Writing unprofessional comments was downfall
Stick to the facts, says OH manager
The doctor who wrote a letter accusing a patient of "trying to milk the system" may have had the best intentions, but he exercised poor judgment in the way he reported his suspicions, says an experienced occupational health manager who has encountered many cases of disability fraud over the years.
The anecdotal, almost casual way in which the doctor described his suspicions created an opening for the patient to complain that the letter violated his rights, 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. The doctor could have reported his suspicions and achieved his goal of alerting the insurer without using unprofessional terminology, she says. Standard workers’ comp terminology and a professional approach would have sufficed.
"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."
Phone conversations might be better
A better option might be to avoid putting the suspicions on paper at all, Colby suggests. After all, the written document is very unforgiving once you’ve made a statement as the doctor discovered when his letter was waved in front of a jury. A verbal conversation puts the physician at much less risk of stepping over the boundary between professional conduct and besmirching a patient’s character, and it also might be more useful in getting your concerns across. The back-and-forth exchange 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 not doing anything that she and most other occupational health professionals have done many times. But the exact manner a doctor reports a malingerer or symptom magnifier can make all the difference in the world. She recalls a case in which a workers’ comp patient was being treated for wrist sprain but seemed very unhappy with her care, depressed, and not improving.
"After a while, I got on the phone with the employer and case manager and I told them that I had the feeling something else was going on in this woman’s life," she recalls. "I said there were no objective findings to prove it, but I wouldn’t be surprised if this woman was being battered at home. That’s a pretty bold statement, but I thought I had to let them know."
Think before you write
If the insurer had used that statement to cut off benefits, the patient may have been unhappy that Colby related her suspicions. But she felt safe saying she thought the woman was battered because there were subjective findings to suggest it, and she was not disparaging the woman in any way. She says she probably would not have felt comfortable putting that suspicion down on paper. If she had been writing a letter about the same patient, she may have stuck to the facts alone and hoped that the case manager drew the same conclusions.
Suggesting the use of surveillance in the Texas doctor’s letter also was improper, Colby believes. She would report any knowledge that a "disabled" worker was working or otherwise active, but surveillance should be the employer’s call. Again, she points out that communicating by phone instead of by letter can ease some of the difficulty. If you report the facts and the employer mentions that surveillance might be in order, it’s not improper to respond with, "Yes, maybe so, but that’s your decision."
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 medical term."
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