Turns into an ethical challenge.
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{ 16 comments }
Where’s the challenge? If he had asked you to drive the getaway car so he could rob the bank to get money for his son’s operation, would you agree? Lying is wrong, even if you can sign MD after your name. Especially.
I tell patients in this situation: “I won’t lie to you, and I won’t lie for you.”
Unbelievable. The guy has HIV and wants to spend a few days with his son before his son ships off to Iraq, perhaps never to return, and this doctor considers it “ethical” to deny him a sick note? The man has HIV, but the doctor claims he had to SEARCH THROUGH HIS CHART to find a reason to give him a sick note, but couldn’t find one! Oh, the moral agonizing he must have went through over that one! I can think of no finer example of how moral absolutism is so often absolutely immoral. He would begrudge a man what may be his last visit with his son, but he adhered to some abstract principle of “honesty” so he can pat himself on the back now.
Of course, you have a hint of just how long that “honesty” and “ethics” would last if this same model patient had requested painkillers for his pain, as judged in the very first paragraph: “He complained only if he was in a great deal of pain or discomfort.” Great, so Mr Honesty and Ethics is one of these doctors who expects people in pain to just grin and bear it unless the pain is severe, and then I am sure he could find some “ethical” reason to keep the guy writhing in agony without even consulting the chart.
Why is is that “ethics” only seems to emerge in such a large number of doctors whenever it comes to denying the patient something he or she desperately needs, or when what is “ethical” and what is in the doctor’s self-interest are one and the same? I doubt this guy has in his entire career ever refunded money to a patient for failure to adequately treat his condition, yet he no doubt thinks it ethical to take money for doing nothing.
You know, just for once, I would like to be able to read Kevin MD or some other medical blog and find more than a few isolated examples of doctors who aren’t self-absorbed, self-important jerks. Please, surprise me sometime.
His plea should be WITH HIS EMPLOYER, not with his doctor.
jb is right. It simply is wrong. The request should’ve gone to the employer; and this sainted gentleman is asking for a professional to bear false-witness.
Gee, Payne Hertz, which other occupation has such a job description? Criminal?
“Why is is that “ethics” only seems to emerge in such a large number of doctors whenever it comes to denying the patient something he or she desperately needs…”
“I would like to be able to read Kevin MD or some other medical blog and find more than a few isolated examples of doctors who aren’t self-absorbed, self-important jerks.”
Leftists and the Godless always confuse the difference between needs and wants. There are several analytical theories as to why this is, but this isn’t the place. It is interesting though that such persons hurl Non-sequiturs and logical fallacies (like a child’s toys) as their “argument,” but, predictably, finish tantrums with projecting via name-calling. It would be more economical for them, and easier/more revealing for the “opponent,” if they would just use name-calling, alone.
Payne:
This may be a shocker but having HIV does not by definition get you off from work. HIV on the HAART therapy usually often well controlled. So, you are saying the doctor should lie correct? For once I would like to see YOU add something (anything) to one of these blogs besides your self-centered doctor hating. Please save your story, I’ve already read it a dozen times on a dozen different medical blogs
If you can’t tell the difference between robbing a bank and telling a small white lie to enable a father to pay what may be his last visit to his son, then you are beyond any explanation I can offer. Seems many on the right can’t tell the difference between two adults having consensual sex and lying an entire nation into a war that has resulted in the deaths of hundreds of thousands either, but I understand if your minister is too busy bashing the “Godless” to point out the distinction for you.
“Leftists and the Godless always confuse the difference between needs and wants. There are several analytical theories as to why this is, but this isn’t the place. It is interesting though that such persons hurl Non-sequiturs and logical fallacies (like a child’s toys) as their “argument,” but, predictably, finish tantrums with projecting via name-calling. It would be more economical for them, and easier/more revealing for the “opponent,” if they would just use name-calling, alone.”
You might follow your own advice next time and spare us the convoluted pseudo-intellectual pablum and just go straight for the ad-hominem.
I know wing-nuts, the heartless and God’s self-appointed representatives feel they know better than we do what our “needs” are, but if you don’t understand the *need* of a father to spend time with his son before he goes to war then you are surely in the wrong profession.
As for “bearing false witness,” that’s really a laugh. We’re not talking about the Ten Commandments here, but common decency and a recognition that moral issues are often not black and white, and a person with a heart knows that sometimes telling a small white lie is the right thing to do. The rigid insistence on small points of morality to the detriment of larger ones is not the mark of a moral man, but a fanatic.
“This may be a shocker but having HIV does not by definition get you off from work. HIV on the HAART therapy usually often well controlled. So, you are saying the doctor should lie correct? For once I would like to see YOU add something (anything) to one of these blogs besides your self-centered doctor hating. Please save your story, I’ve already read it a dozen times on a dozen different medical blogs”
This may comes a shocker to you but I recognize by the fact the guy has a job that HIV is not an automatic ticket out of work, but you fail to recognize that the side effects of HAART therapy are often severe enough to warrant at least a little time off. There may be obvious reasons why this guy can’t discuss this issue with his employer and needs a better cover from a doctor.
As for my alleged “doctor hatred,” if you and your fellows can’t handle criticism of your profession without resorting to cheap accusations of bigotry, then you should avoid blogs other than those that only allow comment from the hallelujah chorus. Stick to the old ladies who think you walk on water because you have an MD after your name. Most of us have been disavowed of the notion of the alleged moral purity of doctors the hard way, and therefore don’t consider you above reproach by default.
Many doctors don’t seem to have any problem with lying to cover up the abuses of their more incompetent and unethical colleagues, even when they maim and kill patients. So don’t get up on your moral high horse over a sick note, as there’s not a one of you who doesn’t know who the dangerously incompetent doctors are in your local community but you are content to enable them with your silence.
Railing at the doctor for not lying to get the patient paid sick days off is misplaced. It doesn’t matter how good the purpose for the time off it. The patient’s work schedule is a matter between him and his employer. If the employer wants to let him off without pay for this purpose, fine! If the employer wants to let him off with pay for this purpose, better! But it is an abuse of the prestige of the doctor to lie to defraud the employer into giving him sick leave when he isn’t sick.
The prestige given to the medical profession to move so much of other people’s wealth around is predicated on the belief by society that doctors are scupulously honest. In other words, the ability to actually help a sick person get leave from work with a mere note is undermined by abusing that.
I have had to explain that to many patients and do not recall ever losing an established patient over that point.
It is not a healthy thing that we have become so institutionalized that people are afraid to talk to their employer about such things, and feel that they must play manipulative institutional games for such a simple human request as time off to visit a son going off to war. Lying to authority is for slaves–not free men.
If you will lie for your patients benefit, then you will lie for your own.
Eventually your patients will figure that out, and the doctor-patient relationship is shot to hell.
“Do I really need this treatment or is the old boy behind on his boat payments?”
Payne:
Thanks for making my point with your rant. I read the article, evidently you didn’t
From the article:
“From my nursing assistant’s notes, I saw he was doing well. Results from his blood tests, CD4 (specialized immune system cells) counts and HIV viral load (the amount of HIV virus in the blood) looked equally good, and his physical exam was unremarkable.”
and
“I scoured my mind and the chart — for something, anything, that would justify a note from me and allow him some time off. I asked him more questions. “Do you have any fever, cough, congestion, reaction to the medication?” But he was healthy; no tests were required; no medication needed change.”
Next time try reading the article. You will sound a little less idiotic when you rant.
As the writer stated, the issue is between the patient and his employer, not asking the doctor to lie.
PS: I am ex-military, if the guy was my employee I would give hime time off with no questions asked. But that is not the point.
@Payne, I don’t really understand your rant – and no, I am not a doctor. The patient had a choice – he could’ve asked his employer for a couple of days off and explained the situation; he could’ve offered to his employer to make up the time by working extra hours on other days or by working on a weekend; he could’ve asked for a couple of days off without pay.
You cannot expect anyone to lie for you. If you want to lie – it is between you and your conscience, but you cannot expect others to do it for you. Even asking someone to lie for you is inconsiderate – you are putting someone into a bad situation: either they have to refuse which is always unpleasant or go against their conscience. I hate when people do it.
@feminizedwesternmale: Leftists and the Godless always confuse the difference between needs and wants
This is totally off-topic, but what does one’s religion or politics has to do with anything? Do you know if the patient or a doctor in the story were religious or not? I don’t agree with Payne, but for all we know she could be religous. There are plenty of religious people who lie and cheat and commit crimes (sometimes in the name of religion), and there are plenty of honest atheists. Religious in America confuse religion with morality.
If it were me (I’m a physician) I’d have given the guy a couple days to be with his son. On the other hand, if I were his employer, I’d have given him the days off as well. I do have employees in my medical practice, after all.
The doctor in question is more of a stickler than I would be. That’s a judgment call.
But instead of the hypothetical two days off. What if it’s THREE days off? Three days triggers FMLA. Now imagine same employee presents you with a FMLA form where you have to describe the illness under penalty for false statements.
Now what?
“The prestige given to the medical profession to move so much of other people’s wealth around is predicated on the belief by society that doctors are scupulously honest. In other words, the ability to actually help a sick person get leave from work with a mere note is undermined by abusing that.”
If the prestige of the medical profession hasn’t been irreparably damaged by:
–250,000 unnecessary deaths a year
–$170 billion a year in fraud
–Doctors offices that look like marketing HQ for drug companies.
–Medical blogs
Then I doubt writing some guy a sick note is going to have much of an impact.
“It is not a healthy thing that we have become so institutionalized that people are afraid to talk to their employer about such things, and feel that they must play manipulative institutional games for such a simple human request as time off to visit a son going off to war. Lying to authority is for slaves–not free men.”
Brave words from someone who works in an industry where you can literally kill people and still expect to keep your job. Out in the real world, where the rest of us live, you can lose your job for looking a little disheveled at work, or for taking too many bathroom breaks due to adverse reactions to your HIV drugs. In the real world, most people with severe chronic illnesses are utterly dependent on their jobs to get coverage for the medical care they need. If this guy loses his job, it is likely he will lose his medical benefits and with them, his life, so his need for a sick note is hardly cavalier. He is no doubt already walking a fine line with his employer due to the fact he is HIV positive and therefore perceived as either gay or a drug addict, and is something of a liability to his employer due to the increased cost of insuring him. I can fully understand why he might be a little reticent about asking for any special favors from his employer. Non of this makes him a “slave.”
“Next time try reading the article. You will sound a little less idiotic when you rant”
You might look a little less idiotic yourself if you refrained from beating people over the head with the obvious in your attempts to smear your opponents. I think it’s pretty obvious the guy wasn’t actually physically ill at the time he requested the note or the whole issue of the doctor having to lie about the sick note would have been moot, and the article pointless. The point I am making about him having HIV is that within the confines of that illness and the known adverse effects of the drugs used to treat it, it would not have been hard to find an acceptable excuse for giving the guy a few days off that few employers would question. It certainly wouldn’t require “scouring the chart” to find an excuse.
What is this guy really was sick and suffering an adverse reaction from his drugs severe enough to warrant some time off in your judgement, but wanted to keep the issue of his HIV confidential? Would you honor the patient’s right to confidentiality and write him a note that disguised his sickness as something else, or would you refuse to write him a note unless he allowed you to mention that he had HIV, as to do otherwise would be “unethical” Really curious to see the answers to this one.
There is also the slippery slope problem. I have actually have people ask me for notes for days that they have already missed for personal non-medical issues. Once you start colluding with people to game the system, where does it stop? Then a request for control drugs that you don’t really think is supported. Then comes the request for controlled drugs for the spouse who just needs one xanax prescription until they can get to their doctor–but you have never met the spouse.
There is only one clear, objective, place to draw the line where you can be consistent: the beginning.
BTW, doctors have been disciplined for fraud for writing untruthful work excuses.
Payne:
You are really rather clueless. Your “reasoning” (actually lack of) makes no sense. The guy is either ill and deserves or work excuse or not. Quit with the circular gobblygook that makes sense to no one. As far as mentioning someone’s illness in a sick excuse whether it be HIV or a UTI, that is clearly (and obviously) a violation of privacy. All any doctor has to do is tell an employer is that the employee was under his care. End of story.
Again, next time read the article before commenting.
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