RE: how to document a off the record request

January 17, 2008

I don't know what the general consensus is going to be

Helen, but I would definitely document the

transaction. You obviously cannot control what she

does when she is at home, but she is reporting this to

you.

I would have probably stated this earlier in the

transaction that you are obligated, by your

professional standards, to document anything and

everything and that she should understand that.

Sounds like a personality disorder. Have to remember

some psych 101 to remember which one.

Good luck.

Soma

January 17, 2008

I would document it. I suspect there is even more to this story. A high percentage of chronic pain patients have a h/o sexual abuse, or physical abuse. I suspect his being a better person might be because he was less irritable, yelling or violent. You should have told her that it is dangerous to mix with alcohol, which it says on the product insert, generally 1 drink feels like 2 or more. You are under no obligation to report, since he is not elderly, but I do think you are obligated to document since what she was doing can count as assault. Also she likely will not be upfront with the next doctor, after her experience with you, they need a "heads up".

Cote

Four Corners Family Medicine, and Laser Aesthetics

-------------- Original message --------------

I have a 42 yo wf patient with fibromyolgia, chronic insomnia, migraine and tension headaches came in with a special request that she wanted to be “off the record”.

Per the patient, her husband is a musician with bad temper who drinks a lot of beer and she has not been happy with the marriage for years, but afraid to tell him (she is unemployed). He was given one month samples of Lexapro by his doctor a few months ago. He took none of it. Without his knowledge, she has been grounding the Lexapro and mixing in his beer for a month and “he became a much better person to live with”. She asked me for a prescription of Lexapro in her name or a lot of free samples. I told her I can not fulfill her request because what she has been doing is illegal and unethical and I asked her to communicate with him.

She is asking my office to transfer her record to another office.

Should I document all of this in her record (which her new doctor could see)? Any legal responsibility to report to any agency?

Thank you in advance for your help.

H. Yang, M.D.

Helping your favorite cause is as easy as instant messaging. You IM, we give. Learn more.

January 17, 2008

hell, yes, give her all the samples you can, prescribe her, him, too, and lots of it! -- as long as she gets a job at the republican national committee. she'll be employed, and maybe then they'll stop singing "bomb, bomb, bomb, bomb bomb iran" and realize that universal health care actually is a good thing. LOLLLHelen Yang wrote: I have a 42 yo wf

patient with fibromyolgia, chronic insomnia, migraine and tension headaches came in with a special request that she wanted to be “off the record”. Per the patient, her husband is a musician with bad temper who drinks a lot of beer and she has not been happy with the marriage for years, but afraid to tell him (she is unemployed). He was given one month samples of Lexapro by his doctor a few months ago. He took none of it. Without his knowledge, she has been grounding the Lexapro and mixing in his beer for a month and “he became a much better person to live with”. She asked me for a prescription of Lexapro in her name or a lot of free samples. I told her I can not fulfill her request because what she has been doing is illegal and unethical and I asked her to

communicate with him. She is asking my office to transfer her record to another office. Should I document all of this in her record (which her new doctor could see)? Any legal responsibility to report to any agency? Thank you in advance for your help. H. Yang,

M.D. Helping your favorite cause is as easy as instant messaging. You IM, we give. Learn more.

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

January 17, 2008

Tricky stuff .. she was assisting her husband by helping him with a

non-compliance issue. I guess you could always ring the hubby's doc

to confirm.

What if the husband were psychotic, and were not taking his

anti-psychotic medications. Would it be illegal to surreptitiously

feed them to him?

> Helen Yang wrote:

>

> I have a 42 yo wf patient with fibromyolgia, chronic insomnia, migraine and

> tension headaches came in with a special request that she wanted to be " off

> the record " .

>

> Per the patient, her husband is a musician with bad temper who drinks a lot

> of beer and she has not been happy with the marriage for years, but afraid

> to tell him (she is unemployed). He was given one month samples of Lexapro

> by his doctor a few months ago. He took none of it. Without his knowledge,

> she has been grounding the Lexapro and mixing in his beer for a month and

> " he became a much better person to live with " . She asked me for a

> prescription of Lexapro in her name or a lot of free samples. I told her I

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

January 18, 2008

What if he is actually bipolar and the meds make him manic and worse. I think

your liability here is huge. I would not do it.

________________________________

From: on behalf of Graham Chiu

Sent: Thu 1/17/2008 2:25 PM

To:

Subject: Re: how to document a " off the record request "

Tricky stuff .. she was assisting her husband by helping him with a

non-compliance issue. I guess you could always ring the hubby's doc

to confirm.

What if the husband were psychotic, and were not taking his

anti-psychotic medications. Would it be illegal to surreptitiously

feed them to him?

> Helen Yang <helenwyang@... <mailto:helenwyang%40hotmail.com> > wrote:

>

> I have a 42 yo wf patient with fibromyolgia, chronic insomnia, migraine and

> tension headaches came in with a special request that she wanted to be " off

> the record " .

>

> Per the patient, her husband is a musician with bad temper who drinks a lot

> of beer and she has not been happy with the marriage for years, but afraid

> to tell him (she is unemployed). He was given one month samples of Lexapro

> by his doctor a few months ago. He took none of it. Without his knowledge,

> she has been grounding the Lexapro and mixing in his beer for a month and

> " he became a much better person to live with " . She asked me for a

> prescription of Lexapro in her name or a lot of free samples. I told her I

--

Graham Chiu

http://www.synapsedirect.com <http://www.synapsedirect.com/>

Synapse-EMR - innovative electronic medical records system

January 18, 2008

Maybe I'm alone in this, but I would feel uncomfortable documenting

this in her record if initially, in any way, I led her to believe

that what she was about to request would remain " off the record. "

After allowing her to proceed with her off-the-record request, I

would feel that it was a violation of doctor-patient confidentiality

to include it in the record. I think that expressing to her that you

think the behavior is illegal and unethical is enough. The fact

that she is having her records transferred does not necessarily mean

that she plans to lie to her new physician to get the med. She may

just feel so embarassed that her doctor-patient relationship has

been irreparably damaged. Just another view...

Sharlene

..

>

> I have a 42 yo wf patient with fibromyolgia, chronic insomnia,

migraine and tension headaches came in with a special request that

she wanted to be " off the record " .

>

> Per the patient, her husband is a musician with bad temper who

drinks a lot of beer and she has not been happy with the marriage

for years, but afraid to tell him (she is unemployed). He was given

one month samples of Lexapro by his doctor a few months ago. He took

none of it. Without his knowledge, she has been grounding the

Lexapro and mixing in his beer for a month and " he became a much

better person to live with " . She asked me for a prescription of

Lexapro in her name or a lot of free samples. I told her I can not

fulfill her request because what she has been doing is illegal and

unethical and I asked her to communicate with him.

>

> She is asking my office to transfer her record to another office.

>

> Should I document all of this in her record (which her new doctor

could see)? Any legal responsibility to report to any agency?

>

> Thank you in advance for your help.

>

> H. Yang, M.D.

>

> _________________________________________________________________

> Helping your favorite cause is as easy as instant messaging. You

IM, we give.

> http://im.live.com/Messenger/IM/Home/?source=text_hotmail_join

>

January 18, 2008

you could write- personal (- marital) issues. The new doc can ask her directly to elaborate.

I have a 42 yo wf patient with fibromyolgia, chronic insomnia, migraine and tension headaches came in with a special request that she wanted to be "off the record".

Per the patient, her husband is a musician with bad temper who drinks a lot of beer and she has not been happy with the marriage for years, but afraid to tell him (she is unemployed). He was given one month samples of Lexapro by his doctor a few months ago. He took none of it. Without his knowledge, she has been grounding the Lexapro and mixing in his beer for a month and "he became a much better person to live with".

She asked me for a prescription of Lexapro in her name or a lot of free samples. I told her I can not fulfill her request because what she has been doing is illegal and unethical and I asked her to communicate with him.

She is asking my office to transfer her record to another office.

Should I document all of this in her record (which her new doctor could see)? Any legal responsibility to report to any agency?

Thank you in advance for your help.

H. Yang, M.D.

Helping your favorite cause is as easy as instant messaging. You IM, we give.

Learn more. -- M.D.

www.elainemd.com

January 18, 2008

As is typical in this situation -- I would recommend talking with your

malpractice carrier about what to do.

I would think that at least a one page documentation of the facts submitted

to the insurance's lawyer would allow you to document what happened for

future reference and not have to document in the chart, per se.

Of course, the other question is...where do you draw the line on what is

considered a threat to life for the husband.

If she was putting coumadin in his beer -- probably needs to be reported to

someone to protect the husband.

Where does Lexapro fall? Got me.

Is that a potentially lethal concoction?

Probably not -- but if you know and did not warn the husband -- I wonder if

you would be culpable in any way.

Just thinking out loud.

Locke, MD

Re: how to document a " off the record

request "

Maybe I'm alone in this, but I would feel uncomfortable documenting this in

her record if initially, in any way, I led her to believe that what she was

about to request would remain " off the record. "

After allowing her to proceed with her off-the-record request, I would feel

that it was a violation of doctor-patient confidentiality to include it in

the record. I think that expressing to her that you think the behavior is

illegal and unethical is enough. The fact that she is having her records

transferred does not necessarily mean that she plans to lie to her new

physician to get the med. She may just feel so embarassed that her

doctor-patient relationship has been irreparably damaged. Just another

view...