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Fam Pract Manag. 1998;5(2):7

To the Editor:

Over the years, we physicians have put up with a progression of bureaucratic rats, cats, and even a few dogs in our exam rooms. But the insurance and governmental intruders have finally grown too big to work around effectively. On Jan. 1, an elephant was placed in the exam room of every family physician. That elephant is the new Medicare documentation guidelines put forth by HCFA.

What is the effect of an “elephant” in the exam room?

  1. Elephants are messy. Sadly, we will now be spending more time and concentration cleaning up after the elephant, checking our count of systems examined, making sure our documentation indicates a complex problem — the constant mental gymnastics that siphon our time and fatigue our cognitive energies.

  2. Elephants crush people. We may say, “I refuse to be constrained by this beast. I will do as I think best in my exam room, document what is necessary and bill what I think fair.” But elephants have a nasty habit of crushing people who don't watch out for them. We have been warned that if we make errors in our judgment (or counting), we may face a Medicare audit, fines and penalties.

If we are to keep high-quality, focused patient care in the exam room, this elephant must be chased out, or at least shrunk down to size! I'm hoping someone out there knows how.


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