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One For The Lawyers

Sat Jun 11, 2011 5:23 am

So I see a fair number of foster kids in my practice and I'm used to having to take 30 seconds at the end of a visit to fill out a little summary form for the court.

I'm also one of the few general pediatricians in our county who takes the local Medi-Cal insurance and who is willing to evaluate and manage kids with ADHD. Their other option is to go to County Mental Health, with a waiting list of over 4 months (and, frankly, crappy care).

Now, I've treated foster kids with ADHD before and had no issues until today when a foster mom asked if I'd received the form from the court that I had to fill out. I got back to my office to find my assistant putting it in my inbox, fresh off the fax. The form claims that it is required of all foster children being prescribed psychotropic medication. It is three pages long. It asks detailed medical questions and asks me to list risks, side-effects, benefits, etc. etc. etc. It apparently must be filled out every time a dose is adjusted. It took me over five minutes to complete.

Now this is new to me, but after I was finished filling it out and the patient had gone home (now doing very well on ADDERALL XR 10mg daily), I got to thinking about it. On the one hand, I share their very reasonable concern about foster children and inappropriate medication with psychotropic meds. On the other hand, I'm a busy primary care pediatrician who works very hard to provide competent and compassionate medical care to my patients at the rate of one every fifteen minutes. I simply do not have the time to fill out paperwork this voluminous every time I start or adjust a med for a foster kid (and I see a fair number of them). I don't get paid extra for this, but rather I do it because I like to, and because it's rewarding work.

I'm certainly willing to be reasonable. I can provide a copy of my clinic notes which I do try to make well-written and complete enough that anyone who knows how to read a medical note can sort out what is going on without too much trouble. But if this is the new court policy, I can't do it.

I do care about these foster kids and I want to continue to help this disempowered population out, so I'd like to come to some agreement with the court and with Child Welfare about this so that I can continue to provide these kids with this badly-needed (and scantly available) service.

Given your experience with court systems like this, what do you think is the best course of action to achieve the desired outcome?

[Edited 2011-06-10 22:24:46]
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RE: One For The Lawyers

Sat Jun 11, 2011 3:34 pm

I'm not a lawyer but it sounds like that form was designed by one, or someone who wasn't a lawyer.

Is it possible for the Doctors who might receive one of these forms to explain to the court how much standard information is on the internet? Google the medication and go to the manufacturer's site?

More importantly, who uses your input to make a decision? If it's someone who is going to rubber stamp it then why bother - just go on the existing decision of the Doctor. If it's someone who will refuse to approve it, are they a Doctor? Obviously not or they wouldn't need all that information.

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