Lie Traps – Hurdles Regarding Lying that Medical Doctors May Face

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by Rabbi Yair Hoffman

The Chofetz Chaim wrote a monograph on the idea of always ensuring that people speak the truth and avoid lying at all costs  It was called Kuntrus Sfas Tamim.

Every so often, we need inspiration to help us achieve our goal of reaching for complete honesty in all that we do.  This can come in the form of seeing how others have acted in trying situations, or in the form of guidance in commonplace hurdles.

Every career has what can be called “Lie Traps.”  These are specific challenges that are particularly prevalent in certain careers that present major stumbling blocks to the Torah prohibition of MiDvar Sheker Tirchak – distance yourself very far from lying.  What follows are some challenges to medical doctors, along with some suggestions as to how to possibly overcome them.  The challenges are culled from an article on KevinMD by Dr. Pamela Wible.

  1. The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting all graduate medical training programs – internships, residencies, and subspecialty programs for all doctors in the United States. New residents are bound by something called an 80-hour cap that was initiated in 2003. If they log hours that are more than this number – they are cited for duty-hour violations, and may be sent for a psych evaluation and also-risk the institution’s accreditation. Many program directors tell the doctors to out-and-out lie and say that there are no work-hour violations. They cite legitimate studies that the extra hours does not actually harm patients. POSSIBLE SUGGESTION:   Not sure if this will work, but there is strength in numbers.  If a few residents join together in an attempt to cultivate honesty and meet with the program director – it can possibly effect a change in the corporate culture.
  2. There is something called a MIPS score, which determines how much reimbursement a doctor will receive from Medicare. There are extra bonuses of 9% when a provider has a high MIPS score. The current legislation for how providers get reimbursed is called MACRA or Medicare Access and CHIP Reauthorization Act of 2015  But doctors will often lie on the Electronic Medical Record by checking off items that were never done – such as the box entitled WNL – within normal limits. Today there are some very rushed visits which leads doctors to, essentially, falsify records.  What should a doctor do to avoid this stumbling block?  POSSIBLE SUGGESTION:   Although it may be against sound medical practice within such limited time for visits, make sure that the assistant or the actual provider actually measures everything that needs to be checked off. 
  3. Doctors often justify packing medical records and the billing of it with items that were never done because the reimbursement from Medicare and insurance companies are dismally low. It also allows for upcoding to higher-level visits and increased reimbursement. It is, however, basically, insurance fraud. How can this hurdle be best addressed? POSSIBLE SUGGESTION:   Either don’t do it or make a checklist as to how to quickly and efficiently perform the particular procedure.
  4. Some doctors will be tempted to lie to patients (and to themselves) because Medicare actually covers a procedure. More beneficiaries now suddenly “need” an intervention. Some doctors often lie telling patients that they have to go on meds in order to meet guidelines. POSSIBLE SUGGESTION: Don’t do it. Remember that you entered medicine to help people.  Reread past issues of the Sefas Tamim newsletter for inspiration.

The Sfas Tamim Foundation publishes a newsletter each week with four columns dedicated to Emes. The first is on the parsha.  The second is inspiration to develop and keep our value of Emes. The third column is halacha about emes.  And the fourth column is a translation of classic texts on Emes.

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STF newsletter – Vol 2 – Iss 5 – 06_04_22b