For me, my homework is to work on better HPIs, definitely better exams which are either typed or dictated and, therefore, accurate, and more time on decision making and rationale. I think that is somewhat missing on the assessment and plan approach. Not that it can't be done, but with our ED it is obvious this was an issue given every ED note now contains a decision making and rationale section where they actually overdo it with a pt with fever making them think of encephalitis and meningitis along with viral syndrome, most of the time with appropriate reasons why they are not. Of course, if you mention meningitis, does the attorney then ask why you didn't do an LP?
Again, it is difficult for the busy PCP to have a patient with left ear pain and an exam that is c/w a bulging red ear on the left to choose Acute Left Otitis Media and then prescribe amoxicillin. But, eventually that approach catches up to you. Of course, there is my still biggest pet peeve of the CC being listed in Past Encounters. I haven't figured out how four diagnoses can be listed for one past encounter, but when the patient's chief complaint is fever X 4 days and not feeling well, that just looks horrible in the past encounters especially when a parent asks for how many ear infections their child has had.
