The Unreasonable Burden of Specialty Level Diagnostic Specificity in Primary Care

As a primary care physician, it helps me to know if my patient has had their appendix, gallbladder uterus or ovaries removed. I can then reasonably eliminate problems with those organs from my differential diagnosis if my patient comes in with sudden abdominal pain.

Maybe esoteric research will someday look for the incidence of Alzheimer’s disease in people with open versus laparoscopic gallbladder surgery. But, honestly, I don’t care as much about that as I care about efficiently diagnosing the problem at hand.

I am not terribly concerned about whether they had their gallbladder or appendix removed laparoscopically or through an open procedure and as long as the uterus and ovaries are gone it doesn’t usually matter to me if the procedure was abdominal or vaginal.

And, how much does it matter to doctors in the trenches exactly which weight loss surgery our patient had many years ago? The general followup considerations at our level of care are roughly the same.

And don’t get me going on macular degeneration. I don’t need to know if it’s wet or dry or any of its other classifications. All I need to know is that my patient has some form of it and needs to see their eye doctor periodically.

My own EMR displays my chosen diagnosis in words, not as the beancounters’ ICD-10 code. And many of the specialist notes I get have the same setup. So, if the eye doctor notes I get don’t have the code, why do mine need the specificity it implies?

Appendectomy is a very basic surgical history item that does not involve billing, but a crucial factor in making a differential diagnosis. I shouldn’t have to hesitate entering it into a new patient’s chart because I forgot to check how big the scar is.

The specifics of an active diagnosis is very soon going to hit our pocketbooks, or at least that of our employers. A diabetic without complications is worth less to our employers than one with a complication. But only the eye doctor knows exactly which complication they have.

In a future post/diatribe, I will write about HCC Coding, aka “Make your patients look as sick as possible so you get more play money now and real cash tomorrow”.

Stay tuned.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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