Finally, Canadian medical charts are not audited the way they are here. My Canadian friends look puzzled when I ask them about compliance issues. They have no idea what I am talking about. The U.S. system has spawned an entire industry serving the burgeoning needs of medical compliance. We are constantly under the microscope. Our notes and letters are scanned to see whether we have used all the requisite buzzwords to justify the charge for a certain level of care. This whole concept of excessive chart documentation recently took a startling turn. The following paragraph began appearing at the end of the office notes of physicians belonging to a prominent academic practice in Massachusetts:
“I hereby attest that the medical record entry accurately reflects signatures/notations that I made when I treated/diagnosed the above listed beneficiary. I do hereby attest that this information is true, accurate, and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.”
Wow. Those last two words resonate: criminal liability. Isn’t this a medical note and not a legal document? Or is it the other way around? Attention Canadian friends, keep scribbling in your paper charts. This cannot happen without a cut-and-paste option.
As we head toward the November presidential election and the debates heat up, keep in mind that there is no such thing as a perfect healthcare system anywhere. We have the high-capacity and costly U.S. system, where an anxious patient of mine with persistently abnormal liver enzymes can get an abdominal ultrasound, computed tomography, and MRI of the liver, all within 48 hours. Or there is the Canadian system, where such speed is nonexistent. Is there a way to incorporate universal coverage without bankrupting the whole system? This is a daunting challenge.
Dr. Helfgott is physician editor of The Rheumatologist and associate professor of medicine in the division of rheumatology, immunology, and allergy at Harvard Medical School in Boston.
