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Independent contractor. 1099 worker, not W-2 employee.What is IC?
Independent contractor. 1099 worker, not W-2 employee.What is IC?
Good medicine means nothing, good charts mean everything.
Can anyone summarize House of God in one sentence?
FTFY.Good medicine means nothing, good charts and call room sex mean everything.
"Eleven states require two-party consent. In other words, everyone involved in a conversation must agree to be recorded. Those states are, California, Delaware, Florida, Illinois, Maryland, Massachusetts, Montana, Nevada, New Hampshire, Pennsylvania and Washington."Check the recording laws in your state. Doing so without consent can be very criminal.
Highly disagree. If my chart doesn’t reflect my eventual MDM then I either need to change my chart or change my management. The latter does happen sometimes when I go back over things objectively. However, including extraneous things in the chart (i.e. severe chest pain on the 18 yo URI with no sign of myocarditis) does nothing to help the patient and everything to potentially hurt you as the physician.
Check the recording laws in your state. Doing so without consent can be very criminal.
Check the recording laws in your state. Doing so without consent can be very criminal.
What if a patient surreptitiously has their phone on while talking to you, and someone else is listening on your conversation. But there is no recording. Is that illegal? That happens to me about once/month.
You do you. This has nothing to do with ethics or not doing what is right for the pt. I give pts good clinical care regardless of what I chart. Its not like I send every young chest pain home without any tests.Negative trops and dimers (if indicated) in 20 year olds with chest pain, no matter how described, matter more than lying in a chart. I’m not saying you have to include every detail, but if they say it’s pressure and you chart sharp, or if it’s not reproducible and you say it is, that’s just plain lying, wrong, and if you get caught can get burned. You do try to make everything fit your disposition. You don’t have to give Dilaudid and do a cath for severe meth gastritis/GERD. You do what’s right for the patient even if it’s not what they necessarily always want.
Most of us live in states where patients can record you without you knowing and can access their own chart. You do this long enough and you realize some things change.
Unless they strap a microphone onto my and the pt, they will barely hear what I am saying. A buddy backing up what the pt says against a trained medical professional is like getting a felon testify for the state.What if a patient surreptitiously has their phone on while talking to you, and someone else is listening on your conversation. But there is no recording. Is that illegal? That happens to me about once/month.
I remember in residency one of the nurses was complaining about the notes they have to write.This may sound bad but I look vital signs and almost never read the nurses notes. They write stuff that makes our job harder, makes me have to defend my workup, etc.
My choice is spend 2-3 min reading their notes, asking them to correct it, sound like a helicopter doc, and then alienate the staff vs never reading it making my shift so much easier.
I pick the later for the past 20 years and never had an issue. Maybe Russian roulette, but even if I got a lawsuit it would have been better than the countless time/stress/unintended fractured relationships. I am sure not many really read through most/all of the notes or it would drive them crazy.
I am sure if people looked at my charts, they would think I was incompetent half the time b/c I really do not write everything the patient states.
That 20 yr old with no medical issues having chest pressure and radiation never goes onto my chart.
Might catch an atypical dissection or PE if you work it up. Young people can have pathologyYou do you. This has nothing to do with ethics or not doing what is right for the pt. I give pts good clinical care regardless of what I chart. Its not like I send every young chest pain home without any tests.
I bet my clinical care is probably just as good or better than yours. You do you but this has zero to do with good pt care and very little to do with ethics.
Young healthy 20 guy comes in with chest pain for the 5th time that is worse ever, crushing, heavy, worse with exertion.
Me - Atypical chart, neg previous work up, I order an EKG/CXR to rule out some weird pericarditis/PTX then DC him in 1 hr.
You - being the ethical doctor charts Crushing chest pain (your ethical remember), worse with exertion, worse pain ever.
Scenario #1 You order a cardiac work up, labs. maybe keep him in the ER for 3 hrs for another set of Trop. He leaves in 5 hrs with atypical CP.
Scenario #2 you D/c with little to zero workup. Dude goes home, shots up drugs, and found dead. Family/Lawyer gets your chart and dude clearly had cardiac angina and as an expert witness, I would tell the Jury that your chart clearly was cardiac angina. Essentially the pt told you he was having cardiac angina and you discharged him. Seems medically unethical to me.
Who do you think gave the pt better care? How are you any more ethical drawing labs for the 5th time and doing a chest pain rule out, or you D/C him without much of a work up for his cardiac story?
Let the ones who have not sinned throw the 1st stone. If you always chart what the pt states (remember you are completely ethical), then go ahead cast the stone. If not, you are just a hypocrite.
Again, I work up for young healthy zebras if my gestalt tells me to. Not all my Youngs get sent packing.Might catch an atypical dissection or PE if you work it up. Young people can have pathology
I don't change patient's words and write inaccurate things in patient's charts. I might be selective with my charting, but I'm not dishonest. In the age of body cameras, cell phones and frequent recording you are going to get burned. Trops x2 don't lie and I don't worry no matter how a patient describes their pain when their testing is negative.You do you. This has nothing to do with ethics or not doing what is right for the pt. I give pts good clinical care regardless of what I chart. Its not like I send every young chest pain home without any tests.
I bet my clinical care is probably just as good or better than yours. You do you but this has zero to do with good pt care and very little to do with ethics.
Young healthy 20 guy comes in with chest pain for the 5th time that is worse ever, crushing, heavy, worse with exertion.
Me - Atypical chart, neg previous work up, I order an EKG/CXR to rule out some weird pericarditis/PTX then DC him in 1 hr.
You - being the ethical doctor charts Crushing chest pain (your ethical remember), worse with exertion, worse pain ever.
Scenario #1 You order a cardiac work up, labs. maybe keep him in the ER for 3 hrs for another set of Trop. He leaves in 5 hrs with atypical CP.
Scenario #2 you D/c with little to zero workup. Dude goes home, shots up drugs, and found dead. Family/Lawyer gets your chart and dude clearly had cardiac angina and as an expert witness, I would tell the Jury that your chart clearly was cardiac angina. Essentially the pt told you he was having cardiac angina and you discharged him. Seems medically unethical to me.
Who do you think gave the pt better care? How are you any more ethical drawing labs for the 5th time and doing a chest pain rule out, or you D/C him without much of a work up for his cardiac story?
Let the ones who have not sinned throw the 1st stone. If you always chart what the pt states (remember you are completely ethical), then go ahead cast the stone. If not, you are just a hypocrite.
You do you. This has nothing to do with ethics or not doing what is right for the pt. I give pts good clinical care regardless of what I chart. Its not like I send every young chest pain home without any tests.
I bet my clinical care is probably just as good or better than yours. You do you but this has zero to do with good pt care and very little to do with ethics.
Young healthy 20 guy comes in with chest pain for the 5th time that is worse ever, crushing, heavy, worse with exertion.
Me - Atypical chart, neg previous work up, I order an EKG/CXR to rule out some weird pericarditis/PTX then DC him in 1 hr.
You - being the ethical doctor charts Crushing chest pain (your ethical remember), worse with exertion, worse pain ever.
Scenario #1 You order a cardiac work up, labs. maybe keep him in the ER for 3 hrs for another set of Trop. He leaves in 5 hrs with atypical CP.
Scenario #2 you D/c with little to zero workup. Dude goes home, shots up drugs, and found dead. Family/Lawyer gets your chart and dude clearly had cardiac angina and as an expert witness, I would tell the Jury that your chart clearly was cardiac angina. Essentially the pt told you he was having cardiac angina and you discharged him. Seems medically unethical to me.
Who do you think gave the pt better care? How are you any more ethical drawing labs for the 5th time and doing a chest pain rule out, or you D/C him without much of a work up for his cardiac story?
Let the ones who have not sinned throw the 1st stone. If you always chart what the pt states (remember you are completely ethical), then go ahead cast the stone. If not, you are just a hypocrite.
Was I your attending?As my favorite attending in residency used to ask all the interns he worked with for the first time, "Should your documentation reflect exactly what was stated by the patient and what happened in the ER?"
"Yes?"
"No you ****ing idiot. Charts are for billing and protecting your *** legally." This was usually followed by "If you aren't going to get a CT scan on a patient with abdominal pain, don't be the idiot that documents that they were tender on exam."
It also makes my life better. I still get to be a doctor at work.Probably true…conceptually true. The reason why I’m in the top 1/3 efficiency (I’m somewhere between 5-8 out of a group of about 20) is I test less. Not markedly so. The average CT% is 23%. I’m 19%. My LOS is slightly lower. So there are efficiencies gained by spending a little more time with people.
Every new resident should start doing this in training. The big hurdle every resident faces is trying to figure out what an attending wants. You will never please every attending, but if your chart matches your workup/diagnosis, then life will be easier.Was I your attending?
I teach my residents that your charting should match your workup.
Cop #1 - I pulled over someone and they started to fight me. I am so sorry that I accidentally pulled my gun, yelled taser, and killed him, caught on bodycam. It was an obvious mistake = Jail time for manslaughter.
Cop #2 - I pulled over someone and they started to fight me. I pulled my gun, shot him, killed him, caught on bodycam. My mind said taser but I will stand by the fact that I feared for my life. It was an obvious mistake = No jury would convict after looking at the body cam. Small woman cop was fighting big guy, justified.