Wednesday, May 04, 2005

I have written previously (here, here, here, here) on disability topics. It has been a while and I think the topics deserves revisiting, especially for newer readers. I'll try not to repeat myself too much. Please go back and read those posts.

Frequently I speak to docs on the phone who say that they have to be advocates for their patients. True enough, but for what should they advocate: what is best for the patient, or what the patient wants?

Do you give your patients everything they want? Even if it results in no harm to the patient? What would you say to a 25 year old man, with no medical problems and no complaints, who, just to check, wants a ETT? Most likely, you would say no. It would not result in harm, but is not medically indicated and would be a burden to the system, right?

But when asked to "fill out this disability form" many physicians do not critically evaluate the criteria, or feel sorry for their patients, and will write "no work."

The American College of Physicians have published their Ethics Manual: Fifth Edition. Link is to the abstract, the full article requires subscription.

On page 566, the articles states the following regarding disability
certification:
Some patients have chronic, overwhelming, or catastrophic illnesses. In these cases, society permits physicians to justify exemption from work and to legitimize other forms of financial support. In keeping with the role of patient advocate, a physician may need to help a patient who is medically disabled obtain the appropriate disability status. Disability evaluation forms should be completed factually, honestly, and promptly. Physicians will often find themselves confronted with a patient whose problems may not fit standard definitions of disability but who nevertheless seems deserving of assistance (for example, the patient may have very limited resources or poor housing). Physicians should not distort medical information or misrepresent the patient’s functional status in an attempt to help patients. Doing so jeopardizes the trustworthiness of the physician, as well as his or her ability to advocate for patients who truly meet disability or exemption criteria.