Last month I was flown to Houston to testify in a custody court case that centered around a Houston pediatrician's letter. He, I think unintentionally, alleged that the child's father was negligent in not applying "Premarin" cream regularly and caused a "morbid" labial adhesion. I had to testify in the father's defense. I had informed him that I treat labial adhesions when symptomatic (UTI, dysuria). I did not discuss it with him, but I strongly suspect that the Houston pediatrician would like to have that letter back. I think your word "careful" is the key. I am very careful writing any letter that I know will be used by a parent against another one. On a lighter note, a mother asked for a letter last July instructing the child's father not to give him a "burr" haircut. She wanted me to use skin cancer as the medical reason....I told her that I hadn't seen those studies, and that I would have a hard time writing the letter with sons at home with the same cut. Rick Rogers MD, general peds > I'm frequently asked to write letters for families for various reasons. > Sometimes there are obvious medical needs, such as a justification for > speech therapy, for Neocate in a completely formula intolerant infant, etc. > Sometimes an insurance company has denied a legitimate claim, or if > they're applying with a new insurance company they need a letter explaining > a resolved or controlled medical condition if the company is claiming > "pre-existing condition." But there are also requests for legal reasons, > often in a divorce situation where one parent wants a letter stating that > they came to all the appointments and were compliant with instructions > while the other parent never came to the office. These legal letters, > while factually accurate, can be misleading if introduced as an isolated > document in a divorce proceeding (as one annoyed parent pointed out to me - > after the fact). I've tried to become more careful about writing letters > in this situation, I'll choose my words very carefully, and I'll tell the > parent that I'm going to cc: a copy to the other parent. The worst > situation I've encountered like this was one where the father was accusing > the mother of Munchausen by Proxy and the mother claimed the father was > being manipulated by his sister, a child psychiatrist. I was caught in the > middle, had no idea who was telling the truth (if either of them were) and > the only winners in this case were the attorneys. > > Today a mother asked me to write a letter because her son had a hernia > diagnosed by me the day after he was in a car accident, and she wanted the > auto insurance to pay the out-of-pocket medical costs of the hernia repair. > I explained that the accident didn't cause the inguinal opening to appear, > though the accident and the subsequent crying "might" have caused enough > intra-abdominal pressure to result in the protrusion into the scrotum, thus > enabling me to diagnose a previously undetected hernia. Since the office > note also stated, "scrotal swelling seen x3 days" and the accident had > occurred only one day before I saw the hernia, it turned out I couldn't do > much for her after all. > > But this got me to thinking about requests such as this. She also wanted a > complete copy of the chart for the legal proceedings. This would take > about 15 minutes or more of staff time. Had I written the letter, it would > have taken me about the same time. Some of these letters have taken 30 > minutes or more since I really want to be very precise in what I write, and > this is a responsibility that cannot be delegated to office staff. > Obviously there is no reimbursement for these services (probably not many > attorneys who would do this at no charge). While I don't mind when there > is a true medical issue involved and I'm helping the family and/or child > with a health issue (especially if it's to help obtain coverage for denied > services or a new insurance policy), I'm not sure if composing a letter for > a parent's legal battle should be a pediatrician's responsibility, unless > the pediatrician believes that the issue directly affects the child's > health (as in MPB, for example). > > Anyone have any thoughts, experiences, office or personal policies, etc. > that they'd want to share? > > Michael Sachs, M.D. > General Pediatrician > group. >