These picayune client specs that add nothing whatsoever

...and the pusilanimous MTSOs who allow them, too afraid either to draw any lines with the client OR, the alternative, to charge more for them (and pay us more for implementing them).

I have one client who insists on this being rendered as "took amoxicillin for 1-2 days" and another client who will raise hell with that and insists on "1 to 2 days"...

If the doc says "Patient will follow up in a week" one client insists on this being rendered as such, while the other insists on "THE patient will follow up in a week."

In that one sentence, you have now have TWO rules to be considered and applied "correctly" ACCORDING TO WHICH ACCOUNT YOU'RE WORKING, and which in each case differ between the accounts.

Yes, we SEEM to do this ALMOST automatically, but the operative words here are "SEEM" and "ALMOST". This is NOT entirely effortless, nor automatic. And this sort of thing, given the enormous number of situations we encounter even within a single report in which we must apply these picayune rules, creates enormous stress, even if it's piled on "one little rule" after another.

It requires, not vigilance, but HYPERVIGILANCE and the toll that it takes is very real and very substantial.

It's the work equivalent of the Chinese water-drop torture, or death by a thousand cuts.

I could go on for weeks with such examples, and absolutely NONE of the rules I could cite make the slightest difference in patient documentation meaning or "quality" (which each provider seems to be able to define for itself, which is more than passing strange if you know anything about quality standards).

Add to this, then, the subjective elements of QA so that you're not only thinking about the client's "rules" but also how QA MIGHT....MIGHT....MIGHT treat some edit that you make.

Example, as if you needed one: ESL dictator (with which the country now seems to be infested and how-the-hell-did-that-happen?): "The patient has been given already IV fluids." You're supposed to make corrections if "grammatically necessary" so your edit looks like this: "The patient has already been given IV fluids."

Comes now the power-mad QA witch and her flying monkeys: THAT EDIT WASN'T "NECESSARY"!!

You fix a dangling participle phrase that results in a totally ludicrous literal meaning ("The patient was in a motor vehicle accident and broke his arm with another car") and you get "IT WASN'T NECESSARY! NOTNECESSARYNOTNECESSARYNOTNECESSARY! MAJORERRORMAJORERRORMAJORERROR!"

So, you start leaving everything exactly as said, and now you get "THIS SHOULD HAVE BEEN CORRECTED! SHOULDACORRECTEDSHOULDACORRECTEDSHOULDACORRECTED! MAJORERRORMAJORERRORMAJORERROR!"

Now you have to somehow divine what someone else you never even met, and who very likely is less experienced than you are, will "think" (I use the word loosely) about your edit.

This adds an even more deadly form of stress than the rules themselves, namely the stress of dealing with ambiguity, uncertainty, the fear of being "wrong" (even when you're not).

We gripe a lot about the lousy line rates being paid - and with good reason. The financial catastrophe that's befallen our profession (while everyone else in healthcare has seen increases, even housekeeping) is made even more unbearable by these things, which amount to death by a thousand tiny cuts.

By the end of the day, I not only hate my employer and the clients I work for, I hate myself for putting up with this CRAP.

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These picayune client specs that add nothing whatsoever - to documentation quality...

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