The second of the two pediatric specialists I've been speaking with had this to say about Mrs. Palin's pregnancy:
I’ll start off by saying that most doctors are honest and try to follow all applicable rules and laws. Of course there are some bad eggs that will lie, cheat and steal but they are the exception.
As a doctor you are often caught between conflicting interests. On one hand you have sworn to “do no harm” via the Hippocratic Oath, thereby putting the patient first. On the other hand, you have to make a living, remain accountable to your practice or employer, and don’t forget the insurance company that pays the bills. I’ll start with a few real life examples to make the point.
Often, I’ll have a parent who asks me to keep their baby in the hospital an extra day or two because they aren’t able to take her home on a particular day. Sometimes it’s because they can’t get off from work, other times it’s because they’re moving. My rule is to look at each situation individually. If the parent has a solid reason for not taking their baby home on a particular day, and the baby could potentially be harmed by the discharge, I’ll put the reason in the note and generally, the insurance company will pay for the extra day. If the parent’s reason for delaying discharge is simply for their convenience, I warn them that the insurance company may deny the extra day and they could get the bill. I will not “fudge” my note.
Of course, there is a gray zone between a solid reason to delay discharge and a flimsy one. One time, I had a parent who was very scared to take her baby home. He was a tiny preemie and had been medically unstable for a long time and had finally straightened himself out. I warned the parents ahead of time that the discharge say was coming. On the discharge day, I called the mother and she said she couldn’t take her baby home. It turns out that she had called in the pest control folks and they would be fumigating her home that day. I’m sure that she purposely scheduled that appointment on the discharge day as a delaying tactic.
I called the case manager, the intermediary between the doctor and insurance company. She reads the charts every day and advises us on insurance issues. She said the extra day would be denied if I thought the baby was otherwise medically ready for discharge. I was between a rock and a hard place. However, this mother was very resourceful and she figured out how to assure that her baby wasn’t going home that day. She had delayed taking the baby’s prescriptions to the pharmacy and they wouldn’t be ready until the next day. I couldn’t send the baby home without his medications, so that settled it.
If I have a difficult parent who is demanding that I do something improper or unethical, and I realize I can’t solve the problem myself, I go straight to risk management. They contact a lawyer and advise me on how to proceed. They usually start by helping me with the language in my notes that explains the situation and would protect the hospital and myself from liability. If the situation escalates, I would let the lawyers handle all of the communication.
Ok, now lets move from reality to the wildly hypothetical. Let think about a big lie, like a fake pregnancy. They say if you drop a frog in boiling water it will jump out, but if you put one in warm water and turn up the heat, it will slowly get cooked. This probably isn't true, but does explain the two ways a big lie like this could proceed.
What if a patient asked their doctor to lie about their pregnancy? This is an easy one. No doctor who cared about their professional standing and their ability to practice medicine in the future would do this. No one who gave up at least 7 years of their life after college to become a doctor would willingly say yes. End of story.
However, let's say the doctor started by caring for a pregnant teenager. At first they were just asked to keep it quiet and not talk about the case with anyone. This is not unusual and is probably how it would start. At some point, however, what if the parent asked for a note from the doctor that the teenager needs to stay home from school for something other than pregnancy, such as mono? Now a line is being crossed, but it still is somewhat understandable and a doctor wanting to please their patient might do this, especially if they’ve known the family for a long time
What if the mother then asks that the name on the records be changed to her name? What if the teenager’s mother starts wearing a pillow under her shirt and claims she is pregnant? What if this mother is a prominent public figure? At this point the doctor is past the point of no return and probably feels like she has no choice but to follow through with the whole lie. Time to get a good lawyer and let them take care of the transition from doctor to defendant.