Once again, I am in receipt of a letter from a specialist (a surgical subspecialty, of course) that has me alternately shaking my head in disbelief and trembling with fury.

The letter was clearly crafted with electronic medical record software to support billing as high a level office visit as possible. In addition to a complete specialty-specific organ system examination, a “Multi-System Physical Examination” was also documented:

• Constitutional: well-nourished, no physical deformities, normally developed, good grooming
• Neck: neck symmetrical, not swollen, normal tracheal position
• Respiratory: no labored breathing, no use of accessory muscles
• Cardiovascular: normal temperature, normal extremity pulses, no swelling, no varicosities
• Lymphatic: no enlargement of neck, axillae, groin
• Skin: no paleness, no jaundice, no cyanosis, no lesion, no ulcer, no rash
• Neurologic/Psychiatric: oriented to time, oriented to place, oriented to person, no depression, no anxiety, no agitation
• Gastrointestinal: no mass, no tenderness, no rigidity, non-obese abdomen
• Eyes: Normal…