Thursday, September 08, 2005
Physicians behave ethically; they don't lie for patients

By Dr. Anthony Policastro Nanticoke Memorial Hospital

Everyone expects his/her physician to behave ethically at all times. As a rule physicians do behave ethically.

However, there are times when patients ask physicians to do something that is not quite truthful. They do not realize that what they are really doing is asking the physician to do something unethical.

Most of the time when this happens, patients do not think it is a big thing. However, there is not always a clear difference between "a little white lie" and "a big whopper."

For example, it is not unusual for patients to ask for a work excuse or a school excuse. The physician is usually very willing to accommodate this request. However, there are times when the request asks for a longer period than is warranted by the medical problem. There are times when a person has an injury and could do some tasks at work. They just may not be able to do the full job. So they ask the physician for the entire day off. They should be asking for a light duty excuse and not a work excuse.

There are times when patients are injured in an accident. They expect to collect worker's compensation. They expect to collect disability. They may expect to file a lawsuit. In order to make their situation sound worse, they again may ask the physician to give them time off from work that they do not need. They may ask the physician to make their injuries sound like more than they really are. I see a lot of patients with learning problems in my office. In most cases, these are things that will affect their grades in school. However, it usually has no effect on their ability to function as a normal healthy child in most other ways.

Sometimes, parents will come to me with a Social Security form looking for me to justify their child as permanently disabled so that they can collect Social Security. I will usually just send the medical records to Social Security without any supporting comments. The records should make it clear whether they qualify or not. There is no need for me to add a letter asking for something that is not necessary.

Another example is related to patients with health insurance. Sometimes an insurer will pay for something to be done under certain circumstances. The patient may request that the physician indicate that those circumstances are present when they are not.

A recent medical study out of Pennsylvania supports this. The study showed that 11 percent of physicians misrepresent patient symptoms in order to have a prolonged hospital stay covered. In another study 15.3 percent of the physicians agreed that it was ethical to do this kind of thing.

For example the most common thing seen was exaggerating how severe the patient's symptoms were. This would allow a continued hospital stay. The second method was to make the patient's diagnosis code a more severe one even if the symptoms did not support that code. The third most common method was actually falsifying patients' signs and symptoms.

What was of more concern was that 26 percent of patients (over one-fourth) felt that this was the right thing to do.

While these kinds of things may seem like the little white lie, each of them is a form of fraud. It may be fraudulent documentation. It may be fraudulent billing. Physicians should not be stretching things like this. More importantly, patients should not be asking them to do so.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.

Test to detect prostate cancer offered at NMH
Nanticoke Health Services will provide PSA screenings on Friday, Sept. 23. The blood tests will be offered at the new Cancer Care Center, adjacent to the hospital from 8 a.m. till 5 p.m. The fee for the test will be $5. Results will be mailed approximately two weeks after the event.

Prostate cancer is the most frequently occurring cancer in men. Between 1980 and 1990, prostate cancer incidence increased 65 percent. It is believed that this increase was the result of improved early detection.

Nanticoke Memorial Hospital encourages men over the age of 50 to take advantage of this service. African-American men are at high risk for developing prostate cancer, as are men who have a family history of the disease. For more contact the Cancer Care Center at 302-629-6611, ext. 2588.

Infant mortality risk factors are examined
The following Infant Mortality Fact Sheet was compiled by The Next Generation of the Delaware Community Foundation.

I. What is infant mortality? The Infant Mortality Rate (IMR) is defined as the number of deaths for infants under one-year of age per thousand (1,000) live births.

II. What does IMR tell us? IMR is more than a record of infant deaths; it is a measure of the quality of life in a given society. First, it speaks to the health of a population as mothers and infants are among the most vulnerable members of society. In addition, disparities in infant mortality rate by race/ethnicity and socioeconomic status are an important measure of the inequalities in a society that exist from the beginning of life.

III. How big is Delaware's problem? In 2001, Delaware had the worst IMR in the nation. In that year, 10.7 infants died for every thousand live births. Unfortunately, 2001 was not just a "bad year" for Delaware. If you average Delaware's IMR numbers over a longer period of time, the story doesn't get much better. For example, averaging the three years from 2000 to 2002, the IMR in Delaware was 9.6, which placed Delaware fourth worst, just below Mississippi, Louisiana and the District of Columbia, and far from the national average of 6.9.

As with the rest of the nation, racial, socioeconomic and geographic disparities in Delaware seem to play a role in Delaware. For example, the IMR for African-Americans in Delaware was 16.0 for the five-year period of 1998 to 2002, compared to 6.9 for Whites. Additionally, during the same five-year period, the city of Wilmington, primarily a low-income, African-American population, had the highest rate of IMR in the state at 13.5. Interestingly, however, the numbers in Kent (9.9) and Sussex (8.3) Counties also indicate a problem in rural populations.

IV. What are the causes? Infant mortality is a complex societal problem. Persistent poverty and racism and the stresses associated with them are root causes. However, infant mortality can also be viewed as the product of two major sets of factors, which can make it a little easier to understand: 1. Maternal risk factors - social, economic and biological forces negatively affecting the mother's health and resulting in a less healthy infant at delivery.

2. Infant risk factors - (a) the level of medical care given before birth to a high-risk mother and (b) level of care (medical or otherwise) given to a small, sick infant upon birth.

The fact that more than 70 percent of infant deaths in Delaware occur in the first month of life suggests that most causes arise from maternal risk factors, either before or during pregnancy, that result in the delivery of a premature, low birth weight or sick neonate. Major maternal risk factors include:

  • Age - adolescent pregnancy and women delaying pregnancy into their later 30s and 40s.
  • Chronic illness - hypertension, cardiovascular and gestational diabetes.
  • Nutrition - under- and over-nutrition and low folate levels.
  • Infection - sexually transmitted and cervical/uterine infection.
  • Stress - from poverty and racial discrimination.
  • Unwanted Pregnancy - unwanted or mistimed pregnancies.
  • Substance Abuse - smoking and alcohol or drug abuse.
  • Prenatal Care - no prenatal care or late initiation of prenatal care.