* * Anonymous Doc: When Notes Go Rogue (Part III)

Tuesday, January 29, 2013

When Notes Go Rogue (Part III)

"Hey, I'm not sure we've met.  I'm the fellow covering a bunch of your patients this month."

"Yeah.  What do you need?"

"I'm not sure if you're just writing draft notes and then going back to change them once you've seen the patients, but I've noticed a bunch of them haven't really been matching up to what's going on when I go see them."

"I don't know, they're fine."

"I'm not trying to cause a problem, I just wanted to check and see if I'm just reading them before they're finished, or you're going back and changing them... like Mr. Patient the other day, where it said he refused a procedure, but he'd already had the procedure."

"Maybe I mistyped, I don't know.  I'm busy.  I can go in and edit that one, I guess.  Who's that-- Mr...?"

"Mr. Patient."

"With the big family?"

"No, the other guy."

"Oh, okay.  You can point him out."

"I just worry that I'm going to make a mistake, if I'm relying on notes that aren't necessarily updated."

"So don't rely on them."

"Yeah, but they're in the system."

"I don't know what you're asking me to do.  If you don't like my notes, you're seeing the patients anyway.  Don't worry about it."

"If you could just double-check that you're not pressing the wrong button, to save your drafts as finalized notes, that might just make it easier for the team."

"I'll be more engaged, sorry.  I've been busy."

"Okay, I just wanted to make sure."

"Yeah, yeah, I'll check them over."


"What is up with the cardiologist?"

"What do you mean?"

"I mean he's actually here, and it's the afternoon.  So weird."


  1. Pity you have to play politics and can't just call him out, but kudos for taking it on.

  2. So glad you spoke up. Sounds like the guy has some issues in his personal life right now maybe (not that that justifies anything)...

  3. Honestly, who cares if the cardiologist has "issues". If he's not actually seeing those patients, he's committing fraud, in addition to potentially causing them harm.

    If any of those patients are self-pay, with no insurance, Medicare or Medicaid, I'm guessing he's still billing them, and if he's billing them, I'm sure he'll send them to collections if they don't pay him.

    He's a piece of garbage. I hope he faces some consequences, but sadly, I doubt this will happen.

  4. I'm with Anon 11:18 on this one. And I'm so glad there's a Part III. Good on ya!

  5. Agree with Anon Jan 29 11:18 pm.

    The other thing is that if you don't report him to people who can actually keep him scared enough to permanently stop this behavior, then he will go back to his old ways as soon as he knows you are no longer keeping an eye on him. I fear your solution is only a temporary one.

  6. Of course, if you were a medical student or someone lower on the totem pole, there's nothing you could probably do about it except risk your career and future to keep him from killing someone.

  7. Check w/the RNs to ask if they've seen the cardiologist. Sometimes patients don't recognize the doc as "the doctor" (we have a young MD that patients often don't "see" as an MD, despite the fact that she clearly introduces herself, explains the plan of care, etc). I know...probably not the issue here, but worth considering in some instances.

    Given the evidence to support the premise that this attending is committing FRAUD: Does your facility have patient safety alerts (or whatever they call them there)? I would be documenting the heck out of every one of these incidents, with details including that the nurses told you they didn't recall even seeing the MD on the unit, etc. Make it as factual as possible, and use whatever admin's favorite format for the year is (eg SBAR). And the nurses can be your allies in documenting such instances (with relish if the doc is otherwise an ass). The physician might have great knowledge, great technical skills, maybe even great bedside manner and rapport with other staff, BUT he is not safe to continue practising if he stoops this low.

    If this were reported as medicare fraud, I think the facility would also bear some burden - this may be the angle that makes them actually step up and address the issue. "I wanted to make sure you, xyz hospital, knew what's going on before some family figures it out and makes a complaint to the insurance co./Medicare/whoever and the hospital gets sued..." Much better to figure out what's going on with the doc (burnout, whatever) privately than publicly, especially if he can be rehabilitated easily.

    And for the comments re: "too low on the totem pole to make waves" ...that's a cop out. There is always SOME way to bring things to the attention of those with the power/authority/willingness to step up and address the issue. Whatever system you're in, find those people that can and will help in this kind of instance.