Ahmad Yousaf, MD, is the 2015-16 Ambulatory Chief Resident in Internal Medicine at Rutgers New Jersey Medical School.
“Oh no, she’s calling again.”
I look at the caller ID in the Chiefs’ office where I sit with one of my co-Chiefs. It is the Documentation Lady. Her call is as regular as BMs with C. diff: Profuse, excessive, associated with a lot of hot air and a bunch of crap, but inevitable. We play a quick game of rock/paper/scissors… I lose. I pick up the call. My voice changes to a sweet phone voice with a sprinkle of passive aggression and self-loathing for the coming 3 to 10 minutes of ‘issues.’
Resident A did not conclude his note with a proper attending ‘supervision’ requirement. In plain English, that means that the resident concluded his note with: “will discuss the case with attending on rounds,” instead of “the attending of record is Dr. X.” Seems like a small difference… because it is. Seems like minutia and a waste of time… again, because it is. BUT, the reality is, she is inarguably correct.
Resident B did not use the proper document title in the note that described the reason for the patient’s conversion from observation status to full admission (needs to stay longer). The resident did explain why the longer stay was needed… but selected the wrong note title. Does it affect patient care? No. Does it affect the resident’s medical education? No. Does it warrant a phone call from the dreaded Documentation Lady…. Yes. Again, she’s right. She knows it. I know it. Everybody knows it.
By Enzoklop – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27958688
So we do our derisory dance on the phone, and I express false frustration at the false incompetence of residents who are caring for sick and dying patients and who are being assessed on clerical skills. To beat a dead horse: The documentation lady is right. Her justification for calling me demanding corrections is also right.
This is an example of the additional skills a doctor MUST learn in residency to one day work efficiently (make money) for his or her hospital. You cannot bill an insurance company without exact documentation, because the insurance company has their own documentation hawks looking for reasons not to pay the hospital. And so the game continues.
The problem is that I never knew I signed up for this game. Most doctors never knew that their lives would have as much to do with note-writing as patient care-giving. In the words of one of my attendings, “Medicine has become a scam.” There is so much administrative garbage to navigate in most nonacademic positions that doctors appear to be doing less and less doctoring — engaging in less eye contact with the people who need us and spending more intimate time with our computer screens. The harsh truth is that, here at the end of my training, my keyboard is more worn out than my stethoscope — and that scares me. I am a pragmatist, and I know that money makes the world spin and that patient notes are what makes the register ka-ching. But I didn’t know it would so significantly affect my ability to get to the bedside.
My phone call ends with a semi-sincere, “have a wonderful day, I am sure I will be hearing from you very soon!” I stare at my co-Chief across the table, and I can see the empathy in his eyes. We laugh at the absurdity, and then he speaks an absolute truth, “Man, I wish I was as good at being a doctor as she is at her job.”
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