Home Forums Discussions General Discussion Review of Systems

I have often had a question about the best way to use the ROS or what is considered best practice. I see everyone do it a different way. I mostly see it done via the ED for coding.

When you are working up a patient or seeing an acute patient, do you:

Ask ROS that would cover far back, like

HEENT: Multiple ear infections as a child, denies eye issues, + strep throats in the past
GU: Denies yeast infections,, + UTIs as a child

or do you make it pertain more to the problem you are working with:

Patient has fever and abdominal pain:

ROS:

HEENT: Denies throat pain, ear pain, congestion
GU: positive for dysuria (if not in the HPI)

________________

I recall being taught that WNL in an exam meant "We Never Looked." and was not to be used

The ED will say the following A LOT:

A 10-point ROS was done and was all negative except for that in the HPI. (Is that worth anything other than coding)?

We are getting rid of ROS and PMH in our notes.

We do the ROS as the immediate problem list for the visit, like your second example. It is in addition to the HPI and I will sometimes document "as per HPI" if it is something extensively covered by the HPI. I put stuff like recurrent problems, surgeries, treatment etc in the Past Medical History.

LOL, I had to troll to get a response. Although, yours was simply responding to the thread and VERY helpful! I like how you do that. It sounds though that you are much more specific and accurate with your approach than say the ED. Do you tend to use ROS that include pertinent negatives and then the positives may be "as per HPI?"

What do you think of the ED mainly putting a 10-point ROS was done and all were negative except for what is in the HPI.

1) first I don't think they did a 10-point ROS when it is something like sore throat or even anything. Is it coincidental that it is always 10 points?
2) I have gone through records such as those that come from Cerner and the exams, while comprehensive for a four-month-old are the same exact words for the six-month-old

I really don't think they do them, plus they don't help much. You may include pertinent negatives in your HPI, but it is more glaring in a ROS that would correlate with a sore throat.

ROS:

GEN: Denies fever or headache
HEENT: Eyes not injected, ears normal, denies nasal congestion, throat red as per hpi
NECK: Denies neck pain
ABD: Denies abdominal pain

Would that be a four-point or a 8-point ros.

Do you tend to use ROS that include pertinent negatives and then the positives may be "as per HPI?"
YES but rarely use as per HPI, will put POSITIVE for XYZ under the system as appropriate

What do you think of the ED mainly putting a 10-point ROS was done and all were negative except for what is in the HPI.
This is just click bait, for the lawyers/coders, when I worked in an ER I hated the way we had to treat and street pts, it is a time game for the ER admin. It is so they can up code everything. NO one ever asked all of the 10 point system items. This is our standard and then will change depening on the complaint that brought the pt into the office. If just for lab review, then we have covered the ROS for the coder/biller.

The format of AC (and most EMR's) is the format of what we learned in physical diagnosis in medical school.
It took most of a day to perform the history and physical and write it up -- but it was a teaching tool.
Later we learned to be more selective about what to ask and what to look for in an actual patient -- but the didactic format has been completely entrenched, and then set in concrete by the "coders"

Agreed. @Chris....I wonder if they asked two ED doctors to name the 10 points....they make it sound like a 10 point ros is always the same.....

While Tom and you are here, do you prefer the History, physicial, assessment and plan or the

assessment, plan, history physical?

Ours always starts with this visit diagnosis

I feel like if I send a patient to a GI consultant, I already know the history and physical and all about them, I just need the impression of the GI specialist and their plan for my patient, so it kinda makes sense there.

I do wish that on discharge summaries or even consult notes, that there would be a place in red either at the top or bottom which plainly lists what the pcp is to do to follow up with the patient.

"History, physical, assessment and plan" is my preference, SOAP note training in the past. I try to get the plan to sound like a narrative note so that if someone else reads the note, ie referral to GI, they know why I am sending the pt. That doesn't mean they read my note because it can be clear that certain ones never do but I think it helps. Probably fooling myself. I know it does nothing for the insurance auditors because it is in a narrative they think I don't do things. They are only looking for bullet points, real quality control on their part! ON that note, there is a large billboard just put up in town fro Wellmed, says something like we're now in town to help your local physician, yeah right!