I’m Just Telling the Truth by Pat Conrad MD

lies

Sitting on the front porch the other night after supper, one of our guests started talking about how he liked his doctor, but he was increasingly angry at having to answer his questions. On his last visit, the doc had asked the man about firearms in the home. A longtime gun enthusiast, the man responded that it was none of the doctor’s damn business. The doc told him that the computer told him to ask, and that it was one of the little boxes he had to check for the insurance company. That led a lady in the group to relate how, while establishing as a new patient, she had given the physician information that she specifically asked her not to record or relate to any other entity. The physician promptly entered said info into the EHR, and it was repeated in the lady’s documentation from her insurance company. She refused to return to that office. All of which got me to thinking.

I thought about this article that “Two-thirds of Americans OK if doctors ask about guns.” We’ve covered this before on this site, and took fire from all sides. But now we have at least the potential that clinicians inquiring into home habits might be related to payment. As for the lady incensed over her private info being entered into that great database in the cloud, I paraphrase Warren Oates as Sgt. Hulka in “Stripes”: Son, there ain’t no medical privacy no more.”

Yeah, I also have empathy for the doc who is trying to keep an accurate record in order to provide the most comprehensive care. That physician, like most of us, is caught between the professional obligations of thoroughness, and the bleeding ethical wounds caused by sharing technology, wielded by the health industry. But of course there is no longer any medical privacy outside of an independent practice with no – and I mean none!- electronic links to the outside world. As we have all now come to learn, HIPAA was only really intended to keep patient info protected from the physician.

My advice to the crowd: Lie. We know from training, and from watching “Scrubs”, that all patients lie, and that’s the truth. I used to get angry when patients lied to me; now I see that lying is a rational response in a world where Big Insurance and Big Government are trying to give everyone a continual, lifelong colonoscopy. When medical databases and insurance premiums treat the occasional fine cigar the same as a 2-pack per day habit, who can afford honesty? If the federal government successfully convinces the insurance industry that it will back any premium increases for private gun owners, skydiving, or entering hotdog eating contests, then those candid discussions with your doc could lead to real money. The elements of employer-based health care, government-provided health care, crony corporatism combining the two, and a whole lighter fluid can full of EHR has accelerated this bonfire of the privacies. We doctors are now the enemies of patient privacy.

Since my physician is now a quasi-government agent, the less he knows about me, the better. Sure, that may sound paranoid. But then again, I don’t own any firearms, have never touched tobacco, had unprotected sex, drink only in moderation, and have not driven over the speed limit since my last ticket. And that’s the truth.

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 “I’m Just Telling the Truth by Pat Conrad MD

  1. Madelyn Sieraski
    August 23, 2016 at 11:03 am

    In the paper chart I had special coded symbols I used to indicate that the patient had been abused, raped etc. I know what it was but it was in an area that did not get sent to insurance etc. I like to believe it helped to keep my patients past between us.

  2. Frank Rubino
    August 21, 2016 at 8:21 am

    This was an incidental happening when I asked about guns in the house and if they were locked up safely. A mother of a 12 y/o girl who went to a sleep over at a girlfriends house asked the other mother the same question and prompted the other mom to remember that dad went hunting and left the shot gun on the dining room table to be locked up later. She immediately took care of it and got dad to lock it up before the girl friends came over to their house. Perhaps reminding each other of gun safety is a better way to place this question rather than “the government made me do it” I learned something from this vignette and I share this with other families.

  3. Perry
    August 13, 2016 at 6:50 pm
  4. Bridget Reidy
    August 13, 2016 at 6:49 pm

    I would disagree that asking about those things is being thorough. To me that word applies to questions that benefit patient care, like getting the real med list even though it takes longer, or digging up that three year old neurosurg consult and two year old colonsocopy report to convince a pt with a fib, hx subdural, and three year GI bleed that they really should be off ASA whatever they were told when they only had a fib. (All things I just did last month in a 40 min visit resulting in a cure of a symptomatic anemia in a patient no one in 3 years had managed to cure, inpt or out, specialist or primary).

    But regarding lying: I resisted lying about doing a complete ROS or physical for a long time, and got paid the same for care that complex as for a cold. Since I preferred feeling useful, I gravitated to the former nonetheless. If all were honest or unwilling to engage in contra-indicated data gathering, everyone who focuses on mostly necessary primary care would have become lower middle class in 1995, and that obviously didn’t happen, so it’s too late now. My deep seated and pathologic love of honesty and hatred of busy work led me eventually to move Canada where no one tells me what is required to do or document at most visits other than whatever I and the licensing authority deem appropriate. But still the pressure to make more than the 20-30 Canadian dollars* for a basic visit is tempting me to use some of the billing codes that pay better and are written in such a way as to seldom be useful. Most the docs here just ignore or pretend not to understand the revised definitions of these codes and risk clawbacks, but I’ve resigned myself to not move again and to continue to feel useful favoring complex care over colds, so remain lower middle class. I can’t say I blame anyone for doing otherwise.

    To those who don’t get that this new list of obligations is different only in quantity from the old one I ask: If a study shows everyone who presents with rectal bleeding should have a colonoscopy, how do you apply it to a thirty year old presenting with something completely unrelated who admits in ROS that two years ago when temporarily constipated they saw a speck of blood on the tissue? Or what GI question unrelated to HPI should be asked of everyone instead and are you sure if answered honestly it won’t create a similar dilemma? We knew about Baye’s theorem and pre and post test probability of disease long before 1995! The situation got this bad because we put up with these kinds of pronouncements from clinical instructors in our own profession who had little or no primary care experience or who were liars themselves, and the bureaucrats just surmised that if they gave them kush jobs they could use their undeserved influence. I think the time for scholarly honesty was already gone from our profession long before, and just wish someone had told me as a premed in 1980.

    And speaking of lying, when will someone with influence point out that treating constant pain to a tolerable level with opiates does not cause addiction, unless the patient lies about their pain not being relieved in order to receive enough for euphoria or relief from psychic pain? Or that there is no entity called non-cancer pain that is qualitatively different from all cancer pain?

    * (in BC, depending on age, after overhead)

  5. Sir Lance-a-Lot
    August 13, 2016 at 8:44 am

    “My advice to the crowd: Lie.”

    Never mind the crowd.

    I tell my patients to lie all the time.

    If I see they have mentioned something about having done some drug 30 years ago in high school, or if they used to drink too much, then stopped, I tell them never to admit that on any forms, because the information never dies, and they have no idea when or how it might one day come back and bite them.

    What they used to do is none of my, or anyone else’s, damned business, same as whether they’ve got guns, or knives, or ball pein hammers, or jalapeno peppers.

    I am not an agent of the government (I can tell because I’m not getting the pension benefits), and I will not collect data for them.

  6. Thomas Guastavino
    August 13, 2016 at 6:56 am

    “My advice to the crowd-Lie”
    In other words, Buff the Chart

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