JonC 101 / Pranks and Rants
Date Subject Line
4/1/2014 Problem-Based Charting mandatory for hospital notes (with penalties)
4/1/2013 Disusering extending to Hospital Computer Accounts unless *Monthly* online training completed Re: disusering today
4/1/2012 Hospital cracking down on copied notes. Will deduct resident salaries if not (retroactively) corrected!
4/1/2011 ACGME Mandates 1-year Addition to all Residency Training Programs to Accommodate Work Hour Restrictions
4/1/2011 Extra tax liabilities for MSTPs?
9/22/2010 Step 2 CS
4/1/2008 Serious network drive problem
4/1/2008 Dropping out of the program

4/1/2014 Problem-Based Charting mandatory for hospital notes (with penalties)
Sent To Stanford Internal Medicine Residents
Context The hospital administration has been experimenting with and trying to push out a measure to have residents write their patient notes in a more rigid and structured manner. For the most part, there has mostly been backlash from the residents in having to change their methods and wrestle with more computer systems.

To further augment broad hospital goals, they recently started "Clinical Documentation Specialists" that (often annoyingly) pester residents to revise the way they phrase their patient notes to make them sound more ill.

Message Hi all,

I've been circumstantially involved in providing feedback on hospital documentation and EMR use based on various projects, and wanted to alert you to important changes.

Some of you may already be familiar with this Problem-Based Charting concept that's being used at [another hospital] and has been piloted in the ICU. This initiative is being pushed from the top administration down to residents to resolve issues with grossly inconsistent and inadequate care documentation. Based on the perceived success in the ICU, they're pushing even harder now, making this a mandatory approach to patient notes on *all* hospital services. They are ratcheting it up even further by no longer allowing *any* free-text in your Assessment and Plans. All of your diagnoses, differentials, and interventions in your new PBCharting style A&Ps will have to be selected from drop-down lists of administration pre-approved ICD10 and CPT codes.

The above apparently addresses inconsistent documentation of illness and severity resulting in poor Observed:Expected outcome scores, and overall improves the efficiency of subsequent hospital billing, making this a priority for the administration.

To help ease the transition, any non-conforming notes you write will result in daily pages from Clinical Documentation Specialists to talk you through how to retroactively correct all notes. To ensure motivation and compliance that would otherwise result in lost revenue from unbillable notes, residents who do not properly use the system or work with with the Documentation Specialists will have their computer accounts disabled after a week. You will have to ask your attending to write notes for you until all of your prior notes are corrected or further disciplinary action is taken.

I copied below a draft of the hospital's full procedure guideline on how this will be rolled out and what you can do about it,

  • happy april fools!! you got me last year, not this year :)
  • When does the enforcement start?
    Later from the same resident...
    oh you got me =)
  • You got me again this year! Strong work. Or maybe I'm just gullible.
  • Jonathan, I trusted you!
  • April fools!! I have to give it to you--you almost got me. You must be on vacation.
  • haha good one!
  • Nice one. You got me!
  • I didn't click it this year :)
  • You got me for the second year in a row
  • Every year, Jonathan Chen, you fool me. Well played. I will expect an email to come through next year as well. ;)
  • You are so full of sh**. Happy April Fool. I was scared for a second.
  • Haha. You got me the first time. You win. :P
  • Lol!! Thank god
  • Well done!!
  • Hahaha good one! It took me a while.
  • Ha!! I totally believed this... But it made me realize that the next time I will be at Stanford I will be a resident and won't be writing so many notes, which actually made me quite happy!!
  • Bahahahaha! Love it!

4/1/2013 Disusering extending to Hospital Computer Accounts unless *Monthly* online training completed Re: disusering today
Sent To Stanford Internal Medicine Residents
Context As residents and hospital employees, we have to complete annual online training modules, which can literally take hours to click through to superficially cover assorted topics on administration, documentation, privacy, safety measures, etc.

Several days prior, some unexplained debacle occurred where hundreds of residents lost their computer account access to one of the hospitals, as per this e-mail excerpt from one of the chiefs:

The [hospital] just got a little crazier. There are many residents who have been disusered (apparently 900) because of incomplete [online] training or some related problem. This means you can't get onto [the computer system], write notes, put in orders, etc.

The three of us don't know why this happened today, and why it has happened to people who did their training as instructed (I'm sorry!!).

I'm sorry that this is happening, and don't know why they disusered people even if they did the training. I lost my access too :(

[The number / e-mail to contact for help is ...]
Message Hi all,

After much aggravation trying to get my [computer] account back online (despite having properly completed the [online] training a while ago), I got one of the managers from the Compliance Office on the phone to figure out what is going on.

Apparently this is part of a measure to strengthen enforcement against poor compliance with professional behaviors. Issues they cited include running around with patient (sign-out) notes in our pockets, leaving them in unlocked rooms or lingering at public printers, leaving public computers logged in, sending patient information through unencrypted e-mail, as well as consistently flagrant disregard for basic hand hygiene, contact isolation, and sterile technique measures.

Management's solution to this, which annoyingly was not properly communicated beforehand, is to require us to complete the online training modules that address these issues, and to do so *Monthy* as a frequent reminder (this is why many of us got our accounts "expired" even though we thought we completed online training >1 month ago). This method will be extended to disabling of our [other hospital] accounts this week unless we complete the [other] training modules monthly as well. Furthermore, the online modules will be modified such that they cannot just be "clicked through," but will require a minimum number of hours of active use to count for credit (if you've ever done an online driver's training course, it's something like that).

Linked below is a copy of a report they provided me with statistics on the frequency of the non-compliance behaviors. They plan to keep these measures in place until compliance rates across all residents are documented above 90% in all categories.

  • LOL this time I did not fall for ur tricks. Hope you're doing well JC superstar.
  • You had me for 3/4 of your email. Well done!
  • That was a really long email for an April fools joke. Also I like how the anime character looks exactly like you :-)
  • I believed you 100%. Well played!
  • Omg JC. That cartoon is effing hiliarious! Hope you're doing well. Well obviously you're doing well, having had the time to draft this. ;o)
  • Dude. Amazing! I *just* found out this was a joke
  • I totally believed this until [...] told me it was a joke haha.
    I wrote back to the class several days later:
    Hmm, kind of surprisingly little response to this message. Am I too predictable? Was the message too credible or not enough? Was the thought of being forced to complete menial tasks on a monthly basis not threatening enough to elicit attention? If so, sounds like learned helplessness against an authority over which one feels no power. Any of the above possibilities make me sad. In any case, with much love for everyone, hope you can enjoy a laugh once in awhile.
  • Before I figured out the joke (i.e. someone told me), I told everyone complaining about being disusered that we are going to have to complete the training monthly. I personally misled at least ~10-15 people. Oh well. Pretty funny.
  • the link is a give away!
  • Actually Jon, I read your email, got totally trolled (!) and just resigned myself to the learned helplessness that is security compliance at the VA. Kudos on a good April fools
  • Hahaha, the moment I saw your e-mail, I knew it was a classic hilarious Jon Chen prank. You had me seriously fooled last year ;)
  • I didn't respond because I was too demoralized after falling for the second April fools prank that day. Props to you!
  • I fell for it last year, nearly again this year ;)
  • haha. dude you got me. i was actually thinking, "Screw the VA!! they can take away my privileges! I'm going to do it for 1 month, then when i'm done with their rotations and I'll never do it again. Damn! I'm glad i'm finishing residency soon."

4/1/2012 Hospital cracking down on copied notes. Will deduct resident salaries if not (retroactively) corrected!
Sent To Stanford Internal Medicine Residents
Context As medical residents, much of our day is often spent writing notes describing the daily care plan for our patients. This can be a very tedious task, and when you have an electronic medical record system, it's pretty darn easy to just copy-and-paste prior notes.

A few weeks prior, a mini e-mail flame war was kindled amongst the residents, regarding copying each other's notes without credit, and recycling daily notes and plans for days without updates. In response to those, I previously left a reply of:

"Plagiarism is the sincerest form of flattery...
... or perhaps just a more common form of laziness. Haven't decided yet."

Message Hi all,

You'll probably hear about this via official channels soon, but wanted to give you a heads up on incoming issues. Giving credit to each other for copied notes was all fun and games, but unfortunately our discussion has opened up another whole Pandora's box. The hospital administration got wind of our prior e-mail thread and they had someone call me with questions related to a current investigation into documentation deficiencies.

Apparently, when we copy our daily progress notes, particularly the assessment and plan, this has bigger implications towards hospital billing. The hospital cannot bill insurance companies for daily notes if a *critical assessment and plan* is not done by an MD. When the A&P is straight up copy-pasted from the prior day, the insurance companies are rejecting billing, arguing that this represents no documentable proof that an MD provided any critical thought into the patient's management.

Because "asking nicely" clearly has not (and most likely will not) change these practice patterns, the administrator I talked to intimated that they will be instituting much stricter enforcement measures. Specifically, for any daily note that insurance refuses to pay for, the hospital's resultant lost revenue will be taken out of the authoring resident's salary! Furthermore, to recoup prior losses, the hospital will require residents to retroactively update any deficient notes from the past year to allow for proper billing, lest the same losses will be extracted from the offending residents' salaries.

If you want to know more, they provided me a report of statistics illustrating the pervasiveness of this type of documentation issue and the memorandum expressing the hospital administration's position and plans (linked below).

Jonathan H. Chen
  • That is great.
  • Well done, my friend. Had me angry and bitter, then laughing aloud.
  • Hehheheheheh...well played, Jonathan!
  • you're awesome.
  • Hahaha you got me! Good work! :) I was starting to sweat bullets for all the notes I write for you interns! Jk :p
  • Awesome, john, just awesome. :)
  • Cute :).
  • That was an impressive email effort. I was suspicious about the salary deduction, but the rest is nicely legit. :)
  • Damn that was good!
  • very nice, was about to cry until i saw the link.
  • i love you
  • Love it. Fucking brilliant. Chen for Chief!
  • Jon!!! You probably gave half our class a near-MI! Haha, good one.
  • JC Superstar, you are a bad mo fo ;)
  • JONATHAN!!! That was a good one...I'll have to admit.
  • totally hilarious, dude!
  • I JUST figured this out. Haha.
  • Oh my goodness I think I just had a cow. I'm ... on vacation and just near about stopped breathing. Thank you for a very well done April fools! Yay for this not being true!!!!!!
  • Ok, you got me. I've spent the last day ... wondering how on Earth we were going to work this out. Well done!

4/1/2011 ACGME Mandates 1-year Addition to all Residency Training Programs to Accommodate Work Hour Restrictions
Sent To UC Irvine 4th Year Medical Students
Context 4th year students about to move on to their first year of medical residency training within a few months. A lot of buzz and controversy over a new national mandate from the ACGME (accreditation board that oversees all medical residency training programs) that will enforce limits on how many consecutive hours a resident can work. Many training programs balked at these "duty hour restrictions," as they often relied on having residents work 30+ hour shifts at a time and >100 hours per week.
Message Hi all,

You'll probably be hearing a lot more about this in the coming days if you haven't already. Due to all of the controversy over the upcoming intern work hour restrictions, many residency programs have been pushing to extend their training programs to ensure they have enough house staff to cover their service needs, and ostensibly to ensure we are getting sufficient training by the end of our residencies.

Rather than this occurring erratically and unfairly across individual programs, the ACGME has decided to unilaterally mandate that ALL residency training programs (starting with our groups this July) be extended by an extra year. This will effectively require us all to go through an extra intern / pre-lim year. I copied the full report at the link below. You should definitely review it to see how these changes will be impacting us.

  • hahah nice! :)
  • That's really funny in retrospect and take this the right way, you're a jerk.
  • THAT IS NOT FUNNY!!!!!!!!! HAHAHAHAHA I almost had a heart attack!!!!!!!!!!!
  • Ha ha ha!! Super Cute!!
  • lol, i like the animation, it looks exactly like you!
  • Wait, what??? Meaning my 3 yr peds program is now 4???
    (Later from the same person): Nrvermind!! Grrrrr Haha
  • OMG scared the shit out of me dude. My heart is still racing.
  • Awesome!!!
  • omg, jonathan!!! best one so far today.
  • Wow man you really had me going with that one....nicely
  • so funny. you almost had me for a second. i liked the attachment!
  • HAHAHAHAHAHAHAH, omg this was SO GOOD.
  • oh had me and XXX arguing, questioning g surg as a specialty choice, and scheming ways to get back to cali--including starting residency over again! good one LOL
  • Very well played Jonathan! You really had me for a few minutes!!! :-) I'm so glad that was a joke.
  • Oh you clever little @$%@#$@#$@#$@# !!!!!!!!!! You and XXX totally freaked me out. I was like... WHA, 2 YRS OF PRELIM! H*LL NO! Alright.... you got me... you got me...
    I haven't had an april fool's joke since.... elementary school? Hahaha, thanks for making me smile :)
  • ... both hates and loves the evil genius of Jonathan Chen

4/1/2011 Extra tax liabilities for MSTPs? Fw: Mistakes in 1098T reporting
Sent To Students of the UC Irvine MD/PhD Program
Context As part of MSTP (Medical Scientist Training Program), our MD and PhD training tuition is paid for (we just have to make a non-refundable contribution in the form of the best year's of our lives). This includes an additional stipend we're essentially paid as a salary for living expenses, though it does not technically come through as a W-2, just a straight check that we get from the University, which we have to report for income taxes ourselves.
Message Hi all,

While doing some last minute tax filing preparations, I was digging through It looked like it had mistakes, because it listed a lot more money than I actually received in stipends. But if you check the e-mail exchange below with the financial aid office, apparently this is accurate as the office reports not only the cash we receive as a stipend, but also the money that is paid on our behalf as tuition and fees.

The critical implication is that our tax liability is almost double what I thought it was. Even more so, as I talked with an accountant for help this year since my tax situation is getting more complex (baby, home, partnership in LLC), he pointed out that for all the years past that I did not account for those amounts, I'm going to be liable and will have to retroactively pay for all of them, plus interest and penalties. This is unavoidable at this point because audits are coming down on everyone receiving training grants this year. This is because the state is desperately tracking down any source of lost revenue it can find amidst the current budget crisis. I made a copy of the full report on the situation at the link below:


Sent: Wednesday, February 23, 2011 10:15 AM
To: Chen, Jonathan
Subject: Re: Mistakes in 1098T reporting

Dear Jonathan:

For the Box 5 ("Scholarships or grants") amount, IRS rules specify that "...institutions must report the aggregate amount of scholarships or grants received for an individual's costs of attendance that the institution administered and processed during the calendar year." The Box 5 amount therefore includes registration fee payments, not just stipend checks.

The amounts you are disputing below are registration fee payments credited to your student account each term. Following your fee payment, the remainder of your financial aid award was disbursed as check. For example, for Spring 2010, your MdPhd Stipend award was $X,XXX.00. Of this amount, you received $X,XXX.50 in your student account to pay registration fees on 02/23/2010, and $X,XXX.50 in EFT/check 7720585 on 03/22/2010.

I have verified all of the records listed online as belonging to your student account. There has been no confusion with another student's records, and no error in 1098-T reporting.

On 2/22/2011 7:02 PM, Jonathan H. Chen wrote:

I was just reviewing my 1098T form online, provided from UCI. My (medical school) ID is ... and name is Jonathan Haelin Chen. Box 5 (Scholarships and Grants) is reporting $XX,XXX which includes several installments that are not accurate. On the page 4 Financial Detail page, the following MdPhD Stipend amounts are correct in that I received them:

1/1/2010 $X,XXX.50
3/22/2010 $X,XXX.50
6/23/2010 $X,XXX.50
8/20/2010 $X,XXX.00

The following amounts are incorrect, I never received them. It appears that someone else's record were mixed in with mine, which is apparent since there are multiple amounts with the same description (e.g., 2 amounts described as "MdPhd Stipend Sprg").

2/23/2010 $X,XXX.50
5/14/2010 $X,XXX.50
8/11/2010 $X,XXX.50
11/19/2010 $X,XXX.50

Thank you for your attention,
  • Triple check this with your accountant. You should not have to pay taxes on the portion that goes toward tuition, that gets deducted from this (seemingly arbitrary) total amount. You should only be responsible for paying taxes on the amount you receive as stipend. (Hence, no back-taxes either, if you've been paying on the stipend portion all along)
    (Later from the same person): Huh... it WAS april fool's day... i barely remember what day of the week it is these days... and i forgot about your I'm quitting email. :-)
  • man, you're good. At first I was thinking, whoa this totally makes sense, then I was thinking when was the last time we all got an email from Jon? Oh yeah, when we was going to quit the program. Classic.
  • That is your best prank yet. Super funny. If I showed my wife that she may have an AMI. Have a great day.
  • you're a terrible human being! jk
  • Except that tuition, fees, books, and other required materials for courses while you are a degree candidate and not required to be reported as income.
    (Later from the same person): Ok you win on that one. Date fail.
  • You absolutely, unequivocally, had me until I clicked the link. Bravo, friend!
  • OMG Jon Chen you always effing get me with these! I love it. Will miss getting your emails every year :(
  • I'm going to assume Jon was not intending to send this tax information out as an April Fool's joke. (A very dangerous assumption ;-)
    I'm not a tax expert, but I can't find any evidence that our tuition payments are taxable [...]
  • AHHAHAHA. WOW. That was a GOOOD April Fool's joke. On a sidenote, i gotta submit my taxes!!
  • I went to H&R Block my first year because of confusing tax situations involving my job prior to starting the MSTP, and we only have to report (& pay) taxes on anything above & beyond what we pay for tuition, books, educational expenses & equipment, etc. [...] (Later from the same person): Hahahahaha.... umm.... obviously I never clicked on the link. ;-)
  • Actually the most crafted April Fool's pulled yet in my records. Totally fell for it.

9/22/2010 Step 2 CS
Sent To UC Irvine 4th year Medical Student Class
Context Step 2 CS (Clinical Skills) is one of exams we must pass to complete medical school. This is a "practical" exam that was recently added as a national requirement, where you meet several "standardized patients" (i.e., actors) and pretend you're evaluating and counseling them on random medical concerns. This exam costs over $1000 for the student, and most students around the nation have to fly out to get to one of only a handful of testing centers.

My message was in response to one of the other students who wrote:
"who has taken their step 2cs? If you have taken it and have a minute and feel like helping a fellow classmate out can you give me some advice via email me or phone. some resident at harbor freaked me out and said people fail all the time and stuff like that."

Message Hi XXX (and anyone else going to take Step 2 CS),

You should tell that Harbor resident to get bent. I'm sure people do fail CS "all the time." A lot like how cars crash on the freeway *all the time!* Just think of all the times you've seen an accident on the freeway! Of course, that's ignoring the other 95+% of cars that pass through completely unscathed. First Aid lists some stats, including that the pass rate for CS is ~96% for US medical students. It's only lower (like 80%) for foreign medical students who have more trouble with English and carrying on an interview.

I just quickly crammed some of the material in First Aid CS the night before. It's okay as a general review to get in the mode, but actually, there was not much overlap with the cases I got at the real thing. You really will just have to rely on your general knowledge of medicine that we all already have. Which is fine, since it's really more about your ability to illicit a relevant history and physical exam and then summarizing your impressions.

If anything, I felt the biggest challenge was time management. You only get 15 minutes per encounter, and I found myself running out of time on several. There's 10 minutes afterwards to write a note on each patient, which should be enough time, but the other annoyance I had was that they limit the word count you can enter. As you may have noticed from this e-mail, I can be pretty verbose, which gave me grief as I kept hitting the limit while writing out the history (though much of it was filled with boilerplate negative review or systems, etc.). In any case, a lot of the evaluation is just based on a checklist of BS items like making eye contact, introducing yourself, washing your hands, auscultating under the gown, draping the patient, etc.

Having said all that, once I find out I failed CS, I'll probably feel pretty dumb. While I'm on this rant, as a thought experiment: If you were considering a diagnostic test that had a 95% pre-test probability of being positive (like say a D-dimer in any chronic hospital patient), the appropriate response should be that the test is an utter waste of time and money.


  • HA HA HA HA!!!!!
  • nice one john :) Hope this year is treating you well!!

4/1/2008 Serious network drive problem
Sent ToGrad Students and Post-Docs of my Computer Science Research Group
Context Computer science research group where essentially all of our work is based on software written on shared network drives. Data center had been having not infrequent issues recently, with sporadic shutdowns, as well as moving our program libraries around.
Message Hey guys,

I think we may have a big problem. Some of my programs were doing funny things, and when I traced it back, I realized there was some serious data corruption on the network drive. The effects are subtle, so you may not have realized it, but any code you've checked in or out and any programs you've been running off any code or libraries in the /home/dock tree in the past couple months are almost certainly invalid, which means we all have a ton of development and experiments to do over. I checked with helpdesk to track the timing and origins of these errors and copied their full report to the link below if you want to know more.


  • I had myself just finished writing my own April's Fool email to some friends when I read yours, which explains why you didn't fool me. I would have hated you otherwise. (Sadly, though, when XXX wants me to rerun tons of experiments from 9 months ago, it's never a joke.
  • Damn you!! Just as I'm trying to finish everything before I leave!!! Actually, that was a pretty good one. I'm glad you included the "info report" -- I might have had a nervous break down otherwise.
  • Holy shit... I'm still jet lagged and that subject heading hit me like a ton of bricks! HAHA! Good one!

4/1/2008 Dropping out of the program
Sent ToStudents of the UC Irvine MD/PhD Training Program
Context In recent months, several students quit the program (deciding to only continue with the MD, and dropping the PhD). A demoralizing sign for everyone else.

In the meantime, at recent student retreats, I've been presenting my work on chemistry reaction software that I developed as part of my PhD project.

Message Hi all,

I know this may come as a surprise to some of you, and I hate to be the 4th one in so many months, but I've decided to leave the MD/PhD program after much deliberation. I just received an impressive buyout offer from a publisher for my reaction software that makes school seem not so meaningful anymore. I'd like to say I'll miss the school and all of you, but now that I have money in the bank, who are we kidding? If you're interested in more information, I linked below a copy of the press release on the acquisition.


  • um, very good :)
  • oh my god you actually got me
  • wow, glad I opened the link. I was going to cry... :-)
  • That’s really good man. You totally got me.
  • our second webmaster, following in XXX’s footsteps, is quite a guy.
  • Brilliant!
  • I hate you Jonathan!!!! I totally fell for it. And you would have been the 5th!!!! And UCI would have NEVER let you make money on something they funded.
  • haha good one. i actually fell for it. =). previously, XXX and i were talking about how we should all approach [the program director] and tell him that we were going to drop out. but then we realized that it wouldnt be too funny for him =P
  • damn it...I already planning on getting free drinks from you on thursday to celebrate your new found fortune
  • Lol. That was a good one. I actually fell for that one. Thanks for the laugh.
  • K....that was smart got me there. Btw, if you do get loaded because the software got bought, make sure you hook me up...^_^
  • That was hilarious but you really should have sent it first thing in the morning…
  • cute. ha ha ha ha. :-) good one.
  • Cute. Almost as good as the article someone sent me about Mike Tyson taking up Ironman
  • Hehe, had me going!
  • Hah! You totally got me!
Collection of prank and rant e-mails I've sent to my various peer groups. My wife says it's things like these that make people think I'm a jerk. When reading these, she also says I'm a nerd and a dork. Some of the replies back do seem to confirm the above suspicions ;-)

Incidentally, the picture above was drawn by my wife many years ago. It was actually intended to reflect my response to getting to eat good food.
pranksRants/index.htm | Page last updated $Date 4/2/2012$