Confronting patients

[rev ronin 3,180]

I confronted one of my worker's comp patients last week.  I felt really good about how I did it:

1) I prepared what I was going to say in advance.  That is, I reviewed the surveillance footage the state investigator had assembled and knew exactly what I was going to say about it.

2) I sat down, faced my patient, and calmly but directly informed him that he had been under investigation, and that I was going to agree with the investigator's recommendation that he appears to be fit to work.  I then explained what I'd seen, what I interpreted it to mean, and that I was going to be releasing him to work immediately.  I let the translator do her work, knowing full well the investigator's footage had shown a far better command of English than the patient had displayed in my exam room.

3) I then talked through the implications: time loss and vocational services would stop, and he would be expected to go back to work. I also talked about his right to appeal my decision, get a copy of the investigator's video footage, and have his lawyer appeal any of the orders.  I made it abundantly clear that I though being placed in this position was damaging to a provider/patient relationship, and I would entirely understand if he transferred to a different provider.

4) He did have some objections to what I told him about the video, but I politely declined to quibble over details, stating that was something his lawyer could dispute if she felt it was appropriate.  I gave him an opportunity for questions, wished him the best, and on the way out he stated he'd prefer to stay with me as attending provider on his claim.

I'd consider it a successful visit.  I knew I was doing the right thing, but now I'm also convinced I did it in the right way.  Patients, even ones we believe to be taking advantage of the system, deserve to be treated with respect and do seem to respond appropriately.

[Guest UVAPAC]

Sounds interesting.

I have literally 15-20 patients at any given time I wish I could order surveillance on.  Is this something your recommended/requested or is this something that the state took into their own hands?