Re: Re: OT: Computerized medical records - How to fix your records

[Guest guest]

At 10:16 PM 9/8/2009, you wrote:

>I think I would make a better doctor than half the doctors I see.

I know you would. My saying: Be your own best detective.

This refers to finding out why your health ailments come from external sources

around you.

Why? Doctors rarely now a days can diagnose what they can not see from inside

their office.

So, they do not see the cracked sewer pipe, the mold on the wall, the peeling

paint with lead

in it, the asbestos, the ....

> What the h*ll.

>Thanks Pete. I didn't know I could comment on my own records, but do you mean

in lawsuit,

No, at any time you care to. Include a cover letter giving explicit

instructions that

the cover letter and attachments (itemize them at the bottom of the cover

letter)

are to be included in your medical file. The next page, the first attachment

page

should be the correction. The cover letter is a just a legal instrument giving

instructions for inclusion into your files, and it hides from view the

underlying

letter, that includes your health information, which according to the new laws,

only the doctor can read and view.

>because where would I write 'rebuttal' on routine doctor visit?

You can do it any way you want to. Hand write the letter, red mark a copy of

from your file,

type in a quote the doctor wrote, and rebut it point by point. There is no

formal way to do this.

I suggest point by point rebuttal. It stands up in court well, no ambiguities

the doctor

can claim he interpreted some other way than what you intended. That is, quote

his

sentence, and put your rebuttal underneath that one sentence. Quote the next

sentence,

etc. Hmm, like I have done in this post. Same style. That way the doctor can

not

claim he thought a sentence you wrote applied to one of this sentences elsewhere

in the rebuttal. Doctors will " do/say " anything to insist they were right.

To my knowledge they can not dismiss you as a patience for including paper work,

or rebutting them. YMMV. That is, the doctor might try it anyway. To get rid

of the squeaky wheel, instead of greasing it. I've found that stating you just

want

to get better, faster, and not have more office visits, and to let's just play

full

on detective doctor and get the thing done, and try out treatments, until

you find what works. In other words, do not just rebut, but be pro-active,

and list things to try, to eliminate, etc, etc.

And for each item you suggest, do it as a QUESTION. Why? Insurance will have

a hard time claiming you were stating a 'fact', instead you were always, always

asking for the doctor's opinion. That way, they can not disallow a test, as the

doctor ordered it, not you. Also, give justification for your suggestions, at

least

one. So, again, the doctor has to evaluate that justification/reason(s) and the

insurance has even a harder time to disallow the cost.

Ask the doctor how to best word your input. They might have a preferred method

they know works, from doing it with other patients. Yes, work with your doctor

on this. Not against him. Solicit him to be on your team, and you on this,

to get the best for you.

>At this point, they are her notes,

Ah, " her notes " is ambiguous. Are you talking about her " owning " pages in your

medical file?

That is not the case. The doctor does not own your medical file. They merely

are the

keeper of it. The medical file may not have anything removed, as you move to a

new

city, a new provider, etc. Copies may be taken, and given to other doctors, but

never

may a page be permanently removed, by any party. There is a legal way to do so.

You ought to learn what it is, if you really want a whole page or several

literally

removed from the file, if they are so very wrong. Typically, it's so much

easier

to add pages that rebut those wrong pages. Later, you can try to get the

entire set removed. Having rebuttal in place, and rebuttal to the doctor's

new opinion, is in your favor, when there is a longer history of dates in

the file, that contradict the one page you want removed, than if you

just go asking for one page to be removed, with no justification other

than your personal opinion. However, once there is a set of pages,

it's harder to remove just one. Catch 22. Why harder? So many

other pages may refer to that one. You can not " edit " any page content,

just add new pages. You can " edit " by rebutting.

Or do you mean by " her notes " , the words the doctor dictated into a

microphone that were transcribed by a typist, or did the doctor hand

write, or type in notes? That is, by notes, I mean their medical opinion.

Yes, those are " her " notes. But not ownership.

>but if I were to apply for private health insurance from same company I am

with, they could review any records I had

Not sure what you are saying here. But you do make a point, which I wish to

hone.

A new insurance firm would read you added pages, and think " trouble maker " ,

so make the style you write your rebuttals in to be as " cooperative " with the

doctor as possible. For example:

I read your notes from my office visit of 09/09/2009 when I got a copy the next

day,

and I read your word " anorexia. " I have a question about this usage. Do you

mean

your medical diagnose is anorexia, but as you have not verbally told me this

diagnose,

it must mean it's just a note, indicating a possibility, not a for sure ailment

I suffer from.

Right? Or is this a referral, that is, must not any psychology conditions be

diagnosed

by a psychologist? As you have not informed me this is your diagnose, there can

be

no treatment for this condition, until you have gotten from my fully informed

consent.

As you have not verbally told me this is your diagnose, obviously my informed

consent

does not exist for anorexia. Where do we go from here? I suggest we logically

look

at this " anorexia " word from several angles. I cover some possible angles

below,

so that we can eliminate any issue or concern over anorexia, and move on to

better evaluations that would prove more fruitful to solving my ailing, and

getting

me out of your office for several years, and so I can return back to work,

family

and friends, full time without being hampered by any ailment. I do not wish

additional

office visits, but want to solve this immediately. Towards that end here are my

thoughts

from various angles. Let me know what you think. I need your feedback, and you

need to hear my " complaints/symptoms " , including external factors that are

not visual when in your examine room (possible pollen allergy(?), toxic exposure

to factory releases, construction dirt, sewer gas leak, etc, etc).

I believe anorexia could not be a valid diagnose for me for these reasons:

1) ...

2) ...

3) ...

Would all of these reasons apply? Which ones would not? Why?

Instead, this condition might be an assumption driven only by physical visual

observations

and not confirmed by anything I have verbal said in your office, to you. I

could see that.

But it must be mentioned to me, before any informed consent can begin.

I believe you may have observed anorexia due to these invalid reasons:

1)....

2)...

3)...

Would all of these reasons apply? Which ones would not? Why?

I believe that the conditions you observed leading you to use the word anorexia

would be better explain taking into account these items:

1)...

2)...

3)...

Would these items apply or not? Why?

I believe these conditions might indicate the following ailments:

1)...

2)...

Would these be things to be looked into and eliminated? Why?

What else might being missed, by me, or by you, in this usage of the word

anorexia?

--

Notice, I used " I believe " all over the place. Or " I feel " , or " I think " also

work.

" I believe " is a little stronger than " I feel, " but weaker than " I think " .

It's also a legal escape hole for you, as you never state any " facts " . Never.

Be sure of that. Or if you feel very strong, then do state " facts " , and say

you feel strongly these facts that must be considered.

Never use a medical term. Stick with ailing, reason, condition. If you

must use a medical term, well, it makes you look like you are trying

to play doctor, you must include a clause to negate that appearance

of playing doctor. Insurance company agent will disallow based upon

you playing doctor, instead of just giving your thoughts. Do not use the

word " symptom " . Avoid it. It's a medical technical term, with highly

specialized meaning.

--

Notice, that it's sort of repetitive, but it's not. Each sentence may refer to

the

previous sentence, but it introduces something new, a small tidbit. Growing

logic.

It a way of preventing ambiguous interpretations. If you jump to a new sentence

without showing the logic chain, then that can make you look bad.

It does not make the doctor look bad, though it might them feel bad, which might

motivate some types of doctors, but might turn them away from you. You have to

determine which style to use. However, recall that this rebuttal will be read

by

the insurance adjustors when looking to offer you insurance.

Always, in your writing, be positive. Give the doctor a way to " save face " , an

out.

That way, they can explain, behind your back, to their peers, what they thought.

Yes, it's a two edge sword. But getting a doctor to cooperate with your

rebuttal

is very important. Or, some doctor's might be better motivated by " IN YOUR FACE

DUDE " attitude, very negative, directly contradicting the doctor might work

better.

You have to judge the right style, each and every time.

Yes, you might have to change styles, escalate, show

frustration, in writing, that your not getting a diagnose

that makes sense.

By being " more logical " than the doctor, eliminating things with justification,

and asking the doctor for each justification if that is " right " , you

Of course, I highly recommend you come up with your own style.

Do not use mine. Some people find it very, very offensive.

Treating them like a child. Such a doctor is too emotional

and not fit for diagnosing that day at work. They should go home

and come back when they can be logical, not emotional.

>that they paid for at one time.

Ok, I included the above, as part of what I did not understand.

Now, after my long example, a bad example, but I would do it that,

as I am a scientist, and my health recovery is worth being a pain

in the doctor's behind, plus future doctor's can then eliminate a

ton, and jump to other guess diagnoses, or might even know off

the top of their head, what you have, and how to treat it. The best

situation. And include that in writing at the bottom of each page.

" I hope the above helps you know what I am suffering from

and the first treatment will work, and be the last treatment. "

Solicit, solicit, solicit. You want the doctor on your side.

I would not do well with emotional doctors. I've seen a few now.

I like logically doctors. They are rarer now a days.

Once a doctor knows you are rebutting, they can no longer fool

around in your medical records, behind your back, and knife you

your back. Be prepared for the knife right between your eyes.

That might be being too paranoid. Be nice to them at all times.

Especially in writing. Always in writing. That way you make

yourself look good. Like an angel.

Never say they got it " wrong " , as that is you presenting a " fact " ,

and playing at doctor. You will not win them with the word " wrong " .

Never use that word.

BTW, I heard that not only must the treatment be given your

" inform consent " , but the diagnose must also have your

inform consent. Anyone confirm this?

And apparently, " fully " informed consent is different from

informed consent. If you tell you doctor you need to be

" fully " informed before giving consent, then they can not

do " less work " and just insist you have 'informed consent.'

Also, you might want to specify your inform consent is only

giving in writing, and never is verbally communicated during

the examine, to the doctor, but can not be given after you

have asked questions, gotten definitive answers (in your

opinion and later research are definitive), and then you

will give informed consent, when you can give " fully informed "

consent based upon independent second opinions, and/or

your own research into the medical literature and from

other health professionals.

Be aware that the doctor takes on certain legal rights, and

these rights are " REMOVED " from YOU. You are no longer

in the full control of your health treatment. The doctor is now

in full control. The only way to get control back, is with this

" informed consent " concept, and spelling it out, in writing

is preferred, by me, with the doctor. The state you live in,

when you get your social security number, now can restrict

your sovereign rights, as granted by the USA federal government.

You change from a sovereign to a " state citizen " , a second class

citizen. You can read this yourself. With this change, state

law covering the relationship you have with a doctor licensed

in that state, comes into full force. Regardless of your status,

the doctor is under state law, and is highly obligated to follow

state law, even if it's not in your best interest. Even if it means

you do not get a correct diagnose, or proper treatment. At

least the doctor can not be held liable by you, as he followed

the law.

Read up on your rights granted you by the state you live

in when you see a doctor, and what rights you lose.

It's very complex.

Hope it helps.