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Hamlet Ivanov
Hamlet Ivanov

The Writers Visit [v3.4]



I think it's fair to say that most of us code by a mixture of rote memorization and gut instinct. We develop a coding gestalt (try explaining that to an auditor). But in doing so, most of us tend to play it safe and undervalue the work we do. As I teach coding to residents and attending physicians, the example of this I see most frequently is coding 99213 for a visit that merits a 99214.




The Writers Visit [v3.4]



Internal coding and documentation audits may strike you the way that visits to the dentist strike the general public, but don't underestimate their value. Every doctor in our 22-person group reviews five dictations per month, and each is a better coder for it. In our practice, the standard is that the physicians should be the coding experts. Nothing teaches me more about coding than reviewing the dictations of my partners to see whether their codes are on target and their documentation is complete.


If we did include the details, we'd realize that many of these are level-4 visits. For example, a new patient, a 60-year-old man, complains of having had a fever, a productive cough, slight dyspnea on exertion, nasal discharge and malaise for the past three days (five elements of the HPI). He denies chills, rash, allergies, dysuria, hemoptysis, sore throat, headaches, chest pain, myalgia, nausea, vomiting and diarrhea (10 systems of the ROS). He has a history of exercise-induced asthma and says that his mother and sister have severe asthma; he smokes a half pack of cigarettes per day; and he works as a carpet layer (three elements of the PFSH).


About 15,200 openings for writers and authors are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.


Speechwriters compose orations for business leaders, politicians, and others who must speak in front of an audience. Because speeches are often delivered live, speechwriters must think about audience reaction and rhetorical effect.


Some writers and authors work part time. Most keep regular office hours, either to stay in contact with sources and editors or to set up a writing routine, but many set their own hours. Others may need to work evenings and weekends to produce something acceptable for an editor or client. Self-employed or freelance writers and authors may face the pressures of juggling multiple projects or continually looking for new work.


The median annual wage for writers and authors was $69,510 in May 2021. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $38,500, and the highest 10 percent earned more than $133,580.


In other respects too, Stevenson was moving away from his upbringing. His dress became more Bohemian; he already wore his hair long, but he now took to wearing a velveteen jacket and rarely attended parties in conventional evening dress.[28] Within the limits of a strict allowance, he visited cheap pubs and brothels.[29] More significantly, he had come to reject Christianity and declared himself an atheist.[30] In January 1873, when he was 22, his father came across the constitution of the LJR (Liberty, Justice, Reverence) Club, of which Stevenson and his cousin Bob were members, which began: "Disregard everything our parents have taught us". Questioning his son about his beliefs, he discovered the truth.[31] Stevenson no longer believed in God and had grown tired of pretending to be something he was not: "am I to live my whole life as one falsehood?" His father professed himself devastated: "You have rendered my whole life a failure." His mother accounted the revelation "the heaviest affliction" to befall her. "O Lord, what a pleasant thing it is", Stevenson wrote to his friend Charles Baxter, "to have just damned the happiness of (probably) the only two people who care a damn about you in the world."[32]


Stevenson was visiting a cousin in England in late 1873 (Stevenson was 23) when he met two people who became very important to him: Sidney Colvin and Fanny (Frances Jane) Sitwell. Sitwell was a 34-year-old woman with a son, who was separated from her husband. She attracted the devotion of many who met her, including Colvin, who married her in 1901. Stevenson was also drawn to her, and they kept up a warm correspondence over several years in which he wavered between the role of a suitor and a son (he addressed her as "Madonna").[36] Colvin became Stevenson's literary adviser and was the first editor of his letters after his death. He placed Stevenson's first paid contribution in The Portfolio, an essay titled "Roads".[37]


Stevenson was soon active in London literary life, becoming acquainted with many of the writers of the time, including Andrew Lang, Edmund Gosse[38] and Leslie Stephen, the editor of The Cornhill Magazine who took an interest in Stevenson's work. Stephen took Stevenson to visit a patient at the Edinburgh Infirmary named William Ernest Henley, an energetic and talkative poet with a wooden leg. Henley became a close friend and occasional literary collaborator, until a quarrel broke up the friendship in 1888, and he is often considered to be the inspiration for Long John Silver in Treasure Island.[39]


Stevenson was sent to Menton on the French Riviera in November 1873 to recuperate after his health failed. He returned in better health in April 1874 and settled down to his studies, but he returned to France several times after that.[40] He made long and frequent trips to the neighbourhood of the Forest of Fontainebleau, staying at Barbizon, Grez-sur-Loing and Nemours and becoming a member of the artists' colonies there. He also travelled to Paris to visit galleries and the theatres.[41] He qualified for the Scottish bar in July 1875, aged 24, and his father added a brass plate to the Heriot Row house reading "R.L. Stevenson, Advocate". His law studies did influence his books, but he never practised law;[42] all his energies were spent in travel and writing. One of his journeys was a canoe voyage in Belgium and France with Sir Walter Simpson, a friend from the Speculative Society, a frequent travel companion, and the author of The Art of Golf (1887). This trip was the basis of his first travel book An Inland Voyage (1878).[43]


In June 1888, Stevenson chartered the yacht Casco and set sail with his family from San Francisco. The vessel "plowed her path of snow across the empty deep, far from all track of commerce, far from any hand of help."[71] The sea air and thrill of adventure for a time restored his health, and for nearly three years he wandered the eastern and central Pacific, stopping for extended stays at the Hawaiian Islands, where he became a good friend of King Kalākaua. He befriended the king's niece Princess Victoria Kaiulani, who also had Scottish heritage. He spent time at the Gilbert Islands, Tahiti, New Zealand and the Samoan Islands. During this period, he completed The Master of Ballantrae, composed two ballads based on the legends of the islanders, and wrote The Bottle Imp. He preserved the experience of these years in his various letters and in his In the South Seas (which was published posthumously).[72] He made a voyage in 1889 with Lloyd on the trading schooner Equator, visiting Butaritari, Mariki, Apaiang and Abemama in the Gilbert Islands.[73] They spent several months on Abemama with tyrant-chief Tem Binoka, whom Stevenson described in In the South Seas.[73]


Stevenson left Sydney, Australia, on the Janet Nicoll in April 1890 for his third and final voyage among the South Seas islands.[74] He intended to produce another book of travel writing to follow his earlier book In the South Seas, but it was his wife who eventually published her journal of their third voyage. (Fanny misnames the ship in her account The Cruise of the Janet Nichol.)[75] A fellow passenger was Jack Buckland, whose stories of life as an island trader became the inspiration for the character of Tommy Hadden in The Wrecker (1892), which Stevenson and Lloyd Osbourne wrote together.[76][77] Buckland visited the Stevensons at Vailima in 1894.[78]


Stevenson was a celebrity in his own time, being admired by many other writers, including Marcel Proust, Arthur Conan Doyle, Henry James, J. M. Barrie,[104] Rudyard Kipling, Emilio Salgari, and later Cesare Pavese, Bertolt Brecht, Ernest Hemingway, Jack London, Vladimir Nabokov,[105] and G. K. Chesterton, who said that Stevenson "seemed to pick the right word up on the point of his pen, like a man playing spillikins."[106]


The Robert Louis Stevenson Museum in St. Helena, California, is home to over 11,000 objects and artifacts, the majority of which belonged to Stevenson. Opened in 1969, the museum houses such treasures as his childhood rocking chair, writing desk, toy soldiers and personal writings among many other items. The museum is free to the public and serves as an academic archive for students, writers and Stevenson enthusiasts.


Q: How can we prepare for an author visit?A: The more time you spend familiarizing the students with my work before I arrive, the more meaningful the visit will be for them. For suggestions on some creative ways to prepare for a visit, please explore the FOR TEACHERS page for ideas. 041b061a72


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