Jul 26, 2016
118
77
Status
Pre-Health (Field Undecided)
While on a Cruise, your patient developed flu-like symptoms. He had a prepaid excursion that day which he was unable to attend due to feeling sick. Upon returning home, he is informed by the travel company that the money spent for the excursion can only be refunded with a signed doctor's note. He asks his physician to write a note indicating that he was ill. How would you handle this situation?

The answer goes on to explain how sometimes physicians may be in the position where they are called to deceive others in keeping their patient's best interest in mind. They say right away how they would not write the doctor's note.

Reasons:
Lying is deceptive, it undermines social trust, how can you believe the doctor in subsequent issues if they are found lying?

Is the patient's health at stake in this case? It is not. The patient is here to get a refund and this is not related to his health.

Then the physician tells the patient that he cannot write the note because he has two ethical duties, to be truthful and to help him as a patient. "If I mislead the travel company, how would my patients trust me to not mislead them in other situations?"

Finally the doctor says he would help the patient brainstorm other ideas to get the money back, did he see the cruise ship doc, can he speak with the manager, etc.

Now here is my point of view: Right off the bat, I was wondering how the physician is being deceptive if he wrote a note to the travel company that he was sick? What if the patient came to the doctor and he still had flu like symptoms? What if the doctor has had an established relationship with this patient where he knows that the patient is an honest and truthful person, and he described his symptoms to the doctor, which the doctor determines were symptoms of the flu?

Cant the doctor write a note to the cruise ship company explaining how his patient did indeed have flu like symptoms, and that they should consider a refund?

While I realize there are so many possible answers for this scenario, would it really be a death sentence to answer that yes you would write the sick note for the patient, as long as you considered other options and where you intended not to deceive anyone? Discuss!
 

Nucleophile1

2+ Year Member
May 12, 2015
384
441
Status
Medical Student
Now here is my point of view: Right off the bat, I was wondering how the physician is being deceptive if he wrote a note to the travel company that he was sick? What if the patient came to the doctor and he still had flu like symptoms? What if the doctor has had an established relationship with this patient where he knows that the patient is an honest and truthful person, and he described his symptoms to the doctor, which the doctor determines were symptoms of the flu?
The question stem indicates that the patient is not sick when they go to their physician. Therefore, it would be unethical and deceptive for the physician to write the note since the physician did not see the patient when they were sick.
 

redsox93

2+ Year Member
Aug 22, 2016
1,256
2,360
Status
Medical Student (Accepted)
I see where you're coming from but to me this prompt sounds like he's going to his doc (you) after learning that he needed a doctor's note and is not longer sick to get a discount. You've gotta play to what the interviewer wants to hear and not add any personal bias like saying you know the guy is honest blah blah blah. What it comes down to is you as a doctor have a huge moral obligation to not fabricate any information as well as develop trust between your patient. If you lie here they might assume you're lying about other things down the road, which leads to poor compliance and poor patient outcomes.
 

The Knife & Gun Club

MS - 4
2+ Year Member
Nov 6, 2015
2,329
4,495
Hollywood Upstairs Medical College
Status
Medical Student
practically I'd write the note...as for MMI answer I think you could say yes or no to writing it as long as you provide a strong logical/ethical foundation for your reasoning. "No" may be easier to defend, but I think a reasonable argument for yes could be made.

If arguing yes i'd say that my patient (who I've followed for quite some time) complained of symptoms I would consider indicative of the flu. Make clear in the note that you did not examine the patient at the time of illness but after their return, since obviously you are not on board the cruise ship.

everyone is happy and no one has violated the sacred ethical code of doctors notes.
 

wizzed101

The Little Prince
May 20, 2016
812
344
Having trouble understanding what you mean here!
I mean that I may lie to help a patient fabricate insurance info in order to get them a life saving procedure when we have exhausted all options. When I compromise my integrity, it should be over something of gravity. The hell I am going to lie for them for a what, a cruise discount? What the hell man, how is this even a moral dilemma?
 
  • Like
Reactions: Akiera

Bumblenest

2+ Year Member
May 15, 2015
128
162
Status
Pre-Medical
I think the big problem is that you have no other way of confirming he actually had flu symptoms at that time. If he went to a doctor during the cruise while he was sick, as that Doctor id have no problem signing a note for him
 
OP
M
Jul 26, 2016
118
77
Status
Pre-Health (Field Undecided)
I mean that I may lie to help a patient fabricate insurance info in order to get them a life saving procedure when we have exhausted all options. When I compromise my integrity, it should be over something of gravity. The hell I am going to lie for them for a what, a cruise discount? What the hell man, how is this even a moral dilemma?
AH thank you for clearing it up. Here is the issue I am having though... For what is the doctor lying about? What exactly will this doctor's note entail? Like @wizzed101 said above, the note could say that this patient suffered from symptoms indicative of the flu during his cruise. While I have not personally seen the symptoms myself, what he described to me sounded like the flu. In this way the doctor is not lying about anything!
 

Bumblenest

2+ Year Member
May 15, 2015
128
162
Status
Pre-Medical
AH thank you for clearing it up. Here is the issue I am having though... For what is the doctor lying about? What exactly will this doctor's note entail? Like @wizzed101 said above, the note could say that this patient suffered from symptoms indicative of the flu during his cruise. While I have not personally seen the symptoms myself, what he described to me sounded like the flu. In this way the doctor is not lying about anything!
Yes but the fact that there is financial gain for the patient to say he had the flu complicates things. Patient coming in to say he had the flu for a check up is a different story
 

drcatknight

Membership Revoked
Removed
Account on Hold
Apr 27, 2014
21
5
Status
Pre-Medical
Yes but the fact that there is financial gain for the patient to say he had the flu complicates things. Patient coming in to say he had the flu for a check up is a different story
But how would the physician be lying in this case? I get how money can complicate the issue though!
 

Bumblenest

2+ Year Member
May 15, 2015
128
162
Status
Pre-Medical
But how would the physician be lying in this case? I get how money can complicate the issue though!
Well i guess it's in that gray zone, but I just imagine this somehow going to the court of law where the company is somehow suing you for something. And I just wouldn't feel as strong standing by that explanation vs if I were actually there to confirm the illness
 

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
A physician can say, "My patient reported symptoms indicative of the flu. Therefore, I assume he was sick, but I cannot fully attest to the validity of his claims since I was not there to check him out."

No one gets sued
Guy probably gets his money back
You're honest and ethical

What else do they want? Sheesh
 

MDProspect

2+ Year Member
Jul 23, 2015
714
639
Status
Medical Student
The ethical issue is acting in the patient's best interest versus upholding the doctor's integrity. From my personal experience, a doctor's note that says something along the lines of "my patient came into my office and told me that he was ill sometime ago." would not suffice for a refund. The physician has to certify (and put their license on the line) that the patient was under their care during the time frame of the illness. As an example, my niece had an ear infection and could not fly due to the pressure change in the plane, which could have exacerbated her condition. In order to get the refund for the trip, her pediatrician had to fill out a form, where she wrote the specific diagnosis and the time frame of when she was under the doctor's care. As well as put her signature and stamp, which made this form a binding document. In this case, the physician would have to lie and commit fraud by saying he/she was taking care of this patient. It's not unheard of patients calling their PCPs and getting a consultation and a prescription over the phone, but from the scenario, it seems that the patient only went to their physician at a later time to exploit the company's refund policy. It's easy to say no, but this answer can easily upset the patient, make you seem callous and self-righteous, and result in the patient changing their physician. In my opinion, the best way to answer an MMI question is to stay neutral and to avoid the extremes of the issue.

It's hard to stay neutral in this scenario, but I would tell my patient that I could not write them a note, because by doing so, both my patient and I will face legal ramifications. However, I can certify that they are currently under my care if he is still experiencing the symptoms of the flu. I would also, as mentioned, recommend for them to contact the ship's physician.

For anyone who wants to go with the simple "no", according to University of Washington's ethical guidelines, a physician has no obligation to the patient in performing services that they find unreasonable or unethical. Particularly since there is no risk of danger to the patient's health by refusing your services. Additionally, medicine is a profession with standards that its practitioners must uphold. Integrity is an attribute that many adcoms and review boards hold dear. With all of these recent Medicaid and Medicare fraud cases, a more stringent screening process has been created to weed out morally malleable candidates.
 
Last edited:

WheezyBaby

RSV Fomite
2+ Year Member
Jun 9, 2016
618
1,066
Status
Resident [Any Field]
A physician can say, "My patient reported symptoms indicative of the flu. Therefore, I assume he was sick, but I cannot fully attest to the validity of his claims since I was not there to check him out."
This is more or less how I'd write my note. "So and so was examined in my office on ##/##. He reports on ##/## he developed these symptoms, which are consistent with xyz. However, on the day of my examination, he was in his usual state of health. Please call with any questions (please don't call me with any questions; also, please accept this note so my patient doesn't get mad at me). Dr. Wheezy"

I'll also let my patients know exactly what I'm saying.
 

wizzed101

The Little Prince
May 20, 2016
812
344
The only problem with that approach is the fact that he will absolutely not get his money back, and will go back to you for another more persuasive note. Why delay the inevitable?
 

WheezyBaby

RSV Fomite
2+ Year Member
Jun 9, 2016
618
1,066
Status
Resident [Any Field]
The only problem with that approach is the fact that he will absolutely not get his money back, and will go back to you for another more persuasive note. Why delay the inevitable?
I will not put things down in my name I have not personally verified. My job is not to ensure the patient gets their cruise money back. If what I can do isn't good enough, then unfortunately the patient is up **** creek. I've had prior auths denied that I could've fudged and saved the patient hundreds of $. Lying is inappropriate and will eventually burn you.
 

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
The ethical issue is acting in the patient's best interest versus upholding the doctor's integrity. From my personal experience, a doctor's note that says something along the lines of "my patient came into my office and told me that he was ill sometime ago." would not suffice for a refund. The physician has to certify (and put their license on the line) that the patient was under their care during the time frame of the illness. As an example, my niece had an ear infection and could not fly due to the pressure change in the plane, which could have exacerbated her condition. In order to get the refund for the trip, her pediatrician had to fill out a form, where she wrote the specific diagnosis and the time frame of when she was under the doctor's care. As well as put her signature and stamp, which made this form a binding document. In this case, the physician would have to lie and commit fraud by saying he/she was taking care of this patient. It's not unheard of patients calling their PCPs and getting a consultation and a prescription over the phone, but from the scenario, it seems that the patient only went to their physician at a later time to exploit the company's refund policy. It's easy to say no, but this answer can easily upset the patient, make you seem callous and self-righteous, and result in the patient changing their physician. In my opinion, the best way to answer an MMI question is to stay neutral and to avoid the extremes of the issue.

It's hard to stay neutral in this scenario, but I would tell my patient that I could not write them a note, because by doing so, both my patient and I will face legal ramifications. However, I can certify that they are currently under my care if he is still experiencing the symptoms of the flu. I would also, as mentioned, recommend for them to contact the ship's physician.

For anyone who wants to go with the simple "no", according to University of Washington's ethical guidelines, a physician has no obligation to the patient in performing services that they find unreasonable or unethical. Particularly since there is no risk of danger to the patient's health by refusing your services. Additionally, medicine is a profession with standards that its practitioners must uphold. Integrity is an attribute that many adcoms and review boards hold dear. With all of these recent Medicaid and Medicare fraud cases, a more stringent screening process has been created to weed out morally malleable candidates.
Legal ramifications? We're talking about a doctor's note for a $100 scuba diving excursion.

The cruise line is adds "we need a doctor's note" to their sick policy as a way to make sure that the refunds that they do give out are limited.

The first line of the prompt is: "While on a cruise, your patient developed flu-like symptoms." Great, I can write a note for that. If you write a note that says "Mr. Rogers reported to me symptoms of the flu, so he probably had the flu...", there's no lawyer that's going to breathe down your neck, and there's absolutely 0 chance of fraud.

---

This isn't even a rare scenario. Telemedicine happens all the time. A patient calls in with a yeast infection and you call in the script to their pharmacist. Every single medical decision, especially one as unimportant as this one, doesn't require a full physical examination & verification of every symptom, in person, by a doctor.

To be honest, if my long time patient says he threw up and had a fever before a trip, why would you even think of not believing him? He's your patient, after all. Ruining your doctor-patient relationship to save a cruise line 100 bucks is a genuinely silly thing to do.

You can be an honest Abe and your patient will get his money back.
 

MDProspect

2+ Year Member
Jul 23, 2015
714
639
Status
Medical Student
Legal ramifications? We're talking about a doctor's note for a $100 scuba diving excursion.

The cruise line is adds "we need a doctor's note" to their sick policy as a way to make sure that the refunds that they do give out are limited.

The first line of the prompt is: "While on a cruise, your patient developed flu-like symptoms." Great, I can write a note for that. If you write a note that says "Mr. Rogers reported to me symptoms of the flu, so he probably had the flu...", there's no lawyer that's going to breathe down your neck, and there's absolutely 0 chance of fraud.

---

This isn't even a rare scenario. Telemedicine happens all the time. A patient calls in with a yeast infection and you call in the script to their pharmacist. Every single medical decision, especially one as unimportant as this one, doesn't require a full physical examination & verification of every symptom, in person, by a doctor.

To be honest, if my long time patient says he threw up and had a fever before a trip, why would you even think of not believing him? He's your patient, after all. Ruining your doctor-patient relationship to save a cruise line 100 bucks is a genuinely silly thing to do.

You can be an honest Abe and your patient will get his money back.
I can tell from your post that you have never dealt with this situation. "Mr. Rogers reported to me symptoms of the flu, so he probably had the flu.." note on a Rx script won't cut it. In the refund form, there is a section, where the doctor needs to write the symptoms and confirm diagnosis, indicate the dates when the patient was under their care, and answer other questions. Then right above the signature line, there is a legal statement that reads, "Any person who knowingly and with intent to injure, defraud or deceive, files a statement claim containing any false, incomplete, or misleading information may be guilty of a criminal act punishable by law." "I have read the foregoing and above answers are true and complete according to the best of my knowledge and belief." When you sign and date the form, you are taking on the legal responsibility.

You can indicate later dates for treatment, but he wont get a refund. So most likely he will ask you to backdate his dates of care. Doing so is fraud.
 
  • Like
Reactions: Matthew9Thirtyfive

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
I can tell from your post that you have never dealt with this situation. "Mr. Rogers reported to me symptoms of the flu, so he probably had the flu.." note on a Rx script won't cut it. In the refund form, there is a section, where the doctor needs to write the symptoms and confirm diagnosis, indicate the dates when the patient was under their care, and answer other questions. Then right above the signature line, there is a legal statement that reads, "Any person who knowingly and with intent to injure, defraud or deceive, files a statement claim containing any false, incomplete, or misleading information may be guilty of a criminal act punishable by law." "I have read the foregoing and above answers are true and complete according to the best of my knowledge and belief." When you sign and date the form, you are taking on the legal responsibility.

You can indicate later dates for treatment, but he wont get a refund. So most likely he will ask you to backdate his dates of care. Doing so is fraud.
It's not fradulent to say "my patient had symptoms indicative of the flu."

The question, from what I see here, does not mention anything about the details of the "refund form".

If you were the patient and you have a fever and are vomiting, it is your obligation not to go on the excursion.

If you are the cruise line, you should be ethically inclined to refund the money for a legitimate excuse like flu-like symptoms. If they make the patient go through the hurdle of getting a doctor's note, so be it.

As a physician, if I get a call from my patient that he's throwing up and has a fever on his cruise, my immediate concern is making him or her well.

You're not lying if you are reporting what the patient says. Every doctor does not have to base every medical decision or report on firsthand account of symptoms.

If your patient says, "I wasn't really sick; just sign the note." I will say no.

If your patient reports that he was symptomatic of the flu, I would write him a note saying it is my opinion he had the flu based off his symptoms.

None of this is unethical.
 

Ehwic

5+ Year Member
Jan 21, 2012
404
164
Status
So what are the possibilities that the patient was experiencing motion sickness from the cruise?

Anywhoo, isn't still more straightforward to write the letter saying that patient has self-reported to exhibited these symptoms that prevented them from attending that event, however, no formal diagnosis has been determined.
 

Matthew9Thirtyfive

*breathes in* boi
Moderator
2+ Year Member
Jan 11, 2016
15,107
22,385
Status
Medical Student
It's not fradulent to say "my patient had symptoms indicative of the flu."

The question, from what I see here, does not mention anything about the details of the "refund form".

If you were the patient and you have a fever and are vomiting, it is your obligation not to go on the excursion.

If you are the cruise line, you should be ethically inclined to refund the money for a legitimate excuse like flu-like symptoms. If they make the patient go through the hurdle of getting a doctor's note, so be it.

As a physician, if I get a call from my patient that he's throwing up and has a fever on his cruise, my immediate concern is making him or her well.

You're not lying if you are reporting what the patient says. Every doctor does not have to base every medical decision or report on firsthand account of symptoms.

If your patient says, "I wasn't really sick; just sign the note." I will say no.

If your patient reports that he was symptomatic of the flu, I would write him a note saying it is my opinion he had the flu based off his symptoms.

None of this is unethical.
They are asking you to confirm a diagnosis. You cannot confirm that they had the flu if you were not there. If they come into your office after the cruise and still have symptoms, you can say they reported to your office with flu-like symptoms starting xx. If they come to your office well and say they had flu symptoms on the cruise, at most you can say that they reported having those symptoms, which is basically you just telling the cruise company what the patient has already told them, which means nothing.

If they don't have symptoms when you write the note, you are being fraudulent if you confirm their symptoms and diagnosis.
 
  • Like
Reactions: MDProspect

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
They are asking you to confirm a diagnosis. You cannot confirm that they had the flu if you were not there. If they come into your office after the cruise and still have symptoms, you can say they reported to your office with flu-like symptoms starting xx. If they come to your office well and say they had flu symptoms on the cruise, at most you can say that they reported having those symptoms, which is basically you just telling the cruise company what the patient has already told them, which means nothing.

If they don't have symptoms when you write the note, you are being fraudulent if you confirm their symptoms and diagnosis.
There are two options in this scenario:
1) Your patient is telling the truth. In which case, you should, of course, write him a note.

2) Your patient is lying to get out of paying for a trip. In which case, you should, of course, not write him a note.

Since there is no time machine or teleportation device in this question, you are to decide based on what the patient reported what his condition probably was.
---
A cruise line can't require a doctor's note from you saying that you were there to evaluate him... he was on a damn cruise, thousands of miles away.

The point of the note is just to say, "Yea. It looks like he had the flu. As such, he shouldn't have been on the excursion and deserves any refund of services." There's nothing else a note could say.

What ******* (excuse my language) is going to write, "I certify on my honor and professional career and on my mother's grave that this man definitely, 100%, had the flu, so help me god." No one has anything to go off of other than the patient's symptoms.

If anyone's to blame, it's the god awful cruise line for wasting my time with a superfluous doctor's note when they know I wasn't there, for having such a beuracratic refund policy, and, oh yeah, for not having a freaking doctor on board who could have dealt with him then and there.

I think it would be beneficial if we were to look at these scenarios realistically and not as times to put on our Law & Order hats. I believe in putting patients' well-being first, ridiculing "idiot cruise lines", and going back to real work!
 
Last edited:

MDProspect

2+ Year Member
Jul 23, 2015
714
639
Status
Medical Student
There are two options in this scenario:
1) Your patient is telling the truth. In which case, you should, of course, write him a note.

2) Your patient is lying to get out of paying for a trip. In which case, you should, of course, not write him a note.

Since there is no time machine or teleportation device in this question, you are to decide based on what the patient reported what his condition probably was.
---
A cruise line can't require a doctor's note from you saying that you were there to evaluate him... he was on a damn cruise, thousands of miles away.

The point of the note is just to say, "Yea. It looks like he had the flu. As such, he shouldn't have been on the excursion and deserves any refund of services." There's nothing else a note could say.

What ******* (excuse my language) is going to write, "I certify on my honor and professional career and on my mother's grave that this man definitely, 100%, had the flu, so help me god." No one has anything to go off of other than the patient's symptoms.

If anyone's to blame, it's the god awful cruise line for wasting my time with a superfluous doctor's note when they know I wasn't there, for having such a beuracratic refund policy, and, oh yeah, for not having a freaking doctor on board who could have dealt with him then and there.

I think it would be beneficial if we were to look at these scenarios realistically and not as times to put on our Law & Order hats. I believe in putting patienta' well-being first, ridiculing "idiot cruise lines", and going back to real work!
Except the cruise line does have an aboard physician, all of them do. However, you have to pay out of pocket to see the physician.
A) The patient should not be reporting to you, but to the cruise doc. As you said, you weren't there to verify that he was sick.
B) The patient should have called you while being sick. Then you could have noted the sickness and taken the patient under your care.
C) You could write him a note that states, "Mr. X came into my office on this date, and reports that he was ill during these dates." Which would be okay, but probably not sufficient for the refund.
 

Matthew9Thirtyfive

*breathes in* boi
Moderator
2+ Year Member
Jan 11, 2016
15,107
22,385
Status
Medical Student
There are two options in this scenario:
1) Your patient is telling the truth. In which case, you should, of course, write him a note.

2) Your patient is lying to get out of paying for a trip. In which case, you should, of course, not write him a note.

Since there is no time machine or teleportation device in this question, you are to decide based on what the patient reported what his condition probably was.
---
A cruise line can't require a doctor's note from you saying that you were there to evaluate him... he was on a damn cruise, thousands of miles away.

The point of the note is just to say, "Yea. It looks like he had the flu. As such, he shouldn't have been on the excursion and deserves any refund of services." There's nothing else a note could say.

What ******* (excuse my language) is going to write, "I certify on my honor and professional career and on my mother's grave that this man definitely, 100%, had the flu, so help me god." No one has anything to go off of other than the patient's symptoms.

If anyone's to blame, it's the god awful cruise line for wasting my time with a superfluous doctor's note when they know I wasn't there, for having such a beuracratic refund policy, and, oh yeah, for not having a freaking doctor on board who could have dealt with him then and there.

I think it would be beneficial if we were to look at these scenarios realistically and not as times to put on our Law & Order hats. I believe in putting patienta' well-being first, ridiculing "idiot cruise lines", and going back to real work!
Maybe you missed it, but a few people on this thread have stated that the forms generally require you to confirm the symptoms/dx. You cannot ethically do that if you weren't there, as that is fraud. All you can say is "patient reports having these symptoms at this time," which as has been said, will likely not be good enough, as the patient can tell them that himself.

It's interesting that you fail to see the ethical issue with filling out a form less-than truthfully. If the form asks you to state that the patient had X, Y, and Z symptoms and you were not there, did not receive a phone call from the patient, or they didn't present to your office still experiencing the symptoms, you cannot sign that form. That is called fraud.
 

drcatknight

Membership Revoked
Removed
Account on Hold
Apr 27, 2014
21
5
Status
Pre-Medical
I think the problem we have here is that we can't seem to agree on what exactly the doctors note would entail. Is there an official "doctor's note" (which I am unaware of simply due to ignorance) or is there an informal doctor's note that can just say "yeah so and so reported symptoms of a flu at this time, I cannot 100% verify but it sounds like it".
 

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
Maybe you missed it, but a few people on this thread have stated that the forms generally require you to confirm the symptoms/dx. You cannot ethically do that if you weren't there, as that is fraud. All you can say is "patient reports having these symptoms at this time," which as has been said, will likely not be good enough, as the patient can tell them that himself.

It's interesting that you fail to see the ethical issue with filling out a form less-than truthfully. If the form asks you to state that the patient had X, Y, and Z symptoms and you were not there, did not receive a phone call from the patient, or they didn't present to your office still experiencing the symptoms, you cannot sign that form. That is called fraud.

I'm not going off what people are saying in this thread for hypothetical tangents; I'm going directly off the prompt.

It starts out saying that "your patient developed flu-like symptoms [on a cruise]." That is the premise. It doesn't say that he lied about it. It says the he actually had those symptoms.

You can also take away that the cruise line understands that getting a doctor's not under no circumstances means that I was there to treat the patient. It's another major premise. Of course I wasn't there... both parties know that.

---

Since your patient is telling the truth,
Since the cruise line knows you weren't there,
And since you know how logic works,
You would be completely right to write a short note saying, again for the 3rd time, "Pt.'s symptoms looked like flu. He deserves a refund." That's it.

---

You guys are adding premises that aren't there such as:
1) your patient is lying (not in the stem)
2) there's a special form that says that you were there in person to evaluate him (obviously not true if you use common sense)
3) the cruise line did have a physician on board, but the pt. refused to see him or her.
^ All of these would change my argument, but none of them are in the question stem.

It is not dishonest, unethical, immoral, or wrong to write a well-worded note that says "looks like he had the flu."
 

wizzed101

The Little Prince
May 20, 2016
812
344
For the last time, man. The policy is there so that they cruise can avoid refunding. Your note doesn't work. And who the heck you think you are to tell them who deserves what?

"looks like he had the flu."
Were you there?

The only way they will ever get a refund is for you to lie about their having the flue BEFORE the cruise, or your patient skyped you, none of which happened.

Your note doesn't work. And since you were so eager to "help" the patient, they come back and ask for one that works. What now? Why wasting time in the first place?
 
  • Like
Reactions: MDProspect

Matthew9Thirtyfive

*breathes in* boi
Moderator
2+ Year Member
Jan 11, 2016
15,107
22,385
Status
Medical Student
I'm not going off what people are saying in this thread for hypothetical tangents; I'm going directly off the prompt.

It starts out saying that "your patient developed flu-like symptoms [on a cruise]." That is the premise. It doesn't say that he lied about it. It says the he actually had those symptoms.

You can also take away that the cruise line understands that getting a doctor's not under no circumstances means that I was there to treat the patient. It's another major premise. Of course I wasn't there... both parties know that.

---

Since your patient is telling the truth,
Since the cruise line knows you weren't there,
And since you know how logic works,
You would be completely right to write a short note saying, again for the 3rd time, "Pt.'s symptoms looked like flu. He deserves a refund." That's it.

---

You guys are adding premises that aren't there such as:
1) your patient is lying (not in the stem)
2) there's a special form that says that you were there in person to evaluate him (obviously not true if you use common sense)
3) the cruise line did have a physician on board, but the pt. refused to see him or her.
^ All of these would change my argument, but none of them are in the question stem.

It is not dishonest, unethical, immoral, or wrong to write a well-worded note that says "looks like he had the flu."
No one is talking about the patient lying. The prompt says he had flu like symptoms during the cruise and came to you after for a note. It then asks if you would write the note. This is not a verbal reasoning prompt where you can assume everything is true. You are one of the characters in the prompt, dude. You are the doctor. You were not on the cruise, so you cannot definitively say that he had the symptoms. All you can say is that he reports having those symptoms. Whether or not that will suffice is up to the cruise line. But you should indicate to your patient that what you wrote is as far as you can go, since saying he definitely had the flu would be lying, since you can't say for sure--which is fraud.

I guess this is why they ask these questions. Jeez.
 
  • Like
Reactions: MDProspect

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
For the last time, man. The policy is there so that they cruise can avoid refunding. Your note doesn't work. And who the heck you think you are to tell them who deserves what?

"looks like he had the flu."
Were you there?

The only way they will ever get a refund is for you to lie about their having the flue BEFORE the cruise, or your patient skyped you, none of which happened.

Your note doesn't work. And since you were so eager to "help" the patient, they come back and ask for one that works. What now? Why wasting time in the first place?
No one is talking about the patient lying. The prompt says he had flu like symptoms during the cruise and came to you after for a note. It then asks if you would write the note. This is not a verbal reasoning prompt where you can assume everything is true. You are one of the characters in the prompt, dude. You are the doctor. You were not on the cruise, so you cannot definitively say that he had the symptoms. All you can say is that he reports having those symptoms. Whether or not that will suffice is up to the cruise line. But you should indicate to your patient that what you wrote is as far as you can go, since saying he definitely had the flu would be lying, since you can't say for sure--which is fraud.

I guess this is why they ask these questions. Jeez.
I'm going off the prompt, not assuming anything else.

If Company X knows that I wasn't there, then a note from me saying that he was probably sick on their cruise, based on his symptoms, should suffice.

Of course you can't say he 100% had the flu. You weren't there. It's in the prompt.

I wasn't on the cruise, but the prompt says he did have the symptoms! He's telling the truth. So, I'll bite the bullet and side with my client.


---
It is so easy to cover your own ass and not do anything. It's such an elementary response to tell the patient, "Sorry, no can do. I might get in trouble." I'm answering what I would actually do; not what my team of lawyers would advise.
 
Last edited:

Matthew9Thirtyfive

*breathes in* boi
Moderator
2+ Year Member
Jan 11, 2016
15,107
22,385
Status
Medical Student
I'm going off the prompt, not assuming anything else.

If Company X knows that I wasn't there, then a note from me saying that he was probably sick on their cruise, based on his symptoms, should suffice.

Of course you can't say he 100% had the flu. You weren't there. It's in the prompt.

I wasn't on the cruise, but the prompt says he did have the symptoms! He's telling the truth. So, I'll bite the bullet and side with my client.


---
It is so easy to cover your own ass and not do anything. It's such an elementary response to tell the patient, "Sorry, no can do. I might get in trouble." I'm answering what I would actually do; not what my team of lawyers would advise.
Nice ninja edit to remove the snarky comment. But for someone so snooty, you seem to be having a difficult time grasping the point of the prompt. If you say anything more than he reports having those symptoms, you are committing fraud. Whether or not the cruise line will accept your note is irrelevant. The point is that he is asking you to write a note confirming he was sick, which you cannot legally do since you weren't there.

"But the prompt says he was sick!" And? This is not a CARS passage where you are some third party impartial observer making a decision using all the known facts. You are the doctor in this situation, and since you were not with him, you can't know for sure. By saying he was definitely sick, you are putting your license on the line by confirming symptoms and a dx that you did not personally see. That's what you don't seem to understand. You can't just take for granted that he's telling the truth, because that's not how the law works.
 

To be MD

Med School Or Bust
7+ Year Member
Mar 15, 2011
913
936
Status
Medical Student
Nice ninja edit to remove the snarky comment. But for someone so snooty, you seem to be having a difficult time grasping the point of the prompt. If you say anything more than he reports having those symptoms, you are committing fraud. Whether or not the cruise line will accept your note is irrelevant. The point is that he is asking you to write a note confirming he was sick, which you cannot legally do since you weren't there.

"But the prompt says he was sick!" And? This is not a CARS passage where you are some third party impartial observer making a decision using all the known facts. You are the doctor in this situation, and since you were not with him, you can't know for sure. By saying he was definitely sick, you are putting your license on the line by confirming symptoms and a dx that you did not personally see. That's what you don't seem to understand. You can't just take for granted that he's telling the truth, because that's not how the law works.
If the patient is telling the truth, as the question stem states, it is not fraudulent to say he was symptomatic of the flu. Alright, man.
My 'snooty' comment was, "wouldn't want you guys to be my physician." Truly wouldn't.

Done with the argument. You win. I would totally side with the cruise line. It would be completely immoral to be otherwise. Of course!
 

Matthew9Thirtyfive

*breathes in* boi
Moderator
2+ Year Member
Jan 11, 2016
15,107
22,385
Status
Medical Student
If the patient is telling the truth, as the question stem states, it is not fraudulent to say he was symptomatic of the flu. Alright, man.
My 'snooty' comment was, "wouldn't want you guys to be my physician." Truly wouldn't.

Done with the argument. You win. I would totally side with the cruise line. It would be completely immoral to be otherwise. Of course!
Wow. You still don't seem to get it. Not sure how to break it down more than how I already have, so maybe someone else can take a crack at it.

You are the doctor in the prompt. You do not know if the patient is telling the truth, exaggerating, just drank a little to much, whatever. You may have a good relationship with him, but that doesn't give you absolute knowledge of his history.

You cannot say he had those symptoms if you weren't there. It's that simple, legally. The fact that you can't see why making a false statement on a legal document is fraud is concerning.