Ethics on writing a note on a patient you've never seen nor will see

[whopper]

Question: My program has all its first year residents doing Internal Medicine and we have no 2nd years.

Normally the first & 2nd years go to morning report in the inpatient unit and write the treatment plans. Since there are no 1st or 2nd years currently able to do this, one of the attendings asked if it were possible for the 3rd & 4th years to do so, then go off to their outpatient rotations.

If you are unfamiliar with a treatment plan, in NJ, such a plan is written so that the patient can review exactly what they are dx'd with, the plan the doctor has for treatment and the conditions the patient needs to fulfill in order to be released (e.g. if they were suicidal, the pt has to deny suicidal ideation for 48 hrs prior to discharge).

Hmmm, I was a little bugged. Isn't it unethical to write anything concerning a patient you haven't ever seen before, nor will see after you leave the morning report? Rermember, the 3rd & 4th years are doing outpatient, we haven't seen the inpatient patients, and haven't interviewed or examined them. If we go to morning report to write a Tx plan, we won't have enough time to interview the patient in question.

I felt the attending who suggested this shouldn't have been asking this in the first place, and I did smell a bit of intent for him to ask this of us because he didn't want to show up to work earlier.

(Treatment plans have to be completed before about 9-10am).

OK fine, I think most of you will agree that this is not supposed to be done, and yeah, I am bringing this up.

However anyone have any good websites that back this up? I just want to review some literary stuff on this before the meeting with the attending.

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[TheWowEffect]

This seems highly inappropriate. Why can't the darn attending move his butt and do what he is supposed to do by himself. Wow... I feel relieved to be in a program where such things would be considered scut and thus, be frowned upon. I wonder what your PD has to say about this. Can't help you with any articles though.

 

[sunlioness]

That's inappropriate. You have to see the patient to write a note on him and if you are unable to do so because of obligations elsewhere, it falls upon the attending. The attending bears ultimate responsibility for EVERYTHING that happens and that must be done on his/her service and if there is no one available to do what needs to be done, s/he has to do it. They get paid for this.

 

[whopper]

Yeah, I agree.

BEfore anyone thinks my program blows, this is something which is still being discussed, and may eventually not be allowed, the program's hours are very lax and we all enjoy being here.

Honestly, given the amount of work they give us, I wouldn't mind just going in there and doing it except for the ethical thing. I made it clear to my Chief (and I'm up for Chief next year) that its not about trying to avoid work, its about us not doing proper & ethical treatment.

I also stated to her that if we are made to do this, I will write in the record that I have not seen the patient, and am only doing the treatment plan because I was ordered to do so by the attending. This will certainly bring up a legal red flag, and heck, if they can't deal with that level of honesty on a chart, they shouldn't request such an action from us!