Stick to formal language in written communications
Patient confidentiality is the issue
The doctor who wrote a letter accusing a patient of "trying to milk the system" may have had the best intentions, but he exercised remarkably poor judgment in the way he reported his suspicions, according to a risk management expert and an experienced occupational health manager who have encountered many cases of disability fraud over the years.
If a physician or staff member wrote such a letter under her hospital’s letterhead, Katherine Dunn, RN, MGA, would be "very upset. The sort of comments in that letter are not professional, and I would be extremely concerned to see my facility associated with them." Dunn is director of risk management at Alexandria (VA) Hospital. Like most everyone who hears of the letter, Dunn was so astonished at the degree of impropriety in the letter that she laughed out loud.
Dunn contends that much of the information in the letter is confidential, and the doctor improperly provided that information to the insurer. She suggests that the better way to approach a situation would have been to contact the patient directly about the concerns.
"If he felt the patient was not cooperating or did not need further care, he should have sent the patient a standard letter outlining those concerns and saying he did not want to continue caring for the patient," Dunn says. "You owe that amount of honesty to the patient, and that letter probably would have solved the whole matter. It’s not likely another doctor would just take on the patient, and a copy to the insurer would have let them know."
Dunn also says the doctor was wrong to continue signing off on the patient’s disability forms while expressing concern that the man was defrauding the insurance system. By continuing to sign the forms, he was part of the fraud, she says.
Professional language is the solution
The doctor could have reported his suspicions and achieved his goal of alerting the insurer without using unprofessional terminology, says Judy Colby, RN, COHN-S, CCM, program director of The Workplace at Simi Valley (CA) Hospital. Colby also is president of the California State Association of Occupational Health Nurses. Standard workers’ comp terminology and a professional approach would have sufficed, she says.
"You could have said that the subjective findings are ABC and the objective findings are XYZ, and the two don’t correlate," Colby explains. "Anyone in the business would know what that means, but you haven’t done anything more than report the facts. You don’t have to come right out and say he’s a fraud."
A better option might be to avoid putting suspicions on paper at all, Colby says. A conversation puts the physician at much less risk of stepping over the boundary between professional conduct and besmirching a patient’s character, and it might be more useful in communicating your concerns. The back-and-forth of a phone conversation with the case manager will allow the doctor to explain exactly what the concerns are and what findings are at issue.
Colby points out that in a broad sense, the Texas doctor was doing something she and most other occupational health professionals have done many times. But the exact manner of reporting a malingerer or symptom magnifier can make all the difference in the world.
Suggesting the use of surveillance also was improper, Colby says. She would report any knowledge that a "disabled" worker was working or otherwise active, but surveillance should be the employer’s call. Again, she says that a phone conversation instead of a letter can ease some of the difficulty.
The bottom line for Colby is that written communications require a strict adherence to professional terminology. "And the last time I looked, milking the system’ was not a medi-cal term."
After the fact, just leave the matter alone
Colby suspects that libelous communications of this type are not at all rare, she says, though she is glad to report that she has never seen one connected to her facility. She suggests it would be a good idea to remind physicians and others that unprofessional language and disclosures have no place in communications concerning patients.
But what if a physician or staff person under your employ writes a libelous letter? Once the letter is in the mail, Dunn says, there is little you can do to make the situation better. And almost anything you do will make it worse.
"I would not write a second letter saying, Sorry about that first letter we don’t support it,’" Dunn says. "Any further correspondence is likely to just draw more attention to the improper communication and make matters worse. The only thing you could do at that point is to wait and see if anything will happen."
For more information, contact Katherine Dunn, Director of Risk Management, Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304-1594. Telephone: (703) 504-3129.
Or contact Judy Colby, Program Director, The WorkPlace, Simi Valley Hospital & Healthcare Services, 2975 N. Sycamore Drive, Simi Valley, CA 93065. Telephone: (805) 583-3200.
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