Do we have enough cross residency data / experience where it is general knowledge that there are specialties which have a relative poverty in Note Taking requirements, and others which are most bountiful?
Are all specialties equal in their "Note taking" time requirements.. for example.. my understanding is that (contrary to intuition), that surgery has extensive demands for patient note taking.. perhaps one of the highest..? .. not sure what specialty would rank at the bottom...
Is there a specialty that is known to have a real dearth of Note-taking?
I'm not saying here, clearly, that one specialty would be better than another because of it...
All physicians should write a note anytime they see a patient. A note has three general purposes:
1) Documentation of the course of medical care for continuity both within your field and among other physicians taking care of the patient.
2) Billing
3) Protection against liability
If you do the first purpose well, explaining your reasoning, what has happened to the patient, and what you plan on doing with them, the third is generally fulfilled. The problem runs into with billing requirements.
I can write a clear note outlining a patients history with an issue with a few lines of HPI and then write a focused assessment/plan that alludes to the relevant physical/lab/imaging findings. This is a nice, compact note that is informative to other physicians, should serve to protect me from liability, and would lead to me (or my attending given I'm in fellowship) not being paid anything for the encounter because I didn't tick enough boxes. These are the notes I write when it's an inpatient followup I/my attending didn't physically see that day, but simply reviewed the chart, because it's easier to both write and read (and we aren't billing for a chart review anyway).
What does that mean? Well, when I see a patient in consultation and bill a level 4 visit (out of 5), which is the most common in most fields I'm aware of, I must document 4 elements of HPI, a 10+ system ROS, a comprehensive past medical/surgical/social/family history, an 8+ system physical exam, and enough data to support moderate complexity in my medical decision making. This tends to bloat up the note. (Of note, a level 5 visit has the same exact requirements except that you just need to support high complexity rather than moderate).
Why can surgeons get away with writing a shorter note? Well, a surgical consult note is usually the same length (and has to meet the same checkboxes)... but inpatient and outpatient post surgical followup notes can't be billed off of if they fall in the post-op global period. They don't give a care about billing off a post-op note because they *can't* bill off it... just for the surgery itself. Also, even when it's a non-operative patient, old habits die hard, and surgical notes tend to be shorter overall. Medical notes also tend to go into further detail regarding management of comorbidites, both because we feel it's good for patient care and also because it helps support a higher level of medical decisionmaking for billing purposes.
There are no specialties that have fewer "note taking" requirements than "write a note anytime you interact with a patient", though there's specialties that don't really see patients that much (diagnostic radiology if you don't do procedures, pathology) that have their own documentation burdens. Residents of course write many of the notes for academic attendings. Many doctors outside of academia also have scribes or assistants that write the notes for them as well. I know one Dermatologist that has MAs do all the documentation along with taking pictures of the relevant rashes, so he can just tell them the plan and move on to the next patient. But those are individual circumstances.
