Ask a Silly Question

My mother used to say, "If you ask a silly question, you will get a silly answer." (Actually, she may have substituted the word stupid for silly.) And yet, most physicians, I believe, jump to respond to almost any question posed on a form or attestation ("just fill out the form doc.") as described in my last post, even at the risk of providing erroneous information and incurring liability to help a third party for free. Let me point out the problems with some of the questions on a "form" presented to me by Comprehensive Health Services (CHSi) as described in last week's case.
 
Question: "Is use of this (these) medication(s) likely to interfere with working in safety sensitive situations?"
 
I do not know what CHSi means by "safety sensitive situation." I might think driving a car would fit, but not only has CHSi failed to specify the situation in question, but they have asked about the effects of the drug(s) in general, not about use of the drug by my patient. CHSi can research such information from a variety of sources on their own. The author of the question has cleverly disguised this opinion question as a fact question, a question appropriate of a fitness for duty examination.
 
Recommended answer: "I do not know." or "I do not provide opinions about my patients or their treatment to third parties."
 
Question: "If they may impair, have alternative medications been considered."
 
If what impairs what, in this double question? I can only assume CHSi refers to the drugs listed on the form, but we do not know what (or whom) might be impaired or how to view the second part of the question if the drugs do not impair. Does CHSi really think a prescriber ever does not consider alternative medications? Either a yes or a no tells them nothing.
 
Recommended answer: "I always consider alternative medications."
 
Question: "Have there been any side effects such as sedation or decreased concentration?"
 
There have been side effects for as long as there have been drugs. That one is easy. Again, CHSi can find information about drug side effects from a variety of sources.
 
Recommended answer: "Yes, of course."
 
Question: "Given the frequent inability of medication users to correctly assess their level of alertness and reaction time, have you used objective measurements to confirm that these side effects do not exist?"
 
Again we have a double question. The first clause is gratuitous and presumptuous. If I do not agree with the premise, how then do I address the ultimate question? The second question also assumes facts not in evidence. I object your honor! I have already stated that side effects "exist." This question also suffers from its all or none quality. Perhaps the author does not know that some side effects occur intermittently, not to mention that patients take some drugs only occasionally.
 
Recommended answer: "I have already stated that side effects exist. How can I confirm that they do not exist?"
 
Question: "Are these conditions likely to interfere with working in safety sensitive situations?"
 
(This question assumes response to a prior request to list the patient's diagnoses.) The author has once again cleverly disguised this opinion question as a fact question, a basic question of a fitness for duty examination. Even a forensic examiner should demand more information before answering yes or no. Also, the author has posed the question in general. I suspect that want to know about the individual in question, but I am not here to help them write questions.
 
Recommended answer: "I do not know." or "I do not provide opinions about my patients or their treatment to third parties."
 
Question: "Do you believe your patient can safely work in safety sensitive situations while taking the above medication (s)?"
 
Now CHSi wants to know about my beliefs? Will they next ask whether I believe in God? Yet again the author has thinly disguised an opinion question. This question also seems to want to, but fail to, ask whether (in your opinion) a medication can render the patient safe in spite of suffering from a condition that might render them unsafe.
 
Recommended answer: "I do not know." or "I do not provide opinions about my patients or their treatment to third parties."
 
Another "form" demands that the patient undergo assessment by a "licensed professional counselor" who will "provide us with the following documentation" and "address the 5 points below." The letter stipulates that the patient must pay for "any tests," but does not indicate who will pay for the assessment. I would insist that CHSi pay for any such assessment conducted by me, but of course I would not conduct such an assessment of a current or past patient, and if I performed such an assessment for CHSi I would never accept the individual as a patient in the future. The "5 points" fit easily into the forensic role paradigm, however the author must suffer from difficulty in counting as their are actually 6 points, the last of which, "Last two office visits notes," implies a clinical or treatment role with corresponding conflicts.
 
Companies like CHSi cannot get away with this kind of exploitation unless we so enable them. Do not take responsibility for what happens to your patient if you even refuse to respond to such "forms" at all. If you do respond do not second guess. Do not provide the information you think they want. Only if we answer literally and ethically will we force CHSi and similar organizations, including government agencies, to shape up. Be the dog, not the tail. If they ask a silly question, give them a silly answer.

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