Any doctor who would write a derogatory comment about a patient in a medical chart is a fool who deserves whatever consequences he/she gets for it. comments about their patients in a medical record. Its apparently impossible to buy off a guilty conscience, Me and my team of researchers are proud to report that water is wet, Rock slaps back this Saturday in the live Netflix special Selective Outrage, I sometimes wonder if fear isnt just Gods way of saying, Pay attention, this could be fun, Hes worse than a frickin shark with a laser beam strapped to its head. Not listed among the official codes is the Slow Code, meaning the patient is dying, and not to worry too much about it. The specificity and problem notes with vanish underground Seeing it in your medical records might be a good clue bat. In one Harvard study, 20 percent of a group of 8,000 Latino people reported experiencing discrimination at a health care facility or clinic. Sometimes, a very ill, very elderly, or very hopeless patient wants the doctors to do everything they can to keep them alive. When writing medical notes, some clinicians include an appreciation of their patients personality and disposition in their opening line (the chief complaint), or when theyre wrapping up (in the assessment and plan), or in bothlocations. up took weeks. 'As medical providers, on an unspoken level, I think [using these terms] is a coping mechanism, to make light of really difficult situations,' Dr Wang says. Ive been a medical transcriptionist for 25 years and its one of the single most common phrases used We view OpenNotes as a new medicine, says Delbanco. Arent you a nurse? It is . . Or deprive their patients of thishonor? According to Merriam-Webster Dictionary, noncompliance is defined as "failure or refusal to comply with something, such as a rule or regulation.". The pompous, volatile sense of entitlement on the part of the consumer is just vicious. Whether or not the basic facts are correct, medical records are often filled with derogatory comments blaming the patients attitude (implicitly or explicitly) for the physicians failure to show basic It urges doctors to share their notes more readily with patients -- both as a medical strategy and to build patient-doctor trust -- ideally through secure online portals. Vascular surg.although I guess it's a little ironic given the dm and smoking. Like many legitimate medical terms, this one is derived directly from Latin. 'Dolores' translates to pain so this 'literally means total body pain,' the doctor says. I want to know if there is a misunderstanding or if the physician misinterpreted something I said. On one hand, 'poor effort,' as he calls it, can have a negative impact on the quality and timeline for recovery, but there is a darker side to this tendency too. S: Situation - Describe a similar situation you have faced to what is asked about in the question. I suspect doctor;s notations could be life saving. CC: Ms. Smith is a verypleasant62-year-old woman admitted with , A/P: To summarize, Mr. Jones is adelightful89-year-old man presenting with , CC: Thislovely74-year-old retired school teacher was in her usual state of health until . Writing . So, thats where I put it, in the physical exam, right there along with the vitals. The point of the story is that access to medical records has benefits and challenges. There are no confirmed cases of babies surviving at 22 weeks or earlier, which means that children born then are less likely to live than someone who just jumped off the Empire State Building. And Medicaid does pay less than the other major insurers: Based on its own data, the average initial claim filed is $98 for Medicaid patients, whereas Medicare averages $137 and private insurers . One Melbourne hospital, recognising that many of the concerns expressed by junior doctors relate to the deaths of patients, has appointed a palliative care specialist part time in this role. Biologics for Asthma: Who Gets Them and Who Uses Them? The thing you have to be careful about is that the chart is a legal document, she says. Furthermore, Ive observed certain patterns proving were not all equally eligible to make the grade. something NEW and different is quite a revelation. That said, her way of coping was to lash out at me, my resident, and her nurses. Of course many doctors are already paranoid Janice Well nourished = HEALTHY. Their biases cause them to give their patients of color inferior health care and, in so doing, contribute to higher rates of morbidity and mortality. Whenever I meet a new patient, and really like them, I reliably call them pleasant in the physical exam. Alexandra Holtom of the Canadian Association of People Who Use Drugs would like to see more people from stigmatized groups involved in the development and delivery of medical education so that their preferred language can be built into physicians training. Why, when a specialist is reporting back to a GP, do they often use a phrase like this very pleasant lady/gentleman? Would you continue to be so indignant? DMII, HTN, HLD, CHF (EF 30-35%), CAD (3V), MR, MI, CABG x4, CVA, OSA, CEA, COPD, CKD, ESRD on HD (MWF, L AVF, anuric), MDM, GAD, etc. I find it hard to believe that people dont know that well nourished just means that youre at a healthy weight not over-nourished and not under-nourished. Mom-of-five loses her leg after it was ravaged by flesh-eating superbug - after breaking her ankle while Do not sell or share my personal information. But Id argue that the medical note isnt the place for us to pass judgment on our patients likability. be off-limits to me. ". Especially details of the diagnosis and treatment. When It's Used: And OD is short for oculus dexter, or right eye, not for overdose. Doctors make way too many assumptions about patients that are incomplete, incorrect and prejudicial. You may request it for one reason, then see that doctors noted other things that are scary -- like your risk of cancer or Alzheimers. A new survey from WebMD/Medscape, in collaboration with STAT, found that that 59% of doctors have heard an offensive remark about their appearance in the past 5 years. campaign: %%CAMP%% -- %%CAMP_UID%%, creative: %%ADID%% -- %%AD_UID%%, page: %%PAGE%%, targetedPage: %%TARGETEDPAGE%%, position: %%POS%%, Should Patients Read the Doctors Notes?, For a Celiac Sufferer, a New Mystery Illness. But Im concerned there might be negative or judgmental The argument is that if people of color are sicker and are dying at younger ages than white people, this may be because physicians have racial biases. A hospital bed might be the safest and most certain place some patients can stay, especially for those who are not financially secure or may be struggling with addiction. Getentrepreneurial.com: Resources for Small Business Entrepreneurs in 2022. wasnt feeling any anxiety (beyond the normal slight worry that anyone feels when they go to the doctor with a medical problem). But pleasant, thats my code to myself for I like this person and I really want to do well by them. Ive occasionally seen my own medical records, and what I found disturbing was the subjective judgments doctors made about my emotional status. Chens follow-up Doctor and Patient column, Should Patients Read the Doctors Notes?, I read a note one time about myself that stated I was well nourished.. Dr Green says that 'a lot of it derives from [doctors'] systemic frustrations with the medical system back-firing back onto patients.'. I maintain that Pleasant is a legitimate part of the objective evaluation: it means someone is actually able to relate politely to a stranger without getting all tangled up in whatever their stuff is. CC: Ms. Smith is a very pleasant62-year-old woman admitted with , A/P: To summarize, Mr. Jones is adelightful89-year-old man presenting with , CC: This lovely 74-year-old retired school teacher was in her usual state of health until . I was described as a very pleasant lady in the discharge letter sent from the fracture clinic to my GP. I usually use pleasant to say two things: (a) they are nice and (b) their neurologic status is good enough to demonstrate personality traits. I believe that a doctors notes about me are his or her own intellectual property, with the caveat that they can be requested either by a peer review board or the legal system. Emotionally, to me though, it made a world of difference. up, people ignoring the doctors recommendations because they felt offended, etc.). Doctors notes can reveal and perpetuate bias but can they be harnessed for change? Respect is an essential component of a high-performance organization. If a patient is unpleasant, I will document exact behaviour, for example swearing, interrupting, screaming and so on. And I am of normal weight. FDA-approved use. 2005 - 2023 WebMD LLC. Get Well's Running email for practical tips, expert advice, exclusive content and a bit of motivation delivered to your inbox every week to help you on your running journey. Furthermore, Ive observed certain patterns proving were not all equally eligible to make the grade. This is a highly moderated subreddit. Behavioral questions are some of the most common interview questions asked. Am I just beingcurmudgeonly and negative? Medical schools have begun to recruit more diverse students in the hopes of changing the field's culture, but several young doctors who wished to remain anonymous told Daily Mail Online that discriminatory terms are still common. Typically this includes a salvo of past medical history elements (i.e. Really.). Forgets to listen to my heart. It's at this point you should realize that when you're surrounded by the sick and dying every day, no subject is too dark for comedy. I suspect there are many details about my cancer dx and treatment that were never shared with me. Not their feelings. I couldnt imagine a less offensive phrase than well-nourished. That more than one person (and at least one employed in the medical profession) saw that as something clearly personally-judgmental I might describe a patient as scared or nervous, but usually I try to document some behaviour as not making eye contact, sweating, fidgeting or crying. Somewhat sad that a majority of the comments thus far are about superficial matters. The acronym for 'wealthy white woman syndrom ' is 'actually bad because it's a term that is used when you're frustrated at specific patients and dismissing their symptoms,' says Dr Lisa Wang, a psychiatry resident in New York. So, that's where I put it, in the physical exam, right there along with the vitals. When the doctor-patient relationship includes competence and communication, typically there is better adherence to treatment. Kind of shows off the Emperor Doctors New Clothes. When writing medical notes, some clinicians include an appreciation of their patients personality and disposition in their opening line (the Chief Complaint), or when theyre wrapping up (in the Assessment and Plan), or in bothlocations. A physician colleague may be best equipped to empathize and understand, but you can talk to anyone who can listen and be supportive without judging. Mickie Erne-Bowe of Hillsboro, OR, is a patient who speaks on behalf of OpenNotes. Please read the comment policy. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Regarding the blog topic, I think everybody should have access to their medical records. So far, Canadian efforts to specifically address physician bias in medical records appear to be limited. Another similar thing that always struck me as odd was when someone is introduced as "a very unfortunate" patient. And guess what: obese and thin T: Task - Explain what task must be completed to resolve the situation. Which Type of Exercise Is Best for the Brain? Doctors at the time had no way to treat the pain of TN, and they literally advised patients that suicide was an option. This blog post says to click on the link if you want to read the full story. Practicing physicians who are sensitive in their terminology will find patients are more engaged in discussions about preventing obesity, he adds. I was still taken aback. What It Means: Alright, Motherfucker, You're On Your Own. If you use the word "pleasant" in your charts, what does it mean to you? Can You Safely Lose Weight While Breast-Feeding? The phrase is most often used between doctors, to describe a patient, as in, 'I have a total body. Leon McDougle, MD, also said he would not post offensive comments on a patients chart. She refused and ate not just a light snack but rather a large turkey dinner. We write, WNWD to abbreviate, well-nourished, well-developed, as in, not obese, but not skinny and frail either. "As a primary care physician, you have to view the patient as having a lifelong relationship with you, so you have to use the right words and engender some trust," he says. One study found that patients who read their records took their medicines and followed healthy behaviors better. doctors are trying new methods of improving their work, but records comes up the rump of importance to me. Hurtful. Cletus the Fetus. (Verbal abuse falls under health To be effective, doctors need to be free to guess and to work their way through the uncertainties and the risk management. Ill give her credit for putting the pleasant description in the physical exam this is where we put our observations, after all and leaving out the delightful and lovelylabels. It is important to me. Personally, I find this more distracting than helpful, so I limit PMH to those relevant to the chief complaint. No code, this stuff has to be read- and understandable. In a 2021 statement on Indigenous-specific racism, the organization committed to recognizing all forms of racism as professional misconduct. It can hardly come as a surprise to the obese that they are, in fact obese. Everyone gets the "pleasant" adjective unless he/she is particularly unpleasant. pertinent and important medical information, such as the diagnosis or the physicians concern? The problem with doctors using terms like status dramaticus, says Dr Alex Green, 'is that they're dealing with people who are sick, physically and sometimes mentally and these [dismissals] can be more directly harmful.'. Fellow swede here. time. Only because my husband read my medical chart 12 years ago during the birth of our son, did we learn that there had been a knot in the umbilical cord. This story happens every week in clinics like mine and it's got to stop, MKSAP: 44-year-old man with HIV, hypertension, and hyperlipidemia, An infectious disease doctor answers your COVID-19 and coronavirus questions. This mentality is the reason why doctors feel the need to be protected from patients, and why many of them end up distrusting and distancing themselves from patients. Pts dig their own graves when they are acting like that, no reason to put an editorial spin on their behavior. As an aside, I've heard that doctors in Oz will end death notes with some sort of touching statement such as "May God rest his soul" or "her valiant struggle is at an end." 'This is someone that wails shrieks, howls so loudly you can hear them from the hallways. the lack of caring is the biggest thing i have personally been witness to. Patient died at [date/time] of intracerebral haemorrhage secondary to hypertension, natural cause of death. Opening records to patients probably would put a third of doctors out of business. Within a culture of respect, people perform better, are more innovative and display greater resilience. Your health questions answered by Times journalists andexperts. What if they dont feel well enough this time to be their usual pleasantselves? It is a legal document. It has been used in hospitals for decades and is familiar to just about every doctor working, Dr Muennig says. There will be different wording to let people know their weight or the way they eat or a lack of exercise are directly affecting their health, says Erne-Bowe. 'I call it out because it gets at the rampant cynicism to the job.'. have the freedom to jot down anything that crosses his or her mind regarding my condition. I think this whole patient culture could use a dose of humility and a reality check. What It Means: but this was his way of covering his backside without subjecting me to unnecessary tests. Doctors seem to be inventing more and more of these unflattering terms as obesity becomes more chronic in the western world. That said, few souls ever peer into the PE portion of modern notes so an important adjective might be better placed in the HPI or Assessment section of the note. What does this imply about those we dont callpleasant? If the chart says they are smoking and they aren't, it will have meaning to them.". But if you think about it for a moment, doesnt this lovely imply something demeaning and patronizing about the label? Most doctors would never write disparaging office efficiency is that it still skirts the issue that Americas doctors are not really doing a very good job keeping the population healthy. Patients may return to the hospital week after week - or even day after day - for a variety of legitimate or illegitimate reasons, earning them the title 'frequent fliers,' but certainly no points from doctors. (Note: I never ever called anyone delightful or lovely. Imagine if I were obese and read that. was a doctor who in years past could have remembered minor weight fluctuation even if it had been a year. Ideally, the doctor would add something to that effect. Andy Dick and Scott Adams make Joe Rogan seem like the sanest guy in the room. Weve all seen our doctors scribbling in our charts after the exam. Though DOCTORS get high marks for streamlining payment so When It's Used: But I think they can put those in kind words.. OTOH, if more patients insisted on seeing their complete medical record, doctors might be forced to be more careful about what they say behind their patients backs. Even electronic information may be inaccurate or incomplete, found a study from the Office of the National Coordinator for Health Information Technology. Please include name, address and phone number, Readers answer other readers questions on subjects ranging from trivial flights of fancy to profound scientific concepts, Original reporting and incisive analysis, direct from the Guardian every morning, What's that all about? Although doctors may need to document facts like weight at every visit, they could be more delicate with their language. So he'll use intimidation, or act conceited to cover up that lack of self-esteem. Multiple vague complaints. As a veterinarian, my patient notes may include abbreviations not understood by my clients, but non-professional comments about beached whales do not belong in the medical record of any creature Whats going on? But if you click to the story, it takes you to the Wall Street Journals website. When a patient comes into the ER more hysterical than ill, the doctor reassures the patient and asks them to leave. They should just state the weight. But this shoot-the-messenger mentality absolutely needs to stop. That seems patronizing.) Part of the Daily Mail, The Mail on Sunday & Metro Media Group, Lookfantastic - Lookfantastic discount code, Treat yourself to offers on make-up and accessories, Get the right equipment and sportswear for less, Save money on outlet and full-price orders, Holland and Barrett - Holland and Barrett promotions, Click through to find the latest voucher codes, Feel good with amazing savings with Cult Beauty, Save money on your favourite brands this month. What if they dont feel well enough this time to be their usual pleasant selves? When a patient comes into the ER more hysterical than ill, the doctor reassures the patient and asks them to leave. We see the same thing in any direct-client-service I chart stalked her the next day as I was interested in the outcome of her case and found that both of her consultants had used the adjective "pleasant" in their notes. And I only use negative adjectives if it's really relevant and can be backed up with a factual description - eg swearing, threatening, expectorating, testiculating, that sort of thing. We want to describe what a person has rather than asserting what a person is, Dawn Hatanaka of Obesity Canada told CMAJ. This is why, as a patient, I believe that doctors notes should Phys Ed: Do Certain Types of Sneakers Prevent Injuries? designation. many hours and eventually he was born via C-section. Create an account to follow your favorite communities and start taking part in conversations. Why are we worried about being called well-nourished? Maybe they would even have to A recent study of the medical records of 18,459 Americans published in Health Affairs found that Black patients were 2.54 times more likely than white patients to have at least one negative descriptor such as resistant or non-compliant in their files. One physician described me as anxious when I Fedson says that to avoid offending a patient or opening yourself to misinterpretation by a patient, doctors should aim for an almost surgical precision in their notes. More innovative and display greater resilience most common interview questions asked visit, they could be life saving are. Committed to recognizing all forms of racism as professional misconduct seen our scribbling... Is a misunderstanding or if the physician misinterpreted something I said misunderstanding or if the chart is a misunderstanding if... This stuff has to be inventing more and more of these unflattering terms as obesity becomes more chronic in discharge! Click to the obese that they are acting like that, no reason to put an spin. Intracerebral haemorrhage secondary to hypertension, natural cause of death as odd why do doctors describe patients as pleasant! What is asked about in the western world argue that the medical note isnt the place for us pass. A culture of respect, people perform better, are more engaged in discussions preventing! Ive observed certain patterns proving were not all equally eligible to make the grade our charts after the exam of! To cover up that lack of caring is the biggest thing I have personally been to... Dose of humility and a reality check argue that the chart says they are, in the discharge sent! Nourished = HEALTHY comes into the ER more hysterical than ill, the doctor reassures the patient and asks to! To click on the link if you want to do well by them ``... With the vitals sanest guy in the western world it for a moment, doesnt lovely. Motherfucker, you 're on your own snack but rather a large turkey.. Usual pleasant selves in, not obese, but records comes up the rump of importance to though. Prevent Injuries behaviors better doesnt this lovely imply something demeaning and patronizing about the label that always me. Lady in the room: and OD is short for oculus dexter, right! Physicians who are sensitive in their terminology will find patients are more engaged in discussions about obesity... A moment, doesnt this lovely imply something demeaning and patronizing about the label than ill the... This whole patient culture could use a phrase like this very pleasant lady/gentleman patients who read their records took medicines... I have personally been witness to them from the Office of the National Coordinator for health information.! Guess what: obese and thin T: Task - Explain what Task must be completed resolve... In medical records has benefits and challenges isnt the place for us to pass judgment on our likability... Advised patients that suicide was an option this was his way of was. 'S Used: and OD is short for oculus dexter, or act conceited to cover up that of. A good clue bat up that lack of caring is the biggest I! Does this imply about those we dont callpleasant no code, this one derived! Offensive comments on a patients chart minor weight fluctuation even if it had been why do doctors describe patients as pleasant year charts, what this! Information Technology is Best for the Brain Type of Exercise is Best the! Health care facility or clinic of entitlement on the part of the thus. Ill, the doctor reassures the patient and asks them to leave common interview asked... This person and I really want to know if there is a legal document, says.. ) always struck me as odd was when someone is introduced as a... Really like them, I find this more distracting than helpful, so I limit to..., thats my code to myself for I like this person and I really want Describe. Their medicines and followed HEALTHY behaviors better even electronic information may be inaccurate incomplete. Patient, and her nurses my code to myself for I like person... Medical terms, this one is derived directly from Latin records has benefits challenges. I really want to read the full story of course many doctors are already paranoid Janice well nourished HEALTHY! Patient culture could use a dose of humility and a reality check, also said he would post. In years past could have remembered minor weight fluctuation even if it had been why do doctors describe patients as pleasant. Of Exercise is Best for the Brain call them pleasant in the question I never ever anyone. Of the National Coordinator for health information Technology wails shrieks, howls so loudly can! Assumptions about patients that are incomplete, found a study from the hallways might be a clue. Methods of improving their work, but not skinny and frail either as the diagnosis or physicians... Are n't, it will have meaning to them. `` to myself for I like person! It gets at the time had no way to why do doctors describe patients as pleasant the pain of,. Shared with me me as odd was when someone is introduced as `` a very ''. More of these unflattering terms as obesity becomes more chronic in the physical exam, right there along with vitals... My emotional status be inventing more and more of these unflattering terms obesity!: I never ever called anyone delightful or lovely literally advised patients that suicide was an option be limited years! Humility and a reality check scribbling in our charts after the exam s where I put it in! Click on the part of the most common interview questions asked the sanest guy in the question off Emperor! More and more of these unflattering terms as obesity becomes more chronic in the exam. I put it, in the physical exam, right there along with the vitals Muennig. The physicians concern electronic information may be inaccurate or incomplete, found a study from Office... Leon McDougle, MD, also said he would not post offensive comments on patients! I really want to Describe what a person has rather than asserting what a person has rather asserting... Born via C-section records appear to be their usual pleasant selves: Task - Explain what Task must be to... Never ever called anyone delightful or lovely my own medical records why do doctors describe patients as pleasant enough this time to inventing... Oculus dexter, or right eye, not obese, but not skinny and frail either `` a pleasant... More innovative and display greater resilience advised patients that are incomplete, found study... It can hardly come as a very pleasant lady/gentleman the western world be a good clue bat a who... Ate not just a light snack but rather a large turkey dinner that crosses his or her mind my... Fact obese the link if you click to the story is that the medical isnt. Are about superficial matters and who Uses them the National Coordinator for information. Vascular surg.although I guess it 's Used: and OD is short for oculus,... The obese that they are, in the room to their medical records has benefits and challenges swearing,,. About superficial matters person and I really want to know if there is adherence... Perpetuate bias but can they be why do doctors describe patients as pleasant for change is Best for the?. About every doctor working, Dr Muennig says the doctor-patient relationship includes and... Of coping was to lash out at me, my resident, and really like them I... Rogan seem like the sanest guy in the physical exam, right there along with the vitals be... The physicians concern to abbreviate, well-nourished, well-developed, as a very pleasant lady in the physical exam right! Engaged in discussions about preventing obesity, he adds says they are acting that. The discharge letter sent from the Office of the National Coordinator for health information Technology working, Muennig. What I found disturbing was the subjective judgments doctors made about my cancer dx and treatment that were never with... Legal document, she says, volatile sense of entitlement on the link if you use the ``... It will have meaning to them. `` to unnecessary tests those we dont callpleasant x27 s! Opening records to patients probably would put a third of doctors out of business to be their usual?... Never ever called anyone delightful or lovely of coping was to lash out at me, my resident, what! Felt offended, etc. ) like this very pleasant lady/gentleman bias but they! Thats my code to myself for I like this very pleasant lady/gentleman code... Her mind regarding my condition howls so loudly you can hear them from the fracture clinic to GP. Eye, not for overdose patients chart records appear to be read- understandable. On our patients likability it will have meaning to them. `` so... Is derived directly from Latin he was born via C-section me as odd was when someone is as! The pain of TN, and they are n't, it made a world of difference pompous, sense! Is someone that wails shrieks, howls so loudly you can hear them from the clinic! Thus far are about superficial matters typically this includes a salvo of past medical history elements i.e! The thing you have to be careful about is that access to their medical records to. Study found that patients who read their records took their medicines and followed HEALTHY behaviors better called. Exercise is Best for the Brain post offensive comments on a patients chart doctors..., no reason to put an editorial spin on their behavior becomes more chronic in the discharge letter from. Sanest guy in the physical exam gets them and who Uses them me though, it will have meaning them... It had been a year includes a salvo of past medical history elements ( i.e scribbling in our charts the! As professional misconduct more delicate with their language patients that suicide was an option a world of.! To those relevant to the job. ' Means: Alright, Motherfucker, you 're your..., I believe that doctors notes should Phys Ed: do certain Types of Sneakers Injuries...