"ORDER!  ORDER IN THE COURT!!" The judge bangs his gavel furiously and yet the din reaction to the verdict is too much.  He falls back into his chair and sighs, with members of the press taking pictures, conducting interviews, and giving expert analysis.

The guilty party sits in stunned silence, staring forward without focus.  His attorney tries to engage him, offering reassurances that an appeal will be made and will be successful.  Family members sit and weep in the courtroom gallery.

Outside in of the courtroom, the prosecuting attorney makes a statement to the press.  "We feel that justice was done in this case.  The facts were clear, and the guilt was obvious.  The jury had no choice but to declare guilt."

Next to the attorney is a woman in a long white coat.  Her face shows satisfaction, but a touch of sadness is evident.  She comes to the microphone and is engulfed in camera flashes and shouting reporters.  She points to a reporter in the front of the crowd and the room grows quiet.

"Doctor Jones, I was wondering what your emotions are in this case.  You seem to be mixed in your reaction."

The doctor looks to the floor and takes a deep breath before speaking.  "Yes, I am ambivalent about all of this.  Mr. Smith has been my patient for ten years, and I thought we had an honest and open relationship.  I'm really disappointed that this could happen.  Yet on the other hand, the offense was clear and the law is plain.  I am always in favor of seeing justice done, even if it hurts.  An example needs to be made to patients everywhere so this won't happen again."

"When did you begin to suspect this was going on?" another reporter shouts out.

"I actually had my first suspicions when he filled out his new patient form ten years ago.  On that form is a question about whether the person has ever smoked, and he checked the 'no' box, but I later found out that when he was 14, he tried a few cigarettes with friends."  The crowd gasps and hands shoot up in the crowd of reporter, but the doctor continues, "I tried to tell myself it was an innocent oversight, but in hindsight I should have seen the writing on the wall."

"Were there other incidents between then and the most recent...uh...falsification?" Asks a woman in a well tailored business suit.

"Yes, there actually were.  He would repeatedly tell me he was taking his medication every day, but I later found out that he would often forget to take his pills on Sunday.  The pharmacist alerted me to this when he was two days late filling his prescription.  When I confronted Mr. Smith on the issue, he made some lame excuse about his wife going to the emergency room.  It's one thing to be a terrible patient, but it's another to lie and pretend you are a good one."

"Anything else?" a voice in the back of the room shouts.

"There was one more incident that got me watching him closely.  He told me he had cut back on his overeating and was frustrated that he was not losing weight.  That very same day I saw him in the supermarket buying Twinkies and Ice Cream.  He knew he had been caught; he wouldn't look me in the eye.  Then he went over to the produce aisle and filled his cart with cantaloupes, but I knew it was just a ruse."

"So about the Review of Systems guilty charge," the woman in the business suite interjects, "what do you think was the thing that convinced the jury: the headache omission, or the false fatigue claim?"

"I think it was the headache, because it was a blatant lie.  I think he got confused about the fatigue - after all, he does get tired every night.  He should have realized I meant decreased energy, and not sleepiness, but I can deal with that mistake.  But to say he didn't have a headache in the past two weeks when he told his wife just ten days earlier that his head hurt, that is a lie.  There is no better way to put it."

"Do you think the penalty is fair?"  the first reporter asks.

The attorney steps up to the microphone and the doctor backs up. "I'll handle this one, since it is about the law.  Yes, we do think that having to wait an extra 30 minutes in the waiting room every visit along with the extra colonoscopy is fair.  But we did feel that changing his medications to non-formulary drugs and requiring prior-authorization would have served as a better deterrent."

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Note to patients: you don't have to fill out the forms perfectly.  They are not being graded.  Please stop apologizing for this.

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