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Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
To the Editor: Dr Sage1
concludes that the best advice for physicians is to "do what is best for your
patients, think twice before accepting free money, and don't sign anything
you don't understand." While the first and second items are straightforward,
it is very difficult in the current environment to avoid signing things one
does not understand. I am in private, solo practice of orthopedic spinal surgery.
In addition to signing more than 35 dictated chart notes a day, cosigning
a physician assistant's notes, and signing 10 drug refills daily, I am faced
with signing multiple forms certifying the necessity for durable medical equipment
and physical therapy. These forms are covered with exceedingly small writing
by various medical care providers, and simply cannot be read in the time allotted.
Failing to sign these, however, limits my patients' access to physical therapy
or much-needed walkers or wheelchairs. At least 40 of these forms cross my
desk each week.
I am reminded of a friend who was an officer on a nuclear submarine
undergoing overhaul. He was faced with a choice of following all the regulations
and never getting the ship completed or signing off on those parts of the
inspection that he felt could safely be omitted regardless of regulation.
Unfortunately, we have come to a similar point in the treatment of patients,
and I believe patients do not suffer as a result. I certainly cannot adequately
police overuse of therapy or equipment, and every time I sign these forms,
I worry about my liability in this regard. A belief clearly exists that physicians
can be made the final scapegoat for everyone else's responsibility to do the
right thing for the patient.
Hieb LD. Fairness in Fraud and Abuse Enforcement. JAMA. 2000;283(10):1289–1290. doi:10.1001/jama.283.10.1287
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