That is great, thanks David!
See also "Man's 4th Best Hospital," the new book by Sam Shem.
Anyone involved in inpatient care will be sadly familiar with note-bloat. It is SOOOO horrible !
It seems to have evolved out of the work-hours reformation: notes are written so that the next shift of doctors can get 'up to speed' on that patient without having to review the entire medical record (or, god forbid, talk to the patient!) So chalk this up as yet-another example of unintended consequences.
Clinic notes are another story altogether – note-bloat there seems to have evolved to maximize billing, as many articles have pointed out.
Mark L Graber MD FACP
Chief Medical Officer; Founder and President Emeritus, SIDM
Professor Emeritus, Stony Brook University, NY
This reminds me of medical school. Because of the intense time pressure we were under during our clinical years (ten admissions per night in some cases) many of my fellow students began to abbreviate their H&P's and would then fill in the gaps with whatever came to mind. Most got away with it but, on occasion, the staff physician, and more usually, the admitting physician would see through the con and call the medical student...and the resident...on the carpet.
Worse, given the amount of time allowed physicians and other clinical staff to do an H&P it's almost expected that it won't be truly thorough.
In fact, I have seen a cycle: Efforts to increase revenue leads to decreased time allotted to the H&P because it doesn't generate income along with an increased time allotted to studies that do generate income. This leads to decreased diagnostic accuracy which leads to increased malpractice law suits which leads to increased liability insurance for the facility which leads to efforts to increase revenue which leads to...
And down we go.
Mark Gusack, M.D.
MANX Enterprises, Ltd.
A heady corrective to all those wanting to "do NLP" with clinical notes, presuming that the note mirrors reality.
I suppose they do. Darkly.