Given the paradox of the success of modern medical technology and
the growing patient dissatisfaction with present-day medicine, critics
have called for a reevaluation of contemporary medical practice. This
paper offers a phenomenological analysis of traditional Navajo
healers and their ceremonies to highlight key aspects of healing. A
phenomenological view of medical practice takes into account three key
features: the lifeworld, the lived body, and understanding. Because of
their closeness to a phenomenological view, traditional Navajo mythology
and healing practices offer insight into the healing process. Contemporary
physicians can appreciate the phenomenological elements of Navajo healing
ceremonies, including the Mountain Chant. Navajo healers help patients
make sense of their illnesses and direct their lives accordingly, an
outcome available to contemporary practitioners, who are also gifted
with the benefits of new technologies. By examining scientific medicine,
Navajo healing practices, and phenomenology as complementary disciplines,
the authors provide the groundwork for reestablishing a more therapeutic
view of health.
Purpose: To compare a template-driven medical documentation system to undirected handwritten documentation and determine whether the template (1) decreases physician evaluation time, (2) increases gross billing, and (3) increases physician satisfaction with the documentation process.Methods: A prospective randomized trial of documentation with a template system (T-System for Primary Care, Dallas, TX) versus undirected handwritten documentation was conducted in 2 separate teams of a single family medicine residency program. After training, one team used the template system and the other team used undirected written documentation. Clinic visit duration was recorded. Medical records were evaluated by a blinded professional coder to assign an evaluation/management code. Clinic visit duration and coding level differences were evaluated using an independent t test. At the conclusion of the study, residents completed a questionnaire to determine physician satisfaction with the documentation tool. Survey responses were on a ؊2 to ؉ 2 Likert scale. Means and standard deviations are reported.Results: A total of 1339 patients were included in the analysis of patient visits. There was no significant difference in clinic time between the template system and the written documentation visits. The mean visit time was 1.75 hours for both teams. For the analysis of gross billing, 1237 charts were included. The mean billing amount for written documentation was $150 and for the template system it was $163-a statistically significant difference. The physicians' surveys favored continuing to use the template documentation method.Conclusions: The template medical documentation system compared with undirected written documentation produced a significantly higher bill for the visit, yielding no differences in evaluation time, and was overall positively received by the residents and faculty.
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