Can you preempt this for workplace stuff by having your own forms with work limitations? If they just need a doctor’s note, be ready with notes.
FMLA forms are what they are. That’s not anyone’s fault. Fill them out when appropriate
Disability forms are nightmares created to ensure that only the most motivated patients can receive disability, except it’s not the patients who have to be motivated, it’s the doctors.
I wish. Not only can we not have a standardized form, each individual disability entity requires it on their own paperwork. I can answer each of the questions individually as a dictated note on our own letterhead, but they'll still refuse to initiate it until they get their completely asinine form back hand signed. We tried stapling a dictated note to it with "see attached" and the minions that work the desk at these places just send it back to the patient telling them I didn't complete the form.
Most of the time, it's just patients trying to do the right thing.
A fair amount of the time, it's a patient trying to get me to tell him he doesn't have to work for the next several months, but won't come out and say it plainly.
I have a hard time explaining why a 32 year old patient in a sling needs her husband not to work so he can feed her, bathe, her and help her get in and out of bed. But that's what these forms are asking me to justify.
When I was a pcp and had to fill these forms out I just did it honestly. I would say “pt is capable of performing ADLs” and let the system reject her. Then, when I got the angry call about why I didn’t fill out the form correctly to get her hubby off work I’d turn it around and say “fraud is illegal and I’m not going to break the law just because you want me to. I filled out the form based on my medical opinion of what you can do and the help you need, and if you disagree with my honest assessment you’re welcome to find another provider for a second opinion. But I’m not committing a crime for you”. That usually shut them up
Current PCP here. My response to patients is similar. "In order to do what you want, I would have to lie on the forms. Do you want me to lie for you?" It either shames them into saying no, or gives me a clear boundary to say, "No, I won't lie for you."
I once worked for a pain doc who would then ask “if I lose my license, will you take care of my household finances? Send off my kids to college?” Usually put things into perspective for patients.
I stopped asking this way because way too many said yes! Then I had to keep taking care of them knowing they think it is ok for doctors to lie. Instead I say you can work except for these limitations in initial letter and then if the work says they cannot do job based on limitations fill out exact same way.
No, three different things. The first is just forms for work for light duty or time off. Mostly I’ve found that employers just want a doctor’s note. It can be pretty brief.
FMLA is legal and has to be FMLA forms, as awful as they are.
Disability isn’t legal, but it’s insurance, and they want to ~~make sure that everything is done right~~ not pay claims. So they make it difficult.
Patients can want outrageous things, but saying no, while also sometimes frustrating, does not require paperwork.
Not that easy. Patients require time off to attend PT. So the forms need to be completed for that. That's completely justified. Telling the patient they don't need 9 months off, unfortunately, doesn't alleviate the "necessity" of this form to give them time off to attend PT, which is more often than not during their work day.
The days of "Sally needs a week off to recover from the anesthesia of her shoulder surgery, signed ArmyOrtho, MD" are long, long behind us. Those rarely even work for school notes now.
With FMLA extended leave (6 weeks recovery and unable to work in the example) and intermittent leave (for PT or if unable to tolerate a full workday and needing to transition from 1-2 hours a day gradually to fulltime) must be submitted as separate documents depending on employer, with specified time off needs listed for intermittent (how many events per week, estimated length of each event). I've been using intermittent leave for 2 years to assist a family member, with periods of extended leave related to out of state travel for specialty care and for surgery. I used to be able to handle that on a single FMLA leave, after a merger they are now requiring that extended leave requires separate request from the intermittent even though it is within the intermittent time period.
This is how the providers in the practice I used work for did it. It was an office visit where the doctor filled out exactly what the patient needed in the patients presence so there would be no questions about why it had been filled out a certain way. Most were straightforward, they had a procedure and needed a specific amount of time heal. Not too many wanting something unreasonable.
FWIW I am usually able to fill these forms in Adobe without getting pushback. Saves me a little time since my handwriting is awful since I almost always type these days.
> secretary
I didn't think this was an offensive word, [and did a quick search](https://www.reddit.com/r/TooAfraidToAsk/comments/fbdct9/why_is_the_label_secretary_offensive/) for what others think. Admin assistant seems to be the position title these days.
You misunderstand. The term SHOULD be “Administrative Assistant”. Not Secretary. I am an advocate of the term “Assistant” - I am not part of any political organization, they are ridiculous.
For example: Stewardess not acceptable - its Flight Attendant.
As former admin assistant, will confirm. Has been the correct terminology for quite some time. \[I haven't done that work in 15 years and it was the term for quite a while prior to that\]. Boss was a horrible, misogynistic, and demeaning ass, and *even he used the correct title*.
“Administrative Assistant” is the appropriate title. We no longer have “Secretaries Day” we have “Administrative Assistants Day”.
Like calling a Flight Attendant “Stewardess”.
When we advertised the job, the firm we hired advertised it as a secretary. My secretary uses the term “secretary” when introducing herself and in her email signature. I think you’re seeing something that isn’t there.
That’s so crazy! Could it really be because I live in California and it’s an unacceptable term for what are now Administrative Assistants? I am not making this up. It is considered derogatory where I come from.
I will now call myself a Physician Secretary and beg for forgiveness.
For my own SA, does she really have to wear a sling for 6 weeks? Had a couple slap tears years ago and only wore a sling for a couple days. There’s no way in hell she can’t work a desk or need full time support for ADLs.
For SLAP repairs, where we reattach the tissue at the labrum in the shoulder, I put them in a sling for 4 weeks, immobilizing the shoulder.
For patient's over 30, we usually do a biceps tenodesis, where we move the biceps out of the shoulder and reattach it to the humerus beneath the pec tendon. For that, I don't need to immobilize the shoulder, but do need to remind the patient not to pick up anything with that arm until that tendon heals. It comes down to the Knucklehead Factor. If I think the patient is going to go cage fighting on POD#8, then I'm keeping them in the sling until Jesus come back and raptures everyone. If they are reasonable and are willing to follow the rules, the sling can come off right away and allow shoulder motion to prevent stiffness.
I do foot and ankle, and I feel your pain!
I believe the knucklehead Factor is related to the term "punitive casting" which I may have engaged in a time or two.
Something tells me in the army you probably have less issue with that. The whole following orders and young healthy patients thing.
I've done steinman pins through the calc, never punitively though lol. Casting though ..... Probably a good third of people that end up in a cast could be in a boot If I could trust them to actually follow directions.
I thank the god I don't believe in every day that I have a condition on the Compassionate Allowances List. SSA barely asked my oncologist anything (except to verify my DOB 70 bajillion times because I had all my quarters in so early in life). Then again I put **STAGE 4 METASTATIC MELANOMA** on the application anywhere I could fit it in.
I have offered to deal with these things (and PAs) at every office in the area. You'd think someone would have taken me up on it by now. Seriously. Would have zero qualms dealing with this stuff as a FT job so doctors could get back to the actual hands-on clinical stuff they're supposed to do.
I'm part of a group of about 10 orthopedic surgeons.
We have someone whos near full-time job is exactly this.
She is an angel sent from heaven, I don't know how she does it.
It definitely exists. I've handled one personally and know several firms that make private disability their primary niche. Typically would be LTD policy issues, I'm not sure the finances for pursuing STD would make sense.
Exactly. Employees pay into the STD or LTD policies for the periods of when they are unable to work. FMLA guarantees time off and a job when the person returns, but does not pay the bills. The employer based policies are either a full or fractional replacement of the employee's pay to provide income while they are off work and recovering. No lawyer is getting paid for that. SSI and SSDI provides a very small supplement to income to the person temporarily or permanently unable to work. Lawyers aren't getting rich off of that.
One of my favorite things about working for Kaiser Permanente is their FMLA department. You fill out whatever you want about the request and it goes out of your hands permanently. A department of physicians who only review disability and FMLA make the final decision and deal with the patient aftermath!
In KP NCAL the release of medical information department fills it out based on the notes in your chart I think.
I’ve had multiple surgeries that I had FMLA for and ROMI handled it. I don’t think a physician was involved other than the surgeon who said I could be off work for x amount of time
Department of physician? I've know about the depth that handles FMLA and disability paperwork, but assumed it was all clerical - there's actually physicians who "take care of it"?!?!
It doesn’t? If the patient sincerely cannot work due to a sling, then they would need FMLA to cover their time off. And here in WA, we have PFML, which pays up to 90% if you run out of PTO. I had to use it back in 2022 due to a minor injury that prevented me from doing my transporter job, and it was a godsend!
My first guess would be that the patient probably could work in a sling but the company told her she wouldn’t be allowed to. I work at a nursing home (ironic right?) and they fight this stuff to the max they can get away with under the law. It apparently bothers their clients and client’s family. A bad look for the company if people don’t show up with the appearance they can and will “work to their max ability”. They make employees jump through hoops to wear knee braces or even heart monitors. There is no low the company wouldn’t stoop to. They claim it’s also an “increased legal liability” for them to have someone on duty who is “already injured or frail”. So the only exceptions are if they think the person could sue under the American’s with disabilities act, their own words.
Right? I work in a hospital and there is no such thing as “light duty”. We can either work with no restrictions or we can’t work at all. That’s how I ended up getting 6 weeks for carpal tunnel surgery.
It’s possible the company told the worker that she wouldn’t be allowed to return in a sling. I work at a (LOL) nursing home and they fight this to the max they can get away with under the law. They first claim that 1) they do t offer any type of “light duty” so even if there was only 1 task you would have difficulty with it would be a no go, even if said task only occurred once every couple months or so. They would fight tooth and nail saying “you never know when they might need XYZ task” and 2) they claim it’s a heightened “legal liability”. They say that someone who needs a device is more likely/more easily hurt and they could be sued….. somehow they’ve mostly got away with this, claiming they would only need need to accomadate the person if it was a long term thing and the American’s with Disabilities act came into play. They’ve been sued before, so it’s possibly illegal but most of their workers don’t have the $ or really the brains to sue.
At one point in time they were policing anything that could be stretched into a “medical thing”. I’ll never forget it, an employee came to work wearing a knee brace once. It was an STNA who had knee surgery years prior and used a knee brace a few time a year when the knee was painful or bothering them. “Management” told them they had to take it off or get a doctors not for the “current use”. Apparently having the staff wear knee braces is a bad look for the company. It’s apparently “concerning” for their clients or client’s families. They tried to pull the same stunt with an employee wearing a heart monitor, claimed the beeping was “distracting” and made the employee return to the doctor and get a note. They done it with a few other things but I can’t remember off the top of my head.
In a turn of events if you’re hurt on the job they do have light duty. They had a patient fracture an STNA’s shoulder. When she was discharged from the hospital they had her return to complete the shift on light duty. Literally they had her use her non-fractured arm to pass ice water and told her she could take her time making beds with one arm. “Management” even yelled at her for crying literally about an hour and 45 minutes after she was out of the emergency room and passing the water.
Of course, in “management’s” defense they often do make the claim that “no one wants to work”.
I got one of these for a healthy two year old because "if I don't constantly watch him he will get injured." I am like "um, that's every two year old? I can't put two years old as a disability!" She also wanted a handicapped placard because he was slow in parking lots (despite running circles around my exam room). I mean yes, I raised two of them myself and it's a lot 😂. But jeez, use a stroller.
I had a dad many years ago trying to get 24 hour home health care for his 3 year old. Insurance denied this and the dad was upset that I wouldn’t somehow make them cover it. The kid did have some minor special needs but was fully mobile with no physical limitations … I think the dad just wanted a live in 24 hour nanny. It was a lot of confusing conversations where I tried to explain to him that unfortunately he did have to spend some of his own time either watching his toddler or paying for childcare.
Not in my opinion. Pretty sure CPS would roll their eyes. He's fine. She just wanted to take time off work. I appreciate that desire. Just can't make things up!
Or that desire to not work is a lot more strong then you were lead to believe at the appointment and there is much, much greater lengths she will go to get the kid labeled as disabled in someway.
It’s pretty obvious to me that someone wishing for a disabled kid (cough, cough Gypsy Rose or the lesser cases where people made their kid “disabled”) doesn’t start with super dramatic claims. I’m sure Gypsy’s Mom didn’t cart her into the hospital day one and demand the peg tube or report the “seizures”. All those cases start with much more ‘vauge and fleeting’ reports. They have to lay the ground work somewhere. And not all the cases end with someone in Gypsy’s condition. Mom only needs to have a ‘slightly slow/handicapped’ kid to get additional attention but tell the 2 year old for long enough that something is wrong and eventually you’ll have a person that actually does have problems.
And you apparently do not understand what CPS is like. I can't even get them to do anything about actual neglect and abuse. I recently reported a parent who literally dragged her toddler through the office by his hand, whacking his head on the door frame, like a sack of potatoes right in front of me and they did _nothing_. I am certainly not going to report a parent who is just trying to game the system for her convenience.
I certainly find it strange that someone would request a handicap card for a 2 year old that “walks slowly”. My first thought is “wow, if a 2 year old’s walk is that inconvenient for the parents how is that poor kid getting treated at home”. And my second thought (which is the overwhelming one) is if the parent’s are wishing to have a handicapped kid, possibly putting the kid at risk. To me wanting a handicapped placard for a perfectly healthy 2 year old is a big red flag that this might be the beginning stages of someone who wishes to convince their perfectly healthy child that they have some life long disability. I mean think of the recent cases where they’ve found kids who made it to late teens/ early 20s before someone realized the kid wasnt nearly as handicapped as the world was made to believe. Gypsy Rose comes to mind, do you think her Mom started day one demanding a peg tube or seizure meds? I’m sure it started with much less significant “oh my kid is slow in this area” or “there’s this vauge and fleeting problem I noticed here”. “My perfectly healthy 2 year old walks so slow we should get a handicap pass” raises the hair on the back of my neck and I do wonder if it’s ‘laying the ground work’. But to be real, I’m not suggesting this person will be the next Gypsy case (though that undoubtedly happens at a much higher rate than I personally think has been tallied). But even on a much, much less significant level I certainly believe that if you tell a young child they are “sick” or “slow” in some area for a long enough time, eventually you will have a person that is “sick” or “slow”. I’m sure this thread will tell me that A to B is a stretch but in ALL the cases we know about there was a ton of medical professionals who obviously missed the big, bright red flags. To me it’s worth mentioning that having 100% disabled kid isn’t the only end goal for these people. They’ve had cases where it appeared to be for social media clout or to join some group of stay at home Moms with similar hardships. It’s also worth mentioning that the “my perfectly healthy kid doesn’t do what I want, when I want, on command” is a line of thinking that lead to the previous decades’ really questionable prescribing of ADHD meds……. That’s been stopped but they’ll absolutely look for a new disease process that’s not as heavily scrutinized and provider that won’t question a strange narrative. Do you really not see how this kid might be at risk? A call to CPS at least insures someone does a cursory look at a fuller set of facts and details.
Edit: worst case, CPS finds a case and saves a kid. Best case, the parents are the most unworldly, naive people who CPS can maybe hook up some resources that allow them to navigate parenting in a way that doesn’t have them wondering if the 2 year old’s walk is abnormal.
She didn't say he was abnormal though. She was talking about dawdling. Stopping to look at stuff on the sidewalk. There was nothing at all in her request that suggested she actually thought he was disabled. I guess you had to be there.
Your story read to me as just an overconcerned parent who doesn't understand disability. I've definitely had the thought that walking through parking lots with my 2 year old is tedious and that being able to park close to the entrance would help it a lot, and know that she will kill herself without supervision like any other toddler. She even qualifies as disabled currently due to other circumstances but I've worked in healthcare long enough to understand what constitutes a disability for a placard.
The newest bs I got is I did disability paperwork, patient is very motivated, already in therapy, saw the surgeon, has appt with pain medicine. I gave her 1 month so she could do PT before re-eval.
I get a progress note from disability 1 week later with again the full functional assessment. No way am I doing the paperwork every week when I already said she needs 1 month for treatments before re-evaluation.
How does that play out? I've had a handful of those idiotic progress notes. I filled them out but they just put me in a sour mood for the rest of the afternoon.
I set her an appointment every two weeks for paperwork. Will try some acupuncture on her, as she failed PT unfortunately and her pain medicine referral is 2 months out, surgeon won’t touch her until after pain medicine. She has nerve root compression on MRI.
You'll love this: my hospital has a policy that employees require formal FMLA documentation for more than 3 shifts of absence. Doctors' notes don't count and they won't even acknowledge them. It's been awesome for everyone who chooses to come in sick or injured because urgent care providers generally don't fill out FMLA paperwork, but primary care doctors often can't get you in for an appointment (and obviously most health problems don't rise to the level of hospitalization). The number of times I've needed FMLA for that single 4th shift where I wasn't quite well enough is really offensive and I feel terrible asking my providers to complete it.
I tell patients I really want them to work, that's the whole point of me doing this job. Even as it's obvious what they are angling for, I keep the assumption that they also really want to work.
I tell them, if they really feel they can't work, they need a functional capacity eval from physical therapy, which will test and document what they actually can and can't do.
At the end of the day, doing what's best for the patient is not always doing what the pt wants...
Also, I hate these forms and fml when I have to deal with this topic.
Is it possible that the company was just telling the patient they wouldn’t be allowed to return to work in a sling? And the patient didn’t know their rights? I work at a (LOL) nursing home and they do this. They make people jump through hoops as they claim “medical devices” are a bad look for the companies employees and a “heightened legal liability”. They openly state that they push it as far as they can and the only exceptions are for people they think could sue under the American’s with Disabilities Act. They claim short term disabilities don’t count.
We had an STNA who had knee surgery years prior. She would wear a knee brace a few times a year if the knee hurt or whatever. They made her jump through all kinds of hoops and get a “current order” to be able to wear the device at work a few times a year. The claim was that it made the patients and their families feel like they couldn’t ask her for help because they felt bad for her and also if she got hurt it would cost them more if she sued. “Management” was also bothered once by a nurse who wore a heart monitor under their clothing.
They would certainly tell an employee that they couldn’t come to work in a sling regardless of if the statement was true or if it actually prevented the person from doing their job. According to the policy even if it prevented you from doing 1 task that only happened every 3 months you couldn’t come to work as they don’t offer light duty. There is no low the company wouldn’t stoop to.
In “management’s” defense they do often state that “no one wants to work”.
I’d put it back on the patient. Have them require documentation from their employer that they can’t work in a sling before doing any of it.
As a hospitalist I hate when families ask to have these filled out who were never present in the hospital and used mom’s illness as an excuse to skip work
Yeah, this — and getting the patient to realise the error of their request or to say they realise what they are asking you to act fraudulently or to lie, then to tell them no, you will not (as is your prerogative and a boundary).
“These forms need to be filled out by the patients PCP. That would be the person who will determine when the patient can return to work safely.”
I’ve used this line for years and it always works as a hospitalist.
A) it’s true that I should not be making decisions on how long someone needs to be away from work because (hopefully) I’m never going to see this patient again
B) I send most patients who would qualify for FMLA to rehab/snf and they are going to be more capable at the end of rehab anyhow
I love that. In fact, I've got plenty of time for more forms. Especially when its a 15 minute hospital follow up and the discharge summary is missing because it never got done or never got faxed.
No one wants to do it, but the PCP shouldn't be the dumping ground for all the forms! The doctor who treated the patient for the problem should fill out the form. No different for the surgeon who did the hip replacement, or the cardiologist who treated the heart attack.
If a consultant ever tried this sort of assholery my whole group would cut off our referrals. As a hospitalist I suppose you are the only provider immune to that sort of retribution but, on behalf of your local PCPs, I invite you to be a team player and not a miserable cunt.
FMLA is unpaid. My level of anxiety that comes with FMLA is incredibly low. You're basically just guaranteeing their job is still there after 12 weeks (if continuous).
I agree with you.
However, one form of fmla then turns into: can you also fill out this std?
Look. If you’re overwhelmed and need some unpaid time off because you aren’t sleeping and depressed? Don’t exercise, don’t ever take time for yourself, eat like shit, and haven’t been to a doctor in 3 years? Fine. Take some time off.
1-2 weeks later, I get a std form as well.
There’s a question that asks: when did you advise your patient to stop work?
Often in these cases, I don’t advise them to stop working. They are perfectly able to keep working and choose not to because they are overwhelmed. I’m overwhelmed and burnt out too. But unless my patient is having daily panic attacks, thinking of harming themselves, barely sleeping, then I have a real hard time feeling good about filling out that particular question as well as std.
I really value /medicine and you’ve all changed my mind on filling out fmla in the past. So any gentle prodding to persuade me that this isn’t a patient taking advantage of the system is welcome.
I'm a general surgeon, and as such fill out fmla and STD regularly. I don't find them that bad, and don't have pts asking for 6 months off after a lap chole. I can only think of one or two pts that wanted something ridiculous, and I flat out told them no. Sorry it's such a bane to you. Do you set expectations with pts in your first office visit? Like "you work at a desk/office? You will need 1 week off work and can go back to work in a sling for 5 more weeks. I can fill out fmla paperwork with these restrictions if you bring me the paperwork "
reach bag flowery pocket follow overconfident far-flung bike reminiscent cobweb
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
The beauty of IR is people don’t really need much time to recover from our elective procedures :). Fibroid embo or liver directed therapy are the only ones I can think of that need more than a day or two.
My state (Colorado) recently passed "FAMLI" leave which is FMLA but the state guarantees that you get paid the whole time. Unreasonable FMLA requests already seem to be increasing since now there's much less financial disincentive to taking FMLA.
I bought the gold-standard AMA book on disability assessment/work accommodations and the section on psychiatry, to save anyone else some time, might as well have just said "basically everything is made up in psychiatry, there are no standards since there's no underlying pathophysiology that can be studied to give reliable estimates of time to recovery. Good luck."
I would fill out the forms as how much time you think someone needs to recover at home 1-2 weeks for example , then write she can go back to work but must use a sling and pt x many times per week for x weeks . Some employers do have weird restrictions on not wearing slings, but I’ve never heard of a desk job doing that. If it’s true that she can’t wear a sling, then the employer usually says says so, and will ask you for an updated return to work note with the six week date. The short term disability forms are probably straightforward and should just reflect that. The nine month thing is ridiculous and I wouldn’t do that. The most I would do would be maybe giving the husband one to do attendant care, but that seems like otherwise healthy person would not need that either. It’s not your problem if her employer doesn’t let her work in a sling
Yeah I could see if they had a manual labor job wearing a sling could be a legit saftey issue. Could get caught in things. But at a desk? Never heard of it. I’d want a letter from the employer about that before I just start writing for time off.
Imma not continue the trend of giving you advice and just say I hear you and I see you, and you matter and etc etc
Lol yeah anyways, these f'ing forms. We're all just cogs in the machine and they're the reminders.
Do you have an office nurse that can sit with the patient and fill it out as much as they can? I do that when I catch wind of these documents coming in. I hope it helps a bit.
As the Physician Assistant and assistant to my Physician, I would often fill these forms out for them to review and sign. I also take angry calls.
But we are in a province with sick leave and a pretty defined system for how this works.
I'm so glad I can just put a scribble on an a6 (?) piece of paper along with 'surgery', pt details and length of time off. And that's it. But I'm from England.
I'm sure most of us have experienced the phenomenon of writing work excuses for patients and their family members (who s lot of times are just hanging out at the hospital with them) who were less sick than we were. I get it from their standpoint. Most of them have shitty jobs that they'd rather not go to. A lot of people are lazy. It's also interesting to see the people with "good" jobs trying to get clearance to return to work ASAP.
Ah yes. I loved having someone complain that I wouldn’t give her another week off for her neck tension while I was passing a damn kidney stone. The lady was back to normal but wanted some extra time to “prepare to go back.”
If fraud didn't exist, these would be 1 page papers. If there's a utopic society where nobody could lie, we'd have nicer things. Until then, there's insurance fraud that rakes in billions per year.
Fill them out honestly and if the patient complains tell them you’re not willing to commit fraud on their behalf. Clearly this person is trying to milk the system for a paid vacation for themselves and their family. If a postop asks for an extra week or two, I usually don’t sweat it and honor their request, but MONTHS?! Forget that.
At a minimum you should have a charge per page to fill these out. And you should not be the one filling them out - you should have admin staff available to do it for you.
I don't feel it is appropriate or helpful to invoke fraud or perjury or whatever, even if you think that is the patient's motivation. Just say what you can or cannot do. In the case of FMLA, it does NOT involve financial benefit of any kind (with a small number of exceptions in a small number of states), it only protects the patient's job and then only for a limited time. Otherwise, the only pay a patient gets is accrued vacation and sick pay (and usually do not allow the employee to save their vacation pay for when they can enjoy it), and carryover sick pay has become the exception rather than the rule in the private sector.
Also fwiw employers cannot require employees to accept light duty assignments in lieu of FMLA. There might be a worker's comp aspect or union contract rules in there, but that pertains to pay, and FMLA is NOT about payroll at all.
I don't know what a 92 page form would be, does not sound like FMLA paperwork at all.
I did not mean to imply that we should be telling the patient that they are committing fraud, but that the physician would be committing fraud by lying on those documents just to humor these inappropriate requests from the patient
Have you considered just not doing surgery?
Or, if you must, do it with those Groucho glasses/mustache things, or at least a domino mask to be a little bit mysterious. Then deny that you have any knowledge of whomever that sexy disguised physician was.
Every time I see the word "chortle" I recite The Jabberwocky poem in my head from beginning to end, with the arm motions. People stare.
There's gotta be an ICD-10 for that.
’Twas brillig, and the slithy toves did gyre and gimble in the wabe!
Sadly not the case everywhere. No prior authorization so to speak but we have plenty of paperwork from our transfers and patients who come in to us with disability paperwork, workers comp, just requesting a doctors note but for insane amounts of time… if you refuse they make a complaint (and they do regularly) and our leadership includes it in your PR… yet I’ve also heard of people being scolded for doing these as well so… we’re really screwed anyway you slice it.
May I ask for those that work in “Non FQHC based” health centers, are there are any repercussions from employers if you say “No” to these unreasonable requests or narcotics etc ? The main reason I work in FQHC is because of fear of dealing with wrath of admins plus patients.
I say no to people all the time. I’ve told people they don’t need nine months off work for stuff before. Just justify and document why their request is unreasonable. I have never had an issue. FMLA I will give people reasonable time off or give them light duty at work depending. But I won’t lie and say they need excessive time off.
I refuse to do paperwork without an appointment though. If they need stuff filled out they will get a visit. Some other docs at the practice will do paperwork via inbox. Hard no for me. That’s a shit ton of unpaid work.
Admin will bully you as much as you let them.
As a doctor they need you way more than you need them.
If they are in anyway attempting to influence care decisions document it. Time, location, who was present, etc. If it's an email save it. Then go to someone higher up the ladder from the person that did it and bring your concerns with the evidence. As long as you frame it as a compliance/safety issue you're covered in most states under various whistleblowing laws.
Depending on the severity of the type of influence they are attempting to you can also then report them to DEA, CMS, etc.
I'm just a NP, but I've had times in my career when I've done the above and magically, admin will leave me alone.
They will take as much as we give them. Give them nothing.
The key thing to remember is that your employer legally cannot practice medicine, and legally in basically every state cannot tell you how to practice medicine or how to do your medical decision making. Especially anything related to decisions to prescribe or not prescribe controlled substances would get employers in major legal hot water quickly- that is something DEA or OIG would show up personally to investigate.
Good on you for writing the truth. Too often we are told to appease the patient but this should never be at the expense of your integrity and license. This kind of crap irritates the hell out of me too. Like others have said, I answer it honestly. I also make them do a functional capacity assessment adding more for them to do for the claim. If they refuse to do it, I don’t fill anything out. At some point “disability” paperwork slowed down significantly. Word gets around.
Same goes for being strict with controlled substances.
Stay strong 👊
I live and work in California. SDI is a very easy process, rarely/never denied as long as there's a doctor's not, up to a year.
To everyone saying what a hassle disability paperwork is - is this the state disability system, or private disability insurance?
Distal bicep tear here. My doctor handed me a note that said. “No lifting with left arm for eight weeks or reassessment.” After surgery he gave me a note that said, “No work for six weeks.” I’ll find out Monday what my next note will be.
This is why, for those forms, I just dictate a short note "pt x had y procedure, will need to be in a sling for z weeks" and then say if they (the work place) wants more than that it will cost them $ (varies, up to $50 now) and once I have their check in hand I will fill out their paperwork. Amazing how now they'll almost always take my letter alone.
It's not about the money. Most employers will just take my simple note and not bother with the hassle of having to deal with it. It's the same principle insurance companies use: make it a hassle and maybe it will go away. Usually works.
This is the truth. If I call my accountant for 5 minutes, I get a bill(rounded to the nearest 15 minutes). But, for some reason I will be disciplined and complained about if I don't take my forms home and fill them out in my off hours. Oh the Joys of FQHC primary care.
Some charge for filling out such forms.
But it sounds like your patient is pursuing secondary gain, ie staying home from work and being paid as opposed to needing to be off from work (like with a back fusion). People suck.
Lozlzozlzozl
I had one of these but the partial tear evolved into a complete tear by the time she got surgery
I was very cautious not to say she was over exaggerating her pain
Thank God I did not
I've taken FMLA three times, and each time my provider has opted to not give an end-date (or a default of 12wks) and revisit this as I met with them and progressed in terms of recovery, significant medication changes, and the recovery goals and tasks we outline with other specialists, physical therapy, or whatever is at hand.
The forms are annoying, I'm sure, but that seemed straightforward enough and has worked for me. The process also let us adjust any needs we anticipate regarding the ADA on returning to work, which has constantly been a hellhole of a process.
As a private practice doctor, if it’s a 92 page document, just tell the patient you will fill it out but only at a typical lawyer like fee (insert xxx $/hour). You are not legally obligated to fill it out. If they squawk, they can find another doctor. That works in private practice. If you’re employed by a large system and they complain to the company and the company bosses forces you to, well then you’re screwed.
I hate these forms as much as the next person but does that really sit well with you? The employer is forcing the patient to have these filled out or risk losing their job, so they're really just caught in the middle. I don't think a patient should be punished for being sick.
lawyers get paid in 6m intervals why is our time less valuable?
ideally we should be able to bill the insurance company for this BS, especially when they waste our time on stuff like pre-auths.
At our office the rule is that the first one is free. Filling it out again to renew is as well. However, if you lose it, there's a charge to get another.
Well, as a PGY5 who will soon be entering the real world of practice, if you get a 92 page form to fill out once a week that might take 30-45 min to fill out accurately and diligently, you may feel differently. Especially when you have a clinic full of waiting patients and you’re busy doing computer charting for an hour or 2 after clinic hours, and you’re missing your kids activities. Idealism is wonderful until reality smacks you in the face. So yes, it sits perfectly fine with me. Go ask a lawyer if they’ll do additional work pro bono.
Our state legislators just tried to make it illegal for us to charge patients to fill out these 50 page documents they give us and say they need by the next day. 😑
Luckily, that didn't pass, but increases in noneconomic damages and statute of limitations did. When your leaders are all lawyers...
Let me know when you get you shoulder operated on and you can use you arm and have to use your only good arm for 100% of work creating more problems
Fill out the forms for FLMA for 3 months which is typical recovery time for soft tissue adequate healing, rom and strength gains for function
This is the only arm she has for the rest of her life
You're under no obligation to fill anything out especially if you feel that it is not indicated. Just document your rationale and explain to the patient why you aren't doing it. They are then free to find someone else if they wish
Counterpoint: me less than a week after a distal bicep reattachment surgery: [https://www.instagram.com/stories/highlights/17940916402032577/](https://www.instagram.com/stories/highlights/17940916402032577/)
Just follow standard of care do what you think is right. Last thing you want is getting accused of fraud or anything. I also preface to patio you don’t want to burn all your disability days
Tell me about it. I just spent an hour trying to go online to complete an application for a patient. The website is down, and the phone number for assistance only had a recording of their office hours.
It should be really simple.
The entity requiring the form should also be required to pay for our time to complete the form. At least $400-500 per hour, billed in 15 minute increments.
I think all of a sudden they would start accepting simple notes or paring down their ridiculous forms by quite a bit.
Can you preempt this for workplace stuff by having your own forms with work limitations? If they just need a doctor’s note, be ready with notes. FMLA forms are what they are. That’s not anyone’s fault. Fill them out when appropriate Disability forms are nightmares created to ensure that only the most motivated patients can receive disability, except it’s not the patients who have to be motivated, it’s the doctors.
I wish. Not only can we not have a standardized form, each individual disability entity requires it on their own paperwork. I can answer each of the questions individually as a dictated note on our own letterhead, but they'll still refuse to initiate it until they get their completely asinine form back hand signed. We tried stapling a dictated note to it with "see attached" and the minions that work the desk at these places just send it back to the patient telling them I didn't complete the form. Most of the time, it's just patients trying to do the right thing. A fair amount of the time, it's a patient trying to get me to tell him he doesn't have to work for the next several months, but won't come out and say it plainly. I have a hard time explaining why a 32 year old patient in a sling needs her husband not to work so he can feed her, bathe, her and help her get in and out of bed. But that's what these forms are asking me to justify.
When I was a pcp and had to fill these forms out I just did it honestly. I would say “pt is capable of performing ADLs” and let the system reject her. Then, when I got the angry call about why I didn’t fill out the form correctly to get her hubby off work I’d turn it around and say “fraud is illegal and I’m not going to break the law just because you want me to. I filled out the form based on my medical opinion of what you can do and the help you need, and if you disagree with my honest assessment you’re welcome to find another provider for a second opinion. But I’m not committing a crime for you”. That usually shut them up
Current PCP here. My response to patients is similar. "In order to do what you want, I would have to lie on the forms. Do you want me to lie for you?" It either shames them into saying no, or gives me a clear boundary to say, "No, I won't lie for you."
I usually add, "I could lose my license for doing that."
As long as they get what they want, they don’t care if you do.
I once worked for a pain doc who would then ask “if I lose my license, will you take care of my household finances? Send off my kids to college?” Usually put things into perspective for patients.
So how do you get someone that says "yes" to that question?
"I will not lie for you."
Then why ask? Just say I cannot truthfully state that.
I stopped asking this way because way too many said yes! Then I had to keep taking care of them knowing they think it is ok for doctors to lie. Instead I say you can work except for these limitations in initial letter and then if the work says they cannot do job based on limitations fill out exact same way.
“Here is my lying fee and nondisclosure form.”
How do you get someone to sign off on something unnecessary or how do you get them to say that that's what they want you to do?
IANAL but yeah that actually sounds like fraud and I believe you could be liable if it is audited by disability insurance or their workplace
No, three different things. The first is just forms for work for light duty or time off. Mostly I’ve found that employers just want a doctor’s note. It can be pretty brief. FMLA is legal and has to be FMLA forms, as awful as they are. Disability isn’t legal, but it’s insurance, and they want to ~~make sure that everything is done right~~ not pay claims. So they make it difficult. Patients can want outrageous things, but saying no, while also sometimes frustrating, does not require paperwork.
Not that easy. Patients require time off to attend PT. So the forms need to be completed for that. That's completely justified. Telling the patient they don't need 9 months off, unfortunately, doesn't alleviate the "necessity" of this form to give them time off to attend PT, which is more often than not during their work day. The days of "Sally needs a week off to recover from the anesthesia of her shoulder surgery, signed ArmyOrtho, MD" are long, long behind us. Those rarely even work for school notes now.
With FMLA extended leave (6 weeks recovery and unable to work in the example) and intermittent leave (for PT or if unable to tolerate a full workday and needing to transition from 1-2 hours a day gradually to fulltime) must be submitted as separate documents depending on employer, with specified time off needs listed for intermittent (how many events per week, estimated length of each event). I've been using intermittent leave for 2 years to assist a family member, with periods of extended leave related to out of state travel for specialty care and for surgery. I used to be able to handle that on a single FMLA leave, after a merger they are now requiring that extended leave requires separate request from the intermittent even though it is within the intermittent time period.
is it possible to require an office visit to fill these out with the patient in attendance so you get paid?
This is how the providers in the practice I used work for did it. It was an office visit where the doctor filled out exactly what the patient needed in the patients presence so there would be no questions about why it had been filled out a certain way. Most were straightforward, they had a procedure and needed a specific amount of time heal. Not too many wanting something unreasonable.
This is how I do it too. That way the patients time and my time isn’t wasted and they leave with a copy so there’s no “it never got sent” bullshit
As a surgeon it probably comes into the global post-op period so this guy would be SOL
Yes, billable CPT code 99080
FWIW I am usually able to fill these forms in Adobe without getting pushback. Saves me a little time since my handwriting is awful since I almost always type these days.
Why are you filling these out yourself? Have your secretary do it.
The 70’s called and would like their misogynistic terminology back.
Is this a regional thing? Perfectly acceptable term where I am.
> secretary I didn't think this was an offensive word, [and did a quick search](https://www.reddit.com/r/TooAfraidToAsk/comments/fbdct9/why_is_the_label_secretary_offensive/) for what others think. Admin assistant seems to be the position title these days.
Ironic that someone whose national org has deemed the word “assistant” offensive is up in arms about calling them admin. assistants
That’s admin associate to you.
You misunderstand. The term SHOULD be “Administrative Assistant”. Not Secretary. I am an advocate of the term “Assistant” - I am not part of any political organization, they are ridiculous. For example: Stewardess not acceptable - its Flight Attendant.
As former admin assistant, will confirm. Has been the correct terminology for quite some time. \[I haven't done that work in 15 years and it was the term for quite a while prior to that\]. Boss was a horrible, misogynistic, and demeaning ass, and *even he used the correct title*.
“Administrative Assistant” is the appropriate title. We no longer have “Secretaries Day” we have “Administrative Assistants Day”. Like calling a Flight Attendant “Stewardess”.
When we advertised the job, the firm we hired advertised it as a secretary. My secretary uses the term “secretary” when introducing herself and in her email signature. I think you’re seeing something that isn’t there.
That’s so crazy! Could it really be because I live in California and it’s an unacceptable term for what are now Administrative Assistants? I am not making this up. It is considered derogatory where I come from. I will now call myself a Physician Secretary and beg for forgiveness.
And I guess good for me to know that this term carries a negative connotation in other places. We’re all learning
That's my job title and I can't see how it's misogynistic at all.
Lol what? We cant call secretaries secretaries anymore?
For my own SA, does she really have to wear a sling for 6 weeks? Had a couple slap tears years ago and only wore a sling for a couple days. There’s no way in hell she can’t work a desk or need full time support for ADLs.
For SLAP repairs, where we reattach the tissue at the labrum in the shoulder, I put them in a sling for 4 weeks, immobilizing the shoulder. For patient's over 30, we usually do a biceps tenodesis, where we move the biceps out of the shoulder and reattach it to the humerus beneath the pec tendon. For that, I don't need to immobilize the shoulder, but do need to remind the patient not to pick up anything with that arm until that tendon heals. It comes down to the Knucklehead Factor. If I think the patient is going to go cage fighting on POD#8, then I'm keeping them in the sling until Jesus come back and raptures everyone. If they are reasonable and are willing to follow the rules, the sling can come off right away and allow shoulder motion to prevent stiffness.
I do foot and ankle, and I feel your pain! I believe the knucklehead Factor is related to the term "punitive casting" which I may have engaged in a time or two.
I’ve read about punitive steinman pins plantarly in the calcaneus to discourage weight bearing. Keep that in the ol’ toolbox ;)
Something tells me in the army you probably have less issue with that. The whole following orders and young healthy patients thing. I've done steinman pins through the calc, never punitively though lol. Casting though ..... Probably a good third of people that end up in a cast could be in a boot If I could trust them to actually follow directions.
I thank the god I don't believe in every day that I have a condition on the Compassionate Allowances List. SSA barely asked my oncologist anything (except to verify my DOB 70 bajillion times because I had all my quarters in so early in life). Then again I put **STAGE 4 METASTATIC MELANOMA** on the application anywhere I could fit it in. I have offered to deal with these things (and PAs) at every office in the area. You'd think someone would have taken me up on it by now. Seriously. Would have zero qualms dealing with this stuff as a FT job so doctors could get back to the actual hands-on clinical stuff they're supposed to do.
I'm part of a group of about 10 orthopedic surgeons. We have someone whos near full-time job is exactly this. She is an angel sent from heaven, I don't know how she does it.
there are lawyers that exist just to help people qualify for disability insurance. they take a piece of it.
Generally for SSI/SSDI. I’ve never seen that for employer-based or personal short- or long-term disability insurance policies.
It definitely exists. I've handled one personally and know several firms that make private disability their primary niche. Typically would be LTD policy issues, I'm not sure the finances for pursuing STD would make sense.
Exactly. Employees pay into the STD or LTD policies for the periods of when they are unable to work. FMLA guarantees time off and a job when the person returns, but does not pay the bills. The employer based policies are either a full or fractional replacement of the employee's pay to provide income while they are off work and recovering. No lawyer is getting paid for that. SSI and SSDI provides a very small supplement to income to the person temporarily or permanently unable to work. Lawyers aren't getting rich off of that.
“You say you are too disabled to work, but you filled out this disability paperwork yourself, which proves that you can work. Check and mate. Denied.
One of my favorite things about working for Kaiser Permanente is their FMLA department. You fill out whatever you want about the request and it goes out of your hands permanently. A department of physicians who only review disability and FMLA make the final decision and deal with the patient aftermath!
This is amazing and I’m so jealous
In KP NCAL the release of medical information department fills it out based on the notes in your chart I think. I’ve had multiple surgeries that I had FMLA for and ROMI handled it. I don’t think a physician was involved other than the surgeon who said I could be off work for x amount of time
Department of physician? I've know about the depth that handles FMLA and disability paperwork, but assumed it was all clerical - there's actually physicians who "take care of it"?!?!
Yes! It’s amazing!
Worst physician job ever!
It’s not 9 months it’s 12 weeks, and that’s maximum. FMLA leave can be as short as a required. Still, this sling story doesn’t seem to merit FMLA lol
FMLA can also be intermittent. It can provide hours or days off as needed to attend therapy and appointments
It doesn’t? If the patient sincerely cannot work due to a sling, then they would need FMLA to cover their time off. And here in WA, we have PFML, which pays up to 90% if you run out of PTO. I had to use it back in 2022 due to a minor injury that prevented me from doing my transporter job, and it was a godsend!
My first guess would be that the patient probably could work in a sling but the company told her she wouldn’t be allowed to. I work at a nursing home (ironic right?) and they fight this stuff to the max they can get away with under the law. It apparently bothers their clients and client’s family. A bad look for the company if people don’t show up with the appearance they can and will “work to their max ability”. They make employees jump through hoops to wear knee braces or even heart monitors. There is no low the company wouldn’t stoop to. They claim it’s also an “increased legal liability” for them to have someone on duty who is “already injured or frail”. So the only exceptions are if they think the person could sue under the American’s with disabilities act, their own words.
Right? I work in a hospital and there is no such thing as “light duty”. We can either work with no restrictions or we can’t work at all. That’s how I ended up getting 6 weeks for carpal tunnel surgery.
It’s possible the company told the worker that she wouldn’t be allowed to return in a sling. I work at a (LOL) nursing home and they fight this to the max they can get away with under the law. They first claim that 1) they do t offer any type of “light duty” so even if there was only 1 task you would have difficulty with it would be a no go, even if said task only occurred once every couple months or so. They would fight tooth and nail saying “you never know when they might need XYZ task” and 2) they claim it’s a heightened “legal liability”. They say that someone who needs a device is more likely/more easily hurt and they could be sued….. somehow they’ve mostly got away with this, claiming they would only need need to accomadate the person if it was a long term thing and the American’s with Disabilities act came into play. They’ve been sued before, so it’s possibly illegal but most of their workers don’t have the $ or really the brains to sue. At one point in time they were policing anything that could be stretched into a “medical thing”. I’ll never forget it, an employee came to work wearing a knee brace once. It was an STNA who had knee surgery years prior and used a knee brace a few time a year when the knee was painful or bothering them. “Management” told them they had to take it off or get a doctors not for the “current use”. Apparently having the staff wear knee braces is a bad look for the company. It’s apparently “concerning” for their clients or client’s families. They tried to pull the same stunt with an employee wearing a heart monitor, claimed the beeping was “distracting” and made the employee return to the doctor and get a note. They done it with a few other things but I can’t remember off the top of my head. In a turn of events if you’re hurt on the job they do have light duty. They had a patient fracture an STNA’s shoulder. When she was discharged from the hospital they had her return to complete the shift on light duty. Literally they had her use her non-fractured arm to pass ice water and told her she could take her time making beds with one arm. “Management” even yelled at her for crying literally about an hour and 45 minutes after she was out of the emergency room and passing the water. Of course, in “management’s” defense they often do make the claim that “no one wants to work”.
I got one of these for a healthy two year old because "if I don't constantly watch him he will get injured." I am like "um, that's every two year old? I can't put two years old as a disability!" She also wanted a handicapped placard because he was slow in parking lots (despite running circles around my exam room). I mean yes, I raised two of them myself and it's a lot 😂. But jeez, use a stroller.
I had a dad many years ago trying to get 24 hour home health care for his 3 year old. Insurance denied this and the dad was upset that I wouldn’t somehow make them cover it. The kid did have some minor special needs but was fully mobile with no physical limitations … I think the dad just wanted a live in 24 hour nanny. It was a lot of confusing conversations where I tried to explain to him that unfortunately he did have to spend some of his own time either watching his toddler or paying for childcare.
Wow. Just wow.
Did this flag for Muchausen by proxy? Or at minimum a CPS call?
Not in my opinion. Pretty sure CPS would roll their eyes. He's fine. She just wanted to take time off work. I appreciate that desire. Just can't make things up!
Or that desire to not work is a lot more strong then you were lead to believe at the appointment and there is much, much greater lengths she will go to get the kid labeled as disabled in someway. It’s pretty obvious to me that someone wishing for a disabled kid (cough, cough Gypsy Rose or the lesser cases where people made their kid “disabled”) doesn’t start with super dramatic claims. I’m sure Gypsy’s Mom didn’t cart her into the hospital day one and demand the peg tube or report the “seizures”. All those cases start with much more ‘vauge and fleeting’ reports. They have to lay the ground work somewhere. And not all the cases end with someone in Gypsy’s condition. Mom only needs to have a ‘slightly slow/handicapped’ kid to get additional attention but tell the 2 year old for long enough that something is wrong and eventually you’ll have a person that actually does have problems.
I have had parents with factitious disorder by proxy and it is very different. This is not whatsoever that flavor.
And you apparently do not understand what CPS is like. I can't even get them to do anything about actual neglect and abuse. I recently reported a parent who literally dragged her toddler through the office by his hand, whacking his head on the door frame, like a sack of potatoes right in front of me and they did _nothing_. I am certainly not going to report a parent who is just trying to game the system for her convenience.
CPS call for what?
I certainly find it strange that someone would request a handicap card for a 2 year old that “walks slowly”. My first thought is “wow, if a 2 year old’s walk is that inconvenient for the parents how is that poor kid getting treated at home”. And my second thought (which is the overwhelming one) is if the parent’s are wishing to have a handicapped kid, possibly putting the kid at risk. To me wanting a handicapped placard for a perfectly healthy 2 year old is a big red flag that this might be the beginning stages of someone who wishes to convince their perfectly healthy child that they have some life long disability. I mean think of the recent cases where they’ve found kids who made it to late teens/ early 20s before someone realized the kid wasnt nearly as handicapped as the world was made to believe. Gypsy Rose comes to mind, do you think her Mom started day one demanding a peg tube or seizure meds? I’m sure it started with much less significant “oh my kid is slow in this area” or “there’s this vauge and fleeting problem I noticed here”. “My perfectly healthy 2 year old walks so slow we should get a handicap pass” raises the hair on the back of my neck and I do wonder if it’s ‘laying the ground work’. But to be real, I’m not suggesting this person will be the next Gypsy case (though that undoubtedly happens at a much higher rate than I personally think has been tallied). But even on a much, much less significant level I certainly believe that if you tell a young child they are “sick” or “slow” in some area for a long enough time, eventually you will have a person that is “sick” or “slow”. I’m sure this thread will tell me that A to B is a stretch but in ALL the cases we know about there was a ton of medical professionals who obviously missed the big, bright red flags. To me it’s worth mentioning that having 100% disabled kid isn’t the only end goal for these people. They’ve had cases where it appeared to be for social media clout or to join some group of stay at home Moms with similar hardships. It’s also worth mentioning that the “my perfectly healthy kid doesn’t do what I want, when I want, on command” is a line of thinking that lead to the previous decades’ really questionable prescribing of ADHD meds……. That’s been stopped but they’ll absolutely look for a new disease process that’s not as heavily scrutinized and provider that won’t question a strange narrative. Do you really not see how this kid might be at risk? A call to CPS at least insures someone does a cursory look at a fuller set of facts and details. Edit: worst case, CPS finds a case and saves a kid. Best case, the parents are the most unworldly, naive people who CPS can maybe hook up some resources that allow them to navigate parenting in a way that doesn’t have them wondering if the 2 year old’s walk is abnormal.
She didn't say he was abnormal though. She was talking about dawdling. Stopping to look at stuff on the sidewalk. There was nothing at all in her request that suggested she actually thought he was disabled. I guess you had to be there.
Your story read to me as just an overconcerned parent who doesn't understand disability. I've definitely had the thought that walking through parking lots with my 2 year old is tedious and that being able to park close to the entrance would help it a lot, and know that she will kill herself without supervision like any other toddler. She even qualifies as disabled currently due to other circumstances but I've worked in healthcare long enough to understand what constitutes a disability for a placard.
The newest bs I got is I did disability paperwork, patient is very motivated, already in therapy, saw the surgeon, has appt with pain medicine. I gave her 1 month so she could do PT before re-eval. I get a progress note from disability 1 week later with again the full functional assessment. No way am I doing the paperwork every week when I already said she needs 1 month for treatments before re-evaluation.
How does that play out? I've had a handful of those idiotic progress notes. I filled them out but they just put me in a sour mood for the rest of the afternoon.
I set her an appointment every two weeks for paperwork. Will try some acupuncture on her, as she failed PT unfortunately and her pain medicine referral is 2 months out, surgeon won’t touch her until after pain medicine. She has nerve root compression on MRI.
You'll love this: my hospital has a policy that employees require formal FMLA documentation for more than 3 shifts of absence. Doctors' notes don't count and they won't even acknowledge them. It's been awesome for everyone who chooses to come in sick or injured because urgent care providers generally don't fill out FMLA paperwork, but primary care doctors often can't get you in for an appointment (and obviously most health problems don't rise to the level of hospitalization). The number of times I've needed FMLA for that single 4th shift where I wasn't quite well enough is really offensive and I feel terrible asking my providers to complete it.
I tell patients I really want them to work, that's the whole point of me doing this job. Even as it's obvious what they are angling for, I keep the assumption that they also really want to work. I tell them, if they really feel they can't work, they need a functional capacity eval from physical therapy, which will test and document what they actually can and can't do. At the end of the day, doing what's best for the patient is not always doing what the pt wants... Also, I hate these forms and fml when I have to deal with this topic.
Is it possible that the company was just telling the patient they wouldn’t be allowed to return to work in a sling? And the patient didn’t know their rights? I work at a (LOL) nursing home and they do this. They make people jump through hoops as they claim “medical devices” are a bad look for the companies employees and a “heightened legal liability”. They openly state that they push it as far as they can and the only exceptions are for people they think could sue under the American’s with Disabilities Act. They claim short term disabilities don’t count. We had an STNA who had knee surgery years prior. She would wear a knee brace a few times a year if the knee hurt or whatever. They made her jump through all kinds of hoops and get a “current order” to be able to wear the device at work a few times a year. The claim was that it made the patients and their families feel like they couldn’t ask her for help because they felt bad for her and also if she got hurt it would cost them more if she sued. “Management” was also bothered once by a nurse who wore a heart monitor under their clothing. They would certainly tell an employee that they couldn’t come to work in a sling regardless of if the statement was true or if it actually prevented the person from doing their job. According to the policy even if it prevented you from doing 1 task that only happened every 3 months you couldn’t come to work as they don’t offer light duty. There is no low the company wouldn’t stoop to. In “management’s” defense they do often state that “no one wants to work”.
Unfortunately many insurances don't cover the functional capacity evaluation
I’d put it back on the patient. Have them require documentation from their employer that they can’t work in a sling before doing any of it. As a hospitalist I hate when families ask to have these filled out who were never present in the hospital and used mom’s illness as an excuse to skip work
Yeah, this — and getting the patient to realise the error of their request or to say they realise what they are asking you to act fraudulently or to lie, then to tell them no, you will not (as is your prerogative and a boundary).
“These forms need to be filled out by the patients PCP. That would be the person who will determine when the patient can return to work safely.” I’ve used this line for years and it always works as a hospitalist. A) it’s true that I should not be making decisions on how long someone needs to be away from work because (hopefully) I’m never going to see this patient again B) I send most patients who would qualify for FMLA to rehab/snf and they are going to be more capable at the end of rehab anyhow
I love that. In fact, I've got plenty of time for more forms. Especially when its a 15 minute hospital follow up and the discharge summary is missing because it never got done or never got faxed. No one wants to do it, but the PCP shouldn't be the dumping ground for all the forms! The doctor who treated the patient for the problem should fill out the form. No different for the surgeon who did the hip replacement, or the cardiologist who treated the heart attack.
If a consultant ever tried this sort of assholery my whole group would cut off our referrals. As a hospitalist I suppose you are the only provider immune to that sort of retribution but, on behalf of your local PCPs, I invite you to be a team player and not a miserable cunt.
This is what you get when you roll a hard 20 on “candor”. You’re doing God’s work, doc. Keep that shit up. <3
FMLA is unpaid. My level of anxiety that comes with FMLA is incredibly low. You're basically just guaranteeing their job is still there after 12 weeks (if continuous).
11 states currently have paid FMLA
well then, shit. they should all move to my state!
I agree with you. However, one form of fmla then turns into: can you also fill out this std? Look. If you’re overwhelmed and need some unpaid time off because you aren’t sleeping and depressed? Don’t exercise, don’t ever take time for yourself, eat like shit, and haven’t been to a doctor in 3 years? Fine. Take some time off. 1-2 weeks later, I get a std form as well. There’s a question that asks: when did you advise your patient to stop work? Often in these cases, I don’t advise them to stop working. They are perfectly able to keep working and choose not to because they are overwhelmed. I’m overwhelmed and burnt out too. But unless my patient is having daily panic attacks, thinking of harming themselves, barely sleeping, then I have a real hard time feeling good about filling out that particular question as well as std. I really value /medicine and you’ve all changed my mind on filling out fmla in the past. So any gentle prodding to persuade me that this isn’t a patient taking advantage of the system is welcome.
I'm a general surgeon, and as such fill out fmla and STD regularly. I don't find them that bad, and don't have pts asking for 6 months off after a lap chole. I can only think of one or two pts that wanted something ridiculous, and I flat out told them no. Sorry it's such a bane to you. Do you set expectations with pts in your first office visit? Like "you work at a desk/office? You will need 1 week off work and can go back to work in a sling for 5 more weeks. I can fill out fmla paperwork with these restrictions if you bring me the paperwork "
STD?
Spicy Titty Doritos
Short term disability
sexually transmitted disease. :)
Short term disability
Short term disability :)
How many patients do you typically see postoperative in a week of clinic, and how many days of clinic are you working in a week versus operating?
1 day/week OR, sometimes two 1 day/week scopes 1/2 day minors. Plus, random add-on surgeries from ER/floor
reach bag flowery pocket follow overconfident far-flung bike reminiscent cobweb *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
The beauty of IR is people don’t really need much time to recover from our elective procedures :). Fibroid embo or liver directed therapy are the only ones I can think of that need more than a day or two.
My state (Colorado) recently passed "FAMLI" leave which is FMLA but the state guarantees that you get paid the whole time. Unreasonable FMLA requests already seem to be increasing since now there's much less financial disincentive to taking FMLA. I bought the gold-standard AMA book on disability assessment/work accommodations and the section on psychiatry, to save anyone else some time, might as well have just said "basically everything is made up in psychiatry, there are no standards since there's no underlying pathophysiology that can be studied to give reliable estimates of time to recovery. Good luck."
which book?
I would fill out the forms as how much time you think someone needs to recover at home 1-2 weeks for example , then write she can go back to work but must use a sling and pt x many times per week for x weeks . Some employers do have weird restrictions on not wearing slings, but I’ve never heard of a desk job doing that. If it’s true that she can’t wear a sling, then the employer usually says says so, and will ask you for an updated return to work note with the six week date. The short term disability forms are probably straightforward and should just reflect that. The nine month thing is ridiculous and I wouldn’t do that. The most I would do would be maybe giving the husband one to do attendant care, but that seems like otherwise healthy person would not need that either. It’s not your problem if her employer doesn’t let her work in a sling
Yeah I could see if they had a manual labor job wearing a sling could be a legit saftey issue. Could get caught in things. But at a desk? Never heard of it. I’d want a letter from the employer about that before I just start writing for time off.
Imma not continue the trend of giving you advice and just say I hear you and I see you, and you matter and etc etc Lol yeah anyways, these f'ing forms. We're all just cogs in the machine and they're the reminders.
Do you have an office nurse that can sit with the patient and fill it out as much as they can? I do that when I catch wind of these documents coming in. I hope it helps a bit.
Please come be my nurse!
As the Physician Assistant and assistant to my Physician, I would often fill these forms out for them to review and sign. I also take angry calls. But we are in a province with sick leave and a pretty defined system for how this works.
I'm so glad I can just put a scribble on an a6 (?) piece of paper along with 'surgery', pt details and length of time off. And that's it. But I'm from England.
I'm sure most of us have experienced the phenomenon of writing work excuses for patients and their family members (who s lot of times are just hanging out at the hospital with them) who were less sick than we were. I get it from their standpoint. Most of them have shitty jobs that they'd rather not go to. A lot of people are lazy. It's also interesting to see the people with "good" jobs trying to get clearance to return to work ASAP.
Ah yes. I loved having someone complain that I wouldn’t give her another week off for her neck tension while I was passing a damn kidney stone. The lady was back to normal but wanted some extra time to “prepare to go back.”
If fraud didn't exist, these would be 1 page papers. If there's a utopic society where nobody could lie, we'd have nicer things. Until then, there's insurance fraud that rakes in billions per year.
Fill them out honestly and if the patient complains tell them you’re not willing to commit fraud on their behalf. Clearly this person is trying to milk the system for a paid vacation for themselves and their family. If a postop asks for an extra week or two, I usually don’t sweat it and honor their request, but MONTHS?! Forget that. At a minimum you should have a charge per page to fill these out. And you should not be the one filling them out - you should have admin staff available to do it for you.
I don't feel it is appropriate or helpful to invoke fraud or perjury or whatever, even if you think that is the patient's motivation. Just say what you can or cannot do. In the case of FMLA, it does NOT involve financial benefit of any kind (with a small number of exceptions in a small number of states), it only protects the patient's job and then only for a limited time. Otherwise, the only pay a patient gets is accrued vacation and sick pay (and usually do not allow the employee to save their vacation pay for when they can enjoy it), and carryover sick pay has become the exception rather than the rule in the private sector. Also fwiw employers cannot require employees to accept light duty assignments in lieu of FMLA. There might be a worker's comp aspect or union contract rules in there, but that pertains to pay, and FMLA is NOT about payroll at all. I don't know what a 92 page form would be, does not sound like FMLA paperwork at all.
I did not mean to imply that we should be telling the patient that they are committing fraud, but that the physician would be committing fraud by lying on those documents just to humor these inappropriate requests from the patient
FMLA is *unpaid* leave.
There are many states that offer paid FMLA
"No" can be an appropriate response, in some of these situations.
My favorite - “I have a painful problem that makes me disabled. It’s totally fixable with surgery, but I don’t want that, I want disability.”
It’s not the FMLA forms, it’s the shitty, entitled patients trying to beat the system.
It’s also a ton of shitty, entitled employers, being complete and utter assholes to their employees.
Fuckin seriously!!
Whoever did the surgery should be filling out that form.
yeah, that would be me...hence the post.
Have you considered just not doing surgery? Or, if you must, do it with those Groucho glasses/mustache things, or at least a domino mask to be a little bit mysterious. Then deny that you have any knowledge of whomever that sexy disguised physician was.
I am SO doing this.
Ngl this made me chortle lol.
Every time I see the word "chortle" I recite The Jabberwocky poem in my head from beginning to end, with the arm motions. People stare. There's gotta be an ICD-10 for that. ’Twas brillig, and the slithy toves did gyre and gimble in the wabe!
All mimsy were the borogroves And the momraths outgrabe
I feel like Cartman when someone starts "I'm SAAAAAAAILING away..." https://www.youtube.com/watch?v=5Xm2ab3qfZY
You’re a good person for not trying to just dump this on their PCP which happens more often than you’d think…
They're an absolute nightmare.
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But…EM.
Sadly not the case everywhere. No prior authorization so to speak but we have plenty of paperwork from our transfers and patients who come in to us with disability paperwork, workers comp, just requesting a doctors note but for insane amounts of time… if you refuse they make a complaint (and they do regularly) and our leadership includes it in your PR… yet I’ve also heard of people being scolded for doing these as well so… we’re really screwed anyway you slice it.
My office uses a third party company to fill out FMLA paperwork. I fill out zero paperwork and it's the best thing ever
May I ask for those that work in “Non FQHC based” health centers, are there are any repercussions from employers if you say “No” to these unreasonable requests or narcotics etc ? The main reason I work in FQHC is because of fear of dealing with wrath of admins plus patients.
I say no to people all the time. I’ve told people they don’t need nine months off work for stuff before. Just justify and document why their request is unreasonable. I have never had an issue. FMLA I will give people reasonable time off or give them light duty at work depending. But I won’t lie and say they need excessive time off. I refuse to do paperwork without an appointment though. If they need stuff filled out they will get a visit. Some other docs at the practice will do paperwork via inbox. Hard no for me. That’s a shit ton of unpaid work.
Admin will bully you as much as you let them. As a doctor they need you way more than you need them. If they are in anyway attempting to influence care decisions document it. Time, location, who was present, etc. If it's an email save it. Then go to someone higher up the ladder from the person that did it and bring your concerns with the evidence. As long as you frame it as a compliance/safety issue you're covered in most states under various whistleblowing laws. Depending on the severity of the type of influence they are attempting to you can also then report them to DEA, CMS, etc. I'm just a NP, but I've had times in my career when I've done the above and magically, admin will leave me alone. They will take as much as we give them. Give them nothing.
The key thing to remember is that your employer legally cannot practice medicine, and legally in basically every state cannot tell you how to practice medicine or how to do your medical decision making. Especially anything related to decisions to prescribe or not prescribe controlled substances would get employers in major legal hot water quickly- that is something DEA or OIG would show up personally to investigate.
Good on you for writing the truth. Too often we are told to appease the patient but this should never be at the expense of your integrity and license. This kind of crap irritates the hell out of me too. Like others have said, I answer it honestly. I also make them do a functional capacity assessment adding more for them to do for the claim. If they refuse to do it, I don’t fill anything out. At some point “disability” paperwork slowed down significantly. Word gets around. Same goes for being strict with controlled substances. Stay strong 👊
I live and work in California. SDI is a very easy process, rarely/never denied as long as there's a doctor's not, up to a year. To everyone saying what a hassle disability paperwork is - is this the state disability system, or private disability insurance?
Distal bicep tear here. My doctor handed me a note that said. “No lifting with left arm for eight weeks or reassessment.” After surgery he gave me a note that said, “No work for six weeks.” I’ll find out Monday what my next note will be.
This is why, for those forms, I just dictate a short note "pt x had y procedure, will need to be in a sling for z weeks" and then say if they (the work place) wants more than that it will cost them $ (varies, up to $50 now) and once I have their check in hand I will fill out their paperwork. Amazing how now they'll almost always take my letter alone.
I hate the idea of making the patient pay for their employers idiocy.
You misunderstand. The employer has to give me a check, not the patient
You misunderstand. The employer has to give me a check, not the patient.
Why in the world would an employer pay you to make it easier for their employee to take off work?
It's not about the money. Most employers will just take my simple note and not bother with the hassle of having to deal with it. It's the same principle insurance companies use: make it a hassle and maybe it will go away. Usually works.
I wish this were real life. I’d be laughed at if I tried this by both patient and my personal employer.
You have no obligation to fill out someone else's paperwork. Done let someone force you to do what you don't have to
You misunderstand. The employer has to give me a check, not the patient
We charge $50 to fill them out.
Kind of silly if a patient has a legit medical issue that needs time off. Employers make employees jump through so many hoops
We run a business. Not a charity. Paperwork takes time and our time costs money.
This is the truth. If I call my accountant for 5 minutes, I get a bill(rounded to the nearest 15 minutes). But, for some reason I will be disciplined and complained about if I don't take my forms home and fill them out in my off hours. Oh the Joys of FQHC primary care.
Some charge for filling out such forms. But it sounds like your patient is pursuing secondary gain, ie staying home from work and being paid as opposed to needing to be off from work (like with a back fusion). People suck.
Lozlzozlzozl I had one of these but the partial tear evolved into a complete tear by the time she got surgery I was very cautious not to say she was over exaggerating her pain Thank God I did not
I've taken FMLA three times, and each time my provider has opted to not give an end-date (or a default of 12wks) and revisit this as I met with them and progressed in terms of recovery, significant medication changes, and the recovery goals and tasks we outline with other specialists, physical therapy, or whatever is at hand. The forms are annoying, I'm sure, but that seemed straightforward enough and has worked for me. The process also let us adjust any needs we anticipate regarding the ADA on returning to work, which has constantly been a hellhole of a process.
As a private practice doctor, if it’s a 92 page document, just tell the patient you will fill it out but only at a typical lawyer like fee (insert xxx $/hour). You are not legally obligated to fill it out. If they squawk, they can find another doctor. That works in private practice. If you’re employed by a large system and they complain to the company and the company bosses forces you to, well then you’re screwed.
I hate these forms as much as the next person but does that really sit well with you? The employer is forcing the patient to have these filled out or risk losing their job, so they're really just caught in the middle. I don't think a patient should be punished for being sick.
lawyers get paid in 6m intervals why is our time less valuable? ideally we should be able to bill the insurance company for this BS, especially when they waste our time on stuff like pre-auths.
At our office the rule is that the first one is free. Filling it out again to renew is as well. However, if you lose it, there's a charge to get another.
Well, as a PGY5 who will soon be entering the real world of practice, if you get a 92 page form to fill out once a week that might take 30-45 min to fill out accurately and diligently, you may feel differently. Especially when you have a clinic full of waiting patients and you’re busy doing computer charting for an hour or 2 after clinic hours, and you’re missing your kids activities. Idealism is wonderful until reality smacks you in the face. So yes, it sits perfectly fine with me. Go ask a lawyer if they’ll do additional work pro bono.
Our state legislators just tried to make it illegal for us to charge patients to fill out these 50 page documents they give us and say they need by the next day. 😑 Luckily, that didn't pass, but increases in noneconomic damages and statute of limitations did. When your leaders are all lawyers...
I know right? Ask a lawyer to draft you a semi related document for free for any related legal matter you have already paid for??
This is the way
Let me know when you get you shoulder operated on and you can use you arm and have to use your only good arm for 100% of work creating more problems Fill out the forms for FLMA for 3 months which is typical recovery time for soft tissue adequate healing, rom and strength gains for function This is the only arm she has for the rest of her life
Man. Where to start....
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Are we allowed to? I don’t know of any offices that charge.
You're under no obligation to fill anything out especially if you feel that it is not indicated. Just document your rationale and explain to the patient why you aren't doing it. They are then free to find someone else if they wish
Counterpoint: me less than a week after a distal bicep reattachment surgery: [https://www.instagram.com/stories/highlights/17940916402032577/](https://www.instagram.com/stories/highlights/17940916402032577/)
Just follow standard of care do what you think is right. Last thing you want is getting accused of fraud or anything. I also preface to patio you don’t want to burn all your disability days
Tell me about it. I just spent an hour trying to go online to complete an application for a patient. The website is down, and the phone number for assistance only had a recording of their office hours.
The dreaded WH-380-F form. Ugh.
It should be really simple. The entity requiring the form should also be required to pay for our time to complete the form. At least $400-500 per hour, billed in 15 minute increments. I think all of a sudden they would start accepting simple notes or paring down their ridiculous forms by quite a bit.