Letters

Obsessed with coding, or patient care?
To the Editor:

In Dr. Carole Guillaume's article "Coding and Documentation Made Easier" (April 1998), she correctly writes that, in spite of level 4 (or even 5) history taking and decision making, the ultimate code for a new patient visit is dictated by the lowest level of the three patient-visit components: history, physical exam and decision making. Because most family physicians will neither perform nor document the mandated 18 elements of the physical exam to qualify for a comprehensive visit, the new patient office visit will rarely, if ever, qualify as anything more than a 99203. In the case described by Dr. Guillaume, the ultimate coding level was 99202!

In essence, family physicians are penalized for focusing their energies on key components of the patient's history or aspects of decision making, rather than simply going through the motions of performing (and documenting) elements of the physical examination that are not relevant to the patient's care!

What do patients complain about more: "My doctor never listens to me" or "My doctor forgot to palpate my apical pulse"?

It is time for all physicians to join ranks in combating stupidity on the part of those who would force us to shift our focus from the care of patients to an obsession with coding, as well-outlined in Dr. Guillaume's tear-out coding reference. If I were teaching residents again, I would encourage them to throw away their coding references and spend more time listening to and thinking about their many interesting patients -- and documenting their findings.

John T. Littell, MD
Hillsdale, Mich.

Computerized charts for the Mac
To the Editor:

Having read your survey of computerized patient record systems (November/December 1997), I noticed that you only have one vendor with a Macintosh operating system. I use MediMac, a Macintosh-native CPR system from HealthCare Communications Inc. (800-888-4344). I love it, and it costs less than you would believe. Your readers who use Macintosh computers might be interested in this information.

Jill E. Mackey, MD
Bear, Del.

Practice management and residency training
To the Editor:

Thank you for your concise articles about issues in primary care that affect me. As a young family physician just out of residency, I need all the information I can get to make sense of the part of medicine I was not prepared for in medical school.

David Fisher, MD
Columbia, S.C.

To the Editor:

I continue to be impressed with the quality of this publication. It's easy to read and has pragmatic content.

Have you considered a discounted subscription rate for residents? It's a great resource for teaching practice management.

Perry Pugno, MD, MPH
Sacramento, Calif.

Editor's note:

We are pleased to hear that the content in Family Practice Management is being used not only to help practicing family physicians but also to train future family physicians in the important issues in practice management. Currently, all second- and third-year residents of allopathic family practice residency programs receive complimentary subscriptions to FPM; other residents can subscribe to the journal at a discounted rate of $37 per year. If your residents are not aware of this, please let them know! For more information, contact Lou Dean Hoerman, FPM Circulation Dept., 8880 Ward Pkwy., Kansas City, MO 64114; 800-274-2237, ext. 3165; E-mail: lhoerman@aafp.org.

Copyright © 1998 by the American Academy of Family Physicians.
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