Wolof Chief & Residence

Wolof Chief & Residence


Vice-President’s Residence

The house at One Observatory Circle in Washington, DC is the official residence of the Vice-President of the United States.

The house was designated the official residence of the vice-president in 1974, after Gerald Ford had been named as the replacement for Vice-President Spiro Agnew. Ford never moved in, however, as he was quickly elevated to president when Richard Nixon resigned. Ford named Nelson Rockefeller as his vice-president, but the Rockefellers already lived in Washington and had no desire to move, so they used the house only for entertaining. As a result, it was Walter Mondale who became the first vice-president to live in the house in 1977.

The house was built in 1894 for the superindendent of the US Naval Observatory. The observatory itself is still in use by the Navy, but the superintendent lives in another residence. In 1923, the Chief of Naval Operations took the house for himself, and it was used as such until 1974.

In 2002, neighbors of the Naval Observatory reported explosion sounds coming from the house, which many interpreted as the construction of a bunker built to help ensure the security of the vice-president's family in times of emergency. Vice-President Joe Biden was reported to have said that "a young naval officer giving him a tour of the residence showed him the hideaway, which is behind a massive steel door secured by an elaborate lock with a narrow connecting hallway lined with shelves filled with communications equipment."

Biden also reportedly said that Cheny's aides often worked on policy in a room in the house. The vice-president's spokesperson later claimed, "What the Vice President described in his comments was not . an underground facility, but rather, an upstairs workspace in the residence, which he understood was frequently used by Vice President Cheney and his aides. That workspace was converted into an upstairs guestroom when the Bidens moved into the residence."

The three-story brick house is compact, 39 by 77 feet (12 m by 23 m), with 9,150 square feet (850 m 2 ) of floor space. On the ground floor are a reception hall, living room, sitting room, sun porch, dining room and small pantry, and lavatories added later to the north side. The second floor contains two bedrooms, a study, and a den. The third floor attic was originally servants' quarters and storage space. The kitchen was placed in the basement, along with a laundry room and other storerooms.


The area around Downing Street was home to ancient Roman, Anglo-Saxon and Norman settlements, and was already a prestigious centre of government 1,000 years ago.

The Romans first came to Britain under the command of Julius Caesar in 55 BC. Making their capital at Londinium downriver, the Romans chose Thorney Island – a marshy piece of land lying between two branches of the river Tyburn that flowed from Hampstead Heath to the Thames – as the site for their early settlement.

These Roman settlements, and those of the Anglo-Saxons and Normans who supplanted them, were not very successful. The area was prone to plague and its inhabitants were very poor. A charter granted by the Mercian King Offa in the year 785 refers to “the terrible place called Thorney Island”. It took royal patronage to give the area prestige. King Canute (reigned 1017 to 1035) built a palace in the area, and Edward the Confessor (reigned 1042 to 1066) and William the Conqueror (reigned 1066 to 1087) maintained a royal presence there. The position of Westminster (as the area became known) as the centre of government and the church was solidified following the construction of the great abbey nearby, on Edward's orders.

Whitehall from St James’s Park – Hendrick Danckerts c.1675

The earliest building known to have stood on the site of Downing Street was the Axe brewery owned by the Abbey of Abingdon in the Middle Ages. By the early 1500s, it had fallen into disuse.

Henry VIII (reigned 1509 to 1547) developed Westminster's importance further by building an extravagant royal residence there.

Whitehall Palace was created when Henry VIII confiscated York House from Cardinal Wolsey in 1530 and extended the complex. Today's Downing Street is located on the edge of the Palace site.

The huge residence included tennis courts, a tiltyard for jousting, a bowling green, and a cockpit for bird fights. Stretching from St James's Park to the Thames, it was the official residence of Tudor and Stuart monarchs until it was destroyed by fire in 1698. It made the surrounding real estate some of the most important and valuable in London – and the natural home of power.

The first domestic house known to have been built on the site of Number 10 was a large building leased to Sir Thomas Knyvet in 1581 by Queen Elizabeth I (reigned 1558 to 1603). He was one of the Queen's favourites and was an MP for Thetford as well as a justice of the peace for Westminster. His claim to fame was the arrest of Guy Fawkes for his role in the gunpowder plot of 1605. He was knighted in 1604 by Elizabeth's successor, King James I (reigned 1603 to 1625), and the house was extended.

After the death of Sir Knyvet and his wife, the house passed to their niece, Elizabeth Hampden, who continued to live there for the next 40 years.

The middle of the 17th century was a period of political upheaval and Mrs Hampden's family was right in the middle of it. Her son, John Hampden, was one of the MPs who opposed King Charles I (reigned 1625 to 1649), and Oliver Cromwell, the Lord Protector, was Mrs Hampden's nephew.

Hampden House, as it was then known, gave Mrs Hampden a prime view of the tumultuous events during the Civil War and the Commonwealth and the early years of the Restoration.

The execution of Charles I in 1649 took place on a scaffold in front of Banqueting House in Whitehall, within earshot of the house. Mrs Hampden was still living there when King Charles II (reigned in Scotland from 1649 to 1685) was restored to the English throne in 1660.

The Parliamentary Commissioners, who took over Crown lands during the time of the Commonwealth, described the house in 1650:

Built part of Bricke and part with Tymber and Flemish qalle and covered with Tyle, consistinge of a Large and spacious hall, wainscoted round, well lighted, and Paved with brick Pavements, two parls wherof one is Wainscoted round from the seelinge to ye floor, one Buttery, one seller, one Large kitchen well paved with stone and well fitted and Joynted and well fitted with dresser boards.

And above stayres in the first story one large and spacious dyneinge Roome, Wainscoted round from the seelinge to the floore, well flored, Lighted and seeled, and fitted with a faire Chimney with a foote pace of paynted Tyle in the same. Also 6 more Roomes and 3 Closetts in the same flore all well lighted and seeled. And in the second story 4 garretts…


Tribal History

The Rappahannocks first met Captain John Smith in December 1607 at their capital town “Topahanocke” on the banks of the river bearing their name. At the time, Smith was a prisoner of Powhatan’s brother, Opechancanough. He took Smith to the Rappahannocks for the people to determine if Smith was the Englishman who, three years earlier, had murdered their chief and kidnapped some of their people.

Smith was found innocent, at least of these crimes. The perpetrator was a tall man. Smith was too short and too fat. Smith returned to the Rappahannock’s homeland in the summer of 1608. He mapped 14 fourteen Rappahannock villages on the north side of the river. The Rappahannock’s territory on the south side of the Rappahannock River was their primary hunting grounds.

English settlement in the Rappahannock River valley began illegally in the 1640s. The Rappahannocks sold their first piece of land to the English in 1651. However, Rappahannock chiefs and councilmen spent more than ten years in county courts trying to get payment for this and other land sales. They never received full payment. By the late 1660s, encroaching settlers and frontier vigilantes forced the Rappahannocks to move, first inland on the north side of the Rappahannock River and later to their ancestral hunting grounds on the south side of the river.

During Bacon’s Rebellion, the Rappahannocks hid with other Tribes in the Dragon Swamp to avoid those English vigilantes who sought to kill all Indians “for that they are all Enemies.” After the rebellion, the Rappahannocks consolidated at one village. In November 1682, the Virginia Council laid out 3,474 acres for the Rappahannock “about the town where they dwelt.” One year later, the Virginia colony forcibly removed the Tribe from their homes and relocated them to Portobago Indian Town. There, the colony used the Tribe as a human shield to protect white Virginians from the New York Iroquois who continued to attack the Virginia frontier and threaten the expansion of English settlement.

In 1705, the Nanzatico Indians, who lived across the Rappahannock River from Portobago Indian Town, were sold into slavery in Antigua. Within a year, the Rappahannocks were, once again, driven from their homes. The Essex County militia removed the Rappahannocks from Portabago Indian town and the land there was patented by English settlers. The Rappahannocks returned to their ancestral homelands downriver, where they continue to live today.

In an effort to solidify their tribal government in order to fight the state for their recognition, the Rappahannocks incorporated in 1921. They were officially recognized as one of the historic tribes of the Commonwealth of Virginia by an act of the General Assembly on March 25, 1983. The Rappahannocks initiated plans to build a cultural center and museum. In 1995, they began construction of the cultural center project and completed two phases by 1997. Phase three, a planned museum, is in the planning stages.

In 1998, the Rappahannocks elected the first woman Chief, G. Anne Richardson, to lead a Tribe in Virginia since the 1700s. As a fourth generation chief in her family, she brings to her position a long legacy of community leadership and service among her people. Also in 1998, the Tribe purchased 119.5 acres to establish a land trust, retreat center, and housing development. The Tribe built their first model home and sold it to a tribal member in 2001. Plans are underway for the retreat center. In 1996, the Rappahannocks reactivated their work on federal acknowledgement, which had originally began in 1921 when their Chief George Nelson petitioned the federal Congress to recognize Rappahannock civil and sovereign rights. The Rappahannocks are currently engaged in a number of projects ranging from cultural and educational to social and economic development programs, all geared to strengthen and sustain their community.


The Secret Life of the White House

The binding ethos of many White House residence workers is discretion and service to the physical structure—and, by extension, to the President who occupies it. Photograph by Tina Hager / White House Photo Office

Before Inauguration Day, the White House residence staff were already exhausted. For several weeks, many of them had worked sixteen-hour days preparing for the transition—the approximately six-hour-long window between when the Trumps would depart and the Bidens arrive. White House transitions typically demand superhuman effort, but this year’s was among the most physically demanding in recent memory. At risk of falling ill with the coronavirus, staffers worked in close quarters to transform the upstairs rooms of the White House, where the windows don’t open and are paned with thick, bulletproof glass, in accordance with the strong preference of the Secret Service.

In previous transitions, the residence staff brought the White House to a state of as-ready-as-possible without making major changes until the new First Family arrived and redecorated. If a departing family took a personal sofa with them, the staff replaced it with one from the White House collection, so that the incoming family need not walk into a bare room. But, under a new White House chief usher, Timothy Harleth, the transition became a far more ambitious affair. Hired by the Trumps, in 2017, Harleth had previously been a rooms manager at the Trump International Hotel in Washington, D.C. Early in the Administration, he had hired a “creative manager,” and on Inauguration Day Harleth enlisted that person to make the upstairs rooms look “ ‘Architectural Digest’-ready,” a residence worker said. In the frantic final hours, the creative manager was laying out guestbooks and new stationery, filling the bookcases with decorative plates and candles, and staging throws on furniture. “They wanted these rooms to look like a high-end hotel,” the worker added.

Harleth wanted to make a good impression on Joe and Jill Biden, who could have extended his tenure. But, Harleth told me, shortly after eleven o’clock on January 20th, less than an hour before the official Presidential changeover, one of the last remaining Trump officials, in the Office of Administration, came to Harleth’s office and told him that the Bidens had requested his departure. The Biden White House hedged on the matter, telling CNN that Harleth was “let go before the Bidens arrived.” (The Trumps could not be reached for comment.) Harleth was shocked at the time, but a week later he told me, “Every family deserves to have the people they want there.”

With or without Harleth, the residence staff soldiered on. The move unfolded at a rapid but methodical pace, with boxes upon boxes stacked and transferred between the historic rooms. “The White House is not big,” another career White House employee, whom I will call Jason, said. “The East Room is chock-full of boxes.” The White House’s two elevators, only one big enough to move furniture, were in constant use. “If you could carry something, it wasn’t going down the elevator,” Jason said. The move was conducted while keeping up appearances for a nationally televised Inauguration celebration later that night. “Imagine your house is being used for a TV show while you were moving, and no one could know you were moving,” Jason said. And, as they always have, the residence staff pulled it off. By the end of the morning, they had set out the Bidens’ family photographs and stocked the kitchen with the family’s favorite foods.

The full story of the residence staffers’ ecosystem is rarely told. Many of the workers have served multiple Presidents, and for that reason they call themselves lifers. Their binding ethos is discretion and loyalty to the White House itself—and, by extension, to whoever is President. They are perpetually insecure in their jobs. Although their employment continues across a transition, it is never guaranteed—they serve at the pleasure of the President. Keeping their jobs requires persuading his staff of their indispensable authority on the arcane methods necessary to operate the old and leaky structure, and of their loyalty and willingness to adapt to a First Family’s needs. They balance those requirements with another: to protect the physical White House itself, often from the people who occupy it.

I met the White House lifers while working as a speechwriter for President Barack Obama. For the past four years, I have spoken with dozens of lifers, former and current, about how they survived the Trump Presidency. I came to understand that the White House does not shed the identities of past Presidents so much as it accumulates them, abides them up to a point, and, ultimately, waits them out. By continuing to do their jobs and serve whoever moves in, the lifers embody the White House’s independence. Donald Trump was yet another test that they survived.

The residence staff numbers ninety people: butlers, chefs, curators, florists, housekeepers, electricians, and others who work in the bowels of the White House. They not only serve a First Family’s use of the White House as a home. They also serve its use of the White House as a stage to advance a political agenda.

Under Trump, that stage grew deathly quiet. On multiple occasions, Trump held events in the White House’s grand rooms—the gold-curtained East Room, the Diplomatic Reception Room, the marble-columned State Floor—to advance his chief political cause: himself. Amid a thirty-five-day government shutdown, Trump served hundreds of hamburgers, buffet style, to the Clemson University Tigers, the N.C.A.A. college-football champions, in the State Dining Room. More recently, he held the Republican Party’s 2020 National Convention on the South Lawn and an Election Night watch party in the East Room. But the level of publicity that those events generated belied how few of them occurred. Among the lifers, a malaise set in. “Nothing happens. It’s a bare-minimum situation,” Jason told me, before Biden’s Inauguration. “For four years, we’ve done two months’ worth of events.” The Trumps hosted only two state dinners, compared with six that the Obamas hosted during their first term.

The Covid-19 pandemic increased the White House’s emptiness. “People stayed home. Everything from food service to national security—if it could be done at home, it was done at home,” Jason said. Harleth told me that the residence staff took Covid-19 precautions more seriously than others at the Trump White House. “We were the ones wearing P.P.E., pushing to get our folks tested,” he said. Still, he conceded, “most of our folks can’t easily telework,” and by his count seven or eight residence staff workers contracted the virus. Once they recovered, those workers were asked to fill in for others, because of their presumed immunity. “It meant that they could work safely while others stayed home,” Harleth said. According to Jason, the lifers were given conflicting advice: stay home later, come in. “There was lots and lots of confusion, no direction from the top, a complete lack of empathy, sympathy,” he said. “The Christmas parties with maskless hordes were catered, but [the staff] would have to be there for this and that. Someone’s got to be there, not everyone can leave while the catering crew comes in. There was not a steady message on how to keep you safe.”

When not upstairs, in the family quarters, the staff works in a labyrinth of rooms below the White House’s northern steps, a space concealed from onlookers milling about on Pennsylvania Avenue. Their corridor is a covered portion of the original northern driveway, with push-button double doors at either end. As I remember it, between those doors, trucks and forklifts rolled in and out, delivering groceries and carting away trash. An Adirondack bench under a flapping white awning was a place to smoke when it rained. Inside, carpenters and electricians pushed rolling carts of tools between white linoleum countertops. Fresh flowers filled walk-in freezers that resembled a Costco produce aisle. Plastic storage boxes stacked against the wall were labelled with their contents: “linens and lawn ornaments,” “tablecloths and patio-furniture covers,” for use on the Truman Balcony. On the occasion of a state dinner, florists laid out thousands of orchids, like dolls, on every available surface, a blinding sea of white. At times, operations men packed the hall with stacks of East Room chairs, backed with bevelled slats painted gold, cream cushions tied to their seats. Around Easter, the Fourth of July, Halloween, and Thanksgiving, lifers filled the hall with enormous craft pumpkins and rabbits, and also red-white-and-blue bunting, for use on the South Lawn. During Christmas, the corridor was transformed into a canapé-making assembly line, overpowered by the smell of fresh pine needles, bacon, baking bread, and propane from the temporary ovens set up on the drive.

When I worked at the White House, I walked through the lifers’ corridor in the mornings, past a Secret Service officer seated by a telephone, head drooping at the end of a sixteen-hour double shift. Dale Haney, the chief groundskeeper since 1972, who is still at the White House, was often walking through the corridor with the Obamas’ dogs, their leashes in one hand and his boxed lunch or breakfast in the other. Butlers and valets leaned against the doorways, talking with chefs. The letter “R” printed on their blue plastic badges granted them access to the upper floors of the house, and they wore expressions of smiling, unyielding discretion. History is etched in the corridor’s stone walls. When the British burned the White House in 1814, oxygen-starved flames rushed out, licking them. A few are still unpainted so that passersby can study the charred spots. Hitches for nineteenth-century horse-drawn carriages stick out from the stones. Chiselled grooves, slightly askew, convey the wobble of the hands that carved them. In 1794, Thomas Jefferson helped recruit Scottish stonemasons to complete the White House.

The lifers’ constancy is useful in a house where the occupants change every four to eight years. Originally, Presidents paid the staffers’ wages, but in the nineteenth century, when the lifers’ ranks grew, Congress began paying their salaries instead, solidifying their status as fixed employees of the house. “The President’s House,” a two-volume history by William Seale, tells many of their stories. A doorkeeper named Tom Pendel began working at the White House in 1864, during the Lincoln Administration. Pendel babysat Lincoln’s youngest son, Tad. He fetched Lincoln to inform him of the arrival of guests or of bad news from the front lines during the Civil War. He nailed wood strips and lines of tallow candles inside the White House windowsills to illuminate the building in celebration of Union military victories. On those occasions, hundreds of people would gather on Pennsylvania Avenue and sing to Lincoln, who would stand at a window to address the crowd. Pendel would “draw the curtain back and stand just out of sight against a wall, holding a candle high, so that the President could be seen,” Seale wrote. After Lincoln’s assassination, Pendel remained at his Pennsylvania Avenue post. Under Rutherford B. Hayes, in a time of particularly high tourist traffic at the White House, Pendel policed souvenir hunters, who would snip tassels from the drapes or pocket inkwells and chandelier pendants. During the Garfield Administration, Pendel repeatedly turned away Garfield’s future assassin—a man who had sought a government position and to whom Pendel said, each time, “The President is unable to see you today.” Pendel held an umbrella over Grover Cleveland’s wife on the rainy Inauguration Day when she moved out of the White House, and he was standing in the entrance hall when news rang out that Cleveland’s successor William McKinley had been shot. Pendel died in 1911, at the age of eighty-four, while standing at his front-door post during the Taft Administration.

Before he retired as the White House maître d’, in 1983, John Ficklin had been on staff for forty-four years, serving nine Presidents in total. Around the time of his retirement, Ficklin spoke to the Washington Post about his career. The son of a slave, Ficklin found work at the White House during F.D.R.’s Administration, through his brother, a White House butler at the time. Ficklin became the head butler under Eisenhower. “You just can’t put down on paper everything that a butler would do,” he told the Post. “Instead of calling someone and saying the President or First Lady wants such and such, you’d just go do it yourself.” About the nearly all-Black butler staff, Ficklin told the Post that he had interviewed white people for butler positions over the years but few seemed really to want the job: “We got quite a few applications, but when it came down to really working, they weren’t very interested.”

Historically, many residence-staff jobs have been passed down through generations of Washington, D.C.,’s Black and white families. “It’s a long tradition,” Betty Monkman, who started in the White House curator’s office in 1967 and retired as chief curator in 2002, told me. Those who worked in the residence “were local people, family members—somebody was always a cousin of somebody else on staff.” When Monkman started, during the Johnson Administration, segregation was still fresh in people’s minds. “I heard many stories about segregated lunchrooms for the residence staff—they were integrated in the fifties,” she told me. “Even when I started, in the late sixties, it wasn’t so integrated in terms of the roles people played. For a long time, African-Americans were butlers, maids, and housemen, versus the engineers, electricians, painters, and carpenters, who were white. Bit by bit, they were hired into the trades.” The distinction meant that white workers often had control of their whereabouts, whereas Black workers had to sit at the ready, to be summoned upstairs at any moment.

For decades, many department heads were white. George W. Bush hired the first Black chief usher, Stephen Rochon. Rochon came from outside the White House, breaking a long tradition of hiring the chief usher from the residence staff. Previously a rear admiral in the Coast Guard, Rochon attempted to bring military efficiency to the staff, but he never gained their full trust, according to those I spoke with. He took great pride in the history of the White House and the role of chief usher, but he gave endless personal tours, a violation of the staff credo to remain behind the scenes. Some of the staff supposed that the tours were Rochon’s undoing the Obamas reassigned him to the Department of Homeland Security. The Obamas hired or promoted first-generation immigrants and women of color to the roles of head chef and chief florist, and they replaced Rochon with Angella Reid, who is Black. She, too, was an outsider, coming to the White House from the Ritz-Carlton company, where she had worked for twenty-one years. Work was difficult for the residence staff under Reid, who earned respect but also a reputation as a taskmaster, and who ran the White House with the exacting and fear-inducing sensibilities of a luxury-hotel manager. Several people told me that Reid made a point of humiliating workers, disparaging their performance in front of their colleagues. (In a statement, Reid said that working at the White House “was not only a highlight of my career but memories I will hold dear for my entire life. I look back fondly and often think about the residence staff, continuing to root them all on. I wish them nothing but the best.”)

The Obama Administration brought a new set of challenges, from the lifers’ perspective. The family hosted events late into the night and again the next morning. They also had some notions that clashed with the lifers’ sensibilities, including setting up a Nintendo Wii in the China Room for their daughters during a holiday break and holding exercise classes in the East Room. “Lincoln lay in state in that room. Kennedy lay in state in that room,” Bill Yosses, the White House pastry chef from 2007 to 2014, told me. The Internet, or lack thereof, was a problem at first, because Obama, his family, and staff were used to accomplishing tasks online the lifers lacked Internet in many of their offices, and, in some cases, shared e-mail accounts. Early in the Administration, when he realized that valets were fulfilling his Amazon orders from their homes, Obama ordered the installation of good Internet for the residence workers’ use.

In other ways, the Obama Administration adapted to the residence staff. For decades, the stage built for speeches and events in the East Room left a couple feet of space between the risers and the ground, exposing unsightly cables. So Dale Haney, the longtime groundskeeper, would line a row of potted ferns along the stage to conceal the gap. But Desiree Rogers, the Obamas’ first social secretary, sought to expel pervasive nineties frump. Yosses said, “The ferns became a four-letter word.” As he recalled it, Haney “always had his ferns ready. He’s, like, ‘Oh you need risers? I’ll get the ferns.’ But Desiree was, like, ‘No fucking ferns. I don’t want ferns.’ ” Rogers left, after just over a year on the job, and the ferns returned. “It was just too easy,” Yosses said. Rogers disputes saying this, and maintains that there was “a wide selection of greenery around the stages at all times.”

The residence staff will tell you that they avoid discussing politics at work, yet in recent years that pact has frayed, as it has elsewhere in America. Tensions surface more than in the past, prompted at times by knowledge of their colleagues’ Facebook posts. “Most people know more or less where people stand,” the residence worker told me. About half of the lifers are people of color, which raises questions about how they tolerated working for Trump. “We have to be impressed with the idea that a bunch of Black and brown people can survive this daily onslaught,” Jason told me. “It speaks to their diligence and loyalty to the house itself—they are not really there for the person.” But they were not impervious to the tone of the Administration. Under Trump, Jason said, Black and brown lifers noted that white people on staff were “saying some real shit . . . meaning they’re comfortable to say what they want to say.”

A little over four years ago, the lifers awaited the Trumps with nervous anticipation. They knew little about the new President, beyond that he owned hotels and fired people on television. He lived in a gilded penthouse apartment on Fifth Avenue modelled after the Palace of Versailles, the very building that George Washington and Thomas Jefferson deemed the anti-White House. In his stump speech, Trump objected to the routine of holding big state dinners in tents on the South Lawn, and promised to build a hundred-million-dollar ballroom. There was “an anticipation of radical change and substantial change, because of the whole ‘Apprentice’ thing, you know—‘You’re fired!’ ” Daniel Shanks, who served as the usher responsible for food and beverage at the residence for twenty-two years, and who retired in October, 2017, recalled. “That wasn’t dispelled immediately, because there was nobody to dispel it.”

Five months in, the Trumps did fire someone: Angella Reid. “It’s not uncommon that you might have a transition of staff when a new Administration comes in. And it’s simply nothing more than that,” Sarah Huckabee Sanders, who was then the deputy White House press secretary, said at the time. After Reid’s firing, the residence staff braced for what might come. The Trumps’ selection of Timothy Harleth, who was relatively young and mid-career, caused some head-scratching. “He didn’t carry the mystique,” Shanks told me. “He was someone from down the street.” Another lifer remembered Harleth’s unceremonious first day, when the new boss wandered the corridor where the workers sit, poking his head around and asking, “Hello, is anybody back there?”

Some workers I spoke with saw Harleth as a kindlier manager than Reid, and expressed respect and admiration for his efforts. But, ultimately, Reid and Harleth shared the same ambitions: to make the White House run more like a hotel, an objective at odds with the philosophy of the longest-serving lifers, who say that a hotel is a place where guests pay to stay. The White House, they will tell you, is a home. According to residence staff workers, Harleth cracked down on overtime pay and led peppy, hotel-staff-style stand-up meetings. As his tenure progressed, he hired former industry colleagues from the Trump International Hotel and the Mandarin Oriental. By the time Harleth left, several workers told me that they believed he was hostile to the lifers. “He saw us as dinosaurs . . . recalcitrant, most likely to complain, most likely to resist change,” the residence worker said. “There was a real condescension on his part for the people who had been there a long time.”


Stewards and Ushers of the White House: 1800-Present

John Briesler

Steward to John Adams, 1800–01

Joseph Rapin

Steward to Thomas Jefferson, 1801

Etienne Lemaire

Steward to Thomas Jefferson, 1801–09

Jean-Pierre Sioussat

Steward to James Madison, 1809–17

Joseph Jeater

Steward to James Monroe, 1817–25

Antoine Michel Guista

Steward to John Quincy Adams, 1825–29

Steward to Andrew Jackson, 1829–33

Joseph Boulanger

Steward to Andrew Jackson, 1833–37

Steward to Martin Van Buren, 1837–41

Steward to William Henry Harrison, 1841

Steward to John Tyler, 1841–45

Henry Bowman

Steward to James K. Polk, 1845–49 Ignatius Ruppert

Steward to Zachary Taylor, 1849–50

Steward to Millard Fillmore, 1850–53

William H. Snow

Steward to Franklin Pierce, 1853–57

Louis Burgdorf

Usher to James Buchanan, 1857–59

Richard Goodchild

Usher to James Buchanan, 1859–61

Usher to Abraham Lincoln, 1861

“Stewardess” to Abraham Lincoln, 1861–62

Pierre Vermereu

Steward to Abraham Lincoln, 1862 (?)

Mary Ann Cuthbert

Stewardess to Abraham Lincoln, 1862–63

Thomas Stackpole

Steward to Abraham Lincoln, 1863–65

Steward to Andrew Johnson, April–June 1865

William Slade

Steward to Andrew Johnson, 1865–69

Valentino Melah

Steward to Ulysses S. Grant, 1869–77

William T. Crump

Steward to Rutherford B. Hayes, 1877–81

Steward to James A. Garfield, 1881

Steward to Chester A. Arthur, 1881–82

Howard Williams

Steward to Chester A. Arthur, 1882–85

William Sinclair

Steward to Grover Cleveland, 1885–89

Steward to Grover Cleveland, 1893

Steward to William McKinley, 1897–1901

Hugo Zieman

Steward to Benjamin Harrison, 1889–91

William McKim

Steward to Benjamin Harrison, 1891–93

Edson S. Dinsmore

Chief Usher to Benjamin Harrison, 1889–92

William Dubois

Steward to Grover Cleveland, 1893–97

Henry Pinckney

Steward to Theodore Roosevelt, 1901–9

[five assistant ushers appointed]

Thomas E. Stone

Chief Usher to Theodore Roosevelt, 1903–9

[five ushers raised to nine in number, assisting chief usher]

Chief Usher to William Howard Taft, 1909–11

[Archibald Butt, a military aide, actually held the authority from 1908 to 1912 when he died on the Titanic position of “steward” dies out]

Irwin “Ike” Hoover

Chief Usher to William Howard Taft, 1913

Chief Usher to Woodrow Wilson, 1913–21

Chief Usher to Warren G. Harding, 1921–23

Chief Usher to Calvin Coolidge, 1923–29

Chief Usher to Herbert Hoover, 1929–33

Chief Usher to Franklin D. Roosevelt, 1933 until his death September 14, 1933

Raymond Douglas Muir

Chief Usher to Franklin D. Roosevelt, 1933–38

Howell G. Crim

Chief Usher to Franklin D. Roosevelt, 1938–45

Chief Usher to Harry S. Truman, 1945–53

Chief Usher to Dwight D. Eisenhower, 1953–57

Chief Usher to Dwight D. Eisenhower, 1957–61

Chief Usher to John F. Kennedy, 1961–63

Chief Usher to Lyndon B. Johnson, 1963–69

Chief Usher to Richard M. Nixon, 1969

Rex W. Scouten

Chief Usher to Richard M. Nixon, 1969–1974

Chief Usher to Gerald R. Ford, 1974–77

Chief Usher to Jimmy Carter, 1977–81

Chief Usher to Ronald Reagan, 1981–86

Gary Walters

Chief Usher to Ronald Reagan, 1986–89

Chief Usher to George H. W. Bush, 1989–93

Chief Usher to Bill Clinton, 1993–2001

Chief Usher to George W. Bush, 2001–7

Stephen W. Rochon

Chief Usher to George W. Bush, 2007–9

Chief Usher to Barack Obama, 2009–2011

Angella Reid

Chief Usher to Barack Obama, 2011 - 2017

Timothy Harleth

Chief Usher to Donald Trump, 2017 - 2021

This article was originally published in White House History Number 26 Fall 2009


The Vice President’s Ceremonial Office

In addition to the Vice President’s Office in the West Wing, the Vice President and his or her staff maintain a set of offices in the Eisenhower Executive Office Building (EEOB), located next to the West Wing on the White House premises. This office, called the Vice President’s Ceremonial Office, served as the Navy Secretary’s Office when the EEOB housed the State, Navy, and War Departments. Today, the Vice President uses the office for meetings and press interviews.

Sixteen Secretaries of the Navy worked here between 1879 and 1921. From 1921 until 1947, General John Pershing occupied the room as Army Chief of Staff and Chairman of the Battle Monuments Commission. Pershing’s occupancy of the office was interrupted only once during these 26 years, when President Hoover was forced to relocate his offices following a Christmas Eve fire in the West Wing in 1929. Since 1960, it has been occupied by every Vice President except for Hubert Humphrey, who used a room on the floor below. Since its restoration in the 1980s, it has been considered a ceremonial office.

William McPherson, a well-known Boston decorator and painter, designed the room. Its walls and ceiling were decorated with ornamental stenciling and allegorical symbols of the Navy Department, hand painted in typical Victorian colors. The floor is made of mahogany, white maple, and cherry, and the two fireplaces are original Belgian black marble.

The room’s chandeliers are replicas of the turn-of-the-century gasoliers that formerly adorned the room. These historical fixtures were equipped for both gas and electric power — with the gas globes on top and the electric lights below.

There are several items of note in the room, but the most interesting may be the Vice President’s Desk. This desk is part of the White House collection and was first used by Theodore Roosevelt in 1902. Several Presidents have chosen to use this desk, including Presidents Taft, Wilson, Harding, Coolidge, Hoover, and Eisenhower. It was placed in storage from December of 1929 until 1945, when it was selected by President Truman. Vice President Johnson and each subsequent Vice President have used the desk. The inside of the top drawer has been signed by its various users since the 1940s.


This online resource continues a long tradition in the U.S. Department of State of making retrospective data about principal officers and chiefs of mission available to the public. The 1873 edition of the Register of the Department of State presented the names of all American diplomatic representatives who had served in each country with which the United States had relations from 1789 to 1873. The 1937 edition of the Register presented a cumulative listing of all of the principal officers of the Department of State from 1789 to 1936. The Biographic Register (as the Register of the United States was renamed) of 1957 presented an updated listing of principal diplomatic agents of the United States from 1789 to 1956, together with a listing of the dates of service of Presidents of the United States and Secretaries of State. In 1973, the Department of State issued United States Chiefs of Mission, 1778−1973, which presented in tabular format a comprehensive historical listing of all United States Ambassadors, Ministers, Ministers Resident, Chargés d’Affaires pro tempore, and diplomatic agents. The publication also included a listing of principal officers of the Department. The Department published United States Chiefs of Mission, 1973−1974 (Supplement) in 1975 with addenda and corrigenda to the 1973 edition. United States Chiefs of Mission, 1778−1982 brought the full text to its second edition.

Principal Officers of the Department of State and United States Chiefs of Mission, 1778−1986 issued by the Department of State in 1986, presented expanded listings based on previous Department publications and additional research and definition. Corrections were made to earlier listings, and information on major executive officers of the Department of State was greatly increased and rearranged. A revised edition, Principal Officers of the Department of State and United States Chiefs of Mission, 1778−1988, was issued in 1988. The final print version of this publication was released in 1991, under the title Principal Officers of the Department of State and United States Chiefs of Mission, 1778−1990. The transfer of this material online has not changed our office’s intent: to document the history of U.S. representation abroad and the chief policymakers in the Department of State. To that end, we have provided a chronological listing of principal officers—essentially all Department officers at the level of Assistant Secretary or above—and Chiefs of Mission. (See below for a discussion of the term, “Chief of Mission.”) These two categories require Presidential or Secretarial designation, and, in some cases, the approval of the Senate. We have made an attempt to comprehensively list all people selected for these positions, even if they were not approved by the Senate, died before taking office, declined the position, or were otherwise unable to serve. For that reason, the pages which list our Chiefs of Mission by country are split into two categories: “Chiefs of Mission” lists those who held the office, and “Other Nominees” lists those who did not.

Positions Included

This database includes officers of the Department who were Presidential appointees (appointed by the President with the advice and consent of the Senate) and chiefs of bureaus who hold rank equivalent to Assistant Secretary of State. These include: Secretaries, Deputy Secretaries, Under Secretaries, Deputy Under Secretaries, Assistant Secretaries, Counselors, Legal Advisers, Chiefs of Protocol, and certain administrators.

Other positions have, from time to time, been included in the database based on their particular circumstances. The complete lists of heads of the United States Information Agency (USIA), for example, are included. USIA was incorporated into the Department in 1999. Other Chiefs of Mission of particular historical interest have also been included.

Positions Excluded

This database does not include representatives, personal representatives, or special representatives of the President or Department of State Chargés d’Affaires or Chargés d’Affaires ad interim (except under certain circumstances) individuals holding diplomatic commissions jointly with other representatives special agents and other individuals on special missions high commissioners Chiefs of Mission in charge of special economic or aid missions liaison officers military governors or commanding officers of occupying forces or their political advisers delegates to international conferences or consular officers who held only consular commissions.

What is a Chief of Mission?

According to the Foreign Affairs Act of 1980 (Public Law 96−465, Section 102(3) (22 U.S.C. 3902)), a Chief of Mission is “the principal officer in charge of a diplomatic mission of the United States or of a United States office abroad which is designated by the Secretary of State as diplomatic in nature, including any individual assigned under section 502(c) to be temporarily in charge of such a mission or office."

The Chief of Mission is often—but not always—an Ambassador. There are currently three classes of diplomatic representation established by the 1961 Vienna Convention on Diplomatic Relations, Article 14: ambassador or nuncio (accredited to the Head of State) envoy, minister, or internuncio (accredited to the Head of State) and chargé d’affaires (accredited to the Minister of Foreign Affairs). These classes have a much longer lineage. Although not a signatory, the United States followed Annex 17 to the Congress Treaty of Vienna (March 19, 1815), which established rank and precedence of diplomatic agents (Ambassadors, Envoys, and Chargés d’Affaires). The Proces-Verbal of the Conference of Aix-la-Chapelle (November 9, 1818), recognized Ministers Resident as an intermediate class between Ministers and Chargés d’Affaires.

The United States first used the rank of Ambassador in 1893, when Thomas F. Bayard was appointed Ambassador to Great Britain on March 30 of that year.

A “Chargé d’Affaires ad interim” refers to a diplomat temporarily acting for an absent Chief of Mission. This database tracks all Chargés d’Affaires and Chargés d’Affaires ad interim who served (1) for a continuous period of 12 months or more, (2) at the establishment or ending of diplomatic relations with a country, or (3) at the closure or opening of an embassy.

Database Contents

The type of information included for each entry varies based on the type of position. Entries will have some or all of these pieces of information:

Name When possible, the full name of the appointee has been included. Years of birth and death State of residency The appointee’s state or territory of legal residence at the time of the appointment is taken from the commission, nomination, or a contemporary official record of legal residence. If the residence was omitted from these sources, the entry does not appear. Some officers changed their legal residence during their careers in such cases multiple residences are listed. Career status (in the Foreign Service) The determination of which Chiefs of Mission were to be denominated as “career” officers posed a number of problems to the early compilers of this work, and continues to pose definitional challenges today. How early could Chief of Mission appointments be said to be of a career nature in view of the fact that until 1946 officers of the Diplomatic Service had to resign from the career services to accept appointment as Ambassador or Minister? Should an officer who had retired as a Foreign Service officer after a long career be considered a “career” officer when later appointed to an Ambassadorship? And what of an officer who had resigned from the Foreign Service after a brief career who was later appointed Chief of Mission? At the time the scope and format of this publication were being planned, a dozen such questions were submitted to the then-Director General of the Foreign Service. It was determined not to attempt to categorize Chiefs of Mission as “career” or “non-career” before the passage of the Act to Improve the Foreign Service on February 5, 1915 (38 Stat. 805), which restructured the Diplomatic and Consular Services. For Chiefs of Mission holding office as such at that date, it was decided to count as “career” those who had at least ten years of continuous diplomatic service under both Republican and Democratic administrations. For Chiefs of Mission appointed later, the term “career” was also applied to those who were at the time of appointment (or had previously been for at least five years) Foreign Service officers, Foreign Service information officers, or career officers in the Diplomatic or Consular Services. The term “career” was also applied to those few individuals who had served as diplomatic secretaries, who had then been commissioned before 1915 as Chiefs of Mission or as Presidential appointees in the Department of State, who were not serving as Chiefs of Mission in February 1915, but who were subsequently appointed or reappointed as such. The term “non-career” is used to designate all other appointees even though they may have been career officers in the civil or military services. Dates of service These dates are included on a position-by-position basis. Principal officers of the Department of State who are Presidential appointees have a date of appointment, date of entry on duty, and date of termination of appointment. Chiefs of Mission are considered to have entered on duty when they present their credentials to their host governments. An effort has been made to fix a date for the termination of the diplomatic mission of each representative vis-à-vis the host government and to describe briefly in each individual case (and as precisely as sometimes incomplete records permit) what action or event brought the mission to either a formal or a de facto close. In the nineteenth century it was customary for a Chief of Mission to present his own letter of recall in current practice most missions terminate in actual fact with the departure of the Ambassador from his or her post. In all periods there have been special circumstances (e.g., death, declaration of war, severance of diplomatic relations) which have brought some diplomatic missions to an end. It should be emphasized that the effective date of a Chief of Mission's resignation frequently does not coincide with the date shown here for the termination of his or her mission abroad. For those who were designated by the Secretary of State, the date of appointment is the same as the date of entry on duty. For Chargés d’Affaires ad interim, dates of service are listed from and to the nearest month.

Key Terms

Steps in Appointment

Nomination is the first step in the appointment process. The President submits the name of the person to be appointed to a high-level position to the Senate for approval by first the Foreign Relations Committee and then by the full Senate. Approval by the full Senate is called “confirmation.” The appointee is then commissioned. After taking the oath of office, he or she enters on duty. Chiefs of Mission, however, are considered to have entered on duty when they present their credentials to their host governments.


Who oversees the White House and the Residence staff?

The White House is managed by the chief usher, a title that has origins from the days when this person “ushered” people in to meet the president and first lady. In the late nineteenth century, the most prominent positions in the White House included the president’s secretary, steward, usher or doorkeeper to the president, and chief doorkeeper, each of whom reported to the president. As the presidency changed and grew, so did these household positions and their respective responsibilities, which eventually merged to create one senior position: White House Chief Usher.

Today, the chief usher is the general manager of the building, overseeing construction and renovation projects, maintenance, food service, as well as the administrative, fiscal, and personnel functions of the residence. The chief usher manages the White House Residence Staff of approximately 90-100 people, consisting of butlers, maids, housekeepers, chefs, cooks, doormen, florists, curators, electricians, plumbers, storekeepers, engineers, and others.


Effective Note-Writing: A Primer for Psychiatry Residents

Note-taking is an art and a skill that is perfected over one’s career. Many residents struggle with documentation during their training, and they might not have a good idea of what elements to focus on. While there are no shortcuts to cultivating this craft, many tips and considerations can be of enormous help for the trainees. In this article, we provide an overview of various aspects of taking notes and offer suggestions for effective documentation. We recognize that these considerations might not apply to all clinical settings.

Purpose of psychiatric documentation

Medical documentation serves numerous functions. It is valuable for psychiatry trainees to reflect on multiple concurrent goals in order to develop a comprehensive note-writing style. Listed below are some major reasons for medical documentation.

1) Record-keeping. Keeping track of clinical information for future reference and for the reference of future psychiatric/medical providers

2) Communication. Communicating with colleagues (other physicians, social workers, etc.), who will utilize the notes as a source of information and guidance. This is particularly important when one writes consultation notes and discharge summaries

3) Billing and reimbursement. Providing information to insurance companies and third parties that is adequate for billing and reimbursement

4) Medico-legal considerations. Securing oneself from a medico-legal perspective, for instance, by documenting an adequate suicide and violence risk assessment

Everyone structures their notes differently, based on how much consideration is given to each purpose. It is common to see very brief notes documenting minimal information needed for billing, and we also see very detailed documentation of medico-legal considerations but with little meaningful clinical information. An ideal note balances these different purposes.

Note-writing styles

Two broad categories of note-taking are the narrative style and the bullet-point/checklist style. Most notes are some combination of both.

The narrative style involves telling a coherent story. It is best suited for the history of present illness section. It provides a meaningful account of “what happened?” and “what is going on?”. The best way to document information is by considering what is the best way to tell that story. An advantage of the narrative style is that it provides a clear picture, but the disadvantage is that it can be lengthy and time consuming.

Bullet-point/checklist style essentially lists the relevant information and symptoms without much detail or context. For instance, listing the DSM-5 criteria for major depression indicates which criteria are reported by the patient. With the rise of electronic medical records (EMRs), there is a tendency to reduce as much of the note to checklists and bullets as possible. It is efficient, saves time, and is great for billing, but it can make notes clunky and difficult to read. Additionally, checklist features in electronic medical records may oversimply the nature of symptoms. An example would be a review of symptoms for mania in EMR which include “insomnia” without specifying that the insomnia should derive from a lack of need for sleep.

Again, an ideal note utilizes both styles in a balanced way that varies from one writer to another.

•Time management.One of the primary challenges of note-writing to balance time on notes with time spent on patient care, and learning to do this efficiently. It is a life-long skill. Notes, especially documentations of initial evaluations, can be very time consuming. Improving typing speed, practicing typing while talking to the patient, and using dictation software are some measures that can be taken. However, patient care should not be compromised for efficiency, so make a point of asking permission to type (or take notes by hand) while you are talking to them.

Templates can also be created for particular situations to save time, which can then be utilized with modifications for specific patients. Some of the common useful templates for psychiatry include basic inpatient admission orders (in “the plan”) risk assessment delirium management on the consult service and a list of DSM-5 criteria that are commonly utilized (eg, generalized anxiety disorder, ADHD).

•Organization.Patients don’t always tell their story and talk about their symptoms in a straight line, and residents often worry that they may forget to ask important questions. It is helpful, especially for junior residents, to have a sheet with a note layout and jot down (or type) information in the relevant section of the history as one listens to the patient. Jumbled notes are often the result of a disorganized psychiatric interview. The patient should be gently guided through the interview without being too rigid. Depending on the context and prior knowledge of the patient, starting the interview with past psychiatry history or social history may be a more effective strategy than starting with history of present illness.

•Information selection.Residents can be overwhelmed with the amount of information obtained in a psychiatric interview. One may wonder what facts to include and exclude in the documentation process. While there is no easy answer, think of the clinical setting of the evaluation and the readers of the note. Assuming the recorded material is not an essential component of a psychiatric note, it can be helpful to ask: Is this information of diagnostic or prognostic value? Does this information impact treatment or disposition? If the answer to both is “no,” the utility of this information should be reconsidered.

•Brevity.The truth is that as clinicians we live extraordinarily busy lives and time is a precious commodity. Note-writing is one area where more is not always better. Lengthy notes can be taxing to sift through, and many clinicians may not read the note at all if it is very long. In the early stages of training, lean toward including rather than excluding details when there is uncertainty regarding relevance, as this will facilitate more productive discussion with supervisors and will lead to the development of better judgment in the future. As training progresses, however, residents should make an effort to write short snippets while still communicating the necessary and relevant information that needs to documented.

General tips for note-writing include the following:

Brief patient quotes can be used as needed (eg, as evidence of thought disorganization, psychosis, or poor insight) but avoid writing down whole paragraphs of patient dialog

Document what is required by the standard of care (eg, that one has reviewed the weight, lipid panel, HbA1c, and other pertinent metabolic parameters for patients on antipsychotics)

Record the fact that risks and benefits of a proposed treatment were discussed with the patient. This is particularly true for an FDA black box warning, such as mortality risk with antipsychotic use in dementia, or possible suicidality with the use of antidepressants in children and adolescents

Write down the rationale for medication changes

Specifiers should be utilized when writing diagnoses. “Schizophrenia, multiple episodes, currently in acute exacerbation” and “major depressive disorder, recurrent, severe, non-psychotic, currently in partial remission” provide a lot of more meaningful information than simply listening “schizophrenia” and “major depressive disorder”

Assessment should not simply be a summary of the history and mental status examination as many residents tend to do assessment should be an opportunity to explain the thought process regarding diagnosis, disposition, and treatment

Junior residents can initially struggle with writing a thorough mental status examination, as the appropriate use of psychiatric terms may not be initially apparent. Start out by simply describing what one is observing in the simplest of terms. A resident who is unsure if “labile affect” is an appropriate description for a particular patient can still confidently document that the patient was “uncontrollably tearful”

There should be internal consistency in the notes. The diagnosis, assessment, and treatment plan should support each other

Notes from other providers such as the emergency department physician or social worker should not be excessively copied and pasted. The relevant information should be summarized or it can be documented that a particular note was reviewed instead of copying it verbatim. When appropriate, be sure to record that something was extracted from a previous note

Typing while talking to patients can be time-efficient but history can end up being disjointed and consist of comments the patient had stated. Take a few minutes after the psychiatric interview to organize the notes before signing off on them

Avoid being overly vague, especially in initial evaluations. If one is documenting that the patient is expressing religious delusions, the delusions should be described

Note etiquette

Notes should not be a place to directly or indirectly complain about patients, team members, or consult teams. Other points to consider include:

Avoid language that may be perceived as judgmental. Instead of documenting that the patient is “lying” or “being deceptive,” it would be better to state what is subjectively reported is at odds with or is inconsistent with what is observed by the team or by the family

Providers should be mindful that patients can at some point request to see their own records. Or in case of a lawsuit, medical records can be read out loud in the court

Unless part of the medical record, notes should not document intimate details of matters such as patients’ personal lives or details of abuse

An awareness of the purposes of psychiatric documentation styles can be help residents perfect their skills. An ideal note balances different purposes and styles. Effective writing requires overcoming a number of practical challenges, such as time management, narrative organization, relevant information selection, and brevity. Making use of the general tips discussed above and being mindful of note-writing etiquettes can be useful in overcoming these challenges.

Recommended Resource:

American Psychiatric Association's A Resident’s Guide to Surviving Psychiatric Training, 3rd Edition, is an online publication for resident and fellows, and includes detailed sections on note-writing. The guide can be accessed on APA’s website: https://www.psychiatry.org/residents-medical-students/residents.

Disclosures:

Dr Aftab is a psychiatry resident and the Chief Resident for Education at Case Western Reserve University/University Hospitals Cleveland Medical Center. Dr Latorre is a psychiatry resident and the Administrative Chief Resident at Case Western Reserve University/University Hospitals Medical Center. Dr Nagle-Yang is the Associate Psychiatry Residency Training Director at Case Western Reserve University/University Hospitals Medical Center. The authors report no conflicts of interest concerning the subject matter of this article.


Additional Tips

  1. CC, ROS, and PFSH may be recorded by ancillary staff or via patient questionnaire, but you must document that you have confirmed this information with the patient [2,3].
  2. What if a patient is unconscious, intubated, or refuses to give a history? If a patient’s condition or circumstance limits acquisition of any history component, add a qualifier describing the limitation, e.g. cannot obtain due to encephalopathy, dementia, intubation, etc. This qualifier applies to all elements of history: HPI, ROS, and PFSH [2,3]
  3. Did you play detective and obtain a history through other sources? Get credit! As an alternative to the extended HPI (E/M level 5 HPI), you can discuss the status of at least 3 chronic or inactive conditions [1,2]

Example: Patient sent from nursing home for altered mental status. He is nonverbal at baseline, but per nursing staff and transfer records, his (1) urinary retention has been stable with Foley in place, he (2) has not missed any seizure medications, and (3) the staff has been controlling his blood glucose well.

A statement describing how and what additional history was obtained will add to the complexity of data review in your medical decision making (MDM), which will be detailed in a later post). The statement “Additional history obtained by family/extended care facility staff” without elaboration will not count [2].

Work Smarter, Not Harder

The elements above describe the minimum data for each level. It is important to include additional data as appropriate and to avoid potential down-coding however, be cognizant of wasting time or space recording historical information which neither contributes to your thought process nor billing. Some items are relevant to many aspects of care: diabetes in the family, bleeding and clotting diatheses, smoking history, and illicit drug use are both PFSH and risk factors. A patient’s living situation is relevant for disposition. Do not include “not relevant” or “non-contributory” history as it does not contribute to billable documentation.


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