[Tripping On…] Request Clinical Notes

My insurance company requested doctor/clinical notes as one of three things to continue my coverage, along with an “extension” note for being on medical leave with specific restrictions. This is different than going to an urgent care or drop-in clinic to have a doctor write a note, I suppose, since there is more medical information and history involved than saying something like ‘the doctor saw the patient at this time.’ It’s worthwhile asking for these.

For one, it cuts down on bad behavior.

Although I believe now that I’m in the clear in terms of having doctors act in ways that are not in my best interest, if I would have known back in April or May to ask my old primary care physician’s office for the notes on what the doctor considered of my case, I could have better articulated my case, and possibly sped up the rate at which I could have received the treatment I needed. Similarly with the old pain management doctor; who knows what he wrote in his reports? I had asked the urgent care doctor for clinical notes when she tended to my wound by assessing, cleaning, and redressing it, but she replied that it wouldn’t be necessary because it was so straightforward.

But still, I’m hearing more often, anecdotally, about bad doctoral behavior.

It usually takes the form of doctors not treating their patients seriously. I felt this way with my old PCP. When he told me that he thought I should return to work, even after I told him I had increased pain, his behavior was like that of a parent telling a child to stop playing around. While I would be curious to see what he actually wrote, I’ve burned that bridge, both in terms of communication and in my mind. Whatever he wrote will not reflect how I experienced the events, so there is no point in reading what isn’t accurate, even if it is for the sake of reproduction here.

Instead, let me quote relevant passages of what my current spine doctor dictated:

“Overall he is doing fairly well from the standpoint of his low back. He is not really having a significant amount of back or leg pain. If he sits for an extended period he does get pain in the coccyx.”

“Subjectively he still does note some difficulty with ambulation and is using canes although he believes the weakness that he had in the legs preoperatively has improved. He can get up on his heel and toes at this point. Subjectively has some weakness of doing a deep knee bend but his patellar reflexes are 2+, Achilles absent.”

“At this point, he is making an adequate postoperative recovery. He needs to do some walking and extensions. He was originally scheduled to go back to therapy twice weekly but did become fatigued and had increased pain when he tried to get back last week. I would recommend that he hold off on therapy for three more weeks. He is not able to return to work until he is ambulating normally and able to sit for an extended period. Sitting is currently limited to 30 minutes. We will see him back in three weeks and get him into physical therapy, sooner if he has any further problems.”

This aligns closely with what I relayed over to the doctor.

I would say, then, that the primary point of getting your doctor’s/clinician’s notes, outside of any sort of medical insurance situation like my own, would be if there is any chance in variation between relaying and receiving information. If I tell the doctor that my spine hurts and one doctor doesn’t note it with much regard, then there is a problem in communication. If I tell the doctor my spine hurts and another doctor notes the specifics, or better yet during the conversation asks for specifics, then there is not much of a problem in communication.

Reviewing the notes is the best way to figure out if there is a problem in communication.

If I could have reviewed my old PCP’s notes, where if there was even a hint of skepticism, then I could have reached out sooner to my employer’s other medical resources. I only switched to my new PCP, who I’m much happier with, because the old PCP’s office denied releasing medical information and was such a pain in the coccyx to deal with in regards to releasing any information, to both me or my insurance company, that it became a ridiculous series of unnecessary hoops to jump through. My insurance company representative told me some clinics are ‘difficult like that’ ‘sometimes.’ If I would have known about their bad behavior sooner, I would have switched sooner, and maybe, I would have had my surgery sooner, and my recovery time would have been lesser than it is now.

It’s sort of like a receipt after purchasing an item, then.

As the Mitch Hedberg joke goes: Why would you need a receipt for a donut? Similarly, if the doctor’s visit is for something straightforward, like a donut, the only point of having the financial receipt or the doctor’s/clinician’s note is if the item were more valuable. Having the receipt of an expensive piece of technology or an unreliable device is useful, otherwise, a receipt for a donut is little more than a memento. Going forward, I’ll ask for the notes of what the doctor dictated or wrote in regards to my case more often. Such requests have been useful to see how responsive the medical staff are regarding such requests. If they are tight-lipped regarding releasing medical information to me, then how much worse are they in situations as I mentioned where major parts of my insurance were denied because they failed to release medical information to relevant parties that I stated would be OK to release information to months prior? That was a situation where my doctor and medical staff weaponized HIPAA at my expense.

Now I know weaponized HIPAA parrying.

Quotes: None.
Sources: My personal and professional experiences.
Inspirations: I requested my clinician’s notes in person on my Tuesday doctor’s visit. I was told they would take a few days to arrive. They arrived early Friday morning. I sent them along to the relevant parties and as I was, I thought of this essay’s title. Although some of these essays feel more like private journal entries, I present them at large to help the medical community, from both the doctor’s perspective and the patient’s perspective. Also, wouldn’t Weaponized HIPAA be a funny name for this essay series or e/Book?
Related: Sober Living essays and Tripping On [The American Healthcare System] chapters.
Picture: Template
Written On: 2020 September 18 [Typing clinician’s notes: From 9:57am to 10:02am. Writing: From 10:03am to “or the doctor’s/clinician’s note is” at 10:27am, then from 10:31am to 10:37am.]
Last Edited: 2020 September 18 [First draft; final draft for the Internet.]
My big goal is writing. My most important goal is writing "The Story." All other goals should work toward that central goal. My proudest moment is the most recent time I overcame some fear, which should have been today. I'm a better zombie than I was yesterday. I'm not better than you and you're not better than me. Let's strive to be better every day.