Liars, Damned Liars, and Clinicians

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Liars, Damned Liars, and Clinicians
Robert S. Crausman MD MMS Chief Administrative
Officer RI Board of Medical Licensure and
Discipline
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Lying

• Never
• Sometimes
• Always

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Lying, situational ethics?

• What if in the patients interest?
• What if mutual interest?
• What if Doctors interest?

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Law of Unanticipated Circumstances or What a
Tangled Web We Weave
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Is it ethical to lie to third party payers to
secure insurance coverage?

• Data
• 1/2 physicians yes- CABG or IV pain meds.
• 1/3 physicians yes- mammography or psychiatric
  referral.

Freeman, VG et al. Lying to patients. Archives
Int Med. 20001602223-4
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Have you ever

• Exaggerated or misstated a patients dx to a third
  party to secure authorization? 21 yes overall
  32 internists
• Upcoded claims to make up for unfair downcodes?
  7 yes 10 internists
• Followed ins rx guidelines that you disagreed
  with? 26 yes OBGYN 35

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The Public

• 26 of potential jurors believe that a physician
  should mislead an insurance company in order to
  persuade the company to pay for medical care.
• www.eurekalert.org/pub_releases/2003-03/uocm-ssp03
  1703.php Alexander, C et al.

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A different perspective

• Altruistic may not be so altruistic
• Lying to Medicare or Medicaid Fraud
• One count per incident!

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Lying to Colleagues

• Trainee Survey
• 1/3 would lie to avoid exchange call
• 1/6 would lie in medical record to protect
  privacy
• 1/20 would lie to cover a mistake
• 1/20 would substitute their own urine to protect
  a colleague
• Green, M et al. Archives Int Med.
  20001602317-23

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Lying and Patients

• For improved health benefits?
• Disability application
• CMN
• IME
• To help business?

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System predicated on trust

• If lying is the norm, then physician input
  disregarded
• Richard Dawkins, The Selfish Gene

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Private Life

• What are the rules when the
• white coat is off?
• or
• Is Clark Kent also expected to fight
• for truth and justice too?

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Culture of Patient Safety

• Do we encourage self reporting or self deception?
• Case examples

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Lying to a Medical Board UPC

• CME
• Case Investigations
• Applications
• Renewals
• Medical Records
• Deposition

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I always tell the truth becauseI am not smart
enough to lie