Recherche du temps perdu

It has become shall we say "fashionable" to add a message in charts, either hand-written or dictated, avowing something along the lines of, "40 minutes was spent with the patient, 60% of which involved discussing the diagnosis and treatment." I realize the fashionable nature relates to issues of billing, since now we are urged to document what we do, so that maximum billing and reimbursement can occur.

I wonder if these statements can live up to the laws of the space-time continuum, though. No one seems to spend a mere 10 minutes with anyone, it's always something like 40 or 50. If a doctor such as this were tracked on a given day, and these amounts of time were totalled, how many hours of the day would be consumed? Would there be any time left for going from one place to another, eating meals, engaging in idle chitchat, sleeping? Would the time on occasion exceed the hours in the day?

Another thing I see, now with everyone using computers for wordprocessing, electronic medical records, is that it can be hard to tell the report of a followup visit from the initial one. Each report has a complete history, a complete physical exam, a complete discussion of the facts, and of course the obligatory "XX minutes was spent with the patient..." One reaction I have to this is that if one takes this at face value, that yes, all of this was done every single visit, this is an obsessive-compulsive person in need of treatment -- the doctor, not the patient.

But the reality check is that, once again, it's all about the billing, all about being able to justify that maximum category and charge in every single patient. On the receiving end of such reports one doesn't know what to believe...is it true that all of this history and exam was done? Sorry, I've got doubts about that.

Sooner or later, people will get called on this. Someone will do the math, check the office practices, the templates, the copied-over notes from one visit to the next. The results aren't going to be pretty, I'm afraid.