The Yellow Hat

Once upon a time, I was a fresh-faced family doctor, buoyed by my own naïve optimism that I could change the world one patient at a time.  I finished my residency, gardened for two months, and began my career at a clinic in South Minneapolis.

The RNs recounted tales of the old clinic, when the docs owned the ramshackle mouse-infested rabbit warren of exam rooms.  Everyone got a nice long lunch break, generally enhanced by cigarettes and martinis.

When I joined we were already sold, entrusting all the administrative rigamarole to business people who had never helped a baby be born, never held the hand of a dying cancer patient.  I knew that a level four visit was worth 1.03 RVUs and I’d be reimbursed accordingly.  I’m sorry Mrs. Swanson, I can’t take a peach pie for treating your sore throat anymore.

In those days, I actually read the old paper charts, turning back the hands of time from computer-printed dictations, to typewritten epistles from the on-site transcriptionist, to the scrawling illegible musings of my senior partners.  I came upon one such note, handwritten on the day I was born: “This nice lady comes in.  She is wearing a yellow hat.  I gave her some antibiotics.”  His signature followed and that was the end of it.

Picture the lawyers drooling over that note, imagining a thousand lucrative scenarios – failure to diagnose, failure to treat, failure to document, failure to discuss possible life-threatening side effects of the unnamed antimicrobial agent.  Not to mention contributing to future antibiotic resistance.  Maybe that nice lady even launched her own strain of Methicillin Resistant Staph Aureus or Vancomycin Resistant Enterococcus.

Compare my partner’s note with the generic exam smartphrase I might’ve popped into my patient’s electronic medical record:




Nose WNL



Neck no LAD

Lungs CTAB

Heart RRR

Abd +BS soft NT no HSM

Ext no C/C/E

CMS intact

Abbreviate, type, truncate, interrupt like some deranged, text-messaging teenager.  Read your inbox every day, even on vacation, or you’ll be seriously swamped.  Expect an automatic 10% paycut if you fall below threshold productivity.  Include elements of the past medical history so you can charge a higher level.  Remember to submit two separate codes for a complete physical exam, one for the routine physical, one for new issues that were addressed.  Give up your prenatal practice.  Outsource hospital care.  Spend more time typing your documentation than you spend face-to-face with your patient.

Stop.  Breathe.

Notice the yellow hat.

Musical Moment

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2 Responses to The Yellow Hat

  1. Jen McKeand says:

    Love, love, love this!

  2. Michael Belfiore says:

    The yellow hat notes says way more about the doc and his patient than any of those abbreviations. Says they had a genuine human interaction. Imagine that!

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