Nine years ago, blogger Jaan Sidorov wrote about new disease that a colleague dubbedCoPaGA Syndrome.” CoPaGA [pronounced koh’ pah gah] is an acronym for Copy Paste Gone Amok.

In that post, he described what all of us have seen but didn’t know what to call it. It was found in a consultant’s report about a patient containing “past data, prior notes, test results, excerpts, quotes, interpretations, and correspondence that had been replicated word for word.”

What the patient told the doctor and what the doctor actually did, including his diagnosis and plan, “were inconspicuously buried toward the end of the EHR document.” Yes, it was a classic case of CoPaGA.

Sidorov said CoPaGA enables the physician to 1) avoid the time-consuming work of talking to a patient, 2) build a documentation trail of faux work, and 3) maximize potential billing.

The “zombie-like propagation of inaccuracies that refuse to go away” is also an important feature of CoPaGA. For example, I have seen records stating a patient has a drug allergy. When questioned, the patient insists that she has no such allergy, but the incorrect allergy cannot ever be expunged from the electronic record especially when it’s been copied and pasted over and over.

The problem was recognized as far back as 2006. Dr. Robert Hirschtick, in a clever submission to JAMA’s “A Piece of My Mind” section called “Copy and Paste,” copied and pasted several of his own paragraphs, which served to delightfully illustrate the problem.

Hirschtick mentioned more issues. Notes are not only longer, they contain information that is past its prime. He said, “Last month’s echocardiogram report takes up permanent residence in the daily results section. Complicated patients are on ‘postop day 2’ for weeks.”

Copying someone else’s notes can be done but may lead to embarrassing results such as a cardiology consultant who copied and pasted “an intern’s note into his own, even including ‘consult cardiology in a.m.’ in his recommendations. Perhaps he meant “consult a more thoughtful cardiologist.”

At the end of his 2010 piece, Dr. Sidorov wondered if meaningful use regulations would help cure CoPaGA Syndrome [stop laughing]. He said, “it remains to be seen.” So far, all we’ve seen is the epidemic of CoPaGA getting worse.

Thanks to Drs. Vinny Arora (@futuredocs), Kevin Pho (@kevinmd), Avital O’Glasser (@aoglassser), and of course Jaan Sidorov (@DisMgtCareBlog)



Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 19,000 followers on Twitter.