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DiscussionYour Tips on how to improve Incomplete Physicians Notes?
Just Want to Talk | Last Active: Oct 13 10:00am | Replies (12)Comment receiving replies
Replies to "This is a little off base as to why you posted this, but, I have noticed..."
I posted it in hopes to get advice on options when I can't get my dr to document details, accuracy and how to approach. I have asked, raised escalation with practice manager and when a care provider tells you that you are dying with a 6- 12 month timeframe, but then medically codes patient records with diarrhea diagnosis code, lacking more specific details, yet puts referral note to hospice services in, it doesn't add up or provide much backup. Costs me my employer paid disability benefits, and not doing anything to correct it. Not even locking these lack thereof notes for 30 plus days. It's not only denied my long short term financial pay benefits, but denied my ability to file and successfully get approval for ssi.
Yes! Absolutely! And makes me so irritated, mad and frustrated at the lack of attention to important AND significant health-related detail!
At my first dr's visit with a new doctor for me I fot the visit notes at the end of the visit and scanned them, and saw several inaccuracies. The one I recall the most was that (incorrectly) I was a smoker - wrong!!! Not me! ...could affect many things, right? - like insurance rates, and who knows what else?
I pointed it out (politely, of course) and it was removed. But how many people don't read/review these notes? [A lot] ...And what else has been incorrectly/inaccurately put into my record that I may never see but could have impacts? [I, and others, will never know!]
I have come to - with the exception of one upsetting visit - greatly respect my PCP, aside from these mistakes, but there is such a fundamental need for trust in this doctor-patient relationship, and unfortunately - like many, many aspects of our daily lives - this trust is damaged, not cared for, and eventually lost.
The struggle for trust, authenticity and conscientious behavior goes on ...