"Incorrect"
Logging
by Jarrod Shapiro, DPM
PRESENT Resident Editor
Botsford General Hospital
Farmington
Hills, MI
This week I’m writing our Residency Rap issue at the behest
of some of my co-residents. During our monthly residency training meeting, in
which we discuss general residency issues, the topic of logging cases came up.
My director, who periodically reviews other programs, has seen good programs
whose residents are logging “incorrectly.”
Here’s my beef. What’s “incorrect” logging? I know. I’ve
talked about this before. However, no other subject seems to upset residents
more (other than the job search) than this one.
If you take a look at the CPME 320 document, you won’t be
able to find any solid information about how to log cases. If you look anywhere
else, you still won’t find any clear information. Nowhere does it say a triple
is one or three procedures. Where does it say a rheumatoid reconstruction is one
case? Should a TMA be one case? How about an ORIF of a bimalleolar ankle
fracture? If a triple’s one procedure (even though I know you log them
separately) why isn’t a flatfoot reconstruction one procedure?
Everyone talks about it, and yet the powers that be are
suspiciously silent on this issue. My explanation for this is twofold. First,
I’m told the CPME meets 2 times per year. How can anything of significance be
decided on with 2 sessions a year? Second, I don’t think they know what to do.
It seems simple to me, but I don’t sit in on their meetings, so who knows?
Perhaps there’s some political issue that needs to be resolved first.
An additional issue is Residency Resource. It’s often
unclear exactly where to log a particular procedure. Take the primary repair of
a plantar plate rupture. There’s nowhere to log it. It’s not the same as a joint
arthrotomy. It’s not a hammertoe repair. So where does it go? How about a
triple? There’s no “triple arthrodesis” tab. Perhaps that’s why everyone logs it
as 3 procedures. Point taken?
Here’s my solution. We split or unbundle every procedure we
do with a detailed description in the “notes” area. We don’t base it on number
of incisions or how it would be billed in the real world. As I mentioned in
Residency Rap
issue 2, the logging should be based on the educational content of the
procedure. Hence, for every individual procedure you do, that’s one procedure. A
triple would be 3, an Austin-Akin would be 2, a flatfoot reconstruction with a
Kidner, gastroc recession, calcaneal osteotomy and MBA would be 4, and a
rheumatoid reconstruction with a 1st MPJ fusion, met head resections, digital
fusions 2-4 and arthroplasty of the 5th would be 9 procedures. It’s easy to
understand and straightforward, eliminating discrepancies between programs. All
we need is for our leadership to step forward, respond to our complaints, and do
something. I’m just glad that my numbers are far above the minimum, so I have a
good buffer when I graduate.
What do you think? Write in with your thoughts.
