Fraud maybe in the eyes of insurance, but this video suggests that the H&P notes have no purpose for cataract surgeries at least so the word fraud is in the title to emphasize the point of the video that some make things like H&P notes out to be a big deal when they may be meaningless for things like cataract operations and their purpose(the purpose of things like H&P notes) is for other people to make more money
Jonathan shaking his head was unexpected and concerning. I'd love for giant notes to be axed though. Even with templates, dictaphone, and smart phrases I always feel behind.
Jonathan shook his head because Jonathan is only concerned with things that are 1) necessary to fulfill ophthalmology goals and 2) relevant/good for the patient. Writing extensive H&Ps for routine cataract surgery does not fulfill ophthalmology's goals (i.e. efficiency, reduced stress, reduced time in clinic, and overall less hassle 😂) and has negligible effect on patient outcomes.
@@ada5851 Oh, I agree completely. It is just disconcerting to see a negative response that obvious from Jonathan. From a lesser being it would've been an open palmed slap.
Insurance: We want to pay less, so we need more documentation to justify reducing payments. administration: We want to get paid more, so we need more documentation to justify increasing our payments.
Assuming the documentation really is used only for billing and has no relationship with the patient's chart or care, the obvious solution is to teach ChatGPT to do it for you. Disclaimer: If you actually do this, and somebody finds out and you get in trouble, that's your problem.
Every time I've had surgery (and it's been a lot), the anesthesiologist has personally come into my room and asked me everything he needed to know. I presume that reading my chart instead would create a level of liability and risk based on him having to have complete and total trust in the person who charted asking all the right questions in the right way and documenting the answer in a way that was appropriate, all for a specialty that isn't even theirs.
We do double check but having your history well documented is INCREDIBLY helpful to help us direct our history, reduce the time it takes for me to double check an elderly patient's medications, and make sure they're not forgetting to tell me something. You would not believe the amount of prodding some people take to remember important things about their health ("do you have any comorbidities or chronic ilnesses?" "No" "ok, what medications do you take every day" "metformin, losartan, atorvastatin"
Each type of doctor cares more or less about specific parts of a patient's history as it pertains to what they need to do and know. In pharmacy for example, we'll ask about and document a med history different than pretty much everyone else.
My Dr spends more time adding codes to my chart to than she does on my visit. I appreciate it bc insurance companies look for any reason to deny coverage but it's frustrating for me and my Dr
@@BruceGinkel Right, money is the sole focus of the entirety of American culture, history and institutions but meaningless to the rest of the world now they're reverted back to the barter system or replaced currency with flowers 🙄 Money is no less important to the rest of the world but for some reason, America is the only wealthy country (wrongly) labeled as money grubbing
@@woodysmith2681 That plays a role but that can be rectified with a quick pre-op and post op note, the reason so much documentation is demanded with specific assessments is primarily because insurance find any reason to not reimburse the Hospital for the services rendered. Even when it comes to discharges. One of the main issues with medicaid is that if the patient is re-admitted within 30 days from discharge, they no longer reimburse the hospital for any aquired costs for the second admission, so the hospital basically eats all the cost. Which is terrible when it comes to patients that just have chronic conditions that require constant hospitalizations for flare ups. Which is why a lot of Hospitals that cater to such patients usually end up closing or being bought out.
I think a story was shared on one of his podcasts about someone getting cataract surgery with an internally displaced neck?? Or some other baffling status like a stroke.
I love how these always rip aside the curtain by the end. I discovered an opthamologist from history today, and I think you'll love him: Patrick Trevor-Roper. He campaigned for ages to make readers available without a prescription in Britain, spoke against the manipulative actions of drug companies (especially their sponsored luxury conferences) in addition to founding a lot of opthamology institutes, especially in developing countries (such as when he organised an oculoplastic unit in Lagos during their civil war). This is somewhat overshadowed in his biographies due to him being one of only THREE MEN in all of Britain who would testify in favor of decriminalising homosexuality in 1955. (It eventually happened, partly thanks to him, in 1967).
I took my dad for his pre op cataract surgery appointment recently and was so impressed. The ophthalmologist was the only doctor who didn’t bang on about his age (91.) Treated him like a human being. He’s booked in and looking forward to it.
There was a Psychiatrist who did this. Was how he rounded on 40 patients a day. Took Medicare a couple years to notice that he was billing for more than 24 hours time every day. Consequences followed.
Billing level is not only based on time. It can and is often based on complexity. For example, a level 4 office visit can be 30-39 minutes, or it can be a visit involving moderate complexity that you only spend 10 minutes on the patient. Unfortunately, this gets abbreviated as something like “OV Est Mod MDM 30-39 minutes”. Then the patient gets mad and says their doctor overbilled because all they understand in the billing statement is “30-39 minutes”. So if you see 40 patients a day and bill level 4 on all of them because they all involved moderate complexity, that can have the appearance of 20 hours billed, but it could actually be perfectly normal billing.
Ophthalmologists have their hands full just taking care of the eyes. Can someone else please handle the rest of the body for us, so we can make sure the correct lens with the correct power goes into the correct eye with an intact posterior capsule, a perfectly sized and well centered capsulorhexis, and an untraumatized iris and corneal endothelium? Oh, and no wound leaks. Thank you.
I always love your ophthalmologist videos because these are the ones coming right from where your heart is. Loved this one, shaking my head at the brutal honesty ophthalmology forced out of that bug xD
@teri2466 correct. Thats why there are 3 levels of eye care professionals. The eye surgeons aka medical doctors only see people with eye dieases, or in need of surgery. The optometrists manage vision testing, dry eye and manage eye health, referring to the Eye medical Dr if disease is present. Opticians can handle all things glasses and contacts once prescription strength is known. I have been e,evated to an eye surgeon after years at tne ophthalmology school clinic. He doesn't use a scribe, I am allotted 7mins in his presence to check an anomaly in the vessels in the back of my eye. I get multiple tests done by machines,with techs, and then HE looks and says, " stable" see you in six months, take care bye.
I have to object here. I work in surgery, and on several occasions there have been changes in a patient's status, or even a new Dx. Sadly, I have found new issues from my patient interviews that the surgeon was not even aware of. Additionally, a full H&P is not required, but a simple attestation that the physian has met with the patient, and no NEW issues have come up since the last full H&P. There is a reason for this, and I don't feel that insurance reimbursement is the reason. You might have the cart before the horse here. Insurance may not reimburse if an updated H&P is not completed, but the updated H&P just makes good sense. Things change in the life of any of us. Even over night, let alone the week(s) since we were last seen my our specialist.
Good point. This is probably more true in ophthalmology compared to other surgical fields. It is true that documentation is dictated by billing now more than ever.
@@DGlaucomflecken I wonder though. Is the documentation mandate due to best practice, which in turn becomes mandated by insurance, ergo, the billing department? I am aware that many billing practices are resultant from practice and/or regulatory guidelines, and not solely for monetary reasons although they are all in bed together to some degree! Great stuff. Look forward so seeing you in Houston in October!!!
The way I'm understanding it, you're doing an H&P review again anyway so why bother with maintaining a document that will potentially get superseded anyway? Just talk to the patient about the immediate status & ask about relevant past history according to your speciality & do the thingy. It's not like doctors across specialties discuss every single case they have in common. Have your own patient files as per your requirements & refer to the files the patients themselves take home every time.
@@apteryx13 "best practice" is an interesting thing. Sometimes it means not having one ex-employee with the only key to the fixit machine, but often it's basically a marketing ploy or a misdirect. Like "Zero Trust Architecture," a best practice that coincidentally requires you to permanently stake your business to a few major tech conglomerates' cloud services.
Why is Anesthesia just hanging around in the Administrator's office? Is he just wandering the safe bits of the hospital while waiting for the surgical suite to be prepped? The safe bits being anywhere where he won't get curbsided. Also, I love that everyone accepts Jonathan's nods and head shakes as accurate appraisals of the questions.
I need a new order every single bloody time I want to do a hearing test on a patient. It doesn’t matter that I’ve been seeing them for 15 years, I need to waste my time getting another doctor to waste their time writing a new order. But I don’t even get to just badger them directly. Oh no, that’s called soliciting a referral (despite the fact that, need I remind you, THEY ARE ALREADY MY PATIENT FOR 15 YEARS). Instead I have to tell the patient to badger that doctor, and then listen to them yell at me because no matter how many times I agree it’s stupid, I can’t change the fact they have to do this
I'm confused... Why can't you just order it yourself? And if the answer is "cuz ENT has to", then why is it "soliciting"? Shouldn't that simply be a referral to a colleague? And I thought the protocols where I'm from were stupid, SMH
@@kerasrc6230 The answer to the first part is the stupid answer you already deduced: because they have to. If another doctor doesn’t order the test, insurance will not pay for it. It’s completely ridiculous, and our professional groups have been lobbying for years to get us direct patient access, but it’s low priority as far as legislation goes so we’ll see if it ever happens. As far as the second part goes, simply asking is considered soliciting in the eyes of the law. Again, it’s stupid. They’re already my patient. If I call your PCP up and say “Hey can you send over an order, Steve needs a new test because he had a sudden hearing loss,” (which by the way is considered a medical emergency), I have solicited that referral and can get in massive trouble for it. The ONLY time we can contact directly is if we attempted a test and were unable to complete it for whatever reason and need to try again (pretty common with toddlers). The whole process is frustrating for us, frustrating for the patients, and benefits absolutely nobody except the insurance company who gets to refuse payment at the slightest hint of a misstep.
This *so* needed to be said! Useless documentation to "justify" billing is a huge component of physician burnout. Unfortunately, I don't think it's really the hospitals' fault as it's true across all practice locations. Insurers are to blame, and I really don't know that pushback is an option, they just won't pay us.
It would only be feasible to push back if Medicare didn't also require it anymore. The amount of paperwork required by the gov not just for billing but also for other aspects like the Meaningful Use and other incentive-based programs is ridiculously high and eats into providers' time.
My family doctor spends more time adding codes to my chart to prevent the insurance co from denying coverage than she does on my visit. It's such a drain on her time
Anesthesiologist here. While knowing the patient's medical status is very important, in low risk surgeries (of which cataract surgery is literally the textbook example), it is virtually irrelevant. So long as the patient is not having an active medical emergency and can lay still long enough for the procedure, they can have cataract surgery.
I'm in trucking. All out paperwork has to be backed up by computer and match 4 different programs. Fuel taxes individual state line milage, start stop times must match E log. BOLs j1 gate tickets fuel receipts. I'm a proficient clerk who drives a semin.
As somebody whose whole job is to collect and track patient data/progress via Epic for oncology clinical trials, THIS IS TOO REAL. It's always fun having to explain to the trial monitors why the PI did two physical exams, how the patient has both daily and discontinued use of Ibuprofen, and how the patient has a Performance Status of 2, 0, and 1 at the same time according to the notes😂 When they ask me how I possibly know what data is accurate in the physician's notes, the best answer I can give them is "ya just start to know what 3 specific areas within the copy and pasted mess that particular physician likes to add new information". Also, the billing team is our arch nemesis. It's a bad day for everyone when you're contacted by billing.
Its the look of someone who has focused all their information absorption from ages 18 to 30 on one very specific area but who knows that there's a whole office worth of staff to shore up the rest
30 min later, the call is finally directed to an associate only for them to accidentally disconnect. After screaming for a min, you call back and the wait time is 2 hours!
If Ophthalmology was Frodo, Jonathan would carry the Ring to Mordor and Mount Doom. Furthermore, the denizens of Middle Earth would have great eye care regardless of insurance coverage!
I'm dying. I've seen so many notes that were obviously completed using quick text and macros. And you are right, it is billing. The quickest way to snag an audit is to bill level 4s and 5s constantly with substandard documentation.
The opthos here love their normals (macros), I just gotta fill in which side and what the lens is. I love it cause it pads my lines per shift (transcriptionist). Other docs have theirs, but opthos have the most.
i had a surgery consult once and afterwards looked at the visit notes to find a few paragraphs talking about having procedures done that we didn't discuss at all, despite the notes themselves saying a few sentences before that i didn't need them!! it was very confusing, so i messaged the surgeon and he said that was put in by accident. makes me think that he was probably using a bunch of macros to write the notes (a lot of the notes were very clearly written more for the insurance person than me, so i don't blame him)
I love how ultra specialized all the doctors in the Glauckenflecken Medical Center are. Like you could get any of them to hold a 3 hour long lecture on the most mundane uninteresting part of their specialty, that all sound made up on the spot. But if you ask anyone of them, but Emergency to get you a band aid, they will look at you as if you were speaking a foreign language
Fun fact from a pharmacy technician: Medicare will not pay for a prescription that says "as directed" on it, no matter how detailed the directions are. If a Medicare patient comes in and the rx says something like "Inject 15 units under the skin three times daily *as directed*" then we have to call the doctor's office and tell them to send over a new prescription without the "as directed". Like?? They don't have time for that and neither do we. As long as the instructions are clear, why does it matter? Dealing with the BS of insurance companies is, by far, my least favorite part of my job.
Huh, pharmacist here. If the instructions are otherwise clear like describe above I just edit out the "as directed" before completing the order. Requires a pharmacist, but it's extraneous info.
@@dryurimom1169 That would be nice. It must be a difference in company policy. I work at a Walmart and our corporate is pretty strict about many things. There certainly are things we can just change with a pharmacist's approval, but unfortunately this isn't one of them at Walmart. We have so many unnecessary hoops to jump through, it's ridiculous. And if we don't roll with it, they won't let us hear the end of it. Working for a huge company sucks sometimes
@@lailanitukuafu Also a CPhT. As long as you’ve got the all the necessary info it doesn’t matter if it says “as directed” on the sig because the patient is using the medication in the manner directed by their prescriber according the sig. I see a lot of women’s health scripts so the patient has been given instructions on how to apply things like a cream or ointment. The sig will regularly say something like “Insert 1 gram vaginally twice daily as directed.” If the package has 60 grams, then you have a 30 day supply. If the sig only said “Insert as directed” then we’d have to call and find out how much to insert and how often.
I used to give patients a printout for titration of their gabapentin. It specified the timing of dose increases, side effects to look for, etc. The pharmacy would object to "as directed", so I bought some large labels and printed my instructions on the label in a tiny font, then slap it on the prescription. Then they said "as directed" was OK. I was a pioneer. Now just about every small electronic device I purchase uses the same tiny fonts, usually in gray.
Jesus, THANK YOU. I get looked at like I'm the jackass for calling out hypocrisy in the system. "that's such a negative outlook". "That's not a professional thing to say". Maybe it's because while I'm still in Med School, I don't have the "street cred" yet (despite qualifications in working in healthcare and healthcare policy), or maybe it's just academic physicians are cowards/gaslit into believing in the system, but I'm so happy to see you call out the BS through the veil of comedy.
That's unfortunately not something the medical system suffers from alone. Way too many people in many different fields would rather be politically correct than call a spade a spade. "That's how we've been doing it" is enough to trigger inertia & status-quo-ism. No one remembers or cares why. And that is how systems get increasingly bureaucratic & begin to stagnate & problems start to fester.
I thank my lucky stars that I am a UK citizen, born and bred. My husband has had numerous surgeries on his right eye (hypertensive uveitis, if you’re wondering) (including cataract surgery) and has regular visits to various ophthalmologists in 3 different hospitals in 3 different counties. He pays train fares to get to the 2 that are not local and he has a prepayment card for his numerous prescription medications (he usually comes home with boxes of preservative-free eye drops) but he pays nothing for the clinic time or any operations. My elderly mum has also has cataract surgery on both eyes as well as YAG laser treatment to correct the PCO that occurred afterwards. All free. She doesn’t even have to pay for her prescription medications due to her age. The NHS is by no means perfect but it’s an excellent concept and a good deal better than what you guys have in the US.
"Spoke with owner prior to surgery, reiterated risks associated with procedure, particularly anesthetic death, hemorrhage, and post operative infection. Advised no indications to delay surgery based on pre-operative exam. O acknowledges risks, and consents to surgery as previously discussed. Will call owner once P is awake and stable, advised no news is good news." -The client communication I've written before every healthy spay or neuter for my entire career, give or take a few words
I write "official" looking notes as an ICU RN and it absolutely cracks me up when all the consulting Physician specialties copy and paste my RN notes into their notes on Epic. Like seriously when was the last time a Hematologist used the Bristol Scale to assess a poop? My RN poop assessment note is in their copy and paste notes. Freaking hilarious cracks me up to no end 😂
“DoCTorS Don’T ListEn tO paTieNTs.” No, darling, your insurance company will only pay for a five-minute visit. Seven minutes if it’s complex. If your doctor spends more time than that with you, said doc will be yelled at for low RBU’s by someone with an MBA who had to do cheat to pass high school chemistry.
I'm gonna need a request, in writing, a week before, requesting each patient H&P. That will give me enough time to bring the request to the weekly for review and approval. If it's rejected, then the requestor could always appeal to the designated appraiser, who is only in on Wednesdays, only communicates in medieval Farsi -- in braille.
I just got to see my favorite eye guys today! I gave them updates on my visit to the specialists. They were happy with the good news and next time they see me we will be glasses kins for the wins. 🎇🏆🏆🏆🎇
Unironically true since you have to have PERFECT health to be considered physical status I and status III onwards is already related to more severe systemic diseases.
I always enjoy your collegial spoofs of the foibles of each specialty. Clearly, all are done with affection. Ophthalmology isn't spared either, although nobody else gets Jonathan. Rural medicine is one of my favourites, as I lived in a rural area for nearly 30 years. It's truly a different world.
I’m a circulating nurse and I read every H&P on every patient. I need to know how to position the patient. I need to know their health histories. I need to know the reason for the surgery. Are they intubated? How much time am I going to have to dedicate to supporting my anesthetist? What is their Glasgow Coma Scale and how close to death are they? If we are debriding a leg wound, I need to know where on the leg so I will know how to prep the skin. If it is a fracture, is it open or closed and how dirty is it? Do they abuse drugs or alcohol? If they are diabetic, are they controlled? My surgeons give me so much useful information in that document, I wish they knew how much I rely on them.
Preach! Superfluous paperwork is the name of the game in mental health care and social work as well. Insurance companies look for any and all reasons to deny claims, and there seems to be no stopping them.
I actually had an ophthalmologist tell me his practice had to stop taking United Health Care because of how measly the reimbursements were. Nice to see insurance companies continuing to screw everyone over.
My pre-op H&P for carpal tunnel surgery as a healthy 30 year old with no underlying conditions or medications consisted of my doctor basically saying, "yup! You're alive! Good luck with surgery!" I didn't even have labs drawn. Total waste of his time, my time, and my precious insurance deductible. As a nurse, I do understand the risks of anesthesia. However, I do think pre-op H&Ps should be, like everything else in healthcare, individualized to the patient. You have a significant medical history or a family history of complications from anesthesia? Over a certain age? Sure! Do an H&P. You are younger, healthy, and have no know family history of complications? As long as you are feeling healthy and well the day of, you are good to go! That would be both more cost effective and a more effective use of the provider's time. Realistically, they aren't catching any underlying condition that wasn't previously known about from the numerous other appointments needed to even get approved for surgery to begin with.
Yep. In my mid 20s I had to have an anesthesia consult because I was on enough meds my doctor had never heard of that she was not confident of what meds needed to be stopped and when. But most people that age are totally fine to go with nothing, or a blood type test if it's a more involved surgery.
I had to go under anesthesia recently. My medications in my chart were wildly inaccurate, I only saw a doctor for about 15 minutes, and everybody forgot to follow up with me about if the examination went through while I was out and what the results were. When I finally got in touch with the doc, I found out somebody had forgotten to reach out to me about a necessary follow up as well. I don’t know what this thing is, but even if it’s a pain in the ass, there’s a lot of shitty employees in healthcare. I’m really glad there’s some kind of hoops that need to be jumped through, if that hospital had just operated on its own terms then they would have knocked me out for 7 grand and left me on the curb without even buying me dinner first, no way I’d trust them to actually catch everything in a chart or history
@MrKhaz101 I agree that there are some terrible healthcare employees. But, if your medications were inaccurate, then you would fit my idea for criteria of needing a pre-Op H&P. I'm essentially suggesting a flow chart to determine if one is necessary. Family history? Any pre-existing conditions? Any medication? If you answer yes, you do an H&P. If no, proceed to surgery. Those H&Ps are not thorough enough typically to catch something that has not been previously diagnosed. That is my point.
"This just looks like you copied and pasted it" and "I keep getting confused where your note was cause I thought it was nursing documentation" are things I hear about my migraine infusion order request frequently. Like it looks like it's copied and pasted...because it kinda was. I just made up a template of all the info they want to know, and all I have to fill in are the things that change. Which really helps because migraine brain fog is brutal, so only needing to paste and put in four pieces of info is much easier. And it looks like a nurse wrote it because writing in medicalise works better 98% of the time. Also I'm a dork, and I had to learn way more about the human body than I ever expected because I often have to teach other doctors about my very unique migraine.
PREACH!! 🙏 It's the same for nurses! "Here, take 6 patients during the day and 7-8 at night, which means you've got less than 10 minutes per patient per hour, but we *need* this nursing care plan that no one pays attention to and this click box form we added because we have too many falls from not enough staff that we don't address but ask how you could've prevented Memaw from falling when she's convinced she has to go to the store at 3am while you and the other 4 staff were coding Pawpaw down the hall." 😭
Realistically, Johnathan is writing those notes and Opthalmology is just signing them. Johnathan doesn't know what the ASA classification is either. He hasn't been to medical school. He probably googled it though.
Primary care doc trimming in, I honestly expected a cameo from family medicine, or the punchline to be that we'll just make the patient's PCP do it I personally do dozens of preops a year for cataract surgery, and for every single one of them it's a giant waste of time and the patient would probably need to be pulseless before I would say anything besides "Go ahead with your cataract surgery, take care"
My Mother was a Hospice Home Calls nurse, I knew I didn’t want to go into medicine because of the paperwork. Secret 🤫 in the summer during high school I’d spend hours helping her do paperwork because this wasn’t counted towards her work hours. It was essentially unpaid overtime. And it was the best way to get anytime with her.
Back in the 80s I rotated through the Massachusetts Eye and Ear Infirmary. All of the ophthalmology H&P's had scant health details except for a giant diagram of an eye that took up the whole page. 😂
I recently made an appointment to see my regular internist for a preop checkup. I'm 65 and in pretty good health. While on the phone with the doctors office they had NO CLUE that this appointment had to be within 30 days of my scheduled surgery date! The scheduler actually stated to me that she thought it would be better if it was BEFORE 30 days?!?
Recently experienced this from the patient end lol. Was going in for a minor surgery and the nurse asked me a bunch of questions for anesthesia, then anesthesia came and asked me all the same questions himself.
Honestly I have a lidocaine allergy and my new opthalmologist slammed the door and was like "I didn't look at your chart!" Then immediately tried to put some anesthesia drop into my eye before the pressure check.
The irony of insurance companies increasing the costs to providers by increasing the amount of work needed for each patient in an effort to compensate the provider less for that procedure that they're making more expensive to perform.
This is totally a jab from Doc G toward insurance for things he’s personally encountered as an ophthalmologist, but that’s cool because he’s right and also taught me how to spell his profession.
I feel like dermatology would really feel this. "I need you to fill all this mountain of paperwork due to the use of 2cc of lidocaine and a kid size band-aid" - It was a skin tag
This is hilarious because the Opthos near me send their patients to our urgent care to get pre op clearance. I find it hilarious and probably fraudulent that a Physician is sending a pt to be cleared by PA. But I do em all so that when I have a scary/icky eyeball pt, I can call in the favor to optho/Jonathan.
Nailed it❗ I HATE cloned H & Ps! I HATE templates because too many physicians forget what's in it and don't change the information to match the patient! Always love it (not) when the patient has a history of BKA and PE states bilateral pedal pulses 2+. I've worked in health care documentation for decades, and shoddy documentation results in so much lost revenue for the physicians. But heck, they saved a few minutes on documentation. 😖
OMG hilarious and so accurate. Retired from practice 2 years ago and could not get out fast enough!. The whole world of medicine is now captive to the time blackhole EMR and the horsesh_t it produces. Love the "every H&P is identical" - like an ophtho doc listens to lungs or palpates anything but your cornea!🤣😂🤣
Now I'm imagining that the norm is for gorilla opthalmologists to perform cataract surgery on their fellow gorillas, and the resulting mental images, starting with a college lecture hall full of gorilla premeds, are delightful! Thank you for your strategic deployment of the word "human" 😊
@@Cog_Nomen I made the mistake of drinking hot coffee while reading this but barely felt my nasal passages burning bc I was laughing so hard!! I'm picturing a distinguished looking flanged male orangutan as the university's Chancellor and a group of long armed gibbons running admissions!
@@justahugenerd1278 It was on an episode of Secrets of the Zoo, which was filmed at Columbus Zoo in Ohio. It's not unusual for human doctors to treat great apes because their anatomy is so similar to ours. A few cardiologists have gorilla patients, since they're predisposed to heart disease, and OB/GYNs have performed c-sections on orangutans and gorillas with high risk pregnancies, most recently in Jan of this year when an OB, anesthesiologist and neonatal nurse at a TX hospital delivered a baby girl gorilla for a mother with pre-eclampsia, which can be fatal. To honor the Dr, whose name is Jamie, the baby was also given a J name - Jameela. Multiple videos here abt it
Patient is alive and has eye(s).
😂😂😂😂 perfection
@@troisquarts3659 The eyes have cataracts. Soon they won’t.
@@anniehasting1133 🤣🤣🤣
But, can the patient see out of those eyes ???
It depends if the initial intention was tp keep patients eyes where they usually are 😂
“Ophthalmology writes notes???” 💀💀💀
🤣🤣🤣🤣🤣🤣
I'm an anesthesiologist and this was my reaction. I never saw anything written by an opthalmologist that wasn't indecipherable eye voodoo notation
@@victorgbs Those notes were actually mini visual processing tests
In Spanish, ophthalmology notes are a lot of letters and numbers that must be translated into human language 😂😂😂
@@victorgbs As an ED doc, I'm reasonably sure they dictate in hieroglyphics.
Fraud is a strong word. I prefer "efficient and effective solutions to excessive paperwork."
Freely Reducing Administration's Unnecessary Documentation
@@HansLemurson Frankly Reducing Administrative Underlings' Duties
The laywers of the insurance companies may take this questiuon to court...
Fraud maybe in the eyes of insurance, but this video suggests that the H&P notes have no purpose for cataract surgeries at least so the word fraud is in the title to emphasize the point of the video that some make things like H&P notes out to be a big deal when they may be meaningless for things like cataract operations and their purpose(the purpose of things like H&P notes) is for other people to make more money
@@red.aries1444lj
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"We'll consider it." is ophthalmologist for "Absolutely not."
I've been saying "I will take it under advisement" for years.
there's a joke somewhere about internal medicine but I can't figure it out
"We'll consider it." Is most people speak for "Absolutely not."
Into the circular file!
It should have bee: "I'll see what I can do."
@@tammyt3434Perfectly fits into my "VERY important files" bin.
Jonathan shaking his head was unexpected and concerning.
I'd love for giant notes to be axed though. Even with templates, dictaphone, and smart phrases I always feel behind.
Jonathan shook his head because Jonathan is only concerned with things that are 1) necessary to fulfill ophthalmology goals and 2) relevant/good for the patient. Writing extensive H&Ps for routine cataract surgery does not fulfill ophthalmology's goals (i.e. efficiency, reduced stress, reduced time in clinic, and overall less hassle 😂) and has negligible effect on patient outcomes.
@@ada5851 Oh, I agree completely. It is just disconcerting to see a negative response that obvious from Jonathan. From a lesser being it would've been an open palmed slap.
I think that more Jonathan saying "No, *you* don't know what that is".
😊jpl
@@VoidWalkerOblivion The second time, not the first time.
Insurance: We want to pay less, so we need more documentation to justify reducing payments.
administration: We want to get paid more, so we need more documentation to justify increasing our payments.
Assuming the documentation really is used only for billing and has no relationship with the patient's chart or care, the obvious solution is to teach ChatGPT to do it for you.
Disclaimer: If you actually do this, and somebody finds out and you get in trouble, that's your problem.
The solution is to replace both with AI
@@trikstari7687 The even better solution is to get them to have their AI arms race in a seperate universe and let this world just do health care.
@@trikstari7687the best solution is to send both AI and insurance companies to the sun
Yup, it makes me dizzy.
Hey, uncrustables are the backbone of the healthcare system
Not just healthcare /consulting
Also, what is that bread? Why does it look like cake?
@@christafranken9170 Sugar. Lots of it.
I thought caffeine held that position. And maybe Adderall for certain specialties
And SSRI's for the other specialties @@phoenixfire8978
Every time I've had surgery (and it's been a lot), the anesthesiologist has personally come into my room and asked me everything he needed to know. I presume that reading my chart instead would create a level of liability and risk based on him having to have complete and total trust in the person who charted asking all the right questions in the right way and documenting the answer in a way that was appropriate, all for a specialty that isn't even theirs.
We do double check but having your history well documented is INCREDIBLY helpful to help us direct our history, reduce the time it takes for me to double check an elderly patient's medications, and make sure they're not forgetting to tell me something. You would not believe the amount of prodding some people take to remember important things about their health ("do you have any comorbidities or chronic ilnesses?" "No" "ok, what medications do you take every day" "metformin, losartan, atorvastatin"
@@victorgbsYou have my utmost respect…
@@victorgbs You know that isn't the answer. The answer is "three pinks and two blues out of my big old tupperware of loose pills"
@@victorgbsI’ve had so many surgeries I often forget major ones.😂
Each type of doctor cares more or less about specific parts of a patient's history as it pertains to what they need to do and know. In pharmacy for example, we'll ask about and document a med history different than pretty much everyone else.
it's always money, whether it's billing or liability
I thought the real reason was liability. An ever-evolving game of CYA.
My Dr spends more time adding codes to my chart to than she does on my visit. I appreciate it bc insurance companies look for any reason to deny coverage but it's frustrating for me and my Dr
It's the only thing America cares about
@@BruceGinkel Right, money is the sole focus of the entirety of American culture, history and institutions but meaningless to the rest of the world now they're reverted back to the barter system or replaced currency with flowers 🙄 Money is no less important to the rest of the world but for some reason, America is the only wealthy country (wrongly) labeled as money grubbing
@@woodysmith2681 That plays a role but that can be rectified with a quick pre-op and post op note, the reason so much documentation is demanded with specific assessments is primarily because insurance find any reason to not reimburse the Hospital for the services rendered. Even when it comes to discharges.
One of the main issues with medicaid is that if the patient is re-admitted within 30 days from discharge, they no longer reimburse the hospital for any aquired costs for the second admission, so the hospital basically eats all the cost. Which is terrible when it comes to patients that just have chronic conditions that require constant hospitalizations for flare ups. Which is why a lot of Hospitals that cater to such patients usually end up closing or being bought out.
"Did the patient get to the OR? Yes? Then they can have cataract surgery."
Wouldn't be the other way around? If they got there they can see...
I think a story was shared on one of his podcasts about someone getting cataract surgery with an internally displaced neck?? Or some other baffling status like a stroke.
@@KeithBoehler Stumble around long enough and even the blind will find their way into the OR
Also stealing the use of the word “Consider” from Internal Medicine will need to be investigated by HR.
Irony. Steal the line from people who actually write real H&Ps...
Jonathan can shake his head?!
I'm...uh...shook.
He can also frown, glare, and an expression with a raised eyebrow that quietly asks, "Oh really"
Reminds me of an ortho surgeon I work with who always puts "Looks great" under "prognosis."
That's it. No elaboration. Same thing every damn time.
☠️☠️☠️
I love how these always rip aside the curtain by the end. I discovered an opthamologist from history today, and I think you'll love him: Patrick Trevor-Roper. He campaigned for ages to make readers available without a prescription in Britain, spoke against the manipulative actions of drug companies (especially their sponsored luxury conferences) in addition to founding a lot of opthamology institutes, especially in developing countries (such as when he organised an oculoplastic unit in Lagos during their civil war). This is somewhat overshadowed in his biographies due to him being one of only THREE MEN in all of Britain who would testify in favor of decriminalising homosexuality in 1955. (It eventually happened, partly thanks to him, in 1967).
He sounds like an awesome dude!
I took my dad for his pre op cataract surgery appointment recently and was so impressed. The ophthalmologist was the only doctor who didn’t bang on about his age (91.) Treated him like a human being. He’s booked in and looking forward to it.
What do doctors normally say about your dad's age? Are they mean to him about it? :(
It's like overweight. "You're very old. Have you considered losing some age? 10 fewer years would be good for you"
WHAT @@philmiller2465
@@justahugenerd1278 Commenting to see the response.
😂 I'd prefer to keep my years, thanks
There was a Psychiatrist who did this. Was how he rounded on 40 patients a day. Took Medicare a couple years to notice that he was billing for more than 24 hours time every day. Consequences followed.
As they should. But a couple of years before anyone noticed? Abysmal.
Billing level is not only based on time. It can and is often based on complexity. For example, a level 4 office visit can be 30-39 minutes, or it can be a visit involving moderate complexity that you only spend 10 minutes on the patient. Unfortunately, this gets abbreviated as something like “OV Est Mod MDM 30-39 minutes”. Then the patient gets mad and says their doctor overbilled because all they understand in the billing statement is “30-39 minutes”. So if you see 40 patients a day and bill level 4 on all of them because they all involved moderate complexity, that can have the appearance of 20 hours billed, but it could actually be perfectly normal billing.
Ophthalmologists have their hands full just taking care of the eyes. Can someone else please handle the rest of the body for us, so we can make sure the correct lens with the correct power goes into the correct eye with an intact posterior capsule, a perfectly sized and well centered capsulorhexis, and an untraumatized iris and corneal endothelium? Oh, and no wound leaks. Thank you.
I always love your ophthalmologist videos because these are the ones coming right from where your heart is. Loved this one, shaking my head at the brutal honesty ophthalmology forced out of that bug xD
I went to an optometrist the other day and was disappointed Johnathan wasn't there.
Just because you didn't see him doesn't mean he wasn't there. Jonathan moves in mysterious ways.
Ophthalmologist is different to a guy who fits eye glasses.
I tried to make an appointment with an opthalmologist because optometrists around here don't have scribes and they said I didn't need one. 😢
@teri2466 correct. Thats why there are 3 levels of eye care professionals. The eye surgeons aka medical doctors only see people with eye dieases, or in need of surgery. The optometrists manage vision testing, dry eye and manage eye health, referring to the Eye medical Dr if disease is present. Opticians can handle all things glasses and contacts once prescription strength is known. I have been e,evated to an eye surgeon after years at tne ophthalmology school clinic. He doesn't use a scribe, I am allotted 7mins in his presence to check an anomaly in the vessels in the back of my eye. I get multiple tests done by machines,with techs, and then HE looks and says, " stable" see you in six months, take care bye.
@@joywebster2678 You're thinking of an optician 😊
I have to object here. I work in surgery, and on several occasions there have been changes in a patient's status, or even a new Dx. Sadly, I have found new issues from my patient interviews that the surgeon was not even aware of. Additionally, a full H&P is not required, but a simple attestation that the physian has met with the patient, and no NEW issues have come up since the last full H&P. There is a reason for this, and I don't feel that insurance reimbursement is the reason. You might have the cart before the horse here. Insurance may not reimburse if an updated H&P is not completed, but the updated H&P just makes good sense. Things change in the life of any of us. Even over night, let alone the week(s) since we were last seen my our specialist.
Good point. This is probably more true in ophthalmology compared to other surgical fields. It is true that documentation is dictated by billing now more than ever.
You are not wrong. But that wouldn't make for a funny satire. ;)
@@DGlaucomflecken I wonder though. Is the documentation mandate due to best practice, which in turn becomes mandated by insurance, ergo, the billing department? I am aware that many billing practices are resultant from practice and/or regulatory guidelines, and not solely for monetary reasons although they are all in bed together to some degree! Great stuff. Look forward so seeing you in Houston in October!!!
The way I'm understanding it, you're doing an H&P review again anyway so why bother with maintaining a document that will potentially get superseded anyway? Just talk to the patient about the immediate status & ask about relevant past history according to your speciality & do the thingy. It's not like doctors across specialties discuss every single case they have in common. Have your own patient files as per your requirements & refer to the files the patients themselves take home every time.
@@apteryx13 "best practice" is an interesting thing. Sometimes it means not having one ex-employee with the only key to the fixit machine, but often it's basically a marketing ploy or a misdirect.
Like "Zero Trust Architecture," a best practice that coincidentally requires you to permanently stake your business to a few major tech conglomerates' cloud services.
Why is Anesthesia just hanging around in the Administrator's office? Is he just wandering the safe bits of the hospital while waiting for the surgical suite to be prepped? The safe bits being anywhere where he won't get curbsided.
Also, I love that everyone accepts Jonathan's nods and head shakes as accurate appraisals of the questions.
I need a new order every single bloody time I want to do a hearing test on a patient. It doesn’t matter that I’ve been seeing them for 15 years, I need to waste my time getting another doctor to waste their time writing a new order. But I don’t even get to just badger them directly. Oh no, that’s called soliciting a referral (despite the fact that, need I remind you, THEY ARE ALREADY MY PATIENT FOR 15 YEARS). Instead I have to tell the patient to badger that doctor, and then listen to them yell at me because no matter how many times I agree it’s stupid, I can’t change the fact they have to do this
I'm confused... Why can't you just order it yourself?
And if the answer is "cuz ENT has to", then why is it "soliciting"? Shouldn't that simply be a referral to a colleague?
And I thought the protocols where I'm from were stupid, SMH
@@kerasrc6230 The answer to the first part is the stupid answer you already deduced: because they have to. If another doctor doesn’t order the test, insurance will not pay for it. It’s completely ridiculous, and our professional groups have been lobbying for years to get us direct patient access, but it’s low priority as far as legislation goes so we’ll see if it ever happens.
As far as the second part goes, simply asking is considered soliciting in the eyes of the law. Again, it’s stupid. They’re already my patient. If I call your PCP up and say “Hey can you send over an order, Steve needs a new test because he had a sudden hearing loss,” (which by the way is considered a medical emergency), I have solicited that referral and can get in massive trouble for it.
The ONLY time we can contact directly is if we attempted a test and were unable to complete it for whatever reason and need to try again (pretty common with toddlers). The whole process is frustrating for us, frustrating for the patients, and benefits absolutely nobody except the insurance company who gets to refuse payment at the slightest hint of a misstep.
This *so* needed to be said! Useless documentation to "justify" billing is a huge component of physician burnout. Unfortunately, I don't think it's really the hospitals' fault as it's true across all practice locations. Insurers are to blame, and I really don't know that pushback is an option, they just won't pay us.
It would only be feasible to push back if Medicare didn't also require it anymore.
The amount of paperwork required by the gov not just for billing but also for other aspects like the Meaningful Use and other incentive-based programs is ridiculously high and eats into providers' time.
My family doctor spends more time adding codes to my chart to prevent the insurance co from denying coverage than she does on my visit. It's such a drain on her time
Direct primary care if you can afford it. It’s usually cheaper than insurance.
Legislation is the problem and solution.
Healthcare employs on the order of one in six US workers. One can't help but notice how few of those are doctors, techs, and nurses.
Anesthesiologist here. While knowing the patient's medical status is very important, in low risk surgeries (of which cataract surgery is literally the textbook example), it is virtually irrelevant. So long as the patient is not having an active medical emergency and can lay still long enough for the procedure, they can have cataract surgery.
And as a surgeon myself, I can truthfully say we aren't the ones that you should trust to determine a patients ASA. 🤭
I'm in trucking. All out paperwork has to be backed up by computer and match 4 different programs. Fuel taxes individual state line milage, start stop times must match E log. BOLs j1 gate tickets fuel receipts. I'm a proficient clerk who drives a semin.
As somebody whose whole job is to collect and track patient data/progress via Epic for oncology clinical trials, THIS IS TOO REAL. It's always fun having to explain to the trial monitors why the PI did two physical exams, how the patient has both daily and discontinued use of Ibuprofen, and how the patient has a Performance Status of 2, 0, and 1 at the same time according to the notes😂 When they ask me how I possibly know what data is accurate in the physician's notes, the best answer I can give them is "ya just start to know what 3 specific areas within the copy and pasted mess that particular physician likes to add new information".
Also, the billing team is our arch nemesis. It's a bad day for everyone when you're contacted by billing.
As someone who fills out prior authorizations all day, I feel your pain. I know where to look in certain provider’s notes for info I need.
I know how ridiculous it sounds, but Ophthalmology bears a striking resemblance to Ortho around 0:40. Maybe they’re not just bros but also brothers.
No, they do not look at all alike. Perhaps you need to see… an Ophthalmologist!
Its the look of someone who has focused all their information absorption from ages 18 to 30 on one very specific area but who knows that there's a whole office worth of staff to shore up the rest
"Your opinion is important to us. Please hold while we direct your call. Your opinion is imp[....]"
30 min later, the call is finally directed to an associate only for them to accidentally disconnect. After screaming for a min, you call back and the wait time is 2 hours!
If Ophthalmology was Frodo, Jonathan would carry the Ring to Mordor and Mount Doom. Furthermore, the denizens of Middle Earth would have great eye care regardless of insurance coverage!
Also, Jonathan wouldn't need a Samwise Gamgee to keep him on track. He would just deliver that ring straight to Mordor.
I'm dying. I've seen so many notes that were obviously completed using quick text and macros.
And you are right, it is billing. The quickest way to snag an audit is to bill level 4s and 5s constantly with substandard documentation.
The opthos here love their normals (macros), I just gotta fill in which side and what the lens is. I love it cause it pads my lines per shift (transcriptionist). Other docs have theirs, but opthos have the most.
i had a surgery consult once and afterwards looked at the visit notes to find a few paragraphs talking about having procedures done that we didn't discuss at all, despite the notes themselves saying a few sentences before that i didn't need them!! it was very confusing, so i messaged the surgeon and he said that was put in by accident. makes me think that he was probably using a bunch of macros to write the notes (a lot of the notes were very clearly written more for the insurance person than me, so i don't blame him)
I love how ultra specialized all the doctors in the Glauckenflecken Medical Center are. Like you could get any of them to hold a 3 hour long lecture on the most mundane uninteresting part of their specialty, that all sound made up on the spot. But if you ask anyone of them, but Emergency to get you a band aid, they will look at you as if you were speaking a foreign language
Fun fact from a pharmacy technician: Medicare will not pay for a prescription that says "as directed" on it, no matter how detailed the directions are. If a Medicare patient comes in and the rx says something like "Inject 15 units under the skin three times daily *as directed*" then we have to call the doctor's office and tell them to send over a new prescription without the "as directed". Like?? They don't have time for that and neither do we. As long as the instructions are clear, why does it matter? Dealing with the BS of insurance companies is, by far, my least favorite part of my job.
Huh, pharmacist here. If the instructions are otherwise clear like describe above I just edit out the "as directed" before completing the order. Requires a pharmacist, but it's extraneous info.
@@dryurimom1169 That would be nice. It must be a difference in company policy. I work at a Walmart and our corporate is pretty strict about many things. There certainly are things we can just change with a pharmacist's approval, but unfortunately this isn't one of them at Walmart. We have so many unnecessary hoops to jump through, it's ridiculous. And if we don't roll with it, they won't let us hear the end of it. Working for a huge company sucks sometimes
@@lailanitukuafu Also a CPhT. As long as you’ve got the all the necessary info it doesn’t matter if it says “as directed” on the sig because the patient is using the medication in the manner directed by their prescriber according the sig. I see a lot of women’s health scripts so the patient has been given instructions on how to apply things like a cream or ointment. The sig will regularly say something like “Insert 1 gram vaginally twice daily as directed.” If the package has 60 grams, then you have a 30 day supply. If the sig only said “Insert as directed” then we’d have to call and find out how much to insert and how often.
I used to give patients a printout for titration of their gabapentin.
It specified the timing of dose increases, side effects to look for, etc.
The pharmacy would object to "as directed", so I bought some large labels and printed my instructions on the label in a tiny font, then slap it on the prescription. Then they said "as directed" was OK.
I was a pioneer. Now just about every small electronic device I purchase uses the same tiny fonts, usually in gray.
Jesus, THANK YOU.
I get looked at like I'm the jackass for calling out hypocrisy in the system.
"that's such a negative outlook".
"That's not a professional thing to say".
Maybe it's because while I'm still in Med School, I don't have the "street cred" yet (despite qualifications in working in healthcare and healthcare policy), or maybe it's just academic physicians are cowards/gaslit into believing in the system, but I'm so happy to see you call out the BS through the veil of comedy.
That's unfortunately not something the medical system suffers from alone. Way too many people in many different fields would rather be politically correct than call a spade a spade. "That's how we've been doing it" is enough to trigger inertia & status-quo-ism. No one remembers or cares why. And that is how systems get increasingly bureaucratic & begin to stagnate & problems start to fester.
I was taken aback by the title. Fraud? Surely Jonathan would have stopped him!
I thank my lucky stars that I am a UK citizen, born and bred. My husband has had numerous surgeries on his right eye (hypertensive uveitis, if you’re wondering) (including cataract surgery) and has regular visits to various ophthalmologists in 3 different hospitals in 3 different counties. He pays train fares to get to the 2 that are not local and he has a prepayment card for his numerous prescription medications (he usually comes home with boxes of preservative-free eye drops) but he pays nothing for the clinic time or any operations. My elderly mum has also has cataract surgery on both eyes as well as YAG laser treatment to correct the PCO that occurred afterwards. All free. She doesn’t even have to pay for her prescription medications due to her age. The NHS is by no means perfect but it’s an excellent concept and a good deal better than what you guys have in the US.
"Spoke with owner prior to surgery, reiterated risks associated with procedure, particularly anesthetic death, hemorrhage, and post operative infection. Advised no indications to delay surgery based on pre-operative exam. O acknowledges risks, and consents to surgery as previously discussed. Will call owner once P is awake and stable, advised no news is good news."
-The client communication I've written before every healthy spay or neuter for my entire career, give or take a few words
Looks like the ophthalmologist cares about physician wellbeing in their universe, too.
Good job, doc.
Jonathan and the ophthalmologist are like Batman and Robin or /Sherlock and Watson......respectively in that order 😂
"...at the expense of the physician."
Opthalmology: "There it is..."
I write "official" looking notes as an ICU RN and it absolutely cracks me up when all the consulting Physician specialties copy and paste my RN notes into their notes on Epic.
Like seriously when was the last time a Hematologist used the Bristol Scale to assess a poop? My RN poop assessment note is in their copy and paste notes. Freaking hilarious cracks me up to no end 😂
Is there anything that the problem isn't billing?
“DoCTorS Don’T ListEn tO paTieNTs.” No, darling, your insurance company will only pay for a five-minute visit. Seven minutes if it’s complex. If your doctor spends more time than that with you, said doc will be yelled at for low RBU’s by someone with an MBA who had to do cheat to pass high school chemistry.
Only technically 😅
I'm gonna need a request, in writing, a week before, requesting each patient H&P. That will give me enough time to bring the request to the weekly for review and approval. If it's rejected, then the requestor could always appeal to the designated appraiser, who is only in on Wednesdays, only communicates in medieval Farsi -- in braille.
This sounds like both a confession and an accusation at the same time...from you personally
I love a spicy Dr. G upload 🙏
Jonathanology should be the only science
It is.
Ophthalmology and Orthopedics H&P
LAFD
"Looks Alive From Door"
The exciting sequel to Yoshi Commits Tax Fraud
Anaesthesia: “Can the patient lie flat?”
Ophthal: “Yes”
Anaesthesia: “Crack on”
I just got to see my favorite eye guys today! I gave them updates on my visit to the specialists. They were happy with the good news and next time they see me we will be glasses kins for the wins. 🎇🏆🏆🏆🎇
I'm definitely an ASA level 2 and so are you
"I like Italian, and so do you."
Unironically true since you have to have PERFECT health to be considered physical status I and status III onwards is already related to more severe systemic diseases.
I always enjoy your collegial spoofs of the foibles of each specialty. Clearly, all are done with affection. Ophthalmology isn't spared either, although nobody else gets Jonathan.
Rural medicine is one of my favourites, as I lived in a rural area for nearly 30 years. It's truly a different world.
That transition at 0:05 was so smooth I audibly gasped
I’m a circulating nurse and I read every H&P on every patient. I need to know how to position the patient. I need to know their health histories. I need to know the reason for the surgery. Are they intubated? How much time am I going to have to dedicate to supporting my anesthetist? What is their Glasgow Coma Scale and how close to death are they? If we are debriding a leg wound, I need to know where on the leg so I will know how to prep the skin. If it is a fracture, is it open or closed and how dirty is it? Do they abuse drugs or alcohol? If they are diabetic, are they controlled? My surgeons give me so much useful information in that document, I wish they knew how much I rely on them.
Hey doc, just wanna say thanks because I'm starting med school this Tuesday and your videos helped keep me motivated!
Preach! Superfluous paperwork is the name of the game in mental health care and social work as well. Insurance companies look for any and all reasons to deny claims, and there seems to be no stopping them.
Probably a mix of insurance billing hoops and liability insurance hoops to jump through.
I actually had an ophthalmologist tell me his practice had to stop taking United Health Care because of how measly the reimbursements were. Nice to see insurance companies continuing to screw everyone over.
I have considered it and have determined Ctrl+C Ctrl+V are my second best friends (after Jonathan).
Like the copy and paste that occurred between 0:05 - 0:06
My pre-op H&P for carpal tunnel surgery as a healthy 30 year old with no underlying conditions or medications consisted of my doctor basically saying, "yup! You're alive! Good luck with surgery!" I didn't even have labs drawn. Total waste of his time, my time, and my precious insurance deductible. As a nurse, I do understand the risks of anesthesia. However, I do think pre-op H&Ps should be, like everything else in healthcare, individualized to the patient. You have a significant medical history or a family history of complications from anesthesia? Over a certain age? Sure! Do an H&P. You are younger, healthy, and have no know family history of complications? As long as you are feeling healthy and well the day of, you are good to go!
That would be both more cost effective and a more effective use of the provider's time. Realistically, they aren't catching any underlying condition that wasn't previously known about from the numerous other appointments needed to even get approved for surgery to begin with.
Yep. In my mid 20s I had to have an anesthesia consult because I was on enough meds my doctor had never heard of that she was not confident of what meds needed to be stopped and when. But most people that age are totally fine to go with nothing, or a blood type test if it's a more involved surgery.
I had to go under anesthesia recently. My medications in my chart were wildly inaccurate, I only saw a doctor for about 15 minutes, and everybody forgot to follow up with me about if the examination went through while I was out and what the results were. When I finally got in touch with the doc, I found out somebody had forgotten to reach out to me about a necessary follow up as well.
I don’t know what this thing is, but even if it’s a pain in the ass, there’s a lot of shitty employees in healthcare. I’m really glad there’s some kind of hoops that need to be jumped through, if that hospital had just operated on its own terms then they would have knocked me out for 7 grand and left me on the curb without even buying me dinner first, no way I’d trust them to actually catch everything in a chart or history
@MrKhaz101 I agree that there are some terrible healthcare employees. But, if your medications were inaccurate, then you would fit my idea for criteria of needing a pre-Op H&P. I'm essentially suggesting a flow chart to determine if one is necessary. Family history? Any pre-existing conditions? Any medication? If you answer yes, you do an H&P. If no, proceed to surgery. Those H&Ps are not thorough enough typically to catch something that has not been previously diagnosed. That is my point.
H&P notes were so disturbing that even Jonathan couldn't nod this time.
Just finished an NHS Nightshift and cannot tell you how glad i am that i didn't have to charge any of my patients for their care.
"This just looks like you copied and pasted it" and "I keep getting confused where your note was cause I thought it was nursing documentation" are things I hear about my migraine infusion order request frequently.
Like it looks like it's copied and pasted...because it kinda was. I just made up a template of all the info they want to know, and all I have to fill in are the things that change. Which really helps because migraine brain fog is brutal, so only needing to paste and put in four pieces of info is much easier. And it looks like a nurse wrote it because writing in medicalise works better 98% of the time. Also I'm a dork, and I had to learn way more about the human body than I ever expected because I often have to teach other doctors about my very unique migraine.
The ending feels like my entire clinic's vibe about the new free trade committee law regarding glasses and the paperwork it gave us. 😂
Never seen an ophthalmology H&P but as a pharmacist, H&Ps are an important part of my daily workups. Gives me a slight bit of background.
"Ophthalmology writes notes!!??!!" 😂😂😂
PREACH!! 🙏 It's the same for nurses! "Here, take 6 patients during the day and 7-8 at night, which means you've got less than 10 minutes per patient per hour, but we *need* this nursing care plan that no one pays attention to and this click box form we added because we have too many falls from not enough staff that we don't address but ask how you could've prevented Memaw from falling when she's convinced she has to go to the store at 3am while you and the other 4 staff were coding Pawpaw down the hall." 😭
Realistically, Johnathan is writing those notes and Opthalmology is just signing them. Johnathan doesn't know what the ASA classification is either. He hasn't been to medical school. He probably googled it though.
Primary care doc trimming in, I honestly expected a cameo from family medicine, or the punchline to be that we'll just make the patient's PCP do it
I personally do dozens of preops a year for cataract surgery, and for every single one of them it's a giant waste of time and the patient would probably need to be pulseless before I would say anything besides "Go ahead with your cataract surgery, take care"
My Mother was a Hospice Home Calls nurse, I knew I didn’t want to go into medicine because of the paperwork. Secret 🤫 in the summer during high school I’d spend hours helping her do paperwork because this wasn’t counted towards her work hours. It was essentially unpaid overtime. And it was the best way to get anytime with her.
As someone well versed in the psych fields, that is an improper use of the term gaslighting. Better word choice would be manipulated or even lied to.
Sometimes they DO gaslight us, though... [Personal examples redacted]
@@RougeRogue52 gaslighting is an extreme form of mental abuse to manipulate and convince someone that they’re insane.
It’s not just lying to someone.
This gave the impression jonathan spoke "We'll consider it."
Post-op note: wound well coaptated. Dressing clean and dry.
That's what you get when morons controls the system
Back in the 80s I rotated through the Massachusetts Eye and Ear Infirmary. All of the ophthalmology H&P's had scant health details except for a giant diagram of an eye that took up the whole page. 😂
I recently made an appointment to see my regular internist for a preop checkup. I'm 65 and in pretty good health. While on the phone with the doctors office they had NO CLUE that this appointment had to be within 30 days of my scheduled surgery date! The scheduler actually stated to me that she thought it would be better if it was BEFORE 30 days?!?
I used pre op h&p to tell who's taking care of the patient and which attending got an r1 to order the wrong radiology
Beautiful!! Thank you!!
Our healthcare system breaks my heart anew each day. 😞
You, always, are the best! Hilarious! Love it!
"Hes cutting crusts off your sandwich right now!"
Jonathanv _presents pristinely trimmed sandwich_
That face 😂 "Jonathan do I know what that means" 🚫
Ooooo how the turn tables!
Recently experienced this from the patient end lol. Was going in for a minor surgery and the nurse asked me a bunch of questions for anesthesia, then anesthesia came and asked me all the same questions himself.
"ophthalmologists write notes?" ROFL!!!
This is how I feel submitting patient care reports as a medic.
You should do a part 2 where you show him taking off a secret camera and giving it to the ER doctor lol
Honestly I have a lidocaine allergy and my new opthalmologist slammed the door and was like "I didn't look at your chart!" Then immediately tried to put some anesthesia drop into my eye before the pressure check.
"We'll consider it." HA! That's G.O.A.T.E.D. My G.
low key dissing insurance companies. well done. i dig this
The irony of insurance companies increasing the costs to providers by increasing the amount of work needed for each patient in an effort to compensate the provider less for that procedure that they're making more expensive to perform.
Seeing Jonathan shake his head no instead of nod his head yes is one of my many sleep paralysis demons.
It’s not just the hospitals that are interested in reimbursement. There are many money first MD’s out there.
This is totally a jab from Doc G toward insurance for things he’s personally encountered as an ophthalmologist, but that’s cool because he’s right and also taught me how to spell his profession.
I feel like dermatology would really feel this. "I need you to fill all this mountain of paperwork due to the use of 2cc of lidocaine and a kid size band-aid" - It was a skin tag
We’ll consider it. 😅
This is hilarious because the Opthos near me send their patients to our urgent care to get pre op clearance.
I find it hilarious and probably fraudulent that a Physician is sending a pt to be cleared by PA.
But I do em all so that when I have a scary/icky eyeball pt, I can call in the favor to optho/Jonathan.
It needs to end with the Jaws music and United Healthcare circling outside the window ... They smell fraud in the water. More money for them.
Nailed it❗ I HATE cloned H & Ps! I HATE templates because too many physicians forget what's in it and don't change the information to match the patient! Always love it (not) when the patient has a history of BKA and PE states bilateral pedal pulses 2+. I've worked in health care documentation for decades, and shoddy documentation results in so much lost revenue for the physicians. But heck, they saved a few minutes on documentation. 😖
I like how UA-cam provides extra information on how this video is made by a doctor licensed in the US
OMG hilarious and so accurate. Retired from practice 2 years ago and could not get out fast enough!. The whole world of medicine is now captive to the time blackhole EMR and the horsesh_t it produces. Love the "every H&P is identical" - like an ophtho doc listens to lungs or palpates anything but your cornea!🤣😂🤣
Thought of you while watching a human opthalmologist perform cataract surgery on a gorilla!
Now I'm imagining that the norm is for gorilla opthalmologists to perform cataract surgery on their fellow gorillas, and the resulting mental images, starting with a college lecture hall full of gorilla premeds, are delightful! Thank you for your strategic deployment of the word "human" 😊
Wait... what?
@@Cog_Nomen Honestly they're probably smart enough, I'd trust em
@@Cog_Nomen I made the mistake of drinking hot coffee while reading this but barely felt my nasal passages burning bc I was laughing so hard!! I'm picturing a distinguished looking flanged male orangutan as the university's Chancellor and a group of long armed gibbons running admissions!
@@justahugenerd1278 It was on an episode of Secrets of the Zoo, which was filmed at Columbus Zoo in Ohio. It's not unusual for human doctors to treat great apes because their anatomy is so similar to ours. A few cardiologists have gorilla patients, since they're predisposed to heart disease, and OB/GYNs have performed c-sections on orangutans and gorillas with high risk pregnancies, most recently in Jan of this year when an OB, anesthesiologist and neonatal nurse at a TX hospital delivered a baby girl gorilla for a mother with pre-eclampsia, which can be fatal. To honor the Dr, whose name is Jamie, the baby was also given a J name - Jameela. Multiple videos here abt it