Letters to the Editor - Aug. 28, 2006

Want ICD codes? Have someone other than the doctor look them up - Parental monitoring of teens is reasonable in isotretinoin therapy

Want ICD codes? Have someone other than the doctor look them up

Regarding "Physicians push to delay move to new ICD code set" (Article, July 10): Your article on the controversy over when to adopt the new codes raises the question, "Why are we using physicians, who are very expensively educated to do diagnosis and therapy, to code?"

The administrative types are always after us to be more efficient, yet they lumber us with this time-consuming chore. As far as I am concerned, we are just translating our accurate verbal diagnoses to another language made up of numbers. It might as well be to ancient Sanskrit for all it means to me.

For instance, to give a patient a lab slip, one must first leave the patient to root out one's expensive-to-buy code book (verbal diagnosis/numerical diagnosis dictionary) while hoping that some number that more or less matches the verbal diagnosis can be found on the first try.

The computer is no more efficient. It needs to be gone to and changed from its usual work to the expensive-to-buy code program.

For example, yesterday I needed "ankle pain." Ankle wasn't listed under "pain" in my book so I had to choose between "leg" and "foot." Any clerk could have chosen just as accurately. This took five minutes away from patient care. This happens many times per day. These five-minute blocks of time add up.

The oft heard administrator argument that the doctor should do the code because that is making a diagnosis is a fallacy. What the doctors are really doing is wasting their time to translate the verbal language into a numerical language we do not need for our work.

If the administrative people need our diagnoses translated into a numerical language (or ancient Sanskrit) for the sake of their computers, then they should be doing it with labor that is cheaper than ours.

Do what you need to do with the coding system. Please leave my time for my patients, not your computers.

--Ann Ewalt Hamilton, MD, Riverside, Calif.

Parental monitoring of teens is reasonable in isotretinoin therapy

Regarding "Mandatory patient registry can place limits on care" (Column, Aug. 7): As a physician and a parent of a teen (although male) who underwent isotretinoin therapy, I was astonished at the case of the teenage girl who became pregnant while apparently taking the drug.

While we cannot control everything our patients do, nothing is mentioned about how the parent was counseled to be involved in this process. Although the mother does not have to be present during the visit by a 16 year old, it seems that she should have had a vested interest in the welfare of her minor child, and have been instructed to monitor both the isotretinoin and oral contraceptive ingestion.

If teen patients are not willing to be monitored by their parents, then perhaps, they should not be offered this expensive and teratogenic therapy.

--Wilma Schiller, MD , Potomac, Md.