legal question

[Rapidsound8888]

Hello all, 

I am a new grad in family practice (which is probably why I am in this situation) and have a legal question. 

I recently saw a new patient (about a month ago) Who came in for some foot pain which I diagnosed as plantar fasciitis, and a cough that was only brought on by cleaning sprays used at his work. He works for a federal agency, and stated that this started when he was assigned to a new area where they spray frequently for cleaning and that he would have coughing fits while coworker sprayed, and then it would stop. No SOB, CP, palpitations, and he denied any coughing when not exposed to sprays or outside, at home etc. I explained that he should refrain from being exposed to these chemicals as it was obvious he was sensitive to them. In my after visit summary I made a statement that the patient should refrain from being exposed to certain cleaning sprays in which he is sensitive to. He asked that I delete all the other stuff (vitals, weight, other diagnoses) so that he could show his employer, which I did (and probably shouldn't have) 

Well he came back today, with a pile of paperwork from agency stating that they want me to sign off of all of it for approval, etc. They even put my suggestion in quotes. I told him that I would not sign off on a complete evaluation, and that my original suggestion was exactly that, a suggestion that he refrains from being around the sprays that they use.

I am curious if anybody things this could backfire on me? Ask any questions if needed. 

Thank you. 

[Mayamom]

Backfire in what way.  Maybe he needs a visit geared toward just this issue.  Maybe he needs some imaging or PFT.   I find in medicine the "oh by the way" always turn out to be more of an issue than the chief complaints.   

[CAdamsPAC]

I would have directed him to the Safety Office or Employee Health for his agency. I also would not have redacted anything from my notes and required him to complete a Records Request form.

[Rapidsound8888]

I definitely did not redact anything in my  actual notes, just took off information on the after visit summary since each provider can have different things on their summary. My thought process was that if he refrained from said chemicals and it resolved his coughing fits, then it wouldn't warrant a full workup, but if it still persisted then we would obviously want to perform CXR, PFTs, etc. 

[CAdamsPAC]

3 minutes ago, Rapidsound8888 said:

I definitely did not redact anything in my  actual notes, just took off information on the after visit summary since each provider can have different things on their summary. My thought process was that if he refrained from said chemicals and it resolved his coughing fits, then it wouldn't warrant a full workup, but if it still persisted then we would obviously want to perform CXR, PFTs, etc. 

The issues began at his workplace so that's where the issue should be addressed or he should arrive with a Workman's Compensation  Claim form from his employer prior to a workup as private health insurance frowns on footing the bill for a workplace related health issue.

[Rapidsound8888]

And that's what I told him, that he needs to speak with his workplace to see if they can work it up. Obviously it was a big mistake to even agree to give him the after visit summary with my suggestion, I just figured his supervisor would just stop using the cleaning spray and use something else, or allow him to leave the building for a minute. But I think he was using my suggestion to prove that he should be transferred or something similar. 

[rev ronin]

57 minutes ago, Rapidsound8888 said:

And that's what I told him, that he needs to speak with his workplace to see if they can work it up. Obviously it was a big mistake to even agree to give him the after visit summary with my suggestion, I just figured his supervisor would just stop using the cleaning spray and use something else, or allow him to leave the building for a minute. But I think he was using my suggestion to prove that he should be transferred or something similar. 

Not a huge deal. When in doubt, refer to an occ med provider who is comfortable dealing with people and forms like that.

I never write suggestions for an employer based solely on an employee's say-so, FWIW.

[surgblumm]

The suggestion to have him see the apprpiriate office of his place of employment is my suggestion and also to make this Workman's Compensation , noy only for billing purposes but in case in the future he has pulmonary disease with the casual relationship of his workplace. In addition, he should be reqesting a high filtered mask and the company needs to review their guidelines for spraying and obsevinf whether or not the are being followed

[bovineplane]

Without knowing his federal department, ie BOP, DHS, DOD etc, there are specific federal forms for recommendations for workplace accomodations. We have a bi-weekly meeting to review any employees with workplace limitations and review accomodations.

For reference we have an employee with an ankle sprain. He went to pcm. Filled forms out recommendation limited standing. We put him on phone duty for the recommended period. I forget the form name but it is BOP specific. Each department likely has a similar form to fill out. If you don't want to fill it out then decline. He will find someone else to do it. 

[BayPAC]

Did you ask your CP about this? Your CP should be a valuable resource in situations like this, esp. for a new grad.