MD Falsifying Charting

[annie.rn]

Last night was not the first time I have seen a doctor walk into a patient's room, never touch them and then chart a complete assessment. It happened again last night. I know this with absolute certainty. The pt. arrived from the ER w/ her husband, both in their early 60's and completely alert and oriented and with the program. They asked when they would see the admitting doctor. I asked if they had seen him in the ER to which they replied "no" and that they had not yet seen a doctor, just a PA. MD comes in about 30 mins. later while I was in the room. Stays for about 3 mins., asking her if she has any health problems or takes any meds to which she responds "no". He very briefly explains the plan of care and never lays a finger on her. I was in the patients room for another 30 mins. He never returned. I confirmed this w/ the pt. to make sure I am not lobbing false accusations. The MD then proceeded to write a full head to toe assessment on the pt. (S1, S2, reflexes, pupil reactivity, the whole 9 yards...had he done it, it would have been a 10 min. exam) He also timed it as if he had seen her in the ER, an hour before her arrival to our unit. It makes me really mad. It's fraud. Have you experienced this and if so, what have you done? I would like to report this to my supervisor. If it were ever investigated the patient is sharp enough to report that she was not physically examined by this MD.

[caliotter3]

You might be too idealistic, but you are not morally incorrect. I am a walkie, talkie and have been treated as if I was a cursory annoyance, almost as poorly as the doctors that never bother at all with their LTC residents, only difference: I am cognizant to realize what is happening. Too many people take their healthcare tasks, and their patients, for granted.

[mhy12784]

Id be careful about pointing fingers and making accusations about false charting.

At my last hospital I forgot their position, but one of the people who reviewed charts told me almost every single patient in the hospital has a respiratory rate of either 16 or 18. Now either that's a coincidence, or just some half assed charting. Even nurses who copyforward their charting and change some things, thats "technically" false unless you actually do a full head to toe assessment on your patient every 2 hours (or whatever the time frame is for your unit)

Its a slippery slope and I dont know what the right answer is, but id just make sure that the line is REALLY crossed before I get upset about it.

[Emergent, RN]

Sadly, we have, more and more, lost the human touch in medicine. Since we all need to feed ourselves, our children, we need to play along and set aside our higher idealism at times. God Bless the OP for caring.

[PMFB-RN, RN]

I have two things to add here.

(1) I would tread very carefully OP, because I doubt very seriously you'll come out on the "winning" side of this if you pursue it. MDs have far more clout and protection than we could ever hope to have.

(2) While I don't condone false documentation, in a sense physical assessments are overrated. I've rarely if ever seen any major clinical decision made based on a physical assessment. It has largely been lost to the technology of imaging and labs.

^ This! Well said.

In addition I would add to the OP, yes the practice is very common and widespread and not just by physicians. I have observed many, many RNs do it as well.

[PMFB-RN, RN]

The reason I didn't bring it up is because it was Thanksgiving night and no one was around on Friday morning. Plus, I DID want to get other's opinions here on AllNurses to see if it was worth it to proceed. I see the pitfalls now and will just let it drop. I'm not going to win this battle. I didn't talk about it w/ anyone else at work. I am 99.9% sure that the doctor did not examine the patient. No reason to get into the long winded particulars though.

I doubt you would win or get anything changed. About 10 years ago we had a nurse who reported this exact behavior by a pediatric hospitalist. In this case the patient was on EEG monitoring and thus was on constant video. The RN had video proof that the physician never examined the patient when he said he did and STILL nothing happend to the physician.

I am not a new nurse. Very experienced, actually. (22 years) I am fairly new to this forum, however, and prior to finding it I've never had access to the opinions of thousands of my nursing peers all the while remaining anonymous. That is why I posted here first before taking any action. Seeing this behavior bothers me more now than it did when I was new. I see the doctors at the hospital where I work being so blase w/ the care of the patients and it seems as if a lot of them really don't give a crap at all. They have very little compassion and the patients have complications that could be avoided if things weren't blown off day after day. Again, something I could write pages about. I guess all my frustrations came to a head w/ this incident.

This is exactly why I find the very high reguard our culture hold for physicians so annoying. If only they knew. Now of course I have been privlaged to work with many very fine, competent and caring physicians in my career. But also lots of the exact oppisit.

I understand that the world is not a perfect place and sometimes doctors (and nurses) look at a previous note to gather their assessment information. However, in this case, it was the initial H&P. The doctor had never seen or examined this patient before. I would think it should be a requirement that the MD gather tat least the first set of admission data with his/her own eyes, ears and hands. Sometimes, people haven't seen an MD in years and things can be caught that the patient isn't aware they even have. Let's say a heart murmur, for example.

He is wrong, you are right. Let is go. But also keep in mind that YOUR assessments may the ONLY actual physical assessments the patient gets. This makes me pay more attention and feel a greater responsibiliety to do good assessments.

[imintrouble, BSN, RN]

Pick your battles.

We've all seen what the OP describes. Some are more flagrant than others.

I wouldn't fight that fight, but we all have a threshold where acceptable meets unacceptable. Or maybe a better way to put it is, what can I live with.

[psu_213, BSN, RN]

I've rarely if ever seen any major clinical decision made based on a physical assessment.

And this is a tragedy. Let's give the patient several large does of radiation even when a problem can be excluded with a thorough physical exam. Sorry, off topic.

To the OP, it's going to be very, very difficult to actually prove that the physician did not do a physical exam. I believe you that it wasn't done, but when the physicians reputation is on the line, he is not going to back down. Unfortunate as what this means--it will likely not end well for the accusing nurse. If you witness dangerous behavior, absolutely report it. Otherwise, it is going to be best to let this go.

[malamud69, BSN, RN]

Welcome to the world of Medicare/Medicaid fraud!!! I handled my grandparents bills from the nursing home before we were able to get them "home" and the number of times the MD billed for a visit etc...was appalling. ..the MD was a phantom because I never saw them neither did the nurses but somehow a full visit/assessment was billed numerous times on days and times I was there! Phantom MD did such a fine job! Sadly. ..this is the norm and the actual reason our system is so broken...

[ktwlpn, LPN]

I observed this more than once in LTC facilities..

That's why my documentation always stated resident "seen by physician" ....That was all I could attest too.

[aortas]

i have seen some pretty stretches of the truth in doctors h&p's, notes, etc. however, the absolute worst i encountered was a respiratory therapist, who liked to tell us he was going after his MD. our facility has another agency come in for RT, so for instance we get someone on a bipap or has a trach, call up the respiratory place, and a therapist comes out. this one particular RT charted on one patient completely made up vitals, SP02, etc...on a patient whom i had sent out to the hospital....on another patient, the respiratory place brought a BIPAP to a new admit. the same RT as before charted notes that he oriented the pt to the BIPAP, vitals, etc...yet the RT came in when the patient was in PT, not even in his room. i asked the patient if he knew what the BIPAP machine was, to which he said, "where did that come from? i have one at home but I've never seen this before". needless to say, my DON and administrator were made aware and he was banned from the building. ass.

[annie.rn]

Thank you for the continued discussion, guys. As I have said previously, I will not be bringing this up w/ anyone as your feedback has lead me to see the pitfalls. Some of your stories of doctors falsifying charting have been appalling.

Thank you PMFB-RN for your post. I, too, have worked with some wonderful doctors, especially early on in my career which was spent mostly in military teaching hospitals. Doctors who would sit at the bedside and listen for 20 mins. to an 80 year old talk about their life. Also, doctors that would take the time to listen to concerns the nurses had about their patients. Even if it was after 9pm.

I have observed a decline in the last 10 years in the quality of the physicians I work with. The biggest offenders have been hospitalists. I don't know if that is the difference (trend toward use of hospitalists) or if it is a community vs. teaching hospital issue.

I know that charting requirements are insane and that MD's are stretched as thin as we are (if not thinner). I DO sympathize w/ them. However, there is no excuse for the absolutely terrible attitudes and apathy a large number of the doctors I work with display. My co-workers have reported being sworn at repeatedly by a few of the doctors and nothing is done about it. Dr.'s with terrible attitudes used to be the exception. Now I am finding them to be a common occurrence.

I get that medicine today is stressful but if they have so much trouble coping that they cannot refrain from the regular use of profanity and if they can't muster up a modicum of consideration for the human condition then maybe they ought to move on to another type of medicine.

I do not think physical assessments are overrated (as one reply said). I like PMFB-RN's thought that the physical assessment I do on admission might be the only one a patient gets so do it well. Yes, I will. And I will continue to try to bring my best self to work everyday despite everything I've written about.