Читать книгу Who's Killing the Doctors? - Alex Swift - Страница 8

Dr. Nora Phillips, a well kept, just-over-50, tall and slender, good looking brunette, was a neurologist in private practice not too far from central Buffarin in western New Work. Her solo practice was in a medium-size, multi-specialty medical building, next door to the city block -formerly used by a major insurance company- where Dr. Barbara Good’s large group of orthopedists occupied its entire two floors. Patronizing the same nearby coffee shops and restaurants, as well as admitting patients to the same hospital, both doctors had become close friends over several years.

Their type of practice was very different, but they occasionally shared a case, an isolated trauma patient with some injuries, first evaluated, treated and followed by Barbara. Some times her friend Nora, interested in chronic pain (from impacts in motor vehicle accidents, from work or sports) was called to review the papers of a case or for an ‘IME’ that involved an actual Neurological examination; rarely, to her dislike, she also had to testify in court on such cases, especially if her opinion was disputed.

Dr. Barbara Good was told by her friend and colleague, over a cup of coffee next door, that she had recently seen a case of a motor vehicle/pedestrian at low speed, with much personal damage claimed by an injured woman but disputed by the insurance company. The case reminded Dr. Good of the case her husband the judge had just had in court and about which they had both talked at length over dinner. Dr. Phillips told her that the injured ‘patient’ had not even had a scratch or any physical signs of any impact or bump to any part of her body to justify ANY symptoms or monetary claim. She told her friend that she expected her report would infuriate the patient once she saw it, even though she had appeared in her office very pleased ‘with the doctor’s thoroughness:’

“A woman on the side of a road, part of large group of people gathered to watch some sort of off-the-road sporting event, was ‘touched’ in her low back by the front bumper of a pickup truck slowing down to stop and park. Witnesses had said it was nothing. All was negative in the E.R. including her X-Rays, and also when I saw her,” Nora said. “She liked me in the office -so she said and thanked my staff- but went crazy when she saw my report that stated I saw nothing wrong with her.

“And as I expected, I have already received a certified letter from the Health Department’s OPC demanding that I turn over to them my consultation on that woman.”

“That alone will have made your heart skip,” said Barbara.

“Yes. I have received other similar certified letters before as I told you and I sort of expected this one, but every time I get one, even if it does not mount to anything, it always sours my day. This one definitely did.”

“I know from several of my own colleagues who also have got them, though I haven’t got any myself,” said Barbara; “but I hear that each time the state’s OPC contacts a doctor, it is almost always for matters of a new complaint against him and that they nearly always send it ‘certified, with-a-green-band-on-the-top’ and requiring a recipient’s signature, to scare and cow the doctor.”

“Yes. This one had all that,” admitted her friend Nora. ”So, with panic bells going on in my head, I immediately complied and sent them the same day my consultation on the case though I didn’t bother to certify the envelop containing my 2-page report”

“I hear,” Barbara said, “that even if a case does not result in any ill effects to you that the case is not wiped out from your dossier, but that they keep it ‘active,’ so all your cases even when they turn out ‘fine,’ eventually add up to get you in trouble.”

“Yes, that seems the case. I was told that by another friend, also a neurologist, that he has been getting two to three times a year uncomfortable ‘green-banded envelopes’ from the Health Department. Apparently this neurologist also does, like me, for various insurance companies, IMEs that more frequently than not, in contested cases, result in opinions disliked by the claimants. And a neurosurgeon two doors up, just relocated to N. Carolina. Probably for the same. All harassment by the state. These patients with legal demands become very infuriated and want to retaliate against us by reporting us to OPC, the state wolves.”

“That is why,” said Barbara, “I don’t do IMEs though I’m often asked to. Most cases are related to claimed injuries and my group of colleagues, all trauma specialists, providing care, not just one-time opinions, would probably become very upset with me if I did them. These cases of course pin doctor against doctor. The orthopedist, rather than the patient, is often more vocal against the IME report from someone like a neurologist, in this case you.”

“And that is why,” went on Nora, “I want to stop doing IMEs though they add to my income. Plus IMEs on adult patients don’t really fit with my child neurology practice. They are totally a world apart. In court, opposing lawyers, and the care provider, of course try to discredit the value of my opinion precisely because my primary specialty is to treat kids! Yet Insurance companies need them and pay well for them… I already stopped for the same reason 10 years ago doing evaluations for the Department of Veterans’ Affairs on Vets with disputed claims and a couple of months ago I also stopped doing disability evaluations for Social Security. My opinion was often also negative for the claimant, unfortunately for him… and eventually for me now!”

“You mean,” said Barbara, Judge Good’s wife, ”most disability cases of vets you saw for the V.A. were phonies in your opinion?”

“At least the disputed cases. Not the obvious ones. And to my knowledge so is the opinion of other neurologists I know who, like me, do IMEs on vets with questionable claims. And what a racket ‘PTSD’!… But I better leave that issue alone…”

“That opinion of yours would not have set well with either the veterans, their advocates, or with those higher up in the Administration…!”

“The whole thing of veterans compensation and the continued need for VA hospitals, when there so many hospitals half empty and there is easy health for all, is very contentious for budget planners in D.C., very tough for politicians to tackle”…

Both paused. After a few more sips of their coffee refills and a couple of bites on their shared danish, Dr. Phillips went on:

“But now the case of this woman in that car accident, for giving my honest opinion and saying that she had no believable injuries or after-effects, is giving ME a headache and high blood pressure. She has such a weak claim that she probably won’t even sue the insurance company -or me- for damages and go in front of a judge. Instead, easier for her, she is retaliating against me, going after my neck, my license.”

“My husband,” said Barbara, “had to rule recently on a similar case of a trivial road accident where he talked both parties into settling, though he thought the claimant should not have got a penny! He hates these cases. He wishes he didn’t have to see any more…”