Emergency Doctor Censured for Focusing on Patients’ Presenting Problems

CHICAGO, IL – Dr. Fred Dulant, medical director for Giant Itsabusiness Healthcare, today announced a three-day suspension issued to recently-hired emergency medicine (EM) doctor Joe Yungenhonest for documenting only the evaluation and exam that he actually did on patients during his last ER shift.

“Dr. Yungenhonest saw 20 patients during his most recent 8-hour shift.  His evaluation and approach were completely inadequate.  For instance, he saw a 25-year-old man who hurt his ankle playing soccer.  Dr. Y documented the appearance of the leg and ankle, made sure the patient could move and feel the foot and toes, checked the pulse and circulation in the foot, got an X-ray that showed no fracture, and sent the patient out in a splint with instructions to follow up in the office with the orthopedic surgeon on call.”

“He failed to document a complete fundoscopic exam, an ENT exam, or abdominal exam.  He did not document a complete 14-point review of systems.  His past medical history just said “otherwise healthy, no chronic medical problems, no meds or allergies.  What kind of note is that?  Then, during the same shift, he had a patient with shortness of breath and during his exam, he actually pulled down the sheet to look at the legs and noticed that the patient has had an amputation of the right foot, which means that the notes from the last 5 ER visits which said ‘DP and PT palpable bilaterally’ make his colleagues look bad.  We just can’t have doctors with this kind of attitude working here. We’re giving him a chance to shape up, but otherwise he’s out of here.”

During the same meeting, Dr. Dulant praised Dr. Ima Lyer for her much more appropriate E&M skills.  “Dr. Lyer documented a level 5 exam on every one of the 23 patients she saw today.  A lesser doctor would have taken at least 20 hours to do and document that much work, but she did it all in 8 hours – all while calling the hospitalist to admit at least half the patients just to be on the safe side!  After all, you don’t have to actually ask the patient about any of their history – just write ‘reviewed as documented in chart’ and voilà!  Level 5 billing!”

“And we have a template in the computer with a complete detailed exam, including a neurologist-level neuro exam, a complete exam of every pulse in the body, a fundoscopic exam as detailed as any retina surgeon would do – so for patients without an obvious reason to actually examine all those things, she knows enough to just click ‘normal male exam.’  If we just had more Dr. Lyers in our group, all the EM doctors could afford a new BMW every year while working 12 shifts a month!”