I've been filling out a lot of death certificates lately.
Not my fault.
The computer system will only accept certain reasons for death. I don't know who set it up this way, but it seems as if anything that could lead to a potential lawsuit, whether it's the real reason for death or not, needs risk management to sign off in order for the system to accept the entry. And they never sign off on it. Leading to maddening conversations over the phone.
"The patient died of a bleed, after he fell."
"Yeah, I'm not going to let you put that in."
"But that's what happened."
"Was there a secondary reason that doesn't sound so... incriminating?"
"We didn't do anything wrong. We can't prevent every patient from ever falling."
"Yeah, I don't think that makes us sound good. What else did he have?"
"He had heart disease."
"I like that one. Put that."
"It isn't what killed him."
"But it would have."
"Yes."
"Soon?"
"Pretty soon, unfortunately."
"Perfect."
And while you may think this doesn't harm anyone... (You shouldn't think that, but maybe you do.) ...it makes me wonder about all of the retrospective studies that look at patient outcomes in various circumstances. Now this guy, who did have heart disease, but it didn't directly kill him, will be coded in the system as someone who died of heart disease, and anyone who runs a study... well, that's not quite accurate information going in.
"And this one, with the medication error. Can we just call that pneumonia?"
"No."
"Are you sure he didn't have pneumonia?"
"Well, no, I'm not sure..."
"There you go."
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"Risk Management" or a wing of some splinter fascist group? Just wrong...
ReplyDeleteThis is so upsetting. Speaking as someone who does these kinds of studies. ... Not to mention the whole issue of ethics. If a patient is harmed, and let's face it, no system or person is perfect, they or their family deserve to know. I wonder how the conversation would go if you just refused to comply. Would you get grief from your higher ups? Would they just go around you to accomplish the same thing?
ReplyDeleteThey are asking your to falsify charts? I'd seriously tread very carefully there, what if one of those cases does go to court?
ReplyDeleteSo doctor, while the patient did fall, hit his head, had a bleed on CT, and didn't have chest pain, elevated enzymes, EKG chagnes, and the autopsy shows no signs of tissue ischemia or thrombosis, you are certain he died of cardiac disease, please explain to the court how this is possible...
Seriously, that's shady as #@%*
Holy whoasus. That's so corrupt. I guess The extent of wtf-ery in medicine will never cease to amaze me.
ReplyDeleteRisk mgmt is crazy everywhere. I review charts for documentation issues. A doc has REQUESTED that I review a death chart from three years ago because it messed with his stats and he wants to know if his documentation put the patient in the wrong risk category. No lawsuit involved, and from what little I DO know about the case it's very likely NOT an issue of bad medical care. Attending is the one asking for it. Risk won't give me the chart. Risk won't give the doc the chart. Bizarre.
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