1. A patient asked me to provide her with a prescription for foot orthotics. She had been seeing an alternative health care professional for sore feet for several months and in the end he fashioned her a $400 pair of shoe inserts. Her insurance company refused to reimburse the money unless the inserts had been ordered by an MD, so she dropped in to inform me I needed to write a prescription for them. The catch is she had never seen me for that particular problem before. She ended her request with “…and make sure it’s dated before June 5th, because that’s when I submitted the claim.” What should I do? If I agree, I’m participating in a low-grade swindle. If I refuse, I’m labelled mean-spirited and difficult. I guess you could say the money’s not coming out of my pocket, so why should I care, but it just doesn’t seem right.
2. Someone with mild quasi-depressive symptoms who has repeatedly eschewed offers of counselling asked for a note stating it was medically necessary for him to take a paid six-month leave of absence so he could “rest up a bit.”
3. A fellow who bumped his head at work two years ago and hadn’t mentioned any problems related to the accident since it occurred came in to see me. He had recently been laid off, so he’d decided to launch a Worker’s Compensation claim over the incident. He wanted an MRI of his head, neck, shoulders and back as well as a referral to a neurologist “right away.”
4. A few people with no particular musculoskeletal disorders asked that letters be sent to their insurance companies informing them that in my opinion it was medically necessary for them to have prolonged courses of massage therapy at their chiropractor’s office. “It’s covered under our plan, so we might as well get our money’s worth.”
5. A fit senior who hikes and rides his mountain bike all over the place insisted I sign a form stating he is too disabled to walk in order to allow him to qualify for an income tax disability credit. He was surprisingly irate when I declined.
6. A patient wanted me to send a letter to the town’s subsidized-rental housing administrator saying I felt it was imperative she and her equally able-bodied spouse be given the next available ground floor apartment. Why? “We don’t like stairs.”
7. A squadron of shady transients drifted into town looking to score prescriptions for OxyContin, fentanyl patches, sedatives and other goodies. Don’t even get me started on those con artists – in the Periodic Table of Society, ER drug seekers are plutonium!
8. One of my patients showed up at the office saying he’d missed the preceding week of work due to a bad cold. He assured me he was fine now, but he needed a return to work note to present to his employer in order to collect his sick pay. Neither I nor any of my colleagues had seen him during the week he was off, so there was no objective way to corroborate his story. This isn’t the first time he’s pulled this stunt. How do I know he wasn’t out moose hunting with his buddies?
9. Another patient had some money locked into a GIC. In order to withdraw the funds prematurely without incurring the standard financial penalties he wanted me to advise his bank that it was medically necessary for him to get his money right away. The reason he needed the money in such a hurry? He wanted to buy a new snowmobile.
And the grand prize winner:
“Can I get a letter saying you feel it’s necessary for my health for me to have carpets installed in my apartment?”
“Why?”
“I like carpet!”
I wonder what a prescription for carpet would look like?
Pssst… Want to Buy Some Medical Products?
A couple of months ago I was in the middle of doing a Pap test when my receptionist knocked on the door.
“Donovan? There’s a Dr. Julep from Ottawa on the line for you.”
“Who?”
“Dr. Julep from Ottawa. She says it’s very important.”
“Okay, I’ll be right there.” I handed my nurse the cervical brush and hurried out of the room. “Hello?”
“Hi Dr. Gray. Listen, I really liked that story you wrote for the Medical Post about drug seekers in the ER.”
“Uh, thank you. What did you say your name was again?”
“Dr. Mint Julep.”
“Do I know you?”
“No, I don’t believe we’ve ever met. Dr. Gray, in light of the recent tragedy in Walkerton, do you have any concerns about the condition of the drinking water in your town?”
“What?”
“As a respected health care professional in your community, you could be generating a substantial amount of additional income by selling high-quality home water purification systems.”
“ What?”
“You could offer them to the patients in your practice. I guarantee you, they’d sell like hotcakes.”
“Are you serious?”
“We also have an exceptional line of vitamins, tonics and natural products.”
“Let me get this straight – you want me to use my office to peddle the medical equivalent of Amway?”
“Our products are of the highest calibre and - ”
“Goodbye!” Click!
Last week I got a phone call from Montreal. This time I was prepared.
“Good afternoon, Dr. Gray! This is Dr. McQuack. Loved your article on cancer in the Medical Post.”
“Do I know you?”
“Ah, no, but Dr. Gray, is it safe for me to assume you have a genuine interest in the health and well-being of cancer patients?”
“No.”
“Uh… but that article you wrote… .”
“I made it all up.”
“Really?”
“Yep.”
“Um, well, anyway we offer several lines of very exclusive biloba vera colonics as well as specially enhanced carrot juice enemas that have been scientifically proven to put most cancers into permanent remission – ”
“As a matter of fact, I don’t even like cancer patients.”
“But – ”
“Have a nice day!” Click!
Sahara Mouth
I once had a sweet little old lady in my practice who complained bitterly of having dry eyes. None of the regular treatments for dry eyes seemed to have the slightest effect on her. I began to wonder if she might have Sjögren’s syndrome, a condition in which autoimmune destruction of the salivary and lacrimal glands leads to chronic dryness of the mouth and eyes. It’s possible to have either problem in isolation, but usually the two coexist. Every month or two when she came to see me at my office I’d ask, “Do you have a dry mouth?”
“No.”
“Are you sure?”
“Positive. No dry mouth, doctor.”
After a couple of years of unsuccessfully battling this mysterious affliction I finally said uncle and referred her to a newly launched dry-eye specialty clinic at a teaching hospital in Toronto. A few weeks later the consultant’s letter arrived. The opening lines read: “This pleasant 80-year-old woman presents complaining of a two-year history of dry eyes and dry mouth. She says she has to suck on hard candy almost continuously in order to relieve the mouth dryness.” What the hell? The consultant went on to conclude: “…a fairly obvious case of Sjögren’s syndrome.” I was gobsmacked. I requested my patient be called in for an appointment pronto.
When she arrived she was grinning from ear to ear. She happily displayed the bottle of Salagen the specialist had prescribed for her.
“This works great! Those doctors in Toronto, they sure know what they’re doing,” she remarked ever so thoughtfully.
I got straight to the point.
“Mrs. Kareishū, how come you always told me your mouth wasn’t dry?”
“Well, my mouth feels moist when I suck on a hard candy, so since I’m just about always sucking on one, it never really gets dry!”
My eyes rolled up with such force I was nearly knocked out.