Dr. Sumkin's paper "The Coding Audit" [1] revived some of the emotional responses that I experienced when our financial officer met with us to discuss how we should document our notes to reflect the level of charges. As an intern and later as a fellow, I longed for the day when I would become an attending physician and would only have to write a few short paragraphs summarizing my assessment and plans for my patients. Now that I am an attending physician, I realize that with the requirements set forth by the Health Care Financing Administration, I have to revert back to writing detailed history and physical findings in order to bill at a higher level. Gone are the days when an attending physician could refer to the resident's or the fellow's notes and concentrate on the discussion on differential diagnoses and a coherent plan. One could only refer to these notes under the review of the system, medical history, social history, and family history.

With the coding system hounding us, the education of our students, residents, and fellows will suffer. Already we are so obsessed by the documentation of the details of the history and physical examination that we spend more time writing our notes than educating the housestaff. It is not unusual to observe a team of students, residents, and a fellow waiting for an attending physician to write his or her long and exhaustive note to justify a level-five billing. The desire to do it "by the book" has distracted us from teaching. As a result, consultative rounds get extended toward the evening hours, when attention spans become poor as hypoglycemia sets in. Furthermore, I do not see that health care for our patients is necessarily improved by the parroting of a medical, social, and family history that has already been obtained in detail by the admitting intern and resident. The patients may be better served if attending physicians are allowed time to digest the details of the information obtained from their own history taking and physical examination (along with details obtained from the chart or synthesized by the team) and then to formulate their own theory of the causes of the patient's illness and ultimately a plan for a course of action. There will then be time for interactive, stimulating discussions and bedside teaching.