Study says doctors will lie to get best patient care

October 24, 1999
Web posted at: 9:07 p.m. EDT (0107 GMT)

By Medical Correspondent Dr. Steve Salvatore

NEW YORK (CNN) -- Would doctors, frustrated by managed health-care programs with strict coverage limits, lie to deliver the best-quality care for patients? A new study indicates many would.

"When it comes down to something like a nose job or a rhinoplasty, only 3 percent said they would do it. But for very significant things like whether or not they thought a bypass was indicated, and it was being withheld, over 50 percent were willing to endorse fudging the data," said Dr. Daniel Sulmasy, one of the study's researchers.

According to the report, published in this week's Archives of Internal Medicine, many also would lie to obtain what they consider important diagnostic tests -- like mammographies for patients who need them.

	VIDEO
CNN's Dr. Steve Salvatore talks with one of the researchers and with spokesmen for managed health care. Windows Media 28K 80K

"We asked whether the physician would be willing to write on the sheet 'suspicious breast lump,' and more than a third of physicians were willing to do that," said Sulmasy, who works in the Department of Ethics at St. Vincents Hospital and Medical Center in New York.

Dr. Charles Cutler, chief medical officer for the American Association of Health Plans, is not surprised by the findings.

"There's a long history of doctors falsifying or stretching the truth to get things paid for under traditional insurance. I'm sure managed-care companies and insurance companies are well aware of it," Cutler said.

The study found that doctors enrolled in Health Maintenance Organizations (HMOs) and managed-care companies were more likely to lie about reports than those who were not.

Sulmasy offers a possible explanation: "There is a lot of increased bureaucratic hassle, a lot more in the way of denials and a greater willingness in the part of the physicians in that sort of environment to deliberately mislead the insurance company."

Although deception may help a handful of patients, some experts recommend that doctors go through proper channels to get the care and coverage their patients need. Ultimately, everyone suffers because third-party payers pass the cost on to consumers.

"In managed care, the treating physician can always call the medical director and talk with the medical director about the individual patient's case. And in most instances, the medical director and the treating physician can work these issues out," Cutler said.

But other experts consider that approach impractical, and are calling for medical-care reforms that do not force doctors to choose between the truth and patient health.