Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 Graham, Thanks for the reminder; Darwin would be proud of you. Science rules join the OUT movement. José From: [mailto: ] On Behalf Of Graham Chiu Sent: Thursday, February 12, 2009 6:47 PM To: Subject: Re: bribery for forgery Well, it's Darwin's 200th birthday anniversary celebrations so I'd rather not talk religion today. I don't recall lying for patients .. but bending the truth a little .... I might have done that in the past. And I know my colleagues have done this. Eg. to get the government to fund a biologic in this country, they have to have rheumatoid arthritis. I know of colleagues who have reclassified a patient with psoriasis as having rheumatoid so that they can get the funding ... But back to specifics. In this case, the patient's wife has asked that the record be altered so that it be shown he never had DM. Well, I wouldn't do that. But it might be argued that he no longer has DM based upon current criteria ( if of course the data we have is correct ). Then others here say that once you have DM, you never lose it. So, which is correct? Was the original diagnosis wrong? Is it wrong for her to ask that the medical records be corrected? This is not the same situation as if the patient still had their glucose intolerance. > Graham, > I have no problems with Jesus or Christianity. And I would, indeed, > have problems facing Jesus if I lied. In my opinion, we need all the > spirituality we can get to survive in this world. And witnessing that is > good for us. > Of course, my real point is that most people in our culture really would > not lie if they thought about their value system when they start. When I > draw them back with a reminder, they see themselves and change their minds. > This religious statement action on my part is really an act of faith in the > people themselves. Again, in my opinion, as a society we need to find ways > to insist gently that people act ethically; and I prefer to do it in a way > that does not make them defensive or angry. > Joanne > > > >> Dear Dennis, >> >> I have had patients ask me to alter the records. I tell them " Surely >> you would not want me to lie. I am a Christian and could not do that and >> still face Jesus. " Then they shut up. One or two appologized after they >> thought about it. > > <cut vas here> > >> Actually, I am more of a pan-diest, but most of these idiots do think of >> themselves as Christian, and I like to bring them to my spiritual home in >> the most efficient way. It is useless to talk to a venal person about >> ethics and service. >> >> Joanne in Drain, Oregon. >> > > -- > Graham Chiu > http://www.synapsed irect.com > Synapse - the use from anywhere EMR. > > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 gary i dont think you did wrong if you evaluatd and managed his hi bp ie you prescribd a treatment or stated the treatment was good but if you didnt manage a problem ie his bp then the code should be the pe code with no additions all the best dr geordie thomson,m.d.On Wed, February 11, 2009 11:30 pm EST, Seto wrote: Dennis, Something similar happened to me recently. I saw a patient for a routine physical. Mid-40s, male. He kept asking for reassurances that the visit would be " free " because his insurance would pay for an annual physical. I told him I couldn't guarantee that the entire visit's cost would be paid for, that it depended on his insurance and how they calculated it. Anyways when I asked if he took any medicines, he named two BP meds. I asked him who prescribed them for him, and he said he gets them from a doctor in the ines, where he is from. His BP was under control so no big deal, but I listed HTN as a diagnosis along with V70.0. I got a call from his mother-in-law later (weird, right?) insisting that I submitted the claim incorrectly because now his insurance says they won't pay for the visit because he has a pre-existing condition. She swears she has known him for 30 years and he has no pre-existing condition. After I get the patient's permission t o talk to her, I tell her that he told me he takes BP medication for HTN. She yells over to him while on the phone, " Did you tell the doctor that you take blood pressure medicine? " " No, no. Sometimes " , I hear him say in the background. Now he claims that it was all a mistake, that he used to take it but not for the past 12 years. He tells me I need to change the diagnosis code otherwise insurance won't pay for the visit. I tell him that I won't lie and I stand by what I submitted. Later on, I called the insurance company and they said they are holding the claim and told the patient to submit old records from his previous doctors here in the US and in the ines before they will make a decision. Sounds reasonable to me. Needless to say, I don't expect to get paid from either the insurance company or the patient for this visit. It sounds like the wife probably thinks her husband never had DM because he never started on any medication fo r it. But she probably wouldn't care even if you explained it carefully to her. She just wants it off his record so that he can lower his insurance premium. It's another sad sign of our dysfunctional healthcare system that patients are punished for switching insurance plans and doctors are forced to consider making unethical decisions in order to help patients. I agree with Pedro that you should stick to your principles and write off the charge. Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good r esult, right? No way. His wife has called me a number of times to " take diabetes off his record " . She insists he " never was Diabetic " and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show " the truth " ; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 Graham, I’m with you. Gee, she’s probably not trying to reduce her insurance premiums so she can buy a third vacation home or really fast sports car or something. I like to think I work more under Maslow’s hierarchy of needs concept; what is good may be a higher level issue than strictly what is right/wrong. (Hopefully this won’t be misinterpreted too much…I was a Human Development major and then got a master’s in pastoral studies with a concentration in medical ethics and probably think a bit on a different plane than medical training teaches us to…..) But this example certainly does point out the craziness of our system; and what it can do to people. To most, doctors seem to be part of the power structure. I say we do what we can, within reason, to show them we are with them. Happy Bday to Darwin and Lincoln. Sharon From: [mailto: ] On Behalf Of Graham Chiu Sent: Thursday, February 12, 2009 3:47 PM To: Subject: Re: bribery for forgery Well, it's Darwin's 200th birthday anniversary celebrations so I'd rather not talk religion today. I don't recall lying for patients .. but bending the truth a little .... I might have done that in the past. And I know my colleagues have done this. Eg. to get the government to fund a biologic in this country, they have to have rheumatoid arthritis. I know of colleagues who have reclassified a patient with psoriasis as having rheumatoid so that they can get the funding ... But back to specifics. In this case, the patient's wife has asked that the record be altered so that it be shown he never had DM. Well, I wouldn't do that. But it might be argued that he no longer has DM based upon current criteria ( if of course the data we have is correct ). Then others here say that once you have DM, you never lose it. So, which is correct? Was the original diagnosis wrong? Is it wrong for her to ask that the medical records be corrected? This is not the same situation as if the patient still had their glucose intolerance. > Graham, > I have no problems with Jesus or Christianity. And I would, indeed, > have problems facing Jesus if I lied. In my opinion, we need all the > spirituality we can get to survive in this world. And witnessing that is > good for us. > Of course, my real point is that most people in our culture really would > not lie if they thought about their value system when they start. When I > draw them back with a reminder, they see themselves and change their minds. > This religious statement action on my part is really an act of faith in the > people themselves. Again, in my opinion, as a society we need to find ways > to insist gently that people act ethically; and I prefer to do it in a way > that does not make them defensive or angry. > Joanne > > > >> Dear Dennis, >> >> I have had patients ask me to alter the records. I tell them " Surely >> you would not want me to lie. I am a Christian and could not do that and >> still face Jesus. " Then they shut up. One or two appologized after they >> thought about it. > > <cut vas here> > >> Actually, I am more of a pan-diest, but most of these idiots do think of >> themselves as Christian, and I like to bring them to my spiritual home in >> the most efficient way. It is useless to talk to a venal person about >> ethics and service. >> >> Joanne in Drain, Oregon. >> > > -- > Graham Chiu > http://www.synapsed irect.com > Synapse - the use from anywhere EMR. > > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 and all; thanks for the prompt and divergent thinking on my problem. I really appreciate the "free for all" that can erupt when I toss a value-laden issue on the table. This is a WONDERFUL SISTER & BROTHERHOOD for sharing and support. Thank you all. I will send a letter, stating I cannot alter my records; and that the two issues are not linked; and if she persists in linking payment to falsifying my charts, then I will seek legal protection from this attempted 'extortion'. And yes, after 3 bills, they go to Collection agency. Too bad for them: if they had come in meekly, offering to pay in full; with his last years normal blood glucose readings, then I probably would have willingly written a comment on his record to mitigate or update the diagnoses listed. I guess this could be termed "manipulation by niceness", but it is how I work! Fact is, with Alteer, my EMIR, my encounters cannot be altered once signed off anyway. I will post a new thread about my "Premium Practice" transition. Just got 3 new retainer patients today. $75 per month single = $900 per year; $125 per month for 2 in same home = $1500 per year. This is helping to pay the overhead! , your retainer is too low. Dennis Galvon Re: bribery for forgery Dennis, can you explain how you changed to a retainer practice, what led you to this decision and how much you charge? I sort of did the same thing last year and started charging a mini-retainer fee of $120/year, which I think is low. Seto South Pasadena, CA A middle aged obese male patient used to be my patient. I diagnosed Diabetes M. type 2 after elevated blood glucose and elevated HbA1c. He was motivated to lose weight, to exercise and change his diet. His sugars dropped into the normal range. He moved on to another doc when I changed to retainer practice last year. Grateful patient, good result, right? No way. His wife has called me a number of times to "take diabetes off his record". She insists he "never was Diabetic" and they can't get cheap insurance now. I recently sent out patient statements and he has modest balance to pay. She has stated that she will only pay my bill when i alter my medical records to show "the truth"; ie: that he never was Diabetic. How should I respond? (yes, this is for real!)Dennis Galvon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 I'm going to continue playing the patient advocate here. > Too bad for them: if they had come in meekly, offering to pay in full; with > his last years normal blood glucose readings, then I probably would have > willingly written a comment on his record to mitigate or update the > diagnoses listed. I guess this could be termed " manipulation by niceness " , > but it is how I work! So, if this patient's wife offered to bribe you with niceness, and by paying their bill in full, you would have been prepared to revisit the diagnosis but since they didn't you won't? I think ethically this is somewhat suspect since the fact of his normal glucose readings is not in dispute. And also I note that you have not dealt with the patient .. only his wife. He may be unaware of what she is doing, yet you are prepared to punish him for his wife's actions? -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 I once had an argument with the QA MD for our practice about this very issue. I saw a patient who had had elevated glucose but through wt loss had normalized BGs and HGB A1Cs. When I saw her in follow up with normal glucose, I didn't refer for annual ophthalmology screening (I don't know if it's warranted or not, I don't believe there's data out there) and this was picked up on QA review. I argued the patient was no longer diabetic as they were on no meds with normal labs, she argued they were diet controlled diabetic ( I wonder if prediabetes is age controlled diabetes); guess who won. More to the point there are ICD codes for "hyperglycemia" and "elevated BP" that could be used if a practitioner was giving a patient time to try lifestyle modifications. I don't know if these trigger the insurance companies' big brother computers to flag the apps or not. Personally, I always use the most benign sounding code for my initial diagnosis of health problems that could cause insurance problems. Another example is using "situational reaction" as the initial diagnosis instead of "anxiety" or "depression" for a diagnosis, especially if they have no previous medical history of these diagnoses. StrazI'm going to continue playing the patient advocate here.On Fri, Feb 13, 2009 at 5:06 PM, Dennis Galvon <djgalvoncomcast (DOT) net> wrote:> Too bad for them: if they had come in meekly, offering to pay in full; with> his last years normal blood glucose readings, then I probably would have> willingly written a comment on his record to mitigate or update the> diagnoses listed. I guess this could be termed "manipulation by niceness",> but it is how I work!So, if this patient's wife offered to bribe you with niceness, and bypaying their bill in full, you would have been prepared to revisit thediagnosis but since they didn't you won't?I think ethically this is somewhat suspect since the fact of hisnormal glucose readings is not in dispute.And also I note that you have not dealt with the patient .. only hiswife. He may be unaware of what she is doing, yet you are prepared topunish him for his wife's actions?-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 Hyperglycemia without diagnosis of DM 790.6. As off 2009” 2 independent (I usually wait 2 weeks) >126 glucose levels and you have a diagnosis of DM (HgA1C does not count). Personally, if the patient has recently become obese, using steroids or HCTZ, I may give her/him the benefit of the doubt (as long as the glucose is not high enough for glucosuria) to lose weight and see if normo-glucemia is reestablished. But I strongly point out that they have DM even if the glucose normalizes and I shoot for LDL in the 70’s, strict BP control at least one good opth check (they usually need it anyways). The tricky part is that eventually all these patients would develop overt DM, I tend not to golden the pill but go for the scary stories to get them in shape. Sometimes it works. Also, there is data out there that these patients may benefit from treatment even with “normal” glucose levels (metformin); the issue becomes you diagnose them and attempt to treat them (weight lose, low LDL, BP control), the insurance company would only pay for those standards with a Dx of DM; or you spare them the diagnosis knowing it would have overt disease down the line, just to spare them insurance issues now. Sounds like the way Medicaid treats patients: “we don’t pay for outpatient treatment but we would pay for the kidney transplant”. José From: [mailto: ] On Behalf Of Strazzullo Sent: Friday, February 13, 2009 10:46 AM To: Subject: Re: bribery for forgery I once had an argument with the QA MD for our practice about this very issue. I saw a patient who had had elevated glucose but through wt loss had normalized BGs and HGB A1Cs. When I saw her in follow up with normal glucose, I didn't refer for annual ophthalmology screening (I don't know if it's warranted or not, I don't believe there's data out there) and this was picked up on QA review. I argued the patient was no longer diabetic as they were on no meds with normal labs, she argued they were diet controlled diabetic ( I wonder if prediabetes is age controlled diabetes); guess who won. More to the point there are ICD codes for " hyperglycemia " and " elevated BP " that could be used if a practitioner was giving a patient time to try lifestyle modifications. I don't know if these trigger the insurance companies' big brother computers to flag the apps or not. Personally, I always use the most benign sounding code for my initial diagnosis of health problems that could cause insurance problems. Another example is using " situational reaction " as the initial diagnosis instead of " anxiety " or " depression " for a diagnosis, especially if they have no previous medical history of these diagnoses. Straz I'm going to continue playing the patient advocate here. On Fri, Feb 13, 2009 at 5:06 PM, Dennis Galvon wrote: > Too bad for them: if they had come in meekly, offering to pay in full; with > his last years normal blood glucose readings, then I probably would have > willingly written a comment on his record to mitigate or update the > diagnoses listed. I guess this could be termed " manipulation by niceness " , > but it is how I work! So, if this patient's wife offered to bribe you with niceness, and by paying their bill in full, you would have been prepared to revisit the diagnosis but since they didn't you won't? I think ethically this is somewhat suspect since the fact of his normal glucose readings is not in dispute. And also I note that you have not dealt with the patient .. only his wife. He may be unaware of what she is doing, yet you are prepared to punish him for his wife's actions? -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 13, 2009 Report Share Posted February 13, 2009 I’ll bet if you do a glucose tolerance test on the that patient, it would still be positive. I don’t think you can cure glucose intolerance. I am also sure that the insurance company has the most recent blood work showing normal levels. But the history of meeting the criteria for DM is still there. It is there decision to call him a diabetic and offer him higher rates. Bring it up to the insurance commissioner as unfair. But the records reflect the truth of the moment. I don't recall lying for patients .. but bending the truth a little .... I might have done that in the past. And I know my colleagues have done this. Eg. to get the government to fund a biologic in this country, they have to have rheumatoid arthritis. I know of colleagues who have reclassified a patient with psoriasis as having rheumatoid so that they can get the funding ... But back to specifics. In this case, the patient's wife has asked that the record be altered so that it be shown he never had DM. Well, I wouldn't do that. But it might be argued that he no longer has DM based upon current criteria ( if of course the data we have is correct ). Then others here say that once you have DM, you never lose it. So, which is correct? Was the original diagnosis wrong? Is it wrong for her to ask that the medical records be corrected? This is not the same situation as if the patient still had their glucose intolerance. > Graham, > I have no problems with Jesus or Christianity. And I would, indeed, > have problems facing Jesus if I lied. In my opinion, we need all the > spirituality we can get to survive in this world. And witnessing that is > good for us. > Of course, my real point is that most people in our culture really would > not lie if they thought about their value system when they start. When I > draw them back with a reminder, they see themselves and change their minds. > This religious statement action on my part is really an act of faith in the > people themselves. Again, in my opinion, as a society we need to find ways > to insist gently that people act ethically; and I prefer to do it in a way > that does not make them defensive or angry. > Joanne > > > >> Dear Dennis, >> >> I have had patients ask me to alter the records. I tell them " Surely >> you would not want me to lie. I am a Christian and could not do that and >> still face Jesus. " Then they shut up. One or two appologized after they >> thought about it. > > <cut vas here> > >> Actually, I am more of a pan-diest, but most of these idiots do think of >> themselves as Christian, and I like to bring them to my spiritual home in >> the most efficient way. It is useless to talk to a venal person about >> ethics and service. >> >> Joanne in Drain, Oregon. >> > > -- > Graham Chiu > http://www.synapsed irect.com > Synapse - the use from anywhere EMR. > > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2009 Report Share Posted February 14, 2009 That's why the diagnosis of IGT was created .... to avoid labelling patients as having diabetes with the adverse insurance implications. > I'll bet if you do a glucose tolerance test on the that patient, it would > still be positive. I don't think you can cure glucose intolerance. The only way is to actually do the test ... and not just bet. -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2009 Report Share Posted February 14, 2009 so what is prediabetes now? Re: bribery for forgery That's why the diagnosis of IGT was created .... to avoid labellingpatients as having diabetes with the adverse insurance implications.On Sat, Feb 14, 2009 at 7:18 AM, Kathy Saradarian <qualityfphughes (DOT) net> wrote:> I'll bet if you do a glucose tolerance test on the that patient, it would> still be positive. I don't think you can cure glucose intolerance.The only way is to actually do the test ... and not just bet.-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2009 Report Share Posted February 14, 2009 Fasting glucose from 100 to 125. This is the link to the January 2009 latest guidelines for Dx. http://care.diabetesjournals.org/cgi/reprint/32/Supplement_1/S62 From: [mailto: ] On Behalf Of Dr Levin Sent: Friday, February 13, 2009 11:17 PM To: Subject: Re: bribery for forgery so what is prediabetes now? ----- Original Message ----- From: Graham Chiu To: Sent: Friday, February 13, 2009 7:19 PM Subject: Re: bribery for forgery That's why the diagnosis of IGT was created .... to avoid labelling patients as having diabetes with the adverse insurance implications. > I'll bet if you do a glucose tolerance test on the that patient, it would > still be positive. I don't think you can cure glucose intolerance. The only way is to actually do the test ... and not just bet. -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2009 Report Share Posted February 14, 2009 I usually consider " pre-diabetes " to be Metabolic Sydrome (syndrome X) of which the impaired glucose tolerance is one component, along with waistline obesity, high triglycerides, high blood pressure, low HDL. Must have the waistline obesity and at least two of the others. Implies likely high-insulin state and some degree of diabetes' risks start to show.I look forward to any other definitions, clarifications, corrections.Tim so what is prediabetes now? Re: bribery for forgery That's why the diagnosis of IGT was created .... to avoid labellingpatients as having diabetes with the adverse insurance implications.On Sat, Feb 14, 2009 at 7:18 AM, Kathy Saradarian qualityfphughes (DOT) net> wrote:> I'll bet if you do a glucose tolerance test on the that patient, it would> still be positive. I don't think you can cure glucose intolerance.The only way is to actually do the test ... and not just bet.-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR. ---------------------------------------- Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.---------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2009 Report Share Posted February 14, 2009 sounds like impaired glucose tolerance is dead Re: bribery for forgery That's why the diagnosis of IGT was created .... to avoid labellingpatients as having diabetes with the adverse insurance implications.On Sat, Feb 14, 2009 at 7:18 AM, Kathy Saradarian <qualityfphughes (DOT) net> wrote:> I'll bet if you do a glucose tolerance test on the that patient, it would> still be positive. I don't think you can cure glucose intolerance.The only way is to actually do the test ... and not just bet.-- Graham Chiuhttp://www.synapsedirect.comSynapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 14, 2009 Report Share Posted February 14, 2009 As a diabetic, I resent the added insurance premiums that insurers are allowed to charge for conditions like diabetes. The increase in premiums should be based on level of claim utilization. When I was paying for a family plan my premiums for myself, my husband and 4 kids was over $2600 per month for a plan with BCBS. It had a 30$ co-pay for office visits and a $1000 deductible per person $2500 per family. I could not continue to pay this amount and I dropped myself off the policy and just paid for my husband and the 4 kids. The premium dropped to $765 per month. In the 6 months we had the plan, My oldest son had 2 mri’s for knee injuries playing football and arthroscopic surgery once. My daughter had to have her appendix removed and my husband developed gallstone pancreatitis and had to have a cholycystectomy. Meanwhile in the same 6 months, I had routine labs done twice and had a podiatry appointment twice and saw my endocrinologist for routine appointments twice. I also had a mammogram and a yearly well female exam. Despite the fact I never had claims that even remotely equaled my monthly premium, the other members of my family had over $20000 in medical expenses during that same period. If health insurance was priced like car insurance and premiums went up for increased claims it would be fairer and would provide an impetus to people to get healthier and stay that way. Drivers who continually have accidents have to pay higher premiums and those who are safe drivers, go to safe driving programs and practice defensive driving are rewarded with lower premiums. My family who cost the insurer so much still has insurance, but me who does what my doctor says to do, consistently has a HgA1C less than 7, Total Cholesterol less than 130 and an HDL above 60 is penalized because I developed diabetes following 2 pregnancies complicated by gestational diabetes. The whole system is flawed and needs to be restructured from the bottom up. Beth Sullivan, DO Clinical Administrator Ridgeway Family Practice Commerce, GA 30529 From: [mailto: ] On Behalf Of Kathy Saradarian Sent: Friday, February 13, 2009 1:18 PM To: Subject: RE: bribery for forgery I’ll bet if you do a glucose tolerance test on the that patient, it would still be positive. I don’t think you can cure glucose intolerance. I am also sure that the insurance company has the most recent blood work showing normal levels. But the history of meeting the criteria for DM is still there. It is there decision to call him a diabetic and offer him higher rates. Bring it up to the insurance commissioner as unfair. But the records reflect the truth of the moment. I don't recall lying for patients .. but bending the truth a little .... I might have done that in the past. And I know my colleagues have done this. Eg. to get the government to fund a biologic in this country, they have to have rheumatoid arthritis. I know of colleagues who have reclassified a patient with psoriasis as having rheumatoid so that they can get the funding ... But back to specifics. In this case, the patient's wife has asked that the record be altered so that it be shown he never had DM. Well, I wouldn't do that. But it might be argued that he no longer has DM based upon current criteria ( if of course the data we have is correct ). Then others here say that once you have DM, you never lose it. So, which is correct? Was the original diagnosis wrong? Is it wrong for her to ask that the medical records be corrected? This is not the same situation as if the patient still had their glucose intolerance. > Graham, > I have no problems with Jesus or Christianity. And I would, indeed, > have problems facing Jesus if I lied. In my opinion, we need all the > spirituality we can get to survive in this world. And witnessing that is > good for us. > Of course, my real point is that most people in our culture really would > not lie if they thought about their value system when they start. When I > draw them back with a reminder, they see themselves and change their minds. > This religious statement action on my part is really an act of faith in the > people themselves. Again, in my opinion, as a society we need to find ways > to insist gently that people act ethically; and I prefer to do it in a way > that does not make them defensive or angry. > Joanne > > > >> Dear Dennis, >> >> I have had patients ask me to alter the records. I tell them " Surely >> you would not want me to lie. I am a Christian and could not do that and >> still face Jesus. " Then they shut up. One or two appologized after they >> thought about it. > > <cut vas here> > >> Actually, I am more of a pan-diest, but most of these idiots do think of >> themselves as Christian, and I like to bring them to my spiritual home in >> the most efficient way. It is useless to talk to a venal person about >> ethics and service. >> >> Joanne in Drain, Oregon. >> > > -- > Graham Chiu > http://www.synapsed irect.com > Synapse - the use from anywhere EMR. > > -- Graham Chiu http://www.synapsedirect.com Synapse - the use from anywhere EMR. Quote Link to comment Share on other sites More sharing options...
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