The Patient-Centered Guide to Workers Compensation: Introduction

Today begins a series of posts about workers compensation that is written from a patient-centered perspective. Many of you reading this have workers compensation insurance. Workers compensation insurance pays for your medical bills and part of you salary if you are injured on the job and can no longer work. You may be under the assumption that the workers compensation insurance company will be on your side if you get injured on the job but this is often not so. In my line of work, I run into all sorts of problems that patients experience with workers compensation insurance. It is my hope that these posts will make you more aware of these problems and when possible, suggestions will be made on how to address them. To those of you who do not have workers compensation insurance you should still read these posts because you are not going to believe some of things that go on in the workers compensation system.

So let's begin with understanding one key fact. Workers compensation insurance is a business. It is not an organization designed to be your friend or to take care of you with the hopes of making you feel better. Like any business, workers compensation companies do not want to lose money. When you are not working they are losing money. If it is clear to the workers compensation insurance company that you are only going to be out of work briefly (e.g., broken arm) then you are not likely going to experience problems because there is an end in sight. It is in cases, however, where there is no end in sight to disability where you will begin to encounter resistance. For example, if you left work because of a back injury and your doctor wrote notes saying you are out of work indefinitely and the prognosis is not determinable yet, this is a perfect recipe for a battle with the workers compensation company. And trust me, they can really apply the pressure when they want to.

Before I go criticizing workers compensation insurance companies I should mention in fairness that there are people who fake injuries and illnesses so they don’t need to work and can live off workers compensation payments. This is known as malingering. In my experience, malingering is actually quite unusual but it does happen from time to time. It only takes a few bad apples to spoil the bunch. As a result, workers compensation insurance companies are especially on guard for malingering. This suspicion can drastically alter your benefits, regardless of whether you feel it is warranted. Stay tuned tomorrow for more specific examples and scenarios. Go here for the fist step.

A passing thought

Just a passing and humorous thought for today's entry. Why does it seem that when you go to the dentist that he or she cannot find the source of what is causing your toothache but is always able to find a bunch of areas on the x-rays that are supposedly cavities but do not hurt you?

Don't worry. It's going to be fine

If I had a penny for every patient or patient's family member who told me that their doctor said to them "Don't worry. It's nothing. You're going to be fine" when reporting symptoms that later turns out to be a serious medical condition, I'd be a millionaire. This is most likely to happen if you are the type of person who shows your emotions or cries during a doctor's visit. My experience has been that these types of patients tend to be dismissed much quicker because the symptoms are presumably in the patient's head. Now sometimes, I would agree that this is the case, but this can only be concluded after a comprehensive evaluation has been performed.

I've had patient's with multiple sclerosis and mother's with serious medical disorders that put the life of the baby at risk get told the "don't worry, it's nothing" comment. I even had one patient with classic stroke symptoms who went to a hospital and was released and told that she had anxiety. She got progressively worse the next day and went to another hospital where she was diagnosed with a stroke. Turns out that the radiologist at the original hospital misread the scan!

My solution to this problem is that if you feel like you know something is wrong with you or a family member and are not getting answers from your doctor, go somewhere else where you will get answers. Some people tend to stick with their doctors as if it is like a marriage and as if seeing another doctor is akin to cheating. Trust me, the doctor doesn't care about that. Think of yourself and your family first.

Insurance games

We all have our pet peeves about problems we have had with insurance companies from the patient's side of things. But I wanted to give you an idea of some of things we have to deal with from the doctor's side of things. Why should you care? Because when insurance companies cause problems with doctors it often translates into problems for patients.

A recent example from my own practice is that I recent performed a pediatric neuropsychological evaluation. Before all evaluations, my outpatient administrative coordinator calls the insurance companies to get pre-authorization for the service, which is rather expensive. We want to know if the insurance company will pay because if they do not then the patient has to sign a self-pay form. The patient wants to know if the service is pre-authorized because then they have a sense of what they will be responsible for.

So in the case I described above, we were informed by the insurance company that the evaluation would be authorized and paid in full. So several months go by after the evaluation and no payment. Why? Because now the insurance company is demanding a letter of support from the child's school saying that such an evaluation was necessary and that the service could not be provided in the school to begin with.

It's not the reasoning that bothers me because obviously the insurance company does not want to pay for a service that is not needed or that can be done elsewhere for free. What bothers me is the procedure. If the insurance company wanted this information, they should have asked for it before the evaluation was done instead of afterwards. Now the patient's family is upset because they think they may be saddled with a bill they cannot pay out of pocket.

When my office called the insurance company back we were told that the insurance company has the right to ask for anything they want after the fact. Well, ok then. But guess what that means now? Now when we get a referral in which the patient has this insurance, we will not schedule an appointment until we get this type of letter, regardless if they ask for it. This delays care to the patient. What many people eventually do is refuse to see patients from certain insurance companies that play this type of shell game. This only further limits the choices of the patient and is an example of how problems behind the scenes affect patient care.

Medical records

If you have seen a doctor in recent years, you have probably heard of "HIPAA" which stands for the Health Insurance Portability and Accountability Act. This law, enacted by Congress in 1996, was created to protect health insurance coverage for workers and their families when they change or lose their jobs. However, the law also specifies how your medical records can be handled with regards to privacy and grants patients full and complete access to their medical records.

It's this last part that I wanted to touch base on today. Even though 11 years have passed, I still come across patients that have no idea that they can get a copy of their medical records. You should always get a copy of your medical records. Here is why. First, I have seen time and time and again that the interpretation of what patients tell me the doctor told them is vastly different from what the doctor actually stated in their dictated notes. Second, if you have a copy of your medical records, this can be of great importance if you see a new doctor who is trying to understand your history. You will likely have forgotten every doctor you saw, the dates you were seen, and all of the findings. If you had the records though, this problem can be avoided.

How do you get the records? Easy. If you were seen in a hospital setting, call the hospital's medical records department. They will ask you to sign a form consenting for the information to be released. If seen by a private doctor, simply call the office and request a copy of the records. If they give you a problem, a quick reminder that they are required to give you the records per the HIPAA law should get their attention. No one wants to be held accountable for violating HIPAA regulations since there are hefty violations that can result from such a complaint. To read more about HIPPA, click here for the HIPAA website.

7 Ways in 7 Days to Be Happy: Day 7

OK, well, you knew it was coming right? My last tip. That's right, even though it is very cliché, I have to do a post on the power of positive thinking. The key take home point to is that your thought control your feelings. Therefore, if you change your thoughts about something your feelings will also change.

Let's think of a few thinking patterns that can lead someone to feel unhappy or depressed. Here are a few: 1) I must get an A on all tests to feel worthwhile and smart, 2) I should have a girlfriend or boyfriend (or be married) in over to feel happy, 3) Things are never going to work out for me, 4) The results of my medical tests are going to show something serious.

So how do we change these thoughts? The important thing to keep in mind is that we don’t want to try to change the thoughts to something completely unrealistic such as "Getting an F on a test is great." That won't work and there is no way you will believe it. What you have to do is reach a middle ground. So eliminate the extreme words like "must" and "should." For example, you can change the first thought to this: "I strive to get an A on all tests but it is ok if I get a lower grade, as long as I know I tried by best." Thus, you still have high expectation but do not set yourself up for failure. The 2nd sentence can be changed to: "I want to have a partner right now but there are still other ways I can be happy even if I am temporarily single." With this thought you can still feel happy even though you have not reached a certain goal yet.

Sentence number 3 acts like a self-fulfilling prophecy. Keep telling yourself things won't work out and this is exactly what will happen because your motivation to succeed depends on your thought process. To succeed in life you need to tell yourself success is possible. Even if you have doubts, you ultimately have to believe there is a future for there to be one.

Sentence number 4 is common for people getting medical tests performed. How do you think the person saying this would feel? Pretty anxious and pretty depressed. The thought needs to be changed to something less extreme, such as: "I am not going to worry about the medical test results until someone tells me I have something to worry about." The person saying which sentence will be happier? Obviously the 2nd one. Change your thoughts and then you will change your emotions. Let us know of some negative thoughts you have changed that helped make you feel happier.

7 ways in 7 days to be happy: Day 6

Another thing you can do to make yourself happier is to exercise. I know, I know…you are too tired when you come home from work, it's hard to get motivated to do it, and it takes time. All of these things are true but the benefits to your mental and physical health far outweigh the costs.

The analogy I give to patients is that stress is like steam in a teapot. You are the teapot. If the steam in the teapot continues to build up with no way to escape, what is going to happen? The teapot will explode. Similarly, if you let stress build up and do not have a release for it, you might explode out of anger, you may get depressed, you may get a serious physical illness, or all three.

You do not have to exercise every single day to get benefit out of it. Even if you can just do some exercise a couple of days a week, that is still better than nothing at all. And it does not have to be lengthy exercise -- even a 20-minute walk is sufficient. I used to exercise almost religiously, but as I have aged and have more responsibilities, this has become almost impossible. But I still make sure I find some time every week to do some exercise and tend to use the exercise bike or talk a walk. I try to do this on the nights I am least tired.

Motivation is the biggest barrier to overcome for most people. I often hear people say, "Once I am doing it, I am fine, but it is hard for me to motivate myself to do it in the first place." Many people fail to realize though, that this type of statement is actually the way to solve the motivational problem. That is, if you can tell yourself that you know from past experience that you will actually enjoy doing the exercise either during or afterwards, you can use that very fact as motivation to get yourself started. In other words, that knowledge can be used to overcome the other reasons you are telling yourself not to exercise or do whatever it is in life you don't feel like doing at the moment. Try it some time, and let me know how it works. Go here for Day 7.

7 Ways in 7 Days to Be Happy: Day 5

Sometimes, we all just need a little piece and quiet. You may have noticed that many of the daily tips provided so far will not only make you happier but they will also make you less stressed. Stress comes in many forms, some of which are very obvious: annoying people, too much too do, things going wrong, etc. But sometimes, we don’t recognize that technology can also make our lives stressful. I am not an anti-technology type of person and in many ways technology certainly makes our lives easier. However, it can also make our lives more stressful by making us so dependent on it. For example, how many people reading this have a Bluetooth wireless phone earpiece that you wear most of the day, a beeper you wear all day, a portable device to check your email, or carry a cell phone at all times. Most people do one of these things and some do all of them.

My advice? Take some time to get away from it all. Get away from the computer, put all the electronic devices away, and just go outside and enjoy what nature has to offer. Whether it is going for a walk or a jog, working in your yard, or sitting on your porch, these are all good ways to take some time for yourself and relax. For me, I try to take at least one time a week where I go in the woods and chop down some wood for the winter. It's a good stress reliever and I know no one can interrupt me with a phone call or an email. Other times, I go for a walk in the neighborhood or at one of the local parks. Feel free to write in with any suggestions you have for others on this topic. Go here for Day 6.

7 ways in 7 days to be happy - Day 4

Another way to improve your level of happiness is to take some time each day to stop and appreciate the things you normally take for granted. We often get so caught up with the hustle and bustle of life that we don't appreciate the fact that we can walk, that we can see, that that we have family members who love us, that the sky is a gorgeous color blue today, or that we have a roof over our head and a warm bed to sleep in at night. People tend not to realize this UNTIL it is taken away either by a serious injury or some severe psychosocial stressor (e.g., divorce, financial hardship). Why wait until something terrible happens to appreciate what you have? I can honestly say that every day I think about how fortunate I am to have a loving family around me, that I am healthy, and that I am getting by financially.

Now, of course, there are people who do have it pretty bad and there are reasons sometimes to de depressed about things at certain times in life. For example, there are soldiers who have lost limbs in Iraq, people who lose their jobs and enter bankruptcy, and people who have spouses who cheat on them. Of the many patients I have seen in these or similar situations I have repeatedly seen that the ones who move forwards with their lives are the ones who do not dwell of what they lost, appreciate what they still have, and are determined to move their life forwards. It all goes back to the general theme of trying to actively control your life. Go here for Day 5.

7 ways in 7 days to be happy - Day 3

When was the last time you had a really good belly laugh? You know, the type of laugh that was so intense that other people looked at you like as if were insane. The type of laughter that was so intense that you almost fell the ground in the process. The type of laughter that was so intense that you were actually brought to tears. Thinking of this probably made you smile because it is not too often that we laugh this hard and such events are remembered as positively unique. Think back to how you felt after such laughter. At a bare minimum, you had to have felt pretty happy. Why? Because laughter actually increases the amount of endorphins released in the body, which is a type of chemical that makes us feel good. Laughter also decreases the amount of epinipherine in the body, which is a stress hormone.

Now, I realize we all can't have intense belly laughs every week, let alone every day. However, we can all add some increased laughter to our lives each week to make us feel happier. There are some people who go an entire week without laughing once. The best way to increase the laughter in your life is to do something that would actively promote laughter. This includes watching a sitcom, watching a funny movie, reading a funny book, listening to a funny radio show, spending time with a friend who makes you laugh, etc. It doesn't have to be every day, bust just once a week. For me, I try to listen to my favorite radio show once a week because it always makes me laugh, and every once in a while, this will actually elicit a hardy belly laugh. Go here for Day 4.

7 ways in 7 days to be happy - Day 2

As you can see from the tip listed on Day 1, I am not going to provide suggestions that I do not practice myself and I will try to provide examples of how I use these strategies in my own life so you can see how easy it is to do. This brings me to the tip for Day 2, which is to get yourself organized. If you are anything like me, you have sources of stress all around you but you may not realize how much it is affecting your life because you are just so darn used to it. Let's take the most common example of this -- clutter. Look around you right now, is your desk at work or the room where you are reading this cluttered. Do your drawers look like a hurricane just came through it. If so, this is adding to your stress level and making you less happy than you can be.

So the solution would seem simple, right? Clean up the clutter. Not so simple you say. You don't have the time, right? I used to think the same thing myself, but then I realized that this was just an excuse because whenever I set myself to clean up the clutter it took far less time than I thought it would. What you need to do is find some time at least once a week that you designate to clean up some of the clutter in your life. If it is a very large task, you don't need to do all of it at once. Just do a chunk of it at least once a week and don't add to the clutter in the interim.

Tonight, my example of following this advice was cleaning up the very home office room where I am typing this blog posting. When I walked in this room tonight there were books all the over the floor that my kids through all over the place, toys tossed all about, and clutter on my desk. I put 10 minutes aside, put on some music, and cleaned up the clutter. What you will find is that once you get yourself started on these types of tasks that you will be motivated to do a little bit more. Proof in point was that I cleaned out a drawer in my office that had been cluttered for 2 years. When I walked into the room later on this evening, it had such a different, stress-free feel to it, and now I much happier, and smiling like Peppermint Patti. Go here for Day 3.

7 ways in 7 days to be happy -- Day 1

These steps listed in the "7 ways in 7 days" to be happy series are not listed in any particular order. All are about equally important. The first step involves making sure you plan something in your day to look forward to. The reason for this is that the many demands of life can easily cause you to fall into a rut: you wake up, go to work all day, come home, spend some time with your family, eat dinner, do some house chores, prepare for work the next day, go to bed, and start the next day all over again. What kind of fun is that? Some people only build fun activities into the weekend, but why have 5 days of boredom in between? If you consciously tell yourself that you are going to make some time for yourself each day, then you will find your week much more enjoyable.

So what kind of fun things am I referring to? Well, it can be anything really and it best if you can schedule multiple small activities throughout the day. For me, I look forward to either reading a chapter of a book each night, working in the woods in my backyard, watching a favorite TV show, and/or working on developing my website. For you, it can be something like the above or something completely different. But just make sure you find something to do each day that you look forward to and enjoy. It will help get you through each day and will make you happier when you are at work.

Please share your ideas on fun activities you do each day so others can get some additional ideas. Go here for Day 2.

7 ways in 7 days to be happy - introduction

There are no books written on how to be depressed. However, there are many books written on how to be happy. Do you know why that is? Because it is easy to be depressed and it takes effort to be happy. Think about it. It is easier to think that the worst will happen and not do anything about it rather than to do something to try to change your life circumstances. It is easier to sit home and resign yourself to being overweight rather than to exercise and diet so you can happier with your body image. It is easier to also think you can just take a pill and that *poof* all of your problems will suddenly go away and you will be happy again. But it just isn't that simple.

Success and happiness in life takes some work. By and large, it doesn't just come to you. So the first step towards becoming a happier person in life is to realize that YOU need to take control of things and stop letting external circumstances control you. It is only once you have come to this realization that you can apply the set of tips I am going to provide over the next week as part of the "7 ways in 7 days to be happy and improve your life" Please pass the word around about this blog series to our friends and loved ones, as this is a topic of interest to many and I would like to see some more happy people in the world. Go here for Day 1.

The Snowblower

What good is a blog if you can't share a few stories from your past that are a little self-deprecating. One freezing cold morning in Buffalo, NY, at about 5am, I drove in my car to my boss's house because we needed to go to Toronto for an important research project. I pulled up my car next to the curb at my boss's house and saw him snow blowing the driveway. The machine was so loud and it was so dark that he had not realized I arrived. I got out of my car and began to walk up the driveway when I suddenly slipped on a patch of black ice. I landed forcefully on my hip and it must have been quite a sight, considering my 6 foot 6, 250 pound frame. I instantly looked up to see if my boss witnessed this embarrassing moment but he did not. I quickly stood up and gingerly walked to his garage. I was greeted with a good morning and an offer to step inside to stay warm. I readily obliged.

As I stood inside, I reached for my cell phone and saw that it was missing. I realized I must have dropped it when I fell. I looked to see where my boss was and sure enough he was snow blowing near where I fell. He had to stop the snow blowing so I could search for the phone, but no luck. I then began to doubt if I even brought it with me and wondered if it fell off my belt clip in the snowy parking lot at my apartment complex. If that happened, there was a good chance someone would run it over. I had no choice. I had to call my wife, who was 6 months pregnant at the time, and ask her to go outside and check for the cell phone. She was not happy to say the least, but did so, and there was no sign of the phone.

At this point, we had to get started on our trip, but on the way, my boss called and then woke up his wife on the phone and asked her to look around on the lawn for the phone. I didn't hear her reaction but imagine she wasn't too happy as well. Nothing was found until several days later when my boss informed me that little pieces of the cell phone were found all over his lawn when the snow melted. It has evidently taken a pass through the snow blower. I was too nervous to ask if the snow blower was ok.

Hey, You Never Know

Part of my job involves asking patients some questions they may find strange or unusual. This includes asking them if they are suicidal, if they ever see or hear things that no on else around them sees or hears, if they believe anyone is following them or out to hurt them, and if they abuse any drugs. Not all patients I see endorse any of these things and some look at me like I'm crazy or will laugh when I ask the questions. This is understandable because to them, it does seem a bit unusual. However, I learned a long time ago, never to assume I know the answers to these questions.

The case I learned this on happened many years ago when I was interviewing a 70-year-old woman as part of a neuropsychological evaluation. We came to the part of the interview where I normally ask about substance abuse and I remember saying to myself "There is no way that this sweet old lady abuses drugs and she is just going to get insulted if I ask." So I didn't ask. One of the reasons I usually always ask this question is because drug abuse can affect cognitive functioning, which is the main thing I assess. So later in the day, when reviewing records, I found reference to substance abuse. With this in hand, I mentioned it to the sweet old lady who turned to me and said "Oh yes. Every night I light up a marijuana joint and smoke it before I go to sleep." Go figure. Since that day, I learned to never make assumptions.

IME restrictions

I think this will be my last post on IME's for now, but I wanted to highlight a brief story about an IME when I was on internship. I don't recall all of the specifics but a core issue in the case was whether the patient suffered acute stress disorder, which is a type of anxiety disorder, after a motor vehicle accident. To step back for a second, when you get an IME, you are told that you must only answer the specific questions posed to you and not to comment on other conditions not asked about.

Why would that be the case? Well, this case illustrates exactly why. Technically, you cannot have acute stress disorder if your symptoms are present past 4 week. We were evaluating the patient many months after injury. So technically, he didn't have acute stress disorder. In my opinion, he actually had posttraumatic stress disorder (PTSD) but that was considered "another condition." Remember, the IME specifically prevented us from mentioning PTSD because it is "another condition." And if you don't follow the IME rules, you don't get paid.

By following the rules, the IME company would get a report back saying that the patient did not have acute stress disorder and this would form the basis to deny his claims, when in fact he really had PTSD. I remember vociferously discussing my disagreement with allowing this to happen at the time, but I had no say in the matter since I was not the one responsible for the report (my supervisor was).

Now that I am practicing as a licensed psychologist, however, I refuse to get involved with these kinds of cases. I feel like I always provide a truly independent evaluation when I see patients, but refuse to perform a traditional IME because I don't want to be put in a situation where I have restrictions placed on me regarding what I can or cannot say. Sure, I am passing a lot of money up by refusing to do this (I have had companied call my office and ask me if I want to do them), but I feel it is the right thing to do --until the system changes

IMEs -- part 3

If you have been following the recent posts on "Independent" Medical Evaluations, you can see that there is a significant problem as the current system is set up. Why does the system continue to run this way despite these problems, you ask. I think part of the reason is that the insurance industry has enormous lobbying groups in Washington DC and on the state and local level that would resist any change because it is in their best interest to keep the system the way it is. So what can you do?

First, if you even a patient in a situation I described, you definitely should contact the head on the insurance commission in your state like I previously mentioned. But if you want legal changes made, you will need to contact your local congressman, state senator, and even the Governor's office. It's the only way such change will ultimately happen.

In my view, the system needs to be changes so that the insurance company is not the party paying for the IME because there is so much possible inherent bias in this. Instead, what needs to happen is that each person pays into a general fund as part of their insurance fund. The fund is run by a statewide independent agency that has absolutely no vested interest in the result of the IME. The agency would be responsible for selecting doctors qualified to perform IMEs. This is the only way I can think of to eliminate the potential bias I have discussed in earlier posts, but if you have other ideas I would like to hear them. In my next blog entry , I will go over a few miscellaneous points about IMEs that I have yet to mention.

IME's -- part 2

The last entry was focused on introducing you to the potential biasing influence of having insurance companies be the one who pays a doctor to perform an "Independent" Medical Evaluation. How do I know that what I am saying is true? Because I have read many of these IME's before and there are some physicians who continue to make the same determination (e.g., the patient is not disabled and does not need further treatment) every single time. One patient I saw was going for an IME with one of these physicians in town and I told him flat out that "The doctor will probably spend very little time with you and that you will likely have your benefits cut off based on his opinion." Sure enough, I saw the patient a few weeks later and he said to me, "You were right, Dr. Carone. My benefits were just cut off based on the IME." This was in the middle of winter here in Syracuse and as a result of having no real income, the poor guy had to amount to heating his house with his oven.

So what can you do about this? My first recommendation is too hire a lawyer. The lawyer will take some of your workers compensation or disability earnings as payment, but the payment is probably worth it to help deal with the hassles you can be put through. If you are cut off from benefits based on an IME and have other doctors who disagrees with the IME decision, you should appeal the IME decision. In a workers compensation system, this will get you a hearing in front of a judge and the benefits are typically reinstated (although sometimes at a lower level) if you have supporting documentation of disability or need for treatment by other doctors. I also recommend documenting how the IME was performed, particularly how much time was spent with you by the physician. Patients continue to tell me that the physician IMEs typically involve only about 10 minutes of face to face contact. This is much too brief. You can send all of your reporting documents to the head of the local insurance commission in your state. Trust me, when insurance companies get a call from the state insurance commission, people listen.

I would be curious to hear about any IME experiences so post a reply if you have one. My next blog entry will have a solution on how to fix this problem once and for all.

"Independent" Medical Evaluations

Ok, so I think I am going to do a few entries related to consumer advocacy, in order to make the public aware of some things that go on inside the system. The first topic of interest has to do with what insurance companies refer to as "Independent Medical Evaluations" or IMEs. Here's how it works. Let us say that one day while you are at work, you lift something too heavy and tear a muscle in your shoulder and strain your back. You go to your own doctor and he says you need surgery and will need to remain out of work until you have healed appropriately. You have the surgery, but you still don't feel that your arm is quite right and you still have moderate to severe back pain. Your personal doctor continues to write out of work notes and in the mean time, you receive workers compensation benefits.

At first, workers compensation insurance is supportive but the longer you remain on disability, the more they have to pay out, and the more likely they are to pressure you to return to work or try to show you are not as disabled as you say you are because then they can cut off your benefits. How do I know this? Because I hear patient after patient tell me this same story with different diagnoses and we have had the insurance representatives call and accuse patients of faking. To be sure, there are people who try to take advantage of the system and the insurance industry in hyper-alert about this. As a result though, a few bad apples spoil the bunch and those with legitimate injuries get stigmatized as fakers. So here is where IMEs come in.

The insurance companies contract with certain doctors who will perform and IME. These evaluations are different because there is no doctor-patient relationship. The doctor is not there to treat you and does not even have to share the results of the evaluation with you. In an ideal world, the main job of the IME doctor is to come to an objective conclusion as to whether the patient has a specific condition, whether it is related to a specific cause (e.g., an injury at work), and various other questions (e.g., whether the patient has fully recovered, whether the patient can go back to work, etc). Although there are plenty of IME doctors who can do such an evaluation with honor and integrity, the system is ripe with corruption for one main reason: the insurance company is the one paying the doctor.

So let's think about what this means for a minute for the doctor. It means a guaranteed paycheck for services rendered and no need to hassle with insurance claims. It also means that if the doctor does not find what the insurance company wants the majority of the time that the insurance company will stop referring cases to them. Therefore, there is an inherent pressure to find what the paying source wants found (e.g., that the patient is not disabled). The next blog entry will continue this topic some more, discuss some of the practical implications, and tell you what you can do about it.

Venting

To date, the majority of my blog entries have been about some of the strange, bizarre, and surreal things I have seen and encountered at the various jobs I have had in different medical settings. I have many other stories I would like to tell but cannot because it would violate patient confidentiality. However, you can be sure that there will many odd stories forthcoming in the future, especially if I remain at my current job, where the motto continues to be: You Can't Make This Stuff Up.

Anyway, I would like to expand the blog to different topics and could sure use some suggestions from those who read this blog from time to time. For now, I guess I just feel like venting on the frustrations I have with current medical and mental health providers who don't take the time to obtain a sufficient history, don't review the available medical records, don't ask detailed questions to really understand the problem at hand, don't provide adequate treatment, and have poor bedside manner. This isn't a diatribe against the entire medical and mental health profession because many do fine work indeed. But it is too often the case that there is shoddy work going on from the stories I hear from patients on a daily basis and from the medical records I constantly review. I often find myself working late hours or bringing work home to make sure I get the job done right. I don't want to do that but feel a moral obligation to do so and wish more would feel the same.

The Pizza Man

A patient I had suffered some serious injuries when he was struck from behind by a speeding car while walking in his neighborhood. The car struck the person so hard that he flew up in the air, crashed through the windshield, and landed in the front passenger seat. The car came to a screeching halt, which caused the man to be ejected from the vehicle and to strike a road sign. If that story wasn't incredible enough, it turns out that the person was struck by a pizza delivery man, who got out of the car after the accident and …..delivered the pizza!



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You Can't Make This Stuff Up (#14)

I was looking through the medical records of a patient I was going to see soon and saw that the patient reported he had been struck by a car nine separate times as a child. I turned to one of the secretaries and said, "I don't see how that's possible. Wouldn't you learn your lesson after the first two times?" Scratching my head, I was looking forward to interviewing this person to figure out how this could happen. On the day of the evaluation, in walked a nice man of limited educational background. The interview went something like this

ME: So, I was looking through your records and it stated you were hit by a car nine times, is that correct?
PATIENT: Yes. That's correct.
ME: Do you remember all nine of these incidents?
PATIENT: No.
ME: OK. How many do you remember?
PATIENT: Two.
ME: Then how do you know there were nine?
PATIENT: Because one time when I was hit by a car, the doctor in the hospital told me "You are like a cat with nine lives." So I figure that if he said that, I must have been hit nine times.

He was completely serious.