Should I disclose my IA to medical schools if it doesn't appear on my transcript?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I am a medical scribe in a fast paced emergency room lol and in outpatient cardiology/internal medicine who is told to document such by physicians lol.

Anecdotal evidence:
1. Patient was in cardiac arrest, resuscitation attempts was failed, yet the physician charted heart/lungs/skin/eyes normal. Signed the chart, went to coding.
2. Ankle sprain/back pain/dental pain/rash/any minor issue-bills level 2 coded chart usually. Multiple physicians/PA's/NP's document such that it is a level 5 and bills as high as possible
3. Cardiology office I work in-same thing. They have a preloaded template with exam findings, and they check heart and lungs. Never check neuro (unless otherwise indicated), never check oropharynx, never check skin other than for edema, never check abdomen and bowel sounds. Yet all the physicians/PA's/NP's chart this and bill for it.

Physicians that I've worked with at top 10 national hospital networks do the same thing. I can tell you for a fact that when patients come in for well check-ups, multiple physicians actually check heart and lungs, but charts, it's documented as cranial nerves intact, no lympadenopathy, no thyromegaly, no JVD, no carotid bruits- a whole bunch **** that they never actually checked.

Dont EMRs have catch all phrases for this? In our EMR we have an "all systems negative" for the catch all.
 
"1. Patient was in cardiac arrest, resuscitation attempts was failed, yet the physician charted heart/lungs/skin/eyes normal. Signed the chart, went to coding.
2. Ankle sprain/back pain/dental pain/rash/any minor issue-bills level 2 coded chart usually. Multiple physicians/PA's/NP's document such that it is a level 5 and bills as high as possible"

These 2 scenarios are unlikely if not impossible (especially #1) now that Medicare is cracking down on audits.

Whoever the provider in #1 was should be prepared to have to answer to their state board.

Unlikely or not, it happens. Got a $4,000+ bill for "level 4" care for "the flu"...
 
These 2 scenarios are unlikely if not impossible (especially #1) now that Medicare is cracking down on audits.

Whoever the provider in #1 was should be prepared to have to answer to their state board.
Impossible HA!

Through two pregnancies I had all types of billed ultrasounds and tests I never received. It's near impossible to prove, and it happened on several occasions. They didn't expect anyone to go through it perhaps, but since I was paying cash, I looked at every detail. And no way I'm going to mistake having a vaginal ultrasound or fetal DNA testing.

Anyways OP, this looks like a scenario where you know what decision you want to make and you're looking for people to cheer you on and help you clear your conscience. Be a big boy/girl, make your decision, accept whatever risks come with that.


Sent from my iPhone using SDN mobile
 
Well, for Scenario 1, if the patient died from cardiac arrest, and the physician bill/codes that the heart was normal...
 
I was under the impression that level of charting didn't depend so much on the "seriousness" of the disease, just how many elements and such you can chart for.
 
I was under the impression that level of charting didn't depend so much on the "seriousness" of the disease, just how many elements and such you can chart for.

Right so if you have an ankle sprain then you do a super focused exam rather than doing an entire exam/work-up. In theory, your exam findings should be focused on the ankle/extremity, maybe heart/lungs if that's routine. But otherwise, you shouldn't have much for the exam. ROS should also be pretty focused. You aren't gonna ask an ankle sprain have you had fevers, chills, nausea, vomiting, abd pain, chest pain, shortness of breath, ect. You get the picture. So given that, the there shouldn't be as many elements of the chart that code for a level 5.
 
Dont EMRs have catch all phrases for this? In our EMR we have an "all systems negative" for the catch all.

There is, but even so, that is still in a way "lying". We have a box were we can check all systems negative otherwise-but that implies that you've asked the entire other ROS and don't want to check off on it. Similarly, with EPIC, we can make smart phrases for the exam which auto-populates normal exam findings, and the physician changes the abnormal findings accordingly-but many people will just apply the smart-phrase even if they did not do the full exam.
 
Right so if you have an ankle sprain then you do a super focused exam rather than doing an entire exam/work-up. In theory, your exam findings should be focused on the ankle/extremity, maybe heart/lungs if that's routine. But otherwise, you shouldn't have much for the exam. ROS should also be pretty focused. You aren't gonna ask an ankle sprain have you had fevers, chills, nausea, vomiting, abd pain, chest pain, shortness of breath, ect. You get the picture. So given that, the there shouldn't be as many elements of the chart that code for a level 5.

Right but asking those questions takes less than a minute and the doctor can run through the motions and get a complete chart.

It seems like a no brainier to me.
 
s
Right but asking those questions takes less than a minute and the doctor can run through the motions and get a complete chart.

It seems like a no brainier to me.

Asking the questions is quick to do, the response though can be lengthy and unrelated. If a patient's there for an ankle sprain, but then when prompted with the questions, starts complaining of this random abdominal pain for the past 2-3 months that is chronic and followed by GI, or random chest/back pain intermittently they have for god knows how long that was worked up by their cardiologist, or other vague symptoms that is managed by a PCP, that can cause you to run down a path of unnecessary testing ect. Those things can also be worked up as outpatient and if they are, there wouldn't be as much of a need to do it in an ER or inpatient setting seeing as that is not what the CC is. Regardless of the setting, when you're pressed to see X amount of patients in a day, those extra minutes matter unfortunately.
 
Should I omit something from the AMCAS application that I am obligated to include? Should I endorse the statement that the application is complete and true when I know it is not?

Should I lie? Should I then lie about having told a lie? Where does it end?

Should I give up my career pursuits and not lie?

The moral answer is clear. What a person would actually do in a situation is not.

This isn't that far off of the thread where people wouldn't report someone who was cheating.
 
Should I give up my career pursuits and not lie?

The moral answer is clear. What a person would actually do in a situation is not.

This isn't that far off of the thread where people wouldn't report someone who was cheating.

The obligation to tell the truth is not on a witness of someone cheating.


Sent from my iPhone using SDN mobile
 
Like?


Sent from my iPhone using SDN mobile

The many states which hold requirements that a person be held liable for not reporting a crime in progress. This is especially true if you were asked by the teacher if you saw person X cheating you claim you did not.
 
The many states which hold requirements that a person be held liable for not reporting a crime in progress. This is especially true if you were asked by the teacher if you saw person X cheating you claim you did not.


The real measure of one's moral compass is whether you will tell the truth when the truth will "hurt" you.
The many states which hold requirements that a person be held liable for not reporting a crime in progress. This is especially true if you were asked by the teacher if you saw person X cheating you claim you did not.

Except in a few schools that have honor codes that require that witnesses report any suspected cheating, a student is not obligated to report suspected cheating to the instructor. However, if the instructors asks outright if you saw a specific person do a specific thing, you are morally obligated, IMHO, to tell the truth rather than to lie.

Do not lie.

If you attest that your application is complete and true and while knowing that it is not complete and true, you are lying.

Being a cheater might not be the end of the line for an applicant but being a cheater and a liar certainly would be.
 
Medical school applications, and being in med school are not the law courts. It is a privilege to enter the field of Medicine, not a right.

No one is saying that this is a court, the question was on the topic of moral culpability.

Being a cheater might not be the end of the line for an applicant but being a cheater and a liar certainly would be.

What are the chances OP applies with his IA and a med school looks over it?

What are the chance OP lies, and doesn't say anything and a med school finds out?
 
These are unanswerable. But when in doubt, I expect people to do the right thing.

The true test of a man's character is what he does when no one is watching.
John Wooden


What are the chances OP applies with his IA and a med school looks over it?

What are the chance OP lies, and doesn't say anything and a med school finds out?
 
Liars lie. They don't stop with one lie. Eventually, the lies catch up with them. It might not be the first lie that trips them up but eventually, someone will catch on. It is not unheard of to pass all of your medical school exams that test your knowledge and still be expelled for a lack of professionalism. The AMCAS is only the first test of one's character and there will be many more.

Professionalism means telling the truth even when it indicates that you made an error in judgement or you screwed up or you are otherwise ashamed of what you've done or failed to do.

Maybe an applicant can cheat, get caught, lie about it and still get into medical school. But that applicant is a medical student who has discovered that lying is a successful strategy.. until one day when it is not. And the real tragedy is that when a resident or physician lies, an innocent patient may die.
 
Top