Doctor Curmudgeon®…”A Mystery, Inside an Enigma.”

By Diane Batshaw Eisman, M.D. FAAP Doctor Eisman, is in Family Practice in Aventura, Florida with her partner, Dr. Eugene Eisman, an internist/cardiologist

In 1939, Sir Winston Churchill spoke of his feelings regarding Russia’s intentions. He said, “It is a riddle, wrapped in a mystery, inside an enigma; but perhaps there is a key.”

My problems are not even on the same planet, the same universe or solar system as the horrors that the Allies faced at the time of World War II.

Yet, the words of Churchill come back to me as I struggle with my personal mindboggling experience: that of coding. Physicians must put the correct code into the patient’s record for each diagnosis; but that is only if they want to be paid for their services.

There are webinars on coding and I despise their consumption of my time. These are the times that I fear my serum chocolate level reaches new and dangerous heights; because In order to remain focused during these sessions, I find relief by increasing my chocolate ingestion.

There are papers that magically appear on my desk and in my email with such annoying titles as:

Tips for coding (tips most likely refers to the tips of an iceberg. And aren’t those iceberg tips protruding from serene water in order to warn you away?)

Code Correctly (and what will happen if I am incorrect? Jail? Probation? Ankle bracelet? Or could I escape into Witness Protection?)

Coding for the Busy Physician (and if I’m busy, why am I to be bothered by coding?)

Coding for You (and what about the other physician in the practice?)

Make Coding Easy (Really? Easy? On what planet do you reside?)
Best Coding for Your practice (Ye Gads! What about the worst coding…so we can avoid it?)

My electronic record does give me codes for the diagnoses. Sure…but not always the exact fit for the diagnosis.

Hire a coder? Not appropriate for our office.

The primary diagnosis is to be listed first. A hierarchy which is too confusing for my now feeble brain.

Sometimes it is difficult to pinpoint one diagnosis. I diligently pick my diagnosis and code and yet…it is still shrouded in an enigma for me

As I brush away the chocolate from my keyboard, I think back to another time when there really was an Enigma.

After World War I, the Germans developed a unique encryption method. The famous Enigma Machine! It looked like a typewriter, but was no ordinary typewriter. Enigma was an electromechanical device that was supposedly able to send encoded messages securely. They could not be deciphered unless you had your own Enigma Machine on hand.

It was in World War II that the machine began to be used by the Nazis. The innocent looking machine allowed them to send coded messages thousands of miles. Smugly, they believe that it was impossible to decipher their codes; after all, they weren’t giving Enigmas to the Allies. No way to decipher their messages without a machine!

Then along came Alan Turing.
Turing found a flaw in the machine. Whenever you typed something, it would never appear as the exact letter you typed. It would always be some letter that was different from what you typed. But he also needed an alphabet set that the Germans had used to encrypt at least one word. The ingenious Turing tried “Heil Hitler.” Turing realized that it was always at the end of every single message. Crack! The sound of the Enigma coded being broken!

To quote again Winston Churchill, “It is a riddle, wrapped in a mystery, inside an enigma;
But perhaps there is a key.”

The brilliant mathematician, Alan Turing, found the key and so I still have hope for my coding enigma.

Dr. Curmudgeon suggests “Bitter Medicine”, Dr. Eugene Eisman’s story of his experiences–from the humorous to the intense—as a young army doctor serving in the Vietnam War.

Bitter Medicine by Eugene H. Eisman, M.D. –on Amazon

Doctor Curmudgeon® is Diane Batshaw Eisman, M.D., a physician-satirist. This column originally appeared on SERMO, the leading global social network for doctors.

SERMO www.sermo.com “talk real world medicine”

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