F***; One of the Worst Words to Hear in Your Busy Workday

Written by: Dr. Nathan Turner

Form… probably the worst four letter F-word. But it’s that time of year again! No, unfortunately not the (finally) beautiful spring weather we’ve been eagerly awaiting after months of bitter cold. I’m talking about tax season! Which means many of us have received a request (or two… or ten) to fill out Canadian Disability Tax Credit forms.

Can’t Live With Them, Can’t Live Without Them

If you were to poll family doctors about what they like least about their jobs, I’m pretty sure everyone’s top ten list would include “forms” or “paperwork”. It’s no fun, most of the time feels like useless bureaucracy, and rarely seems to directly add to patient care.

Among the myriad of possible papers sliding across your desk, frequently you might see:

• AISH application
• Short Term Disability forms
• Long Term Disability forms
• Disability Tax Credit forms
• Blue cross special Authorization forms
• Handicap parking placard forms
• Attending Physician’s Statements
• Insurance history forms
• School/employment/activity medical forms
• Sick notes

…and the list goes on.

Tips and Tricks:

Since unfortunately, we can’t avoid these forms, our FFYFP committee has put together a few tips to hopefully help make them a little less painful:

• Be sure to let patients know that even if they pay for you to complete a form, it does not mean the form will be accepted by their insurance, boss, government, CRA etc. In most cases we are just providing information, and the final decision rests with the organization to which the patient is submitting the form.
• Have a standard policy for form turn around times. Usually around 2-3 weeks is acceptable, but you may want to do it right away, so it doesn’t become a burden.
• Along with the point above, don’t let a patient’s poor planning become your emergency. Many people will come in saying they need forms done by yesterday but that is on them, not on you. Some clinics do charge an extra fee to “rush” forms, but you would need to decide if you are comfortable with that and how to approach it.
• When filling in disability/insurance/tax forms be very clear what “the patient reports” vs what you can confirm to be their functional capacity. Your duty is not to pass judgment but instead just to write what you know. For example, you may say “the patient states they have pain when doing x activity” but if asked for objective findings you should only write what you can confirm on your examination.
• For longer forms like AISH, patients will often have complex medical needs. While AHCIP does not cover fees for the form itself, booking a longer appointment to discuss the patient’s history, symptoms, previous treatment, current life impact, and potential treatment options is a clinical service and may be advisable prior to filling out the form.
• For shorter forms many people suggest filling them out with the patient present to ensure the proper details and history are included, which limits the need to spend time going back and forth to get information.
• Ensure the patient fills out any information on the form they need to provide (ex. demographic info, their own history/description of symptoms, consent for information release, etc.) before leaving the form with you. Work with your front staff to check for this if forms are dropped off.
• Be sure to check the chart for other forms that have been completed for the same issue. Many of them have similar information that you can copy over and save some time.
• For disability forms, if you are lucky enough that your patient has accessed other resources to help with their issue, you can and should ask the patient to have their psychologist, psychiatrist, physiotherapist etc. write you a letter outlining their symptoms/functional capacity and other findings to help support the documentation you are completing.
• Beware predatory tax rebate companies! There are many companies that advertise to patients that they can help them to get disability tax credit for a fee that the patient pays for their service if they get the credit (sometimes a portion of whatever rebate they get for the rest of their lives!). You may want to warn patients not to engage with these companies. If they do go forward, once you complete the report the companies may send you back “suggestions” on what you should write and how to write it to be most likely to get a tax credit approved. Do not adjust what you have written unless you ENTIRELY agree with it, because it is your professional integrity on the line and no one else’s.
• It is often a good idea to set aside specific time to complete forms/paperwork. For some doctors this will be a half day once a week, or long lunches, or a free hour every day where they leave all their physical paperwork to do. Pick something that works for your schedule, so you don’t have piles of forms hanging over your head that seem to take you weeks to complete! It’s not fair to you or your patients.
• The CMPA is a good resource for questions about the medical legal implications of providing notes/opinions. One example is this Knowledge Check which goes through a few cases and provides recommended actions.

Final Thoughts

Finally, don’t feel guilty for charging for form completion. All other professionals charge for their time, we should too. Even if a form takes you 2 minutes to complete you still had to have likely 10+ years of training to complete that form in 2 mins. You are not just charging for your time; you are charging for your expertise/opinion. The AMA Uninsured Services Guidelines to Billing lists some suggested fees for various forms and notes, and discusses the ethics of private billing and all the considerations that go into choosing an appropriate fee. Fees may be adjusted depending on patient circumstances, but don’t sell yourself (and your colleagues) short.

I hope this helps make one of the most unpleasant things about family medicine somewhat less unpleasant! If you have other tips and tricks to share, or any questions on the tips above, please share them in the comments below!