for doing ANY kind of neck manipulations so that leaves only harms. They could take it from there.

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

    #209727 Reply
    Liked by hatton1, Zaphod
    Avatar chrisCD 
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    Essentially, they really don’t want you there if it’s a true hardship.

    Click to expand…

    “…true hardship” being key.  Jury Duty exists for a reason.  If it were you on trial, wouldn’t you want the best set of people to be seated for the jury?  Serving is a hardship, but our company makes it work, as we believe it is important.  Last year I was an alternate for a trial that lasted 3-days and was almost on one that would have lasted a month.  People that try to get out of it frustrate me to no end.  I know there are true cases of hardship, but most are not.  Notices usually come well in advance.  Most people should be able to make the necessary arrangements to be available to serve.

    cd :O) -- Chris Duncan -- "God grant me the strength of eagles' wings, the faith and courage to fly to new heights, and the wisdom to rely on His Spirit to carry me there."

    #209745 Reply
    Avatar Eye3md 
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    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.”

    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.

    Click to expand…

    I remember my days working as an ED doc, and it was great to be able to walk out of a patient’s room who was being ridiculous with their pain pill request. Your suggestions are good, as an ED doc, but they don’t work as easily in an established private practice where you form a relationship with patients (and their families) over the course of years. I will flat out refuse to give extra narcotics, if not justified, but I have people wanting work excuses, for weird reasons, all of the time. When you see these people over and over,  sometimes monthly, it gets to the point where they are just wearing you down. Or if I have an office overloaded with patients, it takes less time to give them the damn excuse than sit there and have a conversation explaining my reasoning behind the “why”.

    #209749 Reply
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
    Posts: 4244
    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.

    Click to expand…

    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.

    Click to expand…

    I remember my days working as an ED doc, and it was great to be able to walk out of a patient’s room who was being ridiculous with their pain pill request. Your suggestions are good, as an ED doc, but they don’t work as easily in an established private practice where you form a relationship with patients (and their families) over the course of years. I will flat out refuse to give extra narcotics, if not justified, but I have people wanting work excuses, for weird reasons, all of the time. When you see these people over and over,  sometimes monthly, it gets to the point where they are just wearing you down. Or if I have an office overloaded with patients, it takes less time to give them the damn excuse than sit there and have a conversation explaining my reasoning behind the “why”.

    Click to expand…

    And you want this patient to remain in your practice why again?

    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

    #209813 Reply
    Liked by CordMcNally
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
    Posts: 4244
    Joined: 05/13/2011
    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.

    Click to expand…

    I see it as the same because it’s asking me to do something I view as wrong in both cases.

    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

    #209814 Reply
    Avatar Eye3md 
    Participant
    Status: Physician
    Posts: 59
    Joined: 12/01/2017

    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.

    Click to expand…

    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.

    Click to expand…

    I remember my days working as an ED doc, and it was great to be able to walk out of a patient’s room who was being ridiculous with their pain pill request. Your suggestions are good, as an ED doc, but they don’t work as easily in an established private practice where you form a relationship with patients (and their families) over the course of years. I will flat out refuse to give extra narcotics, if not justified, but I have people wanting work excuses, for weird reasons, all of the time. When you see these people over and over,  sometimes monthly, it gets to the point where they are just wearing you down. Or if I have an office overloaded with patients, it takes less time to give them the damn excuse than sit there and have a conversation explaining my reasoning behind the “why”.

    Click to expand…

    And you want this patient to remain in your practice why again?

    Click to expand…

    So you are suggesting I kick a patient out of my practice who asks me for a work excuse that I find unreasonable or ridiculous?  I’m supposed to ignore the fact that I’m the only specialists, in my particular field, for hours and therefore make him drive three hours away because of this?  They are not asking me to do something unethical. They are usually lazy that is the problem.  If they have 20/20 vision in one eye, and 20/400 in the other, they think they should be allowed off from work longer. Fortunately, I don’t deal with this much but when I do, it’s usually not the patient as much as it is the family member aggravating us for more time off work………”doc, I think he needs another two weeks off work because of this eye problem”.

    #209875 Reply
    Lordosis Lordosis 
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    I had someone want a week off for constipation. People these days :-\

    “Never let your sense of morals prevent you from doing what is right.”

    #209881 Reply
    Liked by Winkleweizen
    CordMcNally CordMcNally 
    Participant
    Status: Physician
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    Joined: 01/03/2017
    So you are suggesting I kick a patient out of my practice who asks me for a work excuse that I find unreasonable or ridiculous? I’m supposed to ignore the fact that I’m the only specialists, in my particular field, for hours and therefore make him drive three hours away because of this? They are not asking me to do something unethical. They are usually lazy that is the problem. If they have 20/20 vision in one eye, and 20/400 in the other, they think they should be allowed off from work longer. Fortunately, I don’t deal with this much but when I do, it’s usually not the patient as much as it is the family member aggravating us for more time off work………”doc, I think he needs another two weeks off work because of this eye problem”.

    Click to expand…

    To be fair you went from “ridiculous…pain pill request” to “unreasonable or ridiculous work excuses”. Those are different animals. However, if you’re the only specialist around, I think it’s pretty cut and dry if you tell them why they can go back to work according to your medical opinion. If they don’t like it, they can drive 3 hours for a second opinion.

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

    #209889 Reply
    Liked by hatton1, Zaphod
    Avatar Eye3md 
    Participant
    Status: Physician
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    Joined: 12/01/2017
    So you are suggesting I kick a patient out of my practice who asks me for a work excuse that I find unreasonable or ridiculous? I’m supposed to ignore the fact that I’m the only specialists, in my particular field, for hours and therefore make him drive three hours away because of this? They are not asking me to do something unethical. They are usually lazy that is the problem. If they have 20/20 vision in one eye, and 20/400 in the other, they think they should be allowed off from work longer. Fortunately, I don’t deal with this much but when I do, it’s usually not the patient as much as it is the family member aggravating us for more time off work………”doc, I think he needs another two weeks off work because of this eye problem”. 

    Click to expand…

    To be fair you went from “ridiculous…pain pill request” to “unreasonable or ridiculous work excuses”. Those are different animals. However, if you’re the only specialist around, I think it’s pretty cut and dry if you tell them why they can go back to work according to your medical opinion. If they don’t like it, they can drive 3 hours for a second opinion.

    Click to expand…

    That is true, comparing wanting pain pills to a work excuse are certainly different animals. I should’ve stuck with the jury duty excuse to work duty excuse comparison. But, it is easier to say “tell the patient no or go away” than it is to do it face to face. At least for me, that is the situation, especially after building relationships with these people for years.

     

    My fear is the unreasonable nature of patients and how they can relate anything bad to something I did, and not to their actual situation/responsibility. I tell a patient to go back to work, they have a wreck because they were texting and driving, but they turn around and try to sue me because I said it was ok to go to work with 20/20 vision in one eye and 20/400 in the other.  Of course the accident was their fault but the family immediately says “this would never happen if that doctor had let you heal longer”……..even though their vision had been much worse in that one eye before they ever got to me. Trying to explain this while I’ve got 50 other patients waiting is exhausting so I sometimes just say “fine, I’ll give you another week off”

    #209939 Reply
    Avatar AR 
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    Status: Physician
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    Joined: 03/10/2016
    I see it as the same because it’s asking me to do something I view as wrong in both cases.

    Click to expand…

    That’s like saying I see jaywalking and murder as the same thing because they’re both against the law.

    The point was that getting a patient to understand why unnecessary opiates are bad is far more important then getting them to understand why you won’t write them a letter for jury duty.  If I don’t at least attempt to do the former, I’ve arguably failed to meet my responsibilities as a physician.  If I don’t sit them down and explain why I won’t write an unjustifiable jury duty excuse, and instead say “Sorry, company policy”, I haven’t really caused harm or failed to meet my obligations.

    So, sure, they’re the same in one way, but they’re different in another way. And that difference is very important with respect to the appropriate handling of each situation.

    #210010 Reply
    The White Coat Investor The White Coat Investor 
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    I see it as the same because it’s asking me to do something I view as wrong in both cases.

    Click to expand…

    That’s like saying I see jaywalking and murder as the same thing because they’re both against the law.

    The point was that getting a patient to understand why unnecessary opiates are bad is far more important then getting them to understand why you won’t write them a letter for jury duty.  If I don’t at least attempt to do the former, I’ve arguably failed to meet my responsibilities as a physician.  If I don’t sit them down and explain why I won’t write an unjustifiable jury duty excuse, and instead say “Sorry, company policy”, I haven’t really caused harm or failed to meet my obligations.

    So, sure, they’re the same in one way, but they’re different in another way. And that difference is very important with respect to the appropriate handling of each situation.

    Click to expand…

    Why do you need company policy? Why not blame your own policy if you need a policy to blame? “Sorry, it is my policy that I don’t write bogus work notes etc.” 🙂

    Seriously though, I have these conversations all the time. Someone asks for a work note. I ask them what they want it to say, joking that I could write them off for the next year. They ask for a couple of days and I say, “That’s reasonable, here you go.” Or I tell them, “I think you can work with work limitations on the affected arm so that’s all I can write. If your boss decides you can’t do the job with just one arm and wants to send you home, that’s her prerogative.” If it was jury duty, I’d say “I don’t think that’s a reasonable excuse to get out of jury duty so I don’t feel that I can ethically write that note.” If the patient argues with me, I repeat “I don’t think that’s a reasonable excuse to get out of jury duty so I don’t feel that I can ethically write that note.” I rarely have to say it more than three times before they realize I’m saying no. Be the doctor. Own the situation. We have to blame enough on the bureaucracy inherent in our crazy health care system. Trying to blame stuff like this on it in order to somehow avoid looking like the bad guy is silly. If they don’t trust your opinion on simple stuff like this, then why would they trust it on more important issues?

    We’ve had these discussions in my group. I say the same thing. But I have partners that want a policy to blame. We usually make them write the policy.

    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

    #210014 Reply
    Liked by Hank
    Avatar AR 
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    Why do you need company policy? Why not blame your own policy if you need a policy to blame? “Sorry, it is my policy that I don’t write bogus work notes etc.” Seriously though, I have these conversations all the time. Someone asks for a work note. I ask them what they want it to say, joking that I could write them off for the next year. They ask for a couple of days and I say, “That’s reasonable, here you go.” Or I tell them, “I think you can work with work limitations on the affected arm so that’s all I can write. If your boss decides you can’t do the job with just one arm and wants to send you home, that’s her prerogative.” If it was jury duty, I’d say “I don’t think that’s a reasonable excuse to get out of jury duty so I don’t feel that I can ethically write that note.” If the patient argues with me, I repeat “I don’t think that’s a reasonable excuse to get out of jury duty so I don’t feel that I can ethically write that note.” I rarely have to say it more than three times before they realize I’m saying no. Be the doctor. Own the situation. We have to blame enough on the bureaucracy inherent in our crazy health care system. Trying to blame stuff like this on it in order to somehow avoid looking like the bad guy is silly. If they don’t trust your opinion on simple stuff like this, then why would they trust it on more important issues? We’ve had these discussions in my group. I say the same thing. But I have partners that want a policy to blame. We usually make them write the policy.

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    I never said you need a policy.  I’m just saying that inventing a policy for not writing fake jury duty notes is better than inventing policy for not writing opiate prescriptions.  And the reasons for the difference are obvious.  Inventing polices in each of those cases is not the same thing at all.   Of course, no one needs a policy in either case.

    #210018 Reply
    Lordosis Lordosis 
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    Disability Insurance

    I talked with our county employee today about my summons for next week.  I asked if he could let me know this morning so I could adjust my schedule for next Monday.  He told me that I would need to report.

    I had my staff cancel all my Monday appointments…  4 Hours later he called back and made a mistake and I do not need to report.  We are trying to un cancel my Monday appointments.  What a PITA and my office staff is not very happy with me.

    I should have listened to all the advise about postponing it.

    “Never let your sense of morals prevent you from doing what is right.”

    #212118 Reply
    Liked by Peds
    Dreamgiver Dreamgiver 
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    Joined: 03/09/2017

    Essentially, they really don’t want you there if it’s a true hardship.

    Click to expand…

    “…true hardship” being key.  Jury Duty exists for a reason.  If it were you on trial, wouldn’t you want the best set of people to be seated for the jury?  Serving is a hardship, but our company makes it work, as we believe it is important.  Last year I was an alternate for a trial that lasted 3-days and was almost on one that would have lasted a month.  People that try to get out of it frustrate me to no end.  I know there are true cases of hardship, but most are not.  Notices usually come well in advance.  Most people should be able to make the necessary arrangements to be available to serve.

    Click to expand…

    The hardship refers to the patients, not you. How would you feel if you take time off of work to go see a doctor 2 weeks from now or schedule a surgery just to have it canceled because the doctor got called for jury duty?! And if you work in a hospital for most specialties there is no back up. It’s not like there are people sitting on the bench every day waiting for a call to go in and work. Truth is if most docs do not show up for work it is a major major hardship for many people.

    If serving was such a priority, there should be none of this show up in the morning and we’ll see if we need you, or all the games played by the attorneys to get people not on the jury and so on. Sorry, don’t buy any of it.

    #212164 Reply
    Liked by Zaphod, hatton1
    Avatar Tim 
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    Status: Accountant
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    Joined: 09/18/2018

    “If serving was such a priority, there should be none of this show up in the morning and we’ll see if we need you, or all the games played by the attorneys to get people not on the jury and so on. Sorry, don’t buy any of it.”

    I empathize with the disruptive part. Try it figure out how to word the priorities given to different potential jurors to efficiently use their time and minimize the disruption. I mean our civic duties, like all laws are equal aren’t they? Those “silly games” like automatic disqualifications” don’t really count do they? So is it number of patients that will be inconvenienced? Say 30, fair? Not even one hour apiece. How many students are impacted in one hour by a teacher ? Or a bus driver? Oh I get it, your work is more important, right? Or is it the dollar value?
    Not sure if the right to an attorney and trial by peers has value over your practice or if you just don’t buy it at all.
    Help me understand how you think it should work? Jury pool are huge in some courthouses. My intent is asking for a constructive suggestion. It’s cumbersome for everyone, but the best pick of ineffective alternatives.

    #212221 Reply
    Liked by chrisCD, Lordosis

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