Case Study: The Doctor Has Had It with the Paperwork
Mr. Dede is a 53-year-old patient with diabetes. His doctor prescribes a new glucometer for his diabetes management that is much easier to use and requires a much smaller blood sample. When he takes his prescription to the pharmacy, the pharmacy technician tells him that his health insurance requires paperwork to be completed by his doctor before they will allow payment for the device. Mr. Dede comes back a couple of days later saying that his doctor said the pharmacy has to complete the paperwork. The pharmacist calls the doctor to explain that the insurance company specifically prohibits the pharmacy from completing that kind of paperwork. The insurance will only accept the paperwork from the doctor who prescribes the device. The doctor responds, “I’ve had it with the paperwork. I am not doing it,” and hangs up.
Discussion Questions
Completing preauthorization forms, referrals, letters, and other paperwork from other entities take time from the doctors and other health professionals; they are not paid for the time they spend completing such paperwork. However, it may still be part of their responsibilities.
- Does the doctor have the right to refuse completing this paperwork?
- What are the ethical implications of the doctor refusing to complete the paperwork, for the doctor and for the pharmacist? Explain using the specific Sub-competencies of the Core Competency Values/Ethics.
- Besides completing or not completing the paperwork, are there other alternatives the doctor has to help Mr. Dede obtain a glucometer?
- If these individuals where working as a collaborative team, which actions could they take to have a positive outcome for the patient? What could the doctor, pharmacist, patient, and insurance company do?
This case brings up several ethical and practical considerations in healthcare. Let’s delve into your questions:
1. Does the doctor have the right to refuse completing this paperwork?
While the doctor may feel overwhelmed by paperwork, there isn’t a straightforward yes or no answer. Legally, doctors aren’t obligated to complete paperwork that’s not directly related to patient care. However, ethically, they have a responsibility to advocate for their patients’ well-being, which might involve assisting in administrative tasks that facilitate necessary treatments.
2. Ethical implications:
a. Doctor’s perspective:
- Professionalism (Core Competency Value): Refusing necessary paperwork might conflict with the principle of professionalism, as it could impede patient care.
- Patient-centered care: Refusing could potentially compromise the doctor’s duty to prioritize the patient’s health needs.
b. Pharmacist’s perspective:
- Collaboration: The pharmacist’s duty is to ensure the patient receives necessary medication/devices. However, they are also constrained by insurance regulations.
3. Alternatives for the doctor:
- Direct Communication: The doctor could directly communicate with the insurance company to understand the requirements or negotiate an alternative.
- Delegating to Staff: Delegating paperwork to qualified staff within the practice could be an option.
4. Collaborative actions for a positive outcome:
Doctor:
- Seeking Clarification: Contact the insurance company to understand the requirements.
- Delegation: Assigning administrative staff to assist with paperwork.
Pharmacist:
- Advocacy: Continuing to communicate with the doctor to find a resolution.
- Guidance: Providing information about the insurance company’s requirements to facilitate the process.
Patient:
- Understanding: Mr. Dede could communicate his situation and challenges directly to the doctor, seeking alternative solutions.
- Patience: Recognizing that administrative processes can take time.
Insurance Company:
- Clarity: Offering clearer guidelines for paperwork submission.
- Flexibility: Considering alternative routes for submission.
In summary, the doctor faces ethical dilemmas between professional duties and administrative burdens. Collaborative efforts between all parties, seeking clarity, and exploring alternative solutions are pivotal for the patient’s well-being in such situations.