I write to alert my fellow psychiatrists to a disturbing new phenomenon: telephone contacts initiated by insurance companies to "clarify" disability issues. Mental health professionals representing a disability insurance carrier interview the treating psychiatrist and then prepare for their company a summary of the conversation. The company may then terminate the patient’s benefits, implying that the treating psychiatrist concurred in the decision. This misrepresentation can badly damage the doctor-patient relationship.

Out of courtesy to a fellow professional I have participated in a few such discussions, but no more! Here is my response to an insurance company that cited a telephone interview with me as a basis for its determination that my patient was no longer considered disabled:

"That does it! I have participated in my last oral conference with a disability company’s medical consultant. One problem with these interviews is that there is no precise record of what has transpired. Disability decisions are extremely complicated, and discussions regarding disability situations deal with subtle distinctions. I have been suspicious that these conferences will result in my words being turned against me and, worse yet, against my patient.

"Let me again make clear that it is my position in the case of Mr. X. that he is not well enough to work at present. I vehemently object to the misinterpretation and misuse of my comments that your July 24 communication with Mr. X. implies."

Joseph S. Silverman, M.D.

Altoona, Pa.