Over-documentation

[Michelle91518]

Hi everyone, I'm looking for advice on something I have always struggled with and should already know by now. I'm an ANP who worked in a clinic setting for several years, and now I  do medical disability evaluations as an independent contractor. I only have an hour with patients to complete a full one-time evaluation, and that is all I am getting paid for. I find it very hard to reel it in when patients come in with a multitude of complaints, and even though I try to tell them to give me typically their top 3 problems, it still becomes overwhelming,  and I find that I run way over the time I have. I explicitly tell people I only have 30 minutes to gather a history/ROS, and then 30 minutes to do a physical, but when someone comes in with several problems ranging from cardiac to pulmonary to musculoskeletal to everything in-between, I feel as though I have to address each one with some level of adequacy, and by the time I'm done I've probably made only $5 an hour. I have difficulty leaving out details that in all reality probably aren't all that important, and my notes end up long and wordy. If someone is a talker, forget about it! I used to struggle with this very much in primary care, telling patients I could only address 1-2 problems per visit and then going down the rabbit hole when they start complaining about everything. Often times people are late for the appointment too, which leaves me even less time to get it all done. Anyone have any advice for how to manage a patient with several problems that need to be addressed during a one-time, hour long visit? It's hard to leave things out when I want to make sure their issues are well-documented, but then I start drowning.

Thanks in advance!
 

[ToFNPandBeyond]

Yes, you tell them you can only address 1-2 problems due to the limited time you have to fully and adequately address their concerns, then inform them (should they start to drag you down the rabbit hole of problems), that you can schedule a follow up to address their other concerns.

Keyword being follow-up. This allows you to stay on track, and allows the pt to feel they will eventually get their other issues addressed.

Now I'll admit that I'm not too familiar with med evals...if you are not able to do follow-up appts, then my advice doesn't apply. But generally speaking, this is what I usually say to my patients, and it leaves everyone for the most part feeling satisfied. 

[db2xs]

What @ToFNPandBeyond said

[myoglobin, ASN, BSN, MSN]

I did disability evaluations for the State of Washington for several months. I used the "hour" to gather information and "finalized" my reports over the coming week. Mainly, I worked off of a template. Of the 50 or so evaluations that I did none were rejected, but I would not say that they were anything amazing in terms of detail. I usually presented facts in the most favorable light that could be supported with regard to clients, but I have no idea what percentage were successful in obtaining the disability that they sought.