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Responding to patient "unrelated" inquir

September 4, 2013

Question:

Jennifer, 

A patient went to her home with my nurse after surgery.  Late that night the patient wanted to make some food and while reaching for an electric mixer, the mixer blade fell out of her kitchen cabinet and cut her leg.  The nurse was present, but was not injured.  While the patient was thrilled with her surgery, she later had a personal injury lawyer write to me asking to forward his letter about "the incident" to my insurance carrier to amicably settle this !!!  I'm inclined to simply ignore this letter as "the injury" was in the patient's own home, and was not caused by the nurse.  If anything, I would think the patient's own home owner's insurance policy might be involved.
Should anything else be done ???

Thanks,
Dr. A

Answer:

Dr. A, thank you for this question and highlighting a common issue for all practitioners - where do you draw the line with patients and affirmatively say, "this is unrelated to my care, and I cannot help you with this issue."  The lines blend often, and many patients are emboldened to ask for assistance unrelated to services and may be pushy in such requests.  Frequent inquiries include letters to employers excusing from  work, even when the practitioner may not reasonably believe the ailment warrants excuse.  The answer to the above question is a bit more cut and dry - the injury here is completely unrelated to the insurance claim, as the question is posed, and as such, any comment by Dr. A to the carrier about the "injury" would be unrelated, unnecessary and ill-advised for the practitioner to get involved. The only involvement I could see is a statement from the nurse at the patients home attesting to what she witnessed related to the incident.  That statement should be prepared with the assistance of or by counsel and accurately reflect the nurses account (which should have been documented).

Similarly, the example of a patient asking for a note for work or school, unless your medical record supports inability to perform job function or attend school, do not involve yourself in such a request.  Simply advise or have an employee advise the patient that you are not willing/able to provide support for their request.  If a patient persists and causes a larger issue, do not be reluctant to reach out to the police or your attorney for assistance. 

One of the main risks of responding to an unrelated request is involving yourself, and therefore, exposing yourself to a situation you are not involved in and now have unnecessarily involved yourself.  Writing unsupported work-related documents for a patient is a key example.  That document may be used in termination, defense against an unemployment or workers comp dispute, or other contentious interaction.  Should you be unable to support "conclusions" set forth in the written document or communication you have had, you may end up in hot water (from licensure or other agency or third party), when in the first instance you should have abstained from participating.  While the path of lease resistance (complying with a request) may seem the easiest, consider before agreeing your potential involvement should the matter progress.  And remember, as a general rule (exceptions my apply) when an unrelated request comes across your desk - just say no!

Not sure if a request is unrelated/inappropriate?  Ask - Jennifer@Kirschenbaumesq.com or 516 747 6700 x. 302.





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