Does the 14 point review of systems encourage physicians to lie?
As medical students and physicians, more and more of our time is spent with the medical record as opposed to face to face with patients. As part of the history and physical exam documentation, physicians are required to document what is called a review of systems, or ROS.
An ROS is meant to catch any loose ends. One asks about eye issues, abdominal issues, skin issues, etc. from head to toe. But for Medicare to reimburse properly, each visit needs to have a documented 14 point ROS stating explicitly “A 14 point ROS was negative,” or positive when appropriate. This phrase appears in notes so frequently not for patient care but for billing purposes. In fact, I’ve seen quite often that not all 14 of those questions need to be asked and are not asked, but yet that phrase still creeps into the note for billing purposes.
So many of our computerized notes these days are auto-generated using stock auto-fill templates. These lead to longer notes with more clutter, and too often lead us to inaccuracies, or worse, misrepresentations.