I notice now that the doctors chart that they've examined patients through x number or systems i.e. cardio, musculoskeletal, pulmonary, etc., so is this to say that the patient was given the old eyeball but not 'examined'?
A practitioner will chart/document examination of systems because the number of systems involved help define the "type" of office visit for billing and coding purposes. More systems = a more complicated visit which typically comes with a higher charge.
On one hand, in developing a differential diagnosis (or trying to figure out what's wrong with you) it is often prudent to do a good, thorough review of systems and physical exam to be sure you're not missing any connections. On the other hand, when your obgyn starts asking you questions such as "do you wear your seatbelt" and "do you text while driving" in order to add more checkboxes, thus charge you more for your visit, then you know he's trying to bilk the system so you fire him.
Just had a 'complete physical" with a new internal med MD who I thought would be a good PCP. Had a couple of sick visits (bronchitis, sore hip). The 'complete physical' was conducted through my clothing - I had slipped off my sandals so he could inspect feet as I was sitting on exam table. He stood beside me, inspected my body from shoulders to hips, palpated then percussed that area through clothing, and then listened to anterior and posterior chest with stethoscope placed on my clothing. I'll be seeking a new PCP (dreadful as the process is) because I don't think a thorough PE on a new patient (or anyone) can be done without ever seeing or touching the patient's skin! 6 pages of computer generated 'health recommendations for my age group' without ANY discussion or attempt to pick out one area of focus didn't convince me that there was anything that he and I could partner on to improve my health or to support my efforts in lifestyle changes. I have an excellent insurance and he is board certified and on staff at one of the major teaching hospitals here, and initial impressions were ok. I'm a nurse, and I have a pretty good idea of what's a 'big deal' and what to let go of. An MD who doesn't do a good physical exam is a technician, not a provider or partner.
Is it permissible to note that "extremities" is spelled wrong on the form, and to comment that one would prefer one's medical employees not to misspell basic terms?
If you don't have patients undress and examine them, you'll be wrong all the time. I weep for the future of medicine and am glad I'll be retiring soonish.
I'm with the "much better that they didn't auto check every normal exam finding that they may not even have examined"....the most important thing is to be accurate to what you did. And, unfortunately a 15 minute outpatient visit does NOT allow for a physical exam head to toe (nor is this reasonable in many patients) nor is there time for this with the number of followups that must be seen in the hospital most days.
Reminds me of an intern I transcribed for who dictated the exact same words for the physical exam for every patient he admitted, regardless of chief complaint or gender or age. He dictated "anion gap" for both anion gap and albumin/globulin ratio. I had to blank every discrepancy and both lab values for each report. The facility finally told us to substitute A/G ratio for the second "anion gap." I used to have nightmares about being in an ER and hearing him say "I'm going to admit you."
Gahhh, I'm an MA/Scribe gaining clinical hours so I can go to PA school. I work at an upscale urgent care that is equipped with more things than a regular urgent care would. I am so tired of corporate telling me I need to make every visit a level 4 no matter what. I don't care but I'm not doing some unethical crap and charting the doctor did something even though they did it. I will only mark things down if I can visually observe them myself or if I can see the doctor do it and then they tell me (RRR,no murmur) I'm so sick of the mandated 10+ body system review etc...
I notice now that the doctors chart that they've examined patients through x number or systems i.e. cardio, musculoskeletal, pulmonary, etc., so is this to say that the patient was given the old eyeball but not 'examined'?
ReplyDeleteThe least he could have done would have been to put check marks on all the other lines.
ReplyDeletestay safe.
anon @ 6:22
ReplyDeleteA practitioner will chart/document examination of systems because the number of systems involved help define the "type" of office visit for billing and coding purposes. More systems = a more complicated visit which typically comes with a higher charge.
On one hand, in developing a differential diagnosis (or trying to figure out what's wrong with you) it is often prudent to do a good, thorough review of systems and physical exam to be sure you're not missing any connections. On the other hand, when your obgyn starts asking you questions such as "do you wear your seatbelt" and "do you text while driving" in order to add more checkboxes, thus charge you more for your visit, then you know he's trying to bilk the system so you fire him.
Just had a 'complete physical" with a new internal med MD who I thought would be a good PCP. Had a couple of sick visits (bronchitis, sore hip). The 'complete physical' was conducted through my clothing - I had slipped off my sandals so he could inspect feet as I was sitting on exam table. He stood beside me, inspected my body from shoulders to hips, palpated then percussed that area through clothing, and then listened to anterior and posterior chest with stethoscope placed on my clothing.
ReplyDeleteI'll be seeking a new PCP (dreadful as the process is) because I don't think a thorough PE on a new patient (or anyone) can be done without ever seeing or touching the patient's skin!
6 pages of computer generated 'health recommendations for my age group' without ANY discussion or attempt to pick out one area of focus didn't convince me that there was anything that he and I could partner on to improve my health or to support my efforts in lifestyle changes.
I have an excellent insurance and he is board certified and on staff at one of the major teaching hospitals here, and initial impressions were ok. I'm a nurse, and I have a pretty good idea of what's a 'big deal' and what to let go of. An MD who doesn't do a good physical exam is a technician, not a provider or partner.
Ortho rounds?
ReplyDeleteIsn't this a level 4 visit?
ReplyDeleteAll else deferred, I mean in addition to the usual deferred, which we all know what those are.
ReplyDeleteIt is nice to see such a clear, concise note. Many times I see 6 pages of bullshit that basically says the same thing!
ReplyDeleteIs it permissible to note that "extremities" is spelled wrong on the form, and to comment that one would prefer one's medical employees not to misspell basic terms?
ReplyDeleteIf you don't have patients undress and examine them, you'll be wrong all the time. I weep for the future of medicine and am glad I'll be retiring soonish.
ReplyDeleteI'm with the "much better that they didn't auto check every normal exam finding that they may not even have examined"....the most important thing is to be accurate to what you did. And, unfortunately a 15 minute outpatient visit does NOT allow for a physical exam head to toe (nor is this reasonable in many patients) nor is there time for this with the number of followups that must be seen in the hospital most days.
ReplyDelete"But seems to be having some problems with the disappearing part."
ReplyDeleteReminds me of an intern I transcribed for who dictated the exact same words for the physical exam for every patient he admitted, regardless of chief complaint or gender or age. He dictated "anion gap" for both anion gap and albumin/globulin ratio. I had to blank every discrepancy and both lab values for each report. The facility finally told us to substitute A/G ratio for the second "anion gap." I used to have nightmares about being in an ER and hearing him say "I'm going to admit you."
ReplyDeleteGahhh, I'm an MA/Scribe gaining clinical hours so I can go to PA school. I work at an upscale urgent care that is equipped with more things than a regular urgent care would. I am so tired of corporate telling me I need to make every visit a level 4 no matter what. I don't care but I'm not doing some unethical crap and charting the doctor did something even though they did it. I will only mark things down if I can visually observe them myself or if I can see the doctor do it and then they tell me (RRR,no murmur) I'm so sick of the mandated 10+ body system review etc...
ReplyDelete