Trampled On

wall sculpture of a battle scene with men crushed under foot
“Her neurologist took her off work for six weeks. He told her that her primary care physician had to complete the FMLA and short term disability paperwork**.”

“But I haven’t seen her in three months. He has been managing her. HE is the one who took her off of work. AND I have no records. No consult notes or anything!”

“She’s pretty upset.”

“I don’t blame her.”

I picked up the phone and dialed the neurologist’s number. I told his staff that I was not going to complete the paperwork*** because I felt it was his responsibility. 

“I’ll talk to him and then get back to you.”

Fifteen minutes later:

“Fine, we’ll do it but sometimes these things get denied.”

“You think that I will have better luck getting it covered? Or is this about making the patient mad at me instead of you when it gets denied?”


I have had a ton of these situations come across my desk lately. All specialties. When did this become standard? The truth is, I hate filling out that paperwork as much as the next physician but if I am referring a patient to a specialist, I expect that physician to manage all aspects of care pertaining to why I sent that patient to them. If you don’t think they need to be off of work, I support you 100%. You shouldn’t have to fill out anything.

But if you DO take a patient off of work, YOU do the paperwork. 

….Or, I stop referring to you.

*FMLA (Family Medical Leave Act) allows certain employees to take up to 12 weeks off in a calendar year for a serious medical condition or to care for someone else with a serious medical condition. It is unpaid leave but it does make sure you have a job to come back to. For a physician it is about five pages of stupid questions to complete.

**Short term disability is a policy you have through your employer that pays you a certain percentage of your salary when you have to be off work due to a health condition. It is another three to five pages of questions.

***I would never, ever leave a patient without their paperwork completed. If the physician had continued to refuse, that patient would have gotten their paperwork done by me.  The patient should not be penalized for something they have no control over.


72 thoughts on “Trampled On

  1. They are dumping unpaid work (i.e. paperwork) down the line to try and save money. So much for helping the patient. They’ll try but if you refuse they’ll do it. There are hidden warranties on cars like that. If you don’t demand the repair free of charge, they won’t offer. I’ve seen this before. It is a scummy way to do business.

    You know, I was waiting at a major truck garage here in Ottawa to pick up a truck that wasn’t quite ready. They were stupid enough to allow me to roam around in the employee area, ostensibly to get a coffee from the lunch room. I walked into a board room and a presentation was laid out on the board with work materials at each seat for employee use and study. It was set up for a presentation later that day. Here is the gist of it: Customers pay for our services by the hour, hence the more hours we can bill, the more profitable we become. So here are suggestions on on increasing billable hours: do not use shortcuts – follow the manual; when a truck is presented spend at least 15 minutes checking for other problems; bring other problems to the customer before their truck is fixed and insist that it is a safety concern that you can’t release until it is fixed; do not punch out of the job during breaks or lunches; use the most expensive parts for the job; make sure customer is billed for clean up of floor and all tools; use any other means necessary to delay and add hours to the invoice.

    That was actually written on the board and reproduced in the employee material. I called our fleet manager and told him what I had seen and he stopped using that garage.The garage service manager found me in the conference room and he was very angry and threw me out. Good for business.

    Liked by 3 people

    • Technically, they are allowed to charge for it. We charge $35 in our office (though I let that slide most of the time). The whole system is abused which leaves a bad taste in physician’s mouths and that is part of the problem. I will do some future blogs on that next. As for your story, gah! Crap like that permeates everything.

      Liked by 1 person

      • I was going to ask if you charge to complete the paperwork. The hubs was having chest pains last Monday morning. He went to his primary care physician who admitted him to the hospital for observation and to get a cardiologist to have a look. The cardiologist had a look, decided to forego the stress test that was ordered and head straight for a cath which yielded two stents. Aside from the obvious stress, now we’re trying to figure out who is supposed to be filling out this FMLA paperwork.

        I just got off the phone with primary care’s office. He’s the doc who signed the “out of work” papers. They want to charge $100.00 to fill it out. “It’s a binding legal document,” she said. O_o

        Liked by 1 person

      • Hubs has the day off today so he is going to the cardiologist office to see if they will fill the form. I have no opposition to paying a fee for the form to be completed but $100.00 seemed ridiculous. I was in utter shock when she said it. I think I made her repeat it three times.

        The whole time I’m thinking, okay, he just had a week off with no pay, went back too early because…money…and we’re already going to owe you a nice chunk of change, and you want how damned much for this to be filled out?!?

        This was all taking place in my head. Meanwhile she’s telling me she can ask doc if he’ll reduce the fee, but there’s no guarantee that he will. Then she tacks on for good measure, “You have to have the form either way.” She was sure to let me know that they have me over a barrel. Nice.

        Liked by 1 person

      • Yes, fortunately, he did. He walked in with the papers, the receptionist took them to the admin, the admin came out and said they’d be done by Wednesday. For $25.00. Whew!

        I’m so glad we didn’t have to rely on his primary care to do it. I get that there’s a fee. I get why there’s a fee. I don’t even mind paying a fee. But $100.00 is crazy.

        Liked by 1 person

      • He has a follow up appointment on Friday with his PCP. He plans to speak to him directly. But that was just insane. I really do hope that wasn’t his insurance clerk’s way of just getting out of doing the paperwork. :/

        Liked by 1 person

    • Oh my. I have never doubted that stuff like this happens, but to actually see such a plan laid out like that? I thought it would be things they just tell their staff to do, but not in actual trainings / meetings. It’s like teaching evil.

      Liked by 2 people

    • The majority of specialists are really great and they take care of my patients. Part of the problem is being forced to only refer to certain physicians within the network. That is not always the best physician. I am now dealing with a lot of new specialists that I have not had to work with before which is, I think, where most of this is coming from.

      Liked by 3 people

  2. Every time you write one of these posts I am more educated about the mess this side of the medical system is in. You must have to employ staff just to keep on top of all this paperwork. Do doctors have ongoing training in all this? Do they teach all this to you? Give you consultants? c

    Liked by 2 people

    • We do have to keep a growing number of of people to keep track of the paperwork. For instance, I have a pregnant patient who is seeing an OB. She needs antenatal testing. Her particular insurance company will not allow her OB to do the referral for the testing. I have to do it. We have to fax and call her insurance company with various obscure numbers and info to get a referral approval number that we then have to pass on to the OB. Never mind the fact that I have not seen her in over a year and will not get paid for doing this paperwork. That will take some member of my staff about 30 minutes to do. Stupid busy work designed to make it difficult for the patient and everyone else.


  3. Back before I retired I wrestled with FMLA paperwork, myself. Not just as a patient with a job, but also as a union steward representing other patients with jobs. For us workers, it can be very frustrating trying to get physicians to complete FMLA paperwork. I employed the method of filling out as much of the stupid forms as possible myself, on a sample form, to make the job easier for the doctor. But doctors seemed to view this approach with suspicion.

    Altogether, the paperwork leads to tension between doctors and patients and workers and employers. I had no problem with paying the fee (usually around $25 – $35). If only it were as easy as paying the fee! The biggest problem was getting the doctors to complete the paperwork in a proper and timely manner.

    Liked by 2 people

      • That’s why if you can get a steward from the employee’s union to help you out with it, there’s a good chance you can get it right the first time. Assuming your patient has a union.

        I knew what was needed on these forms. And if the needed info was on there, and management rejected it anyway (which was common), I’d start a grievance rather than allowing the employee and doctor to be inconvenienced again. Management almost always backed down as soon as I started the legal motions.

        Liked by 1 person

  4. My poor GI specialist has to prepare FMLA paperwork for me every 6 months (and for my husband since my husband sometimes has to take time off from work to help me), and his staff does it quickly, efficiently, without complaint, and without charging me for it. Same thing with my primary physician – who has to do FMLA paperwork for me, my husband, and my mother-in-law.

    It used to be that if you were legitimately sick with a long-term condition, you just got a note from your doctor at the beginning of the illness. It was much easier then.

    Liked by 2 people

  5. I had a friend who just had to go through this…many calls to get the paperwork filled out.
    Forms with stupid questions are rampant.
    And everyone is unhappy.
    Great artwork to illustrate. (K)

    Liked by 1 person

  6. Amen, sister! We all need to own our own stuff and do what’s right for the patient. I will often ask patients to go through the questions themselves first, and complete all of the obvious, demographic questions. Then I ask them to put stickies on the form where they need me to write, and bring everything I need to do it–records, etc. This makes them familiar with the form themselves, and gives them a glimpse into our bureaucratic world. I ask them to schedule an office visit to complete the form together, so they can go home with a photocopy. If they come for the visit then the form fee is waived–they have paid with their time and their copay. In the end it can actually serve to bond us–we the patient-physician team, working side by side to get them what they need, swimming upstream in the muddy torrents of a broken system.

    Liked by 3 people

  7. And will you refer to this neurologist in the future? Passing the buck at the expense of one’s patient. Not cool! We need more compassion like what you express in your writing and I’m certain extend in your practice/hospital.

    Liked by 1 person

  8. Filing FLMA in NY is no big deal. I did it once in case I was going to need surgery. Took two seconds, I filled out some, the MD did the rest. NO charge.
    HOWEVER… I want to know who the Dickhead MD’s are who sign just about any workers comp application out there. I have gotten to the point I know prior to hire who is going to “get injured” and be out on comp. It is a business, I swear. I review all staff injuries and incidents I know what is legit and what was premeditated. If people only knew what we pay for our Mod rate for WC, people would be appalled.There has to be some payola…..

    Liked by 1 person

  9. Odd. In most private setups in India, it’s the PCP or equivalent who calls the shots (might even be the local pharmacist or optician as in my case). Without referrals, where would specialists be? I admit there’s nothing pt specific in why they do it, it’s pure commercial good sense….

    Liked by 1 person

  10. While I sympathize with you as an honest physician bemoaning the drudgery of paper work, I must note that nobody here, not you nor any commenter, has acknowledged the elephant in the room. This is from The Fiscal Times:

    Since 2010, federal authorities operating as part of the “Fraud Takedown” initiative have arrested and charged roughly 1,200 people allegedly complicit in defrauding the Medicare and Medicaid programs of more than $3.5 billion.

    That’s “billions”, not “millions”. That’s thousands of millions. As taxpayers, this ought to concern all of us. Paperwork is required in order to prosecute the crooked “doctors, nurses, licensed medical professionals and health care companies” who did this. If you have a better way to make the system work, I’m all ears.


    • FMLA and short term disability have absolutely nothing to do with Medicare or Medicaid. But for Medicare let me give you an example of the paperwork. For insured patients I just write an rx for diabetes testing strips and send it electronically to their pharmacy for a 1 or 3 month supply with PRN (as needed) refills for a year. For Medicare I have to write the prescription, write the diagnosis code for diabetes on it, I must specify a number of refills rather than PRN, then I have to physically print it out, hand sign it, and then physically fax it to the pharmacy. I fail to see how that prevents fraud. An example for Medicaid is a patient with cerebral palsy who need diapers, barrier skin cream, wipes, and pads. I completed the paperwork no less than five different times, each time being told that something needed to be changed. Incontinence or neurogenic bladder or cerebral palsy by themselves are not good enough, it had to be the combination with certain modifiers in place. THEN it was sent back because they wanted a letter stating what the forms say to include with the form. Then it got sent back again. The company could not tell me why it was denied. They resubmitted the paperwork again three times, called the state, and then finally were told that everything was completed correctly the only problem was that the letter needed to state that the barrier skin cream was for barrier protection. Seriously. FOUR months of back and forth to get this patient their supplies. That is not going to help prevent fraud.


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