In the editorial "Forms, lies, and advocacy" [BCMJ 2014;56:213], DRR neatly skewers those medically qualified racketeers who unscrupulously support their equally unscrupulous patients' disability claims. It is, of course, axiomatic that behind every fraudulent disability claim there exists an equally fraudulent medical certificate. After all, sans this authentication such swindles would have no legs at all on which to proceed. DRR's piece ends with the author wondering why some physicians are willing to support such a fraud. This rhetorical wonderment is surely whimsical, the answer being patently found in the old Latin saw, cui bono. As always, cash is king. For some practitioners, the bar is simply set that low.
Elsewhere in the same issue of the journal, another dishonorable practice is described by Dr Keith White, chair, Patterns of Practice Committee [BCMJ 2014;56:223]. Dr White offers words of wisdom to doctors who indulge in this unethical practice. Dr White notes the Billing Integrity Program has seen an increase in the number of physicians engaged in this other swindle. While Dr White spells out clearly how such practice is a contravention of both the MSC Payment Schedule and the CMA Code of Ethics, he also counsels "Billing a $30 visit for a family member is not worth the risk of being audited," plus the warning "Physicians whose family billings exceed $1000 are now being reported to the College of Physicians and Surgeons of British Columbia." This is more of a watch-out article than a smarten-up one. Not so much, don't do this at all, but rather, don't do more than $1000 worth.
Every barrel of apples has a few bad ones, and the College's published disciplinary actions detail those of us who are found to be grievously wanting. DRR and Dr White highlight other patterns of practice that most doctors would find shameful, one of which is on the increase. Recently, I had occasion to draw the attention of one lawyer to the shady practice of another. The first lawyer acknowledged the legal profession has its share of bad apples. He quantified it this way: "There's froth at the top, dregs at the bottom, but the middle third is really quite sound." I wonder how our own barrel is presently divvied up.
--Gerard Ponsford, MBBS
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