Roadkill as Documentation

All bad documentation is based on lies – the lies doctors (and all human beings) tell themselves.

We always believe our lies, because they are how we construct a false reality that makes our bad behavior seem acceptable to ourselves. Theologians might call it original sin, humanists might call it human nature, and psychologists might call it our limbic system gone bad. Children might say they don’t know why they did it. In this respect we are all still kids.

The answer to the question of why trashy documentation persists is that outside of the clinical documentation improvement (CDI)/documentation industrial complex, few really care about it. Doctors don’t, administrators don’t, electronic medical record (EMR) vendors don’t – this issue has had so much lip service paid to it that we can see teeth even when mouths are closed. Bad documentation has survived all efforts of “documentation improvement,” to the point of defeating it. Like the apocryphal story about cockroaches and nuclear Armageddon, mediocre documentation has survived all-out administrative thermonuclear war by the organized forces of CDI. 

Perhaps you don’t think we lie our way into inadequate documentation?

Consider this: the same physician who claims that an electronic mountain of chart trash piled high in the EMR will protect them from a lawsuit piles the same chart trash up each day – and you do not need a medical degree to know that repetition isn’t documentation.

In truth, we accept bad documentation much the same way as we accept refractory bad manners from our relatives. We complain, we plead, but we accept what we cannot change. Doctors know that pleas for better documentation are just innocuous nagging. Only we naggers imagine that without any evidence of change, we are being effective. Physicians can delude themselves into believing they are writing meaningful notes; we can delude ourselves into believing that our CDI efforts are not meaningless.

So we are left with the following choices, in light of the fact that documentation is bloating for exactly the same reason the bellies of roadkill victims bloat:

  1. Documentation isn’t as important as we think
  2. Documentation improvement isn’t as effective as we imagine
  3. Reason hasn’t and cannot solve this problem
  4. The SOAP note now enables swollen notes

The paradigm has shifted – or, in my opinion, it never existed. Ideal notes are rare, not common. Really good notes are not only rare but when found, they are pithy and cogent. Intelligent notes are concise; bloated notes are unintelligible.

Documentation in its present form cannot be fixed – it has been perennially broken and now is just overinflated. It needs to be deflated and made simple:

  1. Why does the patient need to be in the hospital
  2. What is being done to fix this
  3. Why can’t they be discharged

Imagine documenting all of what’s wrong about bad documentation. We are all doing something wrong, to include those of us who are bloating notes and those of us who have been trying to let the gas out of bloated notes. Documentation improvement is a failure. We do not need more vain efforts to fix what has proven to be an insoluble problem – they are Gordian notes.

Our complicated efforts at reforming bad notes has only led to bloated ones. The antidote to bloat is simple: why is the patient here, what are we doing to them, and why can’t they leave.

We treat the poor notes that are offered as documentation and the poor creatures that are offed as roadkill the same – we ignore them, and drive around them. 

We need to stop putting roadkill in our charts.

Comment on this article

Facebook
Twitter
LinkedIn

Related Stories

Defining High-Quality Documentation

Defining High-Quality Documentation

Last week I wrote about the importance of defining what clinical documentation is, within the scope of clinical documentation integrity (CDI) reviews. This week, I’ll

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals.  Don’t miss this chance to protect your hospital’s revenue and reputation!

May 29, 2025
I050825

Mastering ICD-10-CM Coding for Diabetes and it’s Complications: Avoiding Denials & Ensuring Compliance

Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!

May 8, 2025
2025 Coding Clinic Webcast Series

2025 ICD-10-CM/PCS Coding Clinic Update Webcast Series

Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 14, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24