Balancing a Patient’s Request with a Physician’s Ethical Standards

I am sure that we all get various requests for letters and forms. You know, letters of medical necessity for medications or treatments, and the forms for prior authorizations or the appeals for claims that were denied.

Every now and then, I get other requests for letters to be written and forms to be filled out, and I find that sometimes I am caught between the desire to help a patient out and my moral objection to what they want to accomplish.

For example, I get requests from time-to-time from patients for letters to get them out of jury duty. On the one hand, I can understand how someone with diabetes maybe unable to have access to food or their testing supplies if they have a hypoglycemic episode, but on the other hand, I believe in our judicial system, and feel it is everyone’s responsibility to participate, and sometimes that means being on a jury.

A more troubling request I once received was from a patient who recently got pulled over for a DUI. He had come to the office for a routine visit, and when I asked him how things were going, he said he had been pulled over recently. He admitted he had had a drink or two, but that he wasn’t intoxicated. He asked me if I could write a letter saying that people who have diabetes could have symptoms that make them look intoxicated.

I wrote a letter to that effect, making general statements that under certain circumstances diabetics who have hypoglycemia can be disoriented, etc. I did not make any reference to this particular patient nor did I suggest that he had been hypoglycemic. Later, he called me to ask me to testify in his behalf at trial. At this point, he let me know that he had a blood alcohol level that was above the legal limit. I told him that I did not think I would be able to help him. He asked me to speak to his lawyer. I did, but I was afraid that the lawyer would try to convince me to testify. To my pleasant surprise, he did not. As a matter of fact, he basically told me what I already knew. That it would be waste of the patient’s money, a waste of my time and a fruitless effort.

I want to help my patients out when I can, but I sometimes feel like I am caught between a rock and a hard place when what they ask me to do goes against what I believe is right. I don’t want to impose my moral values on others, but I do have to work within the confines of what is legal and ethical.

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