Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 You could put it in as a side note in your initial SOAP that during your history taking, there appeared to be incongruencies with his story and that the patient was unwilling to share what could be critical information regarding past traumas. I would just make it clear that you were unable to get a complete history due to the patient's inability or unwillingness to communicate properly. If it makes you that uncomfortable, then I would consider not taking the case. Intuition can be a powerful compass in these situations.Jamey Dyson, DCSalemOn Jan 13, 2012, at 10:49 AM, a Lehman wrote: Hi group, I am struggling with wording/documenting the fact that I do not believe a new patient I am seeing is a truly reliable historian- liar - of his case or history. Pedestrian hit by a car. This is the second time, first in 2007. He reports being beat up in 2009 but would not provide details. He contradicted himself in recalling the few details of the accident he "remembers". He was reluctant to give me information about his past conditions. Told me I did not need to see the police report. I nicely assured him I needed all the information available to help him to the best of my abilities. My treatment is going to be EXTREMELY conservative until I feel more comfortable with the details behind the case. I want to document this and do a good CYA, but I also do not want to report something that may negatively impact his medical/legal future. Any suggestions on how to nicely call this guy a liar without doing any potential future damage to a potential case? Where is the appropriate spot in the notes for this? a narrative, soap? Should I even be worried about this? Thanks in advance! a Lehman, DC Corvallis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Since you asked, I will happily provide you with my GUT REACTION?:This is a malpractice suit waiting in the wings for you. I would not spend another minute with this individual. Why is he not being simply honest and straight forward with you? Why withholding information?? He has something to hide and is playing you.A liar is a pathological individual who looks for 'victims' for his/her own benefit.They are like fishermen (no disparagement intended for real fishermen..):Cast out, see what you hook, see if you can bring them in.Oh, and they play on your sympathy and compassion to get you hooked.And they believe what they are saying and doing which makes wonderful people like you buy into their 'story'.Listen to yourself. You're trying to find a way to 'make this work' and 'feel right', but it doesn't, does it? Listen to yourself.I know you're trying to be a good/great/compassionate doc. "Next..."IMHO?Ann DC :>0From: "Jamey Dyson" <drjdyson1@...>"a Lehman" <dr.kristinalehman@...>Cc: Sent: Friday, January 13, 2012 11:06:14 AMSubject: Re: Reliable Historian You could put it in as a side note in your initial SOAP that during your history taking, there appeared to be incongruencies with his story and that the patient was unwilling to share what could be critical information regarding past traumas. I would just make it clear that you were unable to get a complete history due to the patient's inability or unwillingness to communicate properly. If it makes you that uncomfortable, then I would consider not taking the case. Intuition can be a powerful compass in these situations.Jamey Dyson, DCSalemOn Jan 13, 2012, at 10:49 AM, a Lehman wrote: Hi group, I am struggling with wording/documenting the fact that I do not believe a new patient I am seeing is a truly reliable historian- liar - of his case or history. Pedestrian hit by a car. This is the second time, first in 2007. He reports being beat up in 2009 but would not provide details. He contradicted himself in recalling the few details of the accident he "remembers". He was reluctant to give me information about his past conditions. Told me I did not need to see the police report. I nicely assured him I needed all the information available to help him to the best of my abilities. My treatment is going to be EXTREMELY conservative until I feel more comfortable with the details behind the case. I want to document this and do a good CYA, but I also do not want to report something that may negatively impact his medical/legal future. Any suggestions on how to nicely call this guy a liar without doing any potential future damage to a potential case? Where is the appropriate spot in the notes for this? a narrative, soap? Should I even be worried about this? Thanks in advance! a Lehman, DC Corvallis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 This brings up the question of how to discharge this patient from care without a charge of abandonment.-- Eileen Machida, DC503-893-0125 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 a, I would heed Dr. Medlin's advice. This is a potential law suit profile patient. You can word the chart without using the word liar. I realize you probably were not intending to use that word. Just be very objective in your description. As though you were reviewing a situation and looking in without being involved. Like you reviewed a chart for a colleague/ IME and you're writing a summary report. Take all emotion out. For example: "Mr. X appears to show reluctance or is unable to offer a complete history. Whether this is due to head injury following a pedestrian vs auto injury, is difficult to tell. Reported findings by the patient have some gaps or are not sequential. For these reasons, I'm unable to formulate a complete diagnosis." You get the idea. Then find another doctor who may have better success with either teasing out the facts, or perhaps is more abrupt and unconcerned with upsetting the patient in a more direct questioning. good luck, Minga Guerrero DC abowoman@... Re: Reliable Historian You could put it in as a side note in your initial SOAP that during your history taking, there appeared to be incongruencies with his story and that the patient was unwilling to share what could be critical information regarding past traumas. I would just make it clear that you were unable to get a complete history due to the patient's inability or unwillingness to communicate properly. If it makes you that uncomfortable, then I would consider not taking the case. Intuition can be a powerful compass in these situations. Jamey Dyson, DC Salem On Jan 13, 2012, at 10:49 AM, a Lehman wrote: Hi group, I am struggling with wording/documenting the fact that I do not believe a new patient I am seeing is a truly reliable historian- liar - of his case or history. Pedestrian hit by a car. This is the second time, first in 2007. He reports being beat up in 2009 but would not provide details. He contradicted himself in recalling the few details of the accident he "remembers". He was reluctant to give me information about his past conditions. Told me I did not need to see the police report. I nicely assured him I needed all the information available to help him to the best of my abilities. My treatment is going to be EXTREMELY conservative until I feel more comfortable with the details behind the case. I want to document this and do a good CYA, but I also do not want to report something that may negatively impact his medical/legal future. Any suggestions on how to nicely call this guy a liar without doing any potential future damage to a potential case? Where is the appropriate spot in the notes for this? a narrative, soap? Should I even be worried about this? Thanks in advance! a Lehman, DC Corvallis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Outside of the “Pants on fire test was suspected positive” notation, you can say that you have concerns about the patient’s ability to accurately recall the events of the accident. You can also recommend psychometric testing with a verbal request to the examiner to check for veracity. If you need to ditch a patient, you only need to give a written explanation that you would like them to seek care elsewhere and recommend that they do so. You can give the names of 2 other doctors (that you don’t like- haha- call them and warn them) but it’s probably not necessary. You could also give the number of the school clinic. -- E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 503-635-6246 Website: http://www.lakeoswegochiro.com From: a Lehman <dr.kristinalehman@...> Date: Fri, 13 Jan 2012 18:49:06 -0000 < > Subject: Reliable Historian Hi group, I am struggling with wording/documenting the fact that I do not believe a new patient I am seeing is a truly reliable historian- liar - of his case or history. Pedestrian hit by a car. This is the second time, first in 2007. He reports being beat up in 2009 but would not provide details. He contradicted himself in recalling the few details of the accident he " remembers " . He was reluctant to give me information about his past conditions. Told me I did not need to see the police report. I nicely assured him I needed all the information available to help him to the best of my abilities. My treatment is going to be EXTREMELY conservative until I feel more comfortable with the details behind the case. I want to document this and do a good CYA, but I also do not want to report something that may negatively impact his medical/legal future. Any suggestions on how to nicely call this guy a liar without doing any potential future damage to a potential case? Where is the appropriate spot in the notes for this? a narrative, soap? Should I even be worried about this? Thanks in advance! a Lehman, DC Corvallis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 13, 2012 Report Share Posted January 13, 2012 Heh? My advice? Well, I agree with Dr. Dyson! Have a good wknd everyone! ph Medlin D.C. From: AboWoman@... Sent: Friday, January 13, 2012 1:18 PM Cc: Subject: Re: Reliable Historian a, I would heed Dr. Medlin's advice. This is a potential law suit profile patient. You can word the chart without using the word liar. I realize you probably were not intending to use that word. Just be very objective in your description. As though you were reviewing a situation and looking in without being involved. Like you reviewed a chart for a colleague/ IME and you're writing a summary report. Take all emotion out. For example: "Mr. X appears to show reluctance or is unable to offer a complete history. Whether this is due to head injury following a pedestrian vs auto injury, is difficult to tell. Reported findings by the patient have some gaps or are not sequential. For these reasons, I'm unable to formulate a complete diagnosis." You get the idea. Then find another doctor who may have better success with either teasing out the facts, or perhaps is more abrupt and unconcerned with upsetting the patient in a more direct questioning. good luck, Minga Guerrero DCabowoman@... Re: Reliable Historian You could put it in as a side note in your initial SOAP that during your history taking, there appeared to be incongruencies with his story and that the patient was unwilling to share what could be critical information regarding past traumas. I would just make it clear that you were unable to get a complete history due to the patient's inability or unwillingness to communicate properly. If it makes you that uncomfortable, then I would consider not taking the case. Intuition can be a powerful compass in these situations. Jamey Dyson, DC Salem On Jan 13, 2012, at 10:49 AM, a Lehman wrote: Hi group,I am struggling with wording/documenting the fact that I do not believe a new patient I am seeing is a truly reliable historian- liar - of his case or history.Pedestrian hit by a car. This is the second time, first in 2007. He reports being beat up in 2009 but would not provide details. He contradicted himself in recalling the few details of the accident he "remembers". He was reluctant to give me information about his past conditions. Told me I did not need to see the police report. I nicely assured him I needed all the information available to help him to the best of my abilities.My treatment is going to be EXTREMELY conservative until I feel more comfortable with the details behind the case.I want to document this and do a good CYA, but I also do not want to report something that may negatively impact his medical/legal future. Any suggestions on how to nicely call this guy a liar without doing any potential future damage to a potential case? Where is the appropriate spot in the notes for this? a narrative, soap? Should I even be worried about this?Thanks in advance!a Lehman, DCCorvallis Quote Link to comment Share on other sites More sharing options...
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