I know what you mean, but as
@Stagg737 points out, that's not what's happening here.
This person is basically too lazy to do notes in any real sense. 99% of the content of their notes is just 1) copied-forward/copied-pasted text from somebody else's note, and 2) their own smartphrases/copy-paste phrases, but used so commonly and indiscriminately that if you've read many of this person's charts, you have no confidence that the particular phrases being used actually apply in that situation.
For example, this person has a stock phrase they use in their HPI that is something like "Patient admits to noncompliance with outpatient regimen." But they will put this phrase in their H&P on a patient for who had not in fact been prescribed an outpatient regimen. Or, wanting to justify using a long-acting injectable antipsychotic, they have a stock phrase that is something like "Patient has a history of repeated rehospitalization due to noncompliance with oral antipsychotic." But they will put this phrase in a note on a patient who has never had a psychiatric admission before. The statement that the patient has a history of repeated hospitalization is a bald-faced lie.
There is
never a time that this person actually writes a real note like "Patient describes worsening depressive symptoms over the past 2 weeks in the setting of the encroaching anniversary of her mother's death. She has had low mood, anhedonia, difficulty sleeping, fatigue, diminished appetite, and poor concentration. She denies suicidal thoughts, but admits that she frequently thinks she would not mind if she went to sleep and didn't wake up. At times she has heard a voice calling her name. She had a similar episode a year and a half ago, at which time her PCP started her on sertraline 50 mg. She found it effective for these symptoms at first, but more recently they have returned." They never write or dictate a narrative like that. Instead, their HPI is one brief paragraph consisting of 3-4 of their same stock/boilerplate sentences they use for almost every patient, and the rest copied/pasted verbatim from ED and consult notes (where people did do a narrative.)
Also, this person avoids doing the first progress note of a hospitalization (i.e., the patient's second day,) because that entails building a progress note from scratch instead of copying one forward. So they will have the midlevel see the patient, who will write something like "Patient seen this morning on rounds. He reports he was nervous about attending groups at first, but attended one yesterday afternoon and found it helpful. Wife visited yesterday evening; they had a good visit and he feels his wife is supportive. Reports his mood is still down, but not having any suicidal thoughts today. Took the first dose of Abilify yesterday and noted no side effects. He is starting to be able to identify activities he looks forward to upon going home, like tending his garden."
Then the next day, this person will do their progress by copying forward the midlevel's, and leave the subjective section totally unchanged. The subjective section will literally be that exact paragraph above, with nothing added or changed. Then they will continue to copy that forward for days, so that for several days in a row, that exact paragraph is the subjective section of each day's progress note. Again, with nothing added or modified.
And I think what's so galling about this is that I feel like all through med school and residency, we were taught that the absolute
worst thing you could
possibly do is to put false information in your note, with one subset of that being the infamous "documenting that you did things you didn't do." We had it drilled into us that if you did that, you were with 100% certainly going to be successfully sued, potentially lose your license, possibly even get criminally convicted of fraud. Yet this person has just been brazenly getting away with this for years, with nobody saying or doing anything about it.
In addition to the poor documentation, this person routinely reveals such poor understanding of diagnostics and treatment that it would be almost comical if it weren't so bad for patient care. As I keep saying, if you could hear this person talk, you would know what I mean. You would be shocked to see some of the treatment decisions, to overheard some of the comments about when this or that medication is indicated or contraindicated, etc. It's as though a very unintelligent but very cocky and self-assured layman overheard a few discussions about psychiatry and thought that a few words and phrases they plucked out of those discussions (without any real understanding) made them knowledgeable and qualified to practice psychiatry.
I'm open to any suggestions. Maybe I jumped the gun by bringing up fraud right away. These are all good things to know about. Though no, I'm not in New York and as far as I can tell, my state doesn't have an OPMC, though I see from the medical board website there is a way to file a complaint there.
