If the Wall St Journal was doing an article on life insurance applications and how underwriters interpret your medical records they would have their hands full. Without exaggerating most medical records contain errors and ambiguous notes. To be fair to the underwriters they weren’t present at your doctor appointment to hear the real tenor of the conversation and any recommendation. The office notes might say something like, “discussed snoring – provided referral for sleep study”. Very few doctors tape and have their conversations transcribed into the records of their patients, so that note from the records came from a longer discussion that might have gone like one of these….
1. The husband brought his wife along when he came in for a regular checkup and the wife decided to bring up her husband’s snoring. The doctor noted that snoring is a problem that can be caused by a number of things from sleep position to upper and lower jaw alignment to allergies. It can also be caused by sleep apnea. So the doctor sends the patient on his way with material on ways to determine and fix the majority of snoring problems. If none of those ideas seem to help, “here’s a referral (prescription) for a sleep study if you decide it’s necessary”.
2. The husband and his wife come in specifically to discuss a snoring issue that has become a real issue when the lights go out. They discuss all of the possible reasons for the raucous night time cacaphony and the doctor tells them several things they can try, but says, “It might be worth getting a sleep study just as the quickest way to figure out what’s causing the snoring, so here’s a referral if you decide that’s a direction you want to go”.
3. The husband comes in complaining of feeling tired and lethargic during the day. He says he’s been checking his blood pressure at Safeway and it’s been running kind of borderline by the chart they have. He also shares with the doctor that his wife has complained that he frequently snores very loudly and almost seems like he’s gasping for air. The doctor explains sleep apnea can cause the symptoms and then says, “I think you should get a sleep study. While it could be something else, the symptoms you’ve described are a red flag for for sleep apnea. I’ll have our sleep study clinic contact you to make an appointment. Make sure they send a copy of the results to me.”
All of those scenarios could be summed up by “discussed snoring and provided referral for sleep study”. Scenarios 1 and 2 make the sleep study an option or a consideration that the doctor is leaving up to the patient Number 3 is telling the guy that he really needs to have this checked out. He’s telling the guy to get it done and have a copy sent to him. So, no one ever stops their doctor and asks them how they’re going to write up your office notes? Almost no one ever looks over their office notes to see if it seems right to you? And no one ever tells their doctor to be clear in their notes if it is an order or an option to use that referral he gave you? A little attention to those records may be in order.
And when your medical records hit the desk of a life insurance underwriter they will put a screaming halt to your application because your records say “provided referral” for a sleep apnea test and you never did the test? In scenarios 1 and 2 you had an option for the testing and a referral so you wouldn’t have to go back to the doctor and ask for one. The life insurance take on that is that you are non compliant with your doctor’s “orders”, when it could be as simple as you went home and your wife raised your side of the adjustable bed and just like in the commercials, you quit snoring and therefore you never used the “option” of having a sleep study. If option 3 was you then you’re stuck getting a sleep study unless you can get a second opinion saying it isn’t necessary. Much easier to get the sleep study.
Bottom line. A lot of doctors are good at health care, but very few are good at making sure their records and intentions are going to be clear to someone else reading them, or even clear to them at a later date. We unravel these misunderstandings fairly frequently so if you have questions or need help getting past a referral that was an option and not an order, call or email me directly. My name is Ed Hinerman. Let’s talk.