Angry Doctor

Thursday, August 03, 2006

W.W.H.D. 2a

Assuming you didn't go with option E in the preceeding part of the question...


"The patient returns to your clinic and informs you that his company still refuses to reimburse him for the planned surgery.

You advise him to proceed with the surgery nonetheless to avoid the long-term complications of the condition.

He repeats his request for you to write a memo stating that he was referred to your clinic from the polyclinic, and tells you that he will default follow-up and treatment of his condition if you do not do so."

What should you do?

A. Relent
Your first priority is the patient's health.

B. Stand your ground
Reiterate that you cannot provide the memo he wants, but keep his case open and give him an open date to see you.

C. Terminate the patient-doctor relationship
Tell him you cannot continue the patient-doctor relationship given the circumstances, and refer him to your best friend/worst enemy.

D. Explore other pathologies
Continue the consultation with a view to exploring if he needs to see a psychiatrist.

What would Hippocrates do? What would you do?

posted by angry doc at 5:30 pm

8 Comments:

  • B. But refer him to the MSW to see if the social worker can do anything for him.

    By Anonymous Anonymous, At August 03, 2006 9:11 pm  

  • Explain to him that the doctor's memo is a medico-legal document and that it cannot contain any false information. As I mentioned in the previous post, by certifying that the patient was referred to the clinic via the polyclinic and not the EMD is tantamount to an outright lie. He should be told to revisit the polyclinic, obtain the letter necessary for the surgery and revisit the clinic. In the meantime, an open date can still be scheduled for him as you now have a duty of care for the patient.

    By Anonymous Anonymous, At August 03, 2006 10:35 pm  

  • I think it's ridiculous of the patient to ask a doctor to lie. If he prefers to default treatment at the expense of saving money, it's a (his) personal decision, isn't it?? It sounds like a bit of emotional blackmail. He should not impose unnecessary distress on others for his own selfish gains. Unless he has (proven) financial difficulties, then prob you can write a memo for govt subsidise.

    By Blogger Beth, At August 03, 2006 11:41 pm  

  • The problem is in the system. Why should the company only pay when it is referred by the polyclinic. What is the principle behind that policy? Is there no provisions for emergencies in the company?

    I think the doc shouldn't tell a lie to help the person get a reimbusrement. I remember some dental head who is a nice guy help a patient with some claims by declaring the patient's name instead of their relatives name or something like that. I cannot remember the exact details but it got that dental guy into a hot soup. I don't think it is worth the doctor's while trying to be creative here. All the patient have to do is to get a referral from the polyclinic and start the process again. The policy says surgury will be paid if referred by the poly clinic. It didn't say the person after consulting the A&E dept, cannot consult the polyclinc to get a referral. The only thing I see the doc can help is to help him schedule another visit in a few days time with the poly referral. If he is not willing to do that I will not be bother to help. The ball is in his court.

    BTW they are just changing the status of subutex to CD.

    By Blogger palmist, At August 04, 2006 12:08 pm  

  • Yes, it's ironic.

    Patients expect doctors to be ethical, but some will ask doctors to lie for them.

    Patients expect doctors to have good judgement, but some will lie to doctors and use emotional-blackmail.

    palmist - thanks for the info. I will post an update on Subutex later.

    By Blogger angry doc, At August 04, 2006 12:30 pm  

  • Hey angrydoc,

    To be honest I used to work in orthopedics too. I know the boys.

    Anyway I have encountered these sort of cases during my time in the hospital.

    My advice is to do X : which is to write a memo for him to go see Patient Client Services and speak to the administrators.

    I learned this because one of my friends got ticked off before for trying to take matters into his own hands. The admin told him, to refer these cases to them in future and they will handle it.

    So I started writing memos saying :

    "Dear Admin,

    This patient has the following problem (eg this subsidy dilemma). As it is a non-clinical and largely insurance/administrative problem, please kindly assist him accordingly.

    Yours

    Dr oz bloke"

    I found that it worked well. For one the patient felt I was trying to help and did care. Second I was not the one who made the "difficult decision or explanation".

    In the end the patient went ahead with his surgery and the company paid for it. What happened in between I can only guess Singhealth spoke to the company.

    So the moral of the story is.....don't take on more than what you are expected to do! The administrators don't like it either cos when the complaint letter comes (from either the company or the patient) they also have a headache.

    By Blogger Dr Oz bloke, At August 04, 2006 1:15 pm  

  • I was about to suggest the same thing as Dr Oz Bloke. Let the administrators settle this issue. It is after all what they were hired for and this is totally NON medical.

    By Anonymous Anonymous, At August 04, 2006 6:05 pm  

  • the issue of the system (whether co. should pay for surgery leading fr A&E visit aside, the crux of the qn is what should the dr do. ask yourself if *you* are the patient shoes, how would you hope your dr to help you. yes, agree that it'd be wrong for dr to lie, but there's nothing else to stop him from helping pt writing a ltr to the pt's co. for eg. of course, can refer to admin, but pls dun do that because it's "admin and out of medicine"-LH

    By Anonymous Anonymous, At October 05, 2007 2:15 pm  

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