Contracts and diabetes   (September 27, 2007)

A while back, I received an e-mail asking if "oaths" are an appropriate part of the patient-doctor relationship, and if patients should be asked to sign oaths, and if doctors also should be signing an "oath" for their diabetic patients.

Granted the word oath seems a bit strong, let's replace that word with "contracts." Then the answer is yes. Patients should have a written outline of what is expected, and both the doctor and patient should sign off on the document.

Is it practical? Sure. I did it for many years in private practice: every patient got a handwritten report of what we discussed, what their lab showed, what their targets are for the next period of time, and advice on how to handle their diabetes. Then I signed it, asked them to also sign (no one refused), then gave them a copy (and kept one in their medical records).

Why isn't this commonly done? Well, it's work. But for diabetes, I think it was worth it: no question about what we said (whether talking to the patient next time, to the referring doc, or to the clerks at the health insurance companies).