Skip to main content

Reclaiming the review of systems: An opportunity for medical educators

Visual Abstract

Photo Credit: A. Rodman / Catie Glatz

INTRODUCTION

The review of systems (ROS)—a head-to-toe inventory of patient symptoms separate from the history of present illness—has been a part of medical practice for generations. It is codified in our documentation and case presentations, required by the government and private insurance for billing, and ingrained from the earliest days of medical school.

The preclinical years feature virtuous praise for thorough data collection, and students periodically encounter stories of the ROS unearthing hidden clues to a diagnosis. But in the clinical setting, they see a more jaded reality of ROS screening forms being ignored and witness billing fraud with the ubiquitously documented “a 10-point review of systems was performed and is otherwise negative.”1

Recently, the Center for Medicare and Medicaid Services (CMS) abandoned its 1995 requirement to document a specific number of organ system inquiries for reimbursement. This demise of the obligatory ROS offers medical educators a unique opportunity to enhance the teaching of history taking and clinical reasoning, emphasize professionalism, and center the encounter on the patient rather than the note.

Click here to read the full article.