Once Upon A Time, there lived an old man and an old doctor, in a far away village. The old man was sick, and so he called for the doctor. The old doctor came to visit, and found the old man had a diseased heart. The doctor knew he was going to die soon. The doctor comforted the old man, and gave him medicine to ease his pain. The old man’s suffering was relieved and he was grateful to the doctor. Feeling more alert, he watched the doctor jot down a few notes on a piece of paper before he packed his bag and made ready to depart.
“Will you return, Doctor?” the old man asked.
“Yes, of course. In a few days,” the doctor replied.
“What were you writing in your notebook just now?” The old man was curious.
“Oh, just a few notes to help remind me about your case,” said the doctor. “You see, I have a lot of patients, and sometimes I need to jog my memory. I too am getting older, as is my memory.”
“I understand completely,” the old man said, and bade the doctor farewell.
The old man, despite his heart malady, began to feel stronger. After a few days he started to wonder when the doctor would return to visit him again. He needed more medicine and was surprised that the doctor had not come back to him. He made some inquiries and was soon saddened to learn that the old doctor himself had succumbed to a sudden heart attack, and was no more.
Being of a practical nature, the old man knew that he needed to find a new doctor. And lo! there was a new doctor, fresh out of Medical School, who had come into town that very day to replace the old doctor who had died. He sent out a request for this new doctor to come and visit him. To his surprise he received an answer that this new doctor did not come to his patients’ houses. Rather, the patients were expected to come to his clinic in the center of town. This was a hardship for the old man, but he quickly understood that this was the way of the world, and there was no use fighting against it.
So the old man got his cane, put on his coat, and made his way down to the new doctor’s clinic.
Here he sat and waited along with many fellow patients until finally a nurse came and brought the man into the inner part of the clinic, where, after another wait, the new doctor finally appeared.
The old man knew that the new doctor did not know his case, so he started telling him his story. The doctor though held up his hand and said,
“Wait a minute.”
The doctor opened up a notebook sitting on a table next to him. He spent a few minutes turning pages until he got to the page he was looking for. He then started writing in the notebook.
After a few minutes, the old man asked, “What are you writing in your notebook just now?”
The doctor was silent. He continued to scribble furiously in the notebook. He did not look up at the old man or ask him any questions. It appeared that there was a certain amount of information that he needed to enter into the notebook, and he only had a limited time to do so. The doctor’s forehead broke out in a sweat as he tried to write things down as fast as he could. Finally, the doctor slammed the notebook shut, and without a word, left the room.
The old man was stunned. Before he could react, however, the nurse came in and told him it was time to leave. The old man asked the nurse about his medicine. The nurse said that the new doctor had a system whereby his medical prescription would automatically be sent by carrier pigeon to the apothecary in town, to be picked up at his convenience. The nurse assured him that everything was taken care of, and she needed to prepare the room for the next patient.
The old man asked the nurse, “Is the doctor a good doctor?”
The nurse seemed taken aback. “Yes, of course.”
“How so?” asked the old man.
The nurse laughed. “What a silly question. The doctor went to the best medical school. He won awards in his internship and residency. But more important than any of that, he has a System.”
“What kind of System?” The old man could tell from the nurse’s tone of voice that the word “system” was capitalized.
“Well, you saw it in action. He is able to generate a complete history, upload the past medical and surgical history, create a full 12 point review of systems, and generate a physical that touches on each major body part in an amazingly short period of time.”
The old man pondered this. Then he said, “But the doctor did not talk to me, did not examine me, did not tell me what was wrong.”
The nurse laughed again. “Of course not. If he did all that, there would be no time for him to create his documentation. He would have to see fewer patients and you would have to wait even longer to see him. You wouldn’t like that, now would you?”
The nurse tried sheparding her patient out of the room. The doctor would be mad at her if she didn’t get the next patient ready quickly enough. But the old man resisted, and she became frustrated.
“What is wrong?” she asked.
“I…I am having pains in my chest. I think I am having a heart attack.” The old man turned pale, and he collapsed to the floor.
The nurse called for the doctor. The young doctor came back in, glanced at the old man clutching his chest on the floor, and went back to the table where his notebook lay. He opened, found the correct page, and started writing again.
The nurse looked at the old man writhing on the floor, and she became concerned. She didn’t want to interrupt the doctor in his important task of documentation, but finally she could hold back no longer.
“Doctor!” she said in an urgent tone of voice. “You are getting behind in your appointments. Can’t you do something?”
The doctor did not look up from his task, but did answer. “It’s this new System. The forms don’t allow entering a second patient visit on the same day without amending the initial visit, which, as you know, is a 10 step process. If I miss one of the steps I have to start over again. So it does not help if you interrupt me, Nurse.” He said the last rather curtly.
The nurse was subdued. “Yes, Doctor. I’m sorry, Doctor.”
Finally with a look of relief, the doctor finished his task and closed the notebook. He smiled and addressed the nurse.
“Sorry I was a bit abrupt with you. But, after all, this was an emergency situation. I had not planned for this episode of critical care in my office. Overall though, despite its quirks, the System worked and I am back on track.”
The nurse smiled. “Don’t mention it. I’m just amazed that the System was able to handle something like this. It certainly has been a boon for Medicine that the technology exists today to create such a System for Documentation.”
“Indeed.” The doctor pulled out his pipe and lit it, taking a few puffs. It was something he did when he became contemplative. He grinned.
“With this Documentation System, I can handle something like this and even have a few moments to think about how things used to be. You know, how the doctors of yore took care of patients.” He tapped some ashes from his pipe.
The nurse, who was older and did remember those days, nodded her head. “Yes, I remember those days. The doctors spent all their time talking to patients, and examining patients, and thinking about what would be the best treatment for their patients. They spent so much time with those tasks that they didn’t have time to fully document in their charts!”
“Yes,” agreed the doctor. “Those docs of old couldn’t nail a 12-point review of systems if they tried. So, all that work, and they could only bill a Level I visit! Ridiculous.” He opened the notebook and pointed to the page with the stem of his pipe. “Here today, on this gentleman, I have documentation to support a Level V office visit, plus 15 minutes of Critical Care Time. There’s is no way the old docs could have done that.” He glanced at his watch. “Oh, if I don’t stop chatting, I really will be getting behind.”
The nurse nodded, and glanced down at the old man, who now lay stiff and still. “What about him?” she asked.
The doctor stepped over the old man to leave the room. “Well, call for an ambulance to take him to the hospital. He needs a doctor.”
The nurse knelt down and felt the old man’s carotid artery. There was no pulse.
“He has died, Doctor,” she stated.
“The morgue then.” The doctor rolled his eyes. “Now I have to do a death summary too. This is not my day.” He went back to his notebook once again, now in a foul mood. “This will never do.”
The nurse hesitated, then finally asked, “Should I cancel Mrs. Thornsberry?”
The doctor continued scribbling furiously, and the nurse knew better than to ask again.