Empathy vs. Objective Medical Evidence

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“Hey Doc, I could use a few extra days off of work, will you write me a note?” How many times have physicians heard this request from their patients? Most healthcare providers genuinely care about their patients and are empathetic, but in some cases, empathy can go too far and providers’ statements in the record may be considered fraudulent if there is no “objective medical evidence” in support of this practice.

In my years of reviewing disability insurance claim appeals, many healthcare providers opine in the record that their patient cannot return to work for some period of time, without specifying why, other than to list their various diagnoses. There is no specific information as to how a particular medical condition impacts the specific activities of the patient’s occupation.

Recently, I reviewed the medical record of a woman who worked as a receptionist at a medical practice and claimed that her chronic low back pain prohibited her from working more than twenty hours per week. Her activity level at work was entirely sedentary. Although numerous providers stated in the record that her low back pain was so severe that she could not possibly work full-time, there was no objective medical evidence in the record to support this opinion.

The most egregious statement in the record was from the woman’s pain-management dentist, who she saw for TMJ (temporo-mandibular joint) issues. The dentist actually wrote a letter to her attorney stating that due to the severity of her lumbo-sacral disc disease, she would undoubtedly be wheelchair-bound within two years! Clearly this opinion is far outside the scope of practice of any dentist.

Upon review of the medical record, there was a current MRI which demonstrated a 20% bulging lumbo-sacral disc, a condition common in approximately 25% of American adults, a vast majority of whom are asymptomatic. Interestingly, there was another MRI report in the chart from ten years prior which showed no change in the disc bulge over time. Further digging into the record revealed that the patient is very athletic and fit, going to the gym multiple times weekly including using the rock-climbing wall. There was no objective medical evidence in the record whatsoever that the chronic mild bulging disc had any clinical impact.

As one can imagine, after reviewing my report on this case, the judge declined plaintiff’s request for additional spousal support. Provider empathy is one thing; fraud is another. We expect that healthcare providers demonstrate empathy toward their patients; however, medical decision-making and prognostic opinions must be made solely on the basis of objective medical evidence.

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