Notes. Anything to avoid doing them at this point. I remember when I was a kid, I would go to the doctor's office, he would come in and chat with my mom, listen to my lungs, write a quick note in the manila folder with the cool letter and number stickers and we would go home. Granted, I have no idea how they got paid or what system was in place for billing, but it all seemed so very easy.
When you come in to see me, your provider, you check in and sign a bunch of papers and make up some excuse on why you can't pay your copay, or have any money to put towards your back balance. After all, your insurance pays part of your bill. Once you have signed your right to privacy away to your insurance company, they are greeted by my medical assistant. Not a nurse, they are too expensive. Instead of a professional with a 4 year degree in health science, you are triaged by a high school graduate with a 6 week course certificate. They don't know the first thing about the medications on that list they are reviewing with you. They will misspell them in your chart and then complain that the system never finds metroformin.
After you have reviewed everything with this 20 something millennial who is chewing gum, they leave and you assume they going to discuss everything you talked about in the with the provider. Nope. They are logging your vital signs in the computer after they check facebook and take a selfie. They update your status in the system to "waiting for provider". And in that place in the encounter where they should write why you are here they type "follow up" or "refill". That's it. If you have pain, bleeding, rash, they may put that one word in the chart. But rest assured the information you spent 10 minutes explaining to that young person is gone, wasted breath.
I come in, the blacksheep provider of my god forsaken community. I have 15 minutes to engage with the patient, including any physical exam. The med list is completely wrong. The over the counter supplements are not listed. You are taking St. Johns wart with your prozac and three magnesium pills a day since your yoga instructor suggested it. You also have stopped taking your beta blocker because you read online that it will cause you to develop wrinkles on your ear lobes. Since last visit you have had heart palpitations, chest pain and are unable to sleep. You also have a skin tag you would like removed, you want to ask about the flu shot and get my opinion on COVID. I mean, do you really need the booster? Your mother's sister's friend got the COVID booster this time and ended up losing the ability to hear colors.
We get through all of this, on exam things seem normal, slight tachycardia and elevated blood pressure. Neuro is normal. I spend an additional 15 minutes with you going over supplements and what you should and shouldn't take. I also encourage you to call the office with questions before you make any changes to your medication. No new medications. Restart beta blocker. Follow up in 3 months? 6 months? next week? 3 months, so we can make sure you are not doing any serious damage to your health.
I am now behind 15 minutes, I close my laptop, I will finish this note later. Go on to the next 20 patients I see during the day. Staying a consistent 45 minutes behind, working through lunch. So here I am on sunday, not working on the 100 notes or so I have that needed to be completed 4 days ago. Looking at the encounter from Monday on sunday I vaguely remember seeing you. Now, I need to take what is in the chart, clean it up and make it presentable to the insurance company so I can justify them paying me 80% of what the think is appropriate. Problem is, this is your note.
CC: Booster/Questions
HPI: 45 year old here for ongoing follow up. asked a bunch of stupid questions about articles they read on google. Has been overdosing on magnesium. Refusing to listen to any type of reason about vaccinations. Believes election was stolen. Has skin tag on ass that is starting to bother her.
Medical History:
Cognitive impairment
Social History:
TRUMPER
Family History:
Trailer trash
PE : WNL
Asssessment:
Encounter for banging head off of wall
Plan :
Plane : Continue to come in every 3 months and ignore all of my medical advice. Take medications you feel like taking. Have a stroke in about 5 years, lose all function of your right side, learn to sign your name with your left hand so you can sign the papers from your lawyer to sue me for not preventing your stroke.
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