View Full Version : A question of ethics - psychiatrists


Mphelp
01-31-12, 01:32 PM
I am scheduled to see my new pdoc for 2nd time later this week. During our first visit, he gave me a small list of information he wanted me to get to him before our next appt. one of those items was the notes taken by my last pdoc, whom I had seen only twice over the course of 3 hours. I left thinking this should be a fairly simple task. He had even begun suggesting some things I could tell my old doc as reasons for leaving him for the new doc, all of which I had declined, as I didn't have any issue being honest.

I called my old pdoc and the gentlemen that answers the phone for him seemed to completely understand and agree with my reasons for leaving. He stated that he would send my request over to the doc right away and get back to me, which he did later that day. He called back and said that the doc said "there isn't much in the way of notes, but he can send them with a written authorization from me". This made perfect sense to me because how much notes can there be from two visits and also considering this doc has a policy to not take written notes during sessions, as it might distract the patient. I immediately sent written authorization and waited.

A week later I learn the notes still have not been sent so I make a follow up call. I left a message to follow up and later get a call back stating that my request will take some time because there are 54 pages to be copied (I had asked that they be faxed) and that they will have to charge me $30 to do so.

This is when it dawned on me that maybe this doc is being dishonest? Why would he originally state that there is hardly any notes and then a week later produce 54 pages in notes? I hadn't thought of this before....perhaps that is why my new doc was trying to help me out with reasons I could give that wouldn't hurt the old docs feelings?

My previous doc has a private practice and I went to him for the simple reason that he was the easiest and quickest person to get in to see, that was covered under my insurance. I had been told by my gp that I should "see someone"....

Has anyone else had a similar experience? Is it possible or even feasible that a pdoc would falsify notes and create notes that weren't there before just out of spite that u are leaving them for another doc? Are pics really honest people or have they been know to be dishonest? I am new to the world of psychiatry and under normal circumstances I don't usually think this way of people...I just find this whole thing a bit odd and now I'm feeling quite anxious over my upcoming appt with the new doc.

Sorry for the lengthy post...anyone else care to weigh in on this? Am I overreacting?

namazu
01-31-12, 01:55 PM
He called back and said that the doc said "there isn't much in the way of notes, but he can send them with a written authorization from me". This made perfect sense to me because how much notes can there be from two visits and also considering this doc has a policy to not take written notes during sessions, as it might distract the patient. I immediately sent written authorization and waited.

A week later I learn the notes still have not been sent so I make a follow up call. I left a message to follow up and later get a call back stating that my request will take some time because there are 54 pages to be copied (I had asked that they be faxed) and that they will have to charge me $30 to do so.

That is really odd... Unless you had extensive testing and/or records from a previous-previous pdoc in there, I can't imagine 54 pages of notes from 2 visits, unless it's printed in a ginormous font with about 1-2 words per page. I wonder if there's been some mistake. I'd call back and make sure they have the right patient info and didn't pull someone else's file by accident.

You should be able to request a copy of the notes for yourself as well (by law, they have to provide medical records, but not "psychotherapy notes" in most places, but medical records would have info like presenting complaints, diagnoses made, meds prescribed, which is probably all you really need to send to the new pdoc). That would let you see what's in them and be sure they're being honest.

In most states, there is also a maximum fee that doctors are allowed to charge for copies of notes, which you may be able to find through your state's medical regulations (thought $30 for 54 pages may not exceed it -- but I think you should follow up on what the 54 pages include...).

My general feeling is that most pdocs are basically honest and decent people, and certainly they subscribe to a code of ethics and they are licensed by medical boards that expect honesty of them. I'd assume "error" before I'd assume highway robbery, but I'd definitely follow up, and if they truly are trying to pull something shady, don't hesitate to look up the state board of medical ethics and report it.

BR549
01-31-12, 01:58 PM
Why doesn't your doc have you sign an authorization allowing him to obtain your records from your old doc? Alternatively, have you asked to see the records in question to make sure there are 54 pages about you and not prescribing info and "filler" not necessarily pertaining to you personally?

Here's some information on California Patients Guide pertaining to medical records/fees.
www.calpatientguide.org/iii.html

Scroll down to How do I get my medical records transferred to my new doctor:
www.mbc.ca.gov/consumer/complaint_info_questions_records.html#13

Mphelp
01-31-12, 02:59 PM
Thanks for the helpful information. For the sake of keeping my post as short as possible, I see I left out the fact that I did call back and ask how it went from "not much in the way of notes" to 54 pages. Of course, adding to the mystery, I never received a return phone call...additionally, that particular pdoc is the only pdoc I've ever seen, so there certainly couldn't have been records or notes from any other doc.

I will call again and see what they say to providing copies of those records to me. I am just afraid of any surprises when i go in to see my new doc this week...I honestly was not concerned before as I have absolutely nothing to hide but now this has got me concerned.

Mphelp
01-31-12, 03:06 PM
Here's some information on California Patients Guide pertaining to medical records/fees.
www.calpatientguide.org/iii.html

Well this is interesting...according to this site and some basic math, they should only be able to charge me $13.50 to photo copy my records....

ginniebean
01-31-12, 03:09 PM
I'd be quickly making a call to the doc and telling him that I'll be delighted to pick up photocopies of his 54 pages. You have a right to see the contents of these 54 pages and I would sure as heck want to.

Canuck223
01-31-12, 03:25 PM
As far as I know, origional notes are the property of the doctor, and he has a professional obligation to retain them. In Ontario, I believe the doctor has to retain physical posession of the file for a set number of years.

He may have to share the information in his records, but not for free. Most charge a nominal fee for the first few pages, then a set fee per page after.

cameron90
01-31-12, 07:09 PM
I think BR549's links covers the questions about medical records. It does seem strange but I don't really see any kind of logic in falsifying medical records/notes. Even the notes that a doctor takes has to be written in indelible ink, dated and signed, and they are considered legal documents. The repercussions of falsifying or changing the notes (thought not a criminal offense, there are huge fines associated and potential reprimanded by the medical board or authority) would far outweigh any benefit your doctor would get. It could just be the fact that you want them faxed. I didn't realize how much it costs now to FAX something. I guess it's because not many people have fax machines anymore and they're not as prevalent due to the internet and email. I had to fax one sheet to Canada from Europe a while ago, and that was almost 7 Euros...

In my experience, I feel that psychiatrists are generally decent people who are, like any other medical practitioner, bound to a code of ethics, and breaching this code can result in very significant repercussions. There are probably those who may be involved in unethical and unprofessional behaviour, but I think and would like to believe, that there are fewer of these people in the psychiatric profession than other professions.

purpleToes
01-31-12, 09:31 PM
I don't think it would be worth any doctor's time to create 50+ pages of fake documentation for a measly thirty bucks, or even out of spite. I'm sure there's another explanation.

Mphelp
01-31-12, 11:41 PM
Thanks for all of the feedback. I'm going to assume that whatever he sends is legit notes etc and if it ends up being a mix up or there is something else that doesn't seem right, I will deal with it. Based on the comments here, I have to think there is some logical explanation, which I will find out about in a couple more days. Will report back after my next appt.