Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We must demand a return to meaningful notes

Robert Centor, MD
Physician
August 30, 2013
Share
Tweet
Share

I had a nice conversation with a dermatologist at a party recently.  He started complaining about the notes he receives from other physicians.  He used terms like piles and piles of junk.

Talk to any experienced physician and they will tell you that once upon a time our teachers taught us to write notes appropriate to the situation, not appropriate to the billing system.

Several years ago I ranted about the necessity for coding experts.  What does that have to do with good medical care?

In 1973 we were taught to write SOAP notes.  SOAP notes served me and my patients well throughout my internship, resident, and early years in outpatient practice.  What happened?  With the introduction of resource-based relative value scale (RBRVS), bureaucrats had the opportunity to make rules about what constituted a level 1, 2, 3, 4 or 5 note.

Thomas Sowell stated succinctly, “You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing.”

The bureaucrats came up with a plan for documentation that shows a total lack of understanding of medicine.

Electronic medical records have made this worse.  Now we have institutionalized bad notes.  And bad notes harm patient care.

Physicians now spend too much sorting through the haystack of notes that document unnecessary 12 point review of systems, and repeated complete physical exams when they are totally unnecessary.  We see note after note repeating all the laboratory data.

The problem here is that the physician note writer is not involved in figuring out what data are important.  Our current notes are mindless.  They do not reflect our thought processes.

When we were taught about SOAP notes, they went like this:

  1. Write a separate SOAP note for each problem – either a diagnosis or a complaint
  2. For each problem include first the subjective data related to that problem
  3. Then the objective data – physical exam, relevant lab data and imaging
  4. Then your analysis – this section reflects your current thought process
  5. Finally the current plan – lab tests, medications, surgical consult, etc.

We need to know what our colleagues are thinking.  We need to review our students and residents thought processes.  Notes written like this require thinking, thinking about what are the relevant data and how one evaluates the data.

I believe that such notes help us think more clearly about our patients.  They clearly make it easier for other physicians to review our notes and thought processes.

We must demand a return to meaningful notes.  We must let everyone know our outrage over cut and paste notes, data overload notes, and non-thinking notes.  Our patients deserve understandable notes.  Unfortunately, today we have horrible notes, and we are not teaching our students and residents to think, partly because of the notes they must write for billing purposes only.

ADVERTISEMENT

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Prev

Dear patients: My skill set no longer matches your needs

August 29, 2013 Kevin 206
…
Next

After an adverse event: What should doctors disclose to patients?

August 30, 2013 Kevin 4
…

Tagged as: Health IT, Primary Care, Residency, Specialist

Post navigation

< Previous Post
Dear patients: My skill set no longer matches your needs
Next Post >
After an adverse event: What should doctors disclose to patients?

ADVERTISEMENT

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

More in Physician

  • Why heart and brain must work together for love

    Felicia Cummings, MD
  • How pain clinics contribute to societal safety

    Olumuyiwa Bamgbade, MD
  • Why frivolous malpractice lawsuits are costing Americans billions

    Howard Smith, MD
  • How AI helped a veteran feel seen in the U.S. health care system

    David Bittleman, MD
  • Why physician strikes are a form of hospice

    Patrick Hudson, MD
  • How a doctor defied a hurricane to save a life

    Dharam Persaud-Sharma, MD, PhD
  • Most Popular

  • Past Week

    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • The overlooked power of billing in primary care

      Jerina Gani, MD, MPH | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • This isn’t burnout, it’s moral injury [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why heart and brain must work together for love

      Felicia Cummings, MD | Physician
    • Who are you outside of the white coat?

      Annia Raja, PhD | Conditions
    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Physician practice ownership: risks, rewards, and reality

      Paul Morton, CFP | Finance
    • How peer support can save physician lives [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • The overlooked power of billing in primary care

      Jerina Gani, MD, MPH | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • This isn’t burnout, it’s moral injury [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why heart and brain must work together for love

      Felicia Cummings, MD | Physician
    • Who are you outside of the white coat?

      Annia Raja, PhD | Conditions
    • How hospitals can prepare for CMS’s new patient safety rule

      Kim Adelman, PhD | Conditions
    • Physician practice ownership: risks, rewards, and reality

      Paul Morton, CFP | Finance
    • How peer support can save physician lives [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We must demand a return to meaningful notes
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...