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Re: Disability and the TruthFrom: Betsy Hyde (elishyde@connix.com)Fri May 1 17:34:07 1998
>Thanks Dr. Cristally to bring this point to discusion, and I would like >to post my question to all the members of this forum. How much we should >tell te patient, their relative or insurance helth companies about the >illnes of our patients?, how ethical it is not to tell the whole truth?, >what we gain, what we lose telling the whole truth or the partial truth? >thanks >Luis I feel that we practice under an ethical obligation to be honest with the women who seek our care. I am always honest and open with them, although if there is a situation which is worrisome or troublesome, I am always careful to leave open the door of hope, as long as it is consistent with the facts (Examples include fetal anomalies, extreme prematurity etc). I do not feel I am under any obligation to disclose anything to relatives *unless* the woman wishes that I share the facts of her care with her family/friends. Then I use her wishes about the extent of my disclosure. I will also tell the truth to her insurance company. If she has a condition which, in my opinion, would benefit from her being out of work, I will attempt to get her disability. In the case in point (twins, 30 weeks), I was more upset that the attending physician had written a request for disability citing twins, and I had written more documentation citing twins and preterm contractions, had multiple phone conversations with the disability company, and could not convince them that the standard of care (?is it? and this is why I contacted the list) is for multiple gestations to be OOW sometime in the 3rd trimester. I document in a way which is consistent with accurate, professional charting. I don't make up anything so that the woman can obtain disability. I do chart things which might, if the insurance company reviewed my notes, be problematic...and I am troubled by this...but I don't know any way around this. If I feel that there is a substance abuse problem, I will document what is said to me, and what is my plan of care. If someone has multiple sexual partners, and requests HIV testing, I document that. I have been told that this could compromise the patient's ability to get insurance, but I feel I must document a good assessment and plan of care. Truth telling is one of the foundations of medical ethics, and one which I always try to maintain in my professional practice.
-- Betsy Hyde CNM Branford, CT Midwife in private ob/cnm practice Assistant clinical professor/ Yale University
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