In May’s “Rheuminations” column, “To Document or to Doctor?” (p.6), Dr. Pisetsky speculated on whether paperwork burdens are detracting from patient care. Several readers wrote in with their views on the “document-or-doctor” dilemma. We’ve published a selection of those responses here, and we want to thank everyone who wrote in. Keep those letters coming!—The Rheumatologist’s Editors
I just finished reading your editorial in The Rheumatologist on the nuisances of documentation in modern medicine. I feel very strongly about all that you wrote in the article. As a junior clinical rheumatologist in an academic setting, I almost always feel torn apart by the standards in patient care that I believe in and the pressing factor of productivity, which is inevitable in today’s healthcare economy. Documentation plays a major factor in this equation, as you nicely displayed.
Ironically, the time I spent in reading your article and dropping these lines resulted in a backlog of three charts due for “comprehensive” dictations which will probably be put off as my next patient starts calling for the nurse or looking at his watch. It looks like my wife will give me the same look again while reheating dinner tonight!
Thanks again. Always a pleasure to read your thoughts.
Firas Alkassab, MD
Assistant Professor of Medicine
Division of Rheumatology
University of Massachusetts Medical School, Worcester
I enjoyed reading your piece. I agree 100% with you. However, short of radical changes in our medico-legal practice climate and ways that Medicare looks at physicians and healthcare providers, I am afraid we will continue to treat the chart and computer a lot more than we treat our patients. In my opinion, the first step to fix what corrupts our current healthcare system is reforming the climate in which we practice, followed by vast improvements in the reimbursement mechanisms. To begin with, the current CPT codes and levels of service don’t make a lot of sense from a clinical standpoint. For example, the diagnostic code for rheumatoid arthritis is just one number, and it does not specify how bad or advanced the disease is, or how involved or uneducated the patient may be about his or her own disease. There are no code modifiers for the litigious patient that clearly demands more extensive and time-consuming documentation.
The patient–doctor relationship needs to be freed from interference by others with a vested economic interest in our professional interaction. If there is a factor that will improve the quality of the medical care we provide, it won’t be more CME courses or recertification exams but rather limiting the number of patients we see in the clinic or in the hospital. It is hard to imagine providing good quality care seeing patients every 10 to15 minutes, working at a frantic pace, and having to document like crazy in case Perry Mason comes around later. To a certain extent, we in academia are privileged to have the luxury of seeing patients at perhaps a bit more “relaxed” pace, working with fellows and residents and “double-checking” diagnostic impressions and therapeutic interventions.