Documentation for the sake of documentation?

Editor must not exceed 400 words in length and may be subject to editing or abridgment. Letters must be limited to three authors and five references. They should not have tables or figures and should relate solely to an article published in Circulation within the preceding 12 weeks. Only some letters will be published. Authors of those selected for publication will receive prepublication proofs, and authors of the article cited in the letter will be invited to reply. Replies must be signed by all authors listed in the original publication. To the Editor: In their recent study, Frolkis and colleagues 1 attempt to determine by chart review how often patients with acute myo-cardial infarction are counseled to quit smoking and encouraged to exercise. They acknowledge that if no such counseling nor encouragement is documented in the chart, the study assumes none was done. Certainly a patient hospitalized with an acute infarction is unusually likely to be amenable to the idea of quitting smoking and ought to be so encouraged. But many patients are still not interested in quitting. In those cases, most doctors probably do not document a fruitless attempt at counseling in the chart. Why commemorate a waste of breath with a waste of ink? Frolkis and colleagues suggest doing the documentation if only to placate chart reviewers and defense lawyers. Physician time and patience are finite resources. Suggesting that a patient quit smoking and getting the brush-off from that patient is a bit trying. Having in addition to write in a chart, " Counseled patient to quit smoking, but compliance doubtful, " is considerably more trying on a doctor's patience. Furthermore, a cursory comment about smoking and lifestyle changes, made mainly to justify a chart entry that " covers " the doctor, is very unlikely to leave a patient with any useful motivation. The idea that " If it's not documented in the chart, it wasn't done, " speaks volumes about anyone who subscribes to it. Response We were pleased that Dr Grant acknowledges the importance of counseling high-risk patients to quit smoking cigarettes but were puzzled by the intensity of his objection to documenting such an effort. The use of cigarettes represents the largest preventable cause of mortality and health-related expenditure in the United States, accounting for Ϸ400 000 deaths yearly. 1,2 The data are clear that even brief interventions by physicians and other healthcare professionals can …