What Makes Us Falsify?

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There were two reports recently of faked or falsified reports that caused patients to lose their lives.  The first was in Georgia where a technician  “cleared” 1300 mammograms as normal even though some of them had cancerous masses.  Why did she do this?  Here is what the article said:

She told police she had personal issues that caused her to stop caring about her job, that she had fallen behind processing the piles of mammogram films that stacked up. So she went into the hospital’s computer system, assumed the identities of physicians, and gave each patient a clear reading, an investigative report says. That allowed her to avoid the time-consuming paperwork required before the films are brought to a reading room for radiologists to examine.

The other case involves a VA hospital in Phoenix where a whistleblower alleges that as many as 40 veterans died amid lengthy waits for appointments.  Why would they do this?  Here is what the WSJ article said:

Veterans were being forced to wait some six weeks on a shadow electronic waiting list before being given an actual appointment—in an attempt to make the appointment wait times seem short.

“Sure, when their appointment is created, it’s [sic] can be 14 days out, but we’re making them wait 6-20 weeks to create that appointment,” said the employee email, dated July 3, 2013. “That is unethical and a disservice to our Veterans.”

Both of these cases are disgusting.  There are NO excuses for the radiology technician nor the VA hospital.  They deserve all the punishment that gets meted out to them.  But that’s not my point.  Today’s healthcare system pushes people to falsify.  In the never-ending quest to fulfill unproven metrics and quality indicators, the pressure mounts for people to do stupid things.  You possibly just saw two of them.  You will see more.  And more people will die from it.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “What Makes Us Falsify?

  1. Angela Wall DO
    May 2, 2014 at 10:44 am

    Falsifying the mammogram reports is inexcusable if not criminal. The real problem in the VA case though may be WHY they couldn’t get appointments. I’m sure it’s not due to too many coffee breaks. The demand has vastly exceeded the supply.

  2. Randy
    April 30, 2014 at 10:12 am

    The problem has been around a long time though I agree the increased emphasis on reporting will make it more common. Over the past few decades surveys, audits, JCAHO reviews, etc have become increasingly important. I think this has improved quality. As an example I believe nursing homes provide much better care than they did in the 80’s and much of that is due to the state surveyors and audits.

    There are downsides though. One big one is that in order to justify their existence reviewers have become increasingly nit-picky and focus on things that have no relevance to actual care. The other is what happens here, namely that people have figured out that what is important to reviewers is not how good your care is, it’s how good it looks on paper. This leads to focusing on the paper (or computer report) instead of the patients.

    I’ve been asked a few times by administrators or records personnel to falsify records or patient logs, and have always declined. They never pushed the issue but always seem a bit surprised that I won’t do it.

    With the advent of P4P, PQRS, meaningful use, etc the emphasis will often be on getting the right boxes checked over what happens at the doctor-patient level, and this problem is likely to get worse.

  3. Pat
    April 30, 2014 at 9:33 am

    New physicians in residency are being taught from the start how to up code, and their instructors would be remiss not to do so. But as our desensitization to blood and guts begins day one in gross anatomy, so our comfort with data manipulation for cash also begins in training. We learn to document one more pointless ‘smoking cessation counseling’ for the umpteenth time on the same patient so we can get that level 4 to justify all the actual time spent, and try to meet the overhead and maybe, just a little profit. Do just that thousands of times over years, and one incrementally loses respect for the insurance company/Medicare/’caid and their stupid requirements; and for the companies or hospitals who demand even more data manipulation so that they can better manipulate us; and for the patients themselves, who won’t care about any of this, but will still want their own work note, handicapped tags, lab orders, and school notes justified to the outcomes they want.

    These two examples today are awful, completely inexcusable. But they are only two early ones in what has long since become a fundamentally dishonest industry. As physicians are taught through dollars to become more interested in the codes and computer screens than the living patient, many more, worse examples of this will occur.

  4. Chris Rhody D.O.
    April 30, 2014 at 9:07 am

    I’m sorry this is inexcusable no matter what. Just keep being a good Doctor and ignore the measurers. The VA is that way because politicians keep cutting their funding, then forcing them to meet these criteria. It’s like here’s a 1972 Pinto an 5 dollars for gas now drive from New York to LA. Really makes “War Pigs” make sense. Perhaps they have forgotten the lesson of World War I. They should all be very worried about all these veterans they are disservicing.

  5. V N
    April 30, 2014 at 8:07 am

    What you left out is the fact that medical records now can’t be trusted. They’ve not been able to be trusted for a long time.

  6. Steve Roberts
    April 30, 2014 at 8:07 am

    The VA…. Giving veterans yet one more chance to die for their Country.

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