Legal issues that affect your medical care.

If you listened to Let's Talk Medical with Doctor Gigi on Friday Jan. 6, 2012, you have heard the following issues as Skip & I discussed them live.  This blog will simply put that conversation in print & give me a second opportunity to "think" before I speak!

We spoke about a 60 year old man who presented to a Walk-in Clinic with complaints of leg pain after falling off of a ladder.  The clinic did an x-ray of the injured leg & diagnosed an acute fracture.  The patient was given a splint & was told to see an Orthopedic doctor... which would be delayed by at least 3 days due to the New Year holiday.  The patient's wife later called me (as I was "on call" for the patient's primary care doctor) to ask for help, as the Tylenol & Advil were just not controlling his pain.  When I asked why the Walk-in Clinic had not provided a narcotic pain prescription, the wife replied that they had a big sign posted indicating that they "do NOT give narcotic medicines."  Needless to say, I think that the care rendered by the physician was less than complete, as I suspect that if he/she had a broken leg, he/she would have demanded to have appropriate pain management!  I did help the patient, but many physicians would not have, as we are fearful of losing our licenses to practice medicine if anyone questions that we are over-prescribing narcotics... which are horrendously abused throughout the US, but especially in Florida (where I practice).  I am certain that the posted disclaimer is to dissuade drug-abusers from going to the Walk-in Clinic to get refills of narcotics "after-hours,"  but apparently it has also hampered others from getting much needed appropriate care!

We also discussed that I had to meet a patient in person to hand him a handwritten prescription to refill Ritalin.  Ritalin is basically "speed" which is prescribed for ADD (Attention Deficit Disorder), & in these people it acts "backwards" to slow them down & allow them to focus appropriately on tasks such as work & study.  Again, I see the great potential for abuse, but based upon the Pharmacist's records, he was not an abuser & was appropriately due for a refill.  Again, I did the right thing & went out of my way to get the prescription to him, but as per the law, I could not phone it in & thus had to actually meet him to hand it off.  I don't know about you, but I feel this is over-involvement of the government which burdens me & makes it difficult for patients with this disease to get appropriate care.  It seems to me that I have the knowledge & the responsibility to practice medicine, but unfortunately I am losing the RIGHT to do so freely & in the best interest of my patient!

The point of all this is to make you realize that when you hear news regarding new laws that affect healthcare, remember that those laws might have negative impact on your care!  I am not a lawyer, so I find it difficult to practice medicine when medicine itself has become a business heavily regulated by legal constraints.  Have you noticed that when you are in a car accident most of you end up seeing a lawyer who then refers you to a doctor with whom he works?  That is because many physicians refuse to see cases which will wind up in court, as we feel unprepared to negotiate the legal system in a manner that will help our patients.  To this end, there are physicians who work in that arena all the time... yet these are not your usual primary care doctors... you know, the one's who know you best & can probably care the best for you!

We also discussed that sometimes a dying patient's wishes are not followed, as doing so might result in a lawsuit against the doctor or hospital.  Let's say the patient wants to be a "no code"... indicating that he refuses heroics to just keep him alive if there is no hope for meaningful recovery... but a family member shows up & wants all heroics.  As I say, the patient will not sue me if he is vegetative, but the family member might sue if I "let the patient die."  Since I don't have time or money to deal with this legal dilemma, I am likely to do what the family requests though I know it is terribly wrong & definitely in oppostion of the doctor-patient relationship!!!  The moral of this story is to make sure that your medical & legal paperwork is in order, AND make sure that you discuss this with your family to ensure they follow YOUR wishes and not their own!

It is worth mentioning that if you want a physician to care for you, it is best to establish with that doctor on a "good" day so the doctor has a baseline as to what "normal" is for you.  Thus when you are ill, he will be better able to judge the severity of that illness & provide the best plan of care for YOU... the individual that you are!  In other words, a cough is less significant in a young healthy non-smoker than in an elderly smoker who uses breathing medicines on a normal day.

One e-mail which I received brought up the subject of getting free medicine from the pharmaceutical companies.  This is through a program called the Patient Assistance Program.  If you cannot afford a medicine that your doctor prescribed, first ask if there is a generic (not name-brand) medicine that will suffice, as these are much more affordable on the average.  If this is not an option, Google the medicine name & find the manufacturer.  Go to the manufacturer's website & see if they have a Patient Assistance Program, & if they do, print the application.  You will need to complete some information regarding your income & your diagnosis, & perhaps your physician will have to fill out a part as well.  After mailing the completed application to the manufacturer, they will review it, & if you qualify for assistance, they will mail the medicine to your doctor who will notify you to pick it up. 

There was a question regarding how safe our blood supply is in regards to HIV.  You see, when a person first contracts HIV, he will feel as though he has the flu.  With such general symptoms, it is not likely that he will see a doctor, & even if he does, he is not likely to be diagnosed with HIV.  This acute illness lasts for several weeks, & during this time, the patient will be HIV negative as his body has not yet responded to the HIV virus by making an "antibody."  Unfortunately our HIV tests look for the antibody rather than the virus itself, so there are several weeks between acute HIV infection & our ability to diagnose HIV.  Thus a person could conceivably donate blood which is acutely infected with HIV virus but not yet HIV positive... so the Blood Bank would take that blood & give it to an ill person not realizing how infectious it is!  Obviously our teaching point here is that receiving a blood transfusion is a little risky, & it is always best to receive blood from a family member who you know & trust!  But in the absence of a well-known donor, we can only hope that the Blood Bank continues it's rigorous questioning of donors, as it is the donor's history of illness, travel, medications, etc. which help them to determine whether or not they will allow that person to donate blood.

Lastly, I promised to put in print information regarding 2 exciting programs to help women with breast health.  These are 2 programs for low-incomenon-insured women in Pinellas County.  They are:

     1.  The Mammography Voucher Program - for women 40 - 49 years old.
                    For information & eligibility requirements, call:  (727)-820-4117.

     2.  Florida Breast & Cervical Cancer Early Detection Program - for women 50 - 64 years old.
                    For information & eligibility requirements, call:  (727)-824-6917.

Remember that these programs will assist you to get a mammogram if you qualify, AND they will provide further assistance with follow-up studies such as Ultrasound or even biopsy.  They will even help with treatment for breast cancer such as surgery & chemotherapy!  BUT you must start the process with them... meaning that if you get the mammogram from the program, they will provide further necessary care!  DO NOT get the mammogram elsewhere FIRST, as they will not help you once that has been done!  And remember, these programs are for full-time residents of Pinellas County.  If you live in a different county, parish, or even state, ask your local Health Department if they have similar programs.

Until next time, stay healthy & check out my live radio show Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Petersburg area Fridays from 3:30-4:00PM Eastern time, or on, where you can listen live OR you can listen to the recorded version via Podcast.  And don't forget, you can call in with questions during the live show via: (727)-441-3000 or tollfree via: (866)-TAN-1340.  If you prefer, you can e-mail me at:

Here's to our health!