When should physicians lie for patients?

Even the most honest among us do not tell the truth all of the time.  We are flawed human beings.  We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal?   Have you ever “borrowed” someone else’s idea and represented it as your own?

A few weeks before I penned this, I was presented with two opportunities to lie in order to save a patients a few bucks. The first patient wanted a refill for her heartburn medicine, which she takes once daily.  She asked if I would refill the medicine to take twice daily, so she could get double the supply for the same price.  The second patient asked me to write a note that he was at risk for hepatitis B so that he could get the vaccine for free.   Writing the note would be easy, but claiming that he faced risk of hepatitis B infection would require some prevarication.

I’ll assume that readers know how I responded to the above two issues.   However, many patients, and perhaps some physicians, who are so harassed by insurance companies and an uncaring medical bureaucracy are looking for any measure of relief when they can grab it.  Many of them have risked rising blood pressures and panic attacks trying to talk common sense with insurance company customer service representatives who have less medical training than hospital housekeepers, about getting their medications approved.   I’ve been down that tortured road more times than I can count, and I feel their pain.

I routinely receive disability forms for patients who are seeking this benefit.  I advocate zealously for every patient who has a legitimate claim for any benefit they are entitled to, often making the phone calls with the patient seated beside me.   There are occasions; however, where no matter how hard I squint at the patient’s chart, I just can’t discern any medical evidence of a disability.  Sometimes, I haven’t seen the patient for years.  (Often, disability forms are sent to every physician the patient has seen, so some of these physicians are not appropriate targets.)

Ethical quandaries can be tormenting.   Let’s say a patient is sent to me to evaluate constipation.   A colonoscopy is scheduled.  Since the procedure is diagnostic to evaluate his symptom, he will have to pay much more out of pocket than if the procedure is coded as a routine screening colonoscopy.    Should I slightly adjust my coding to help the guy out?

It doesn’t take much effort to rationalize siphoning a few bucks from insurance companies that many of us think deserve it.  Somehow, we don’t regard this theft as we would shoplifting or stealing a neighbor’s TV.

I could state here that I respect medical insurance companies because of their unwavering devotion to protecting our health and serving the greater good.  But, I’d be lying.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

Image credit: Shutterstock.com

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