Communication with other Professionals

By. Prof.FX.Budhianto Suhadi

Should doctors lie to insurance companies?A 2000 survey by The American Family Physician found that most doctors would deceive an insurance company for some procedures. More than 57% of respondent said they would lie to get authorization for coronary bypass surgery, even though this violates the AMA Code of Medical Ethics. More than 30% would lie to get a mammogram covered.

Should doctors lie to insurance companies?It seems that doctors are more willing to deceive insurance companies when their patients have severe medical issues because only 2% of doctors would lie to get approval for cosmetic surgery.

Should doctors lie to insurance companies?These doctors stated that their first responsibility was as an advocate for their patients. This highlights the conflict and tension between patient advocacy and the ethics of controlling medical costs. Although the rules of third parties were important, they became less important when they compromise the patients best interests.

Felicias case : Arguing the necessity of medical proceduresFelicia was a 24-year-old pregnant patient who came in for an18-week OB visit including an ultrasound. She and her partner wanted to know the babys sex. She had had an early OB ultrasound at nine weeks to determine the pregnancy due date because she was uncertain about her last period. Felicia was a heavy smoker and at her visit, the baby seemed to be small.

Felicias case : Arguing the necessity of medical proceduresFelicia had only gained one pound during the pregnancy. An OB ultrasound was ordered and the baby was found to be a boy, but also experiencing intrauterine growth retardation (IUGR). Felicias insurance company wouldnt pay for the ultrasound because the policy covered just one unless there was a substantial medical indication for a second.

Felicias case : Arguing the necessity of medical proceduresFelicias doctor wrote a letter to the insurance company stating that the ultrasound was ordered not to determine the babys sex, but to check fetal growth based on indications from the OB visit. The company accepted the appeal and paid for the ultrasound.

Pharmaceutical detailingPharmaceutical detailing occurs when representatives form drug companies go to doctors offices to pitch a specific drug. These visits can keep doctors up to date on new drugs and help providers choose newer, more effective treatments, but you must be aware of the conflicts of interest these visits can create. A problematic aspect of these visits is that the drug samples are new and expensive.

Pharmaceutical detailingPatients get started on these free drug samples that are given in the clinic, but soon have to pay for them when the sample runs out. Sometimes a less expensive and equally effective drug is available. Some clinics are now prohibiting visits from pharmaceutical reps due to the conflict of interest this creates. Electronic detailing or e-detailing, is now becoming more common because physicians have less time for face to face meetings.

Correcting a colleaques excessive medication of a patientPhysician : sometimes you see patients who have been seen by other doctors. And they come with the prescriptions. Sometimes a prescription which has been given to the patient contains many drugs, which may not be needed A mother came with her child who had been prescribed a lot of unnecessary drugs.

Correcting a colleaques excessive medication of a patientNow, the question arises : Should I tell the mother that Dont give the medicines, it will harm your child, because if you tell that, then your personal relationship with your colleague might be strained. But you know that so many drugs are not good for the child and therefore should not be used. It is a difficult situation. I told the mother that probably these medicines were prescribed when your physician saw the child for the first time. But I dont think these medicines should be taken any more. So you can stop all these medicines and give only these drugs.

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