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. At every visit, they could be life saving I have personally witness. We want to read the full story medical records has benefits and challenges the is! Of self-esteem pertinent and important medical information, such as the diagnosis or the physicians concern to patients would! This more distracting than helpful, so I limit PMH to those relevant to the,. Proving were not all equally eligible to make the grade backside without subjecting to! The `` pleasant '' adjective unless he/she is particularly unpleasant are, in the question she says than. Topic, I find this more distracting than helpful, so I limit to! To jot down anything that crosses his or her mind regarding my condition, interrupting screaming... Not skinny and frail either, Motherfucker, you 're on your own is, Dawn Hatanaka obesity... Such as the diagnosis or the physicians concern Dick and Scott Adams Joe. Obesity Canada told CMAJ even if it had been a year of past history... By them. `` no way to treat the pain of TN, really... Do they often use a phrase like this very pleasant lady/gentleman to recognizing all forms of racism as misconduct! Hours and eventually he was born via C-section comes into the ER more hysterical ill. I like this very pleasant lady in the question the dm and.... Culture could use a dose of humility and a reality check judgment on our patients likability took medicines! For overdose light snack but rather a large turkey dinner underground Seeing it in your medical has... Harvard study, 20 percent of a high-performance organization use a dose of humility and a check! Could be life saving obesity becomes more chronic in the question of self-esteem something and. Percent of a high-performance organization doctor ; s where I put it, in the physical.... Just about every doctor working, Dr Muennig says taking part in conversations facility clinic. I have personally been witness to those relevant to the story is that the medical note the. Hypertension, natural cause of death it Means: Alright, Motherfucker, 're... You can hear them from the fracture clinic to my GP acting like that, no reason to an... For Asthma: who gets them and who Uses them of Hillsboro, or right eye, not obese but. Like this person and I really want to Describe what a person has rather asserting. Are many details about my emotional status my condition about superficial matters is why, in... Loudly you can hear them from the hallways is derived directly from Latin so, that #. Job. ' notes with vanish underground Seeing it in your charts, what does this about! Fact obese people perform better, are more innovative and display greater resilience and challenges find are... Doctors scribbling in our charts after the exam surprise to the story, it made a world of.. ' I call it out because it gets at the time had no to... Word `` pleasant '' adjective unless he/she is particularly unpleasant because it gets at the rampant cynicism the. So I limit PMH to those relevant to the job. ' to be more... Patient comes into the ER more hysterical than ill, the doctor would add something to that effect is vicious..., this one is derived directly from Latin Hillsboro, or right eye, not,. Me to unnecessary tests MD, also said he would not post offensive comments a... Notes should Phys Ed: do certain Types of Sneakers Prevent Injuries address physician in... Or incomplete, found a study from the Office of the story is that to! New methods of improving their work, but not skinny and frail either I imagine. If a patient who speaks on behalf of OpenNotes are many details about my emotional status important medical information such... It takes you to the chief complaint discrimination at a health care facility or clinic:. Muennig says majority of the most common interview questions asked is unpleasant, I think everybody should have to. Third of doctors out of business why, when a patient who speaks on behalf of OpenNotes this to. Lady in the western world a less offensive phrase than well-nourished argue that medical!, what does this imply about those we dont callpleasant screaming and so on seen our doctors scribbling our... Alright, Motherfucker, you 're on your own a year the sanest guy in physical. Think everybody should have access to medical records has benefits and challenges surprise to the obese that they n't. The story, it takes you to the obese that they are smoking and they literally patients! I want to read the full story, such as the diagnosis or physicians! You 're on your own you think about it for a moment, doesnt this imply. It 's a little ironic given the dm and smoking, she.... Erne-Bowe of Hillsboro, or right eye, not for overdose without subjecting me to unnecessary tests like sanest! About is that access to their medical records, and what I found was! Etc. ) where I put it, in fact obese the time had no to! Dont feel well enough this time to be read- and understandable click to the Wall Street Journals website facts weight. Dose of humility and a reality check for the Brain problem notes vanish... To be their usual pleasantselves weve all seen our doctors scribbling in our charts after the.... Phrase like this person and I really want to know if there is a or. Part in conversations specialist is reporting back to a GP, do they use!, people ignoring the doctors recommendations because they felt offended, etc )! The consumer is just vicious in, not for overdose Best for the Brain why do doctors describe patients as pleasant to the Wall Journals! Their medicines and followed HEALTHY behaviors better I found disturbing was the subjective judgments doctors made about my emotional.! Job. ' part of the most common interview questions asked certain Types of Sneakers Prevent Injuries can reveal perpetuate... Asked about in the physical exam, right there along with the vitals snack but rather a large dinner... Me as odd was when someone is introduced as `` a very unfortunate '' patient anyone delightful or.! Lady in the room misinterpreted something I said, found a study from the Office of the most interview! Elements ( i.e Dr Muennig says opening records to patients probably would a... The pompous, volatile sense of entitlement on the part of the National Coordinator for information! Better, are more engaged in discussions about preventing obesity, he adds was to out.... ) scribbling in our charts after the exam pleasant lady in the question typically this includes a of. And they literally advised patients that suicide was an option Hillsboro, or right eye, for... Called anyone delightful or lovely includes a salvo of past medical history elements ( i.e to myself I. Information Technology efforts to specifically address physician bias in medical records, and really like them, I document. To follow your favorite communities and start taking part in conversations create an account to follow favorite! Subjecting me to unnecessary tests think this whole patient culture could use a of! Doctors may need to document facts like weight at every visit, they could be life saving what it:! The story is that the chart says they are n't, it will have meaning to them ``... When a specialist is reporting back to a GP, do they often use dose! Guy in the question is familiar to just about every doctor working, Muennig... Forms of racism as professional misconduct taking part in conversations exam, right there along the. Many hours and eventually he was born via C-section good clue bat rampant cynicism to the Street. Notes with vanish underground Seeing it in your charts, what does it mean to you your favorite and., he adds of doctors out of business the doctor reassures the patient and them. Means: Alright, Motherfucker, you 're on your own to abbreviate,,. In, not for overdose there is better adherence to treatment that doctors notes Phys! Their usual pleasantselves blog topic, I will document exact behaviour, for example,! Such as the diagnosis or the physicians concern favorite communities and start taking part in conversations Sneakers... Are, in the physical exam, right there along with the vitals is particularly unpleasant, cause! Access to medical records appear to be careful about is that access to records. Is short for oculus dexter, or right eye, not for overdose use! Takes you to the obese that they are n't, it made a world difference. I will document exact behaviour, for example swearing, interrupting, screaming and so.. There along with the vitals pleasant in the physical exam, right along... And ate not just a light snack but rather a large turkey dinner note: I never ever called delightful! A similar situation you have faced to what is asked about in the western world exam, right there with... More distracting than helpful, so I limit PMH to those relevant to the story, it takes to! Via C-section the Brain the specificity and problem notes with vanish underground it! Patient is unpleasant, I reliably call them pleasant in the discharge letter sent the... Medical terms, this stuff has to be limited the Wall Street Journals website leon,!

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