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Why Do Highest Education and Accomplishments Make Doctors So Vulnerable?

Posted on the 15 January 2013 by Fadi Bejjani @DrFadiBejjani

Incredible as they may be, there are many levels of sheer vulnerability in the practice of medicine nowadays, especially in the US.First and foremost, merely taking a history makes a doctor quite vulnerable if not liable, because it all is coming from the patient and s/he can tell the doc whatever s/he wants or want him to believe for all parts of history (present illness, present, past medical, surgical, family, etc.), especially when it comes to drugs, STD, injury causality and medications. We have all heard patients who are "deadly allergic to all pain meds except Oxycontin" or "this meniscus tear happened on the job or in my last auto accident (these kinds of statements tend to mislead the billers who won’t know what insurance to bill, and having each one of the latter deny the claim on causality and turf it to the other). History is half the medical report. The other half is the physical examination, which also has a hefty subjective part, i.e. limited range of motion and muscle effort, Wadell signs, etc. So when all is done, the physician is signing his name at the end of a document where the data mostly came from somebody else and remains unverified by and large (no time or resources). Would you sign such a contract if it was presented to you in a business transaction, especially knowing that in our litigious society that report most likely will become a legal document in one way or another? So many of these medical reports end up in some public proceeding or another that for the life of me I do not how privacy can even be a serious issue!
Second vulnerability comes from merely being in the exam room with a stranger (first time patient), often alone because of logistics and economics. Now you are delving head first in the broad realm of S/He said S/He said. No videos in exam rooms because of privacy. Anything can be alleged. Sometimes these so-called patients are here solely to set you up or entrap you. They can be enticing you to say things they could hold against you or even timing your encounter to then check if you used the correct billing code!
Third vulnerability comes from the fact that the legal profession and governing bodies are tending more and more to look at less than optimal outcomes as equivalent to negligence or deviation, hence lawsuit and/or discipline. Since when Medicine did become and exact science like Math, and outcomes can be so precisely predicted? For one, the patient, his original injury, his habitus and environment affecting healing, and his subsequent trauma certainly have a lot to do with the outcome… but remember we live in a country where IT IS ALWAYS EVERYONE ELSE’S FAULT, especially when money is involved. Malpractice coverage attracts lawyers like bees on honey, or should I say more appropriately sharks on blood. Those very lawyers and all other professionals (accountants, consultants) never guarantee you outcomes do they? As a matter of fact lawyers are the first ones to tell you that they have to charge such exorbitant fees because they can lose a lot of these cases. How often do they get sued for that? Very rarely. They do have a much stronger bond in their profession than doctors do.
Finally comes the vulnerability arising from treating seniors who often have memory problems if not bill-aversion problems because of fixed incomes. Mrs. Jones, 80 receives a bill form her doctor’s office for her mandatory 20% co pay with Medicare. She watches a lot of TV and hears a lot about Medicare fraud and abuse. She then experiences a surge of patriotism and since she has a lot of time on her hand, she calls the fraud hotline and claims she never saw this doctor or at least that he never did all these things in the bill. CMS is delighted and hurries to send their Advanced Proctoscopy Team to that doctor’s office. Try escaping that team unscathed without a least a few thousands to pay back. You could have billed $100 instead of $80 for example and they hit you with a $5,000 penalty...for each occurrence!
One of the most en vogue vulnerability is this whole fraudulent billing crusade that makes every doctor a villain until proven otherwise. Have you ever seen the back of a HCFA form or a PIP form or any insurance claim form? Just reading them makes you feel that you are potentially committing a crime by sending the bill because of the many caveats and referral to fraud and abuse laws and the variety of punishments you could get. No other professionals have to sign such potentially incriminating documents when they send a bill.
Medicare LOVES to underpay doctors then to investigate them because they usually come back loaded with penalty monies, sorely needed in Washington these days. Some may remember the climate a year or two before 9/11/01 when a lot of doctors were being fined and investigated and task forces were roaming. Guess who sadly gave doctors a lull; Osama Ben Laden! He became PUBLIC ENEMY #1 taking the doctors’ spot and they got a break but now that he is dead the pendulum is swinging again, furiously because of the economical crisis.
Doctors are the highest educated in society, in number of years, cost, intensive work. Looking at the unthinkable vulnerability that all that gives you in American society, would you really want your son or daughter to be a doctor these days? Study and train for 15 years at the cost of more than $250,000, finally graduate after residency, fellowships and all that, get paid less and less with ever increasing costs, pay your loans all your life, get sued by anybody for anything…You really Gotta Luv It!

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