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
procedures
Felicia 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
procedures
Felicia 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
procedures
Felicias 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
detailing
Pharmaceutical 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
detailing
Patients 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 patient
Physician : 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 patient
Now, 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.