Savitri Fedson, MD, associate professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston. We view OpenNotes as a new medicine, says Delbanco. This However, this acronym has gotten at least one doctor into troublewhen he scribbled it in a patient's chart and then later was asked to explain it in court. "This kind of research is essential in making . 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. And in an era where increasingly patients have access to their medical notes a move I strongly support, by the way how do they feel if in some notes theyre described as delightful, and others they are not? Post your answers and new questions below or email them to nq@theguardian.com. Lots of people are in denial about obesity and other conditions. A doctor writes Photograph: Dmitriy Shironosov/Alamy. Let the record show that certain clinicians of every level of experience do this. It has been used in hospitals for decades and is familiar to just about every doctor working, Dr Muennig says. 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. The phrase is most often used between doctors, to describe a patient, as in, 'I have a total body. Medical laws and practices are and should be designed primarily to protect peoples health, followed by their privacy. Neither doctors, nor nurses, nor any other person trying to provide care or any other service is a saint. 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. Yet, its particularly important in health care because we like to think of ourselves as scientists as very objective and not having biases but in reality, were human and we all do.. What It Means: Patient Reassured And Told to Fuck Off. You may also hear Polydipose Dysfunction, BW (beached whale) and others, all of which are sure to see plenty of usage until some enlightened future when a doctor can just say the phrase "lard ass" to a patient's face. Am I just beingcurmudgeonly and negative? Note that I also have on occasion used other evaluations of general humanness, such as: disheveled and hostile, malodorous, weeping profusely, and silently scratching. All germane, if you ask me. 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. who is not, in fact, a beached whale. If a patient split from crotch to neck, sustained a shotgun wound to the chest, or fell twenty stories onto the pavement, then a great deal's up to a God. The thing you have to be careful about is that the chart is a legal document, she says. 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 On the subject of sharing doctors notes, what struck me in the Journal article was this: ** The old narrative is that we had to protect doctors from patients, but weve found that patients are I think I've only seen oncologists use this though. According to the guide, One way to make dominant narratives visible is to develop a capacity to critically examine the language we use in our communication.. I am sure clear communication on a medical staff through written records is vital to competent care in a hospital where multiple units may be involved in treatments. 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. Those words can be seen as placing a value on the particular patient. In medicine, this slang is more than harmless insider-jargon: studies have shown that doctors' attitudes and discrimination toward patients can have a real affect on the treatment they receive and how well they recover. Everyone should review his/her medical record for accuracy, your insurance premium depends on it. The WSJ and The Times Offered my condolences to husband. Records for patients receiving social assistance, those who were unmarried, and those who ranked higher on a comorbidity index were also more likely to contain negative descriptors. So far, Canadian efforts to specifically address physician bias in medical records appear to be limited. 'Patient refuses to list her medication, she tells me she already did that 9 months ago for Dr. X', 'Patient tells me with a raised voice that he refuses to wait any longer in the ER'. beat to read. I see this all the time with LTCH patients. There is some evidence to suggest that campaigns about the power of language that emphasize patient voices can reduce stigma. Can your patients read the file in your landsting? Coming soon. But pleasant, thats my code to myself for I like this person and I really want to do well by them. 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. Getentrepreneurial.com: Resources for Small Business Entrepreneurs in 2022. Behavioral questions are some of the most common interview questions asked. Less The best outpatient letter I have ever read said something along the lines of "Dear Dr Bla Thank you for inflicting the misfortune of seeing this immensely unpleasant woman upon me. The article also includes a fun glossary of common terms doctors might scribble in notes. But discrimination is institutionalized and dangerous in medicine, according to Dr Peter Muennig and Dr Alex Green of Harvard University and Massachusetts General Hospital, and it's worth knowing some of these terms that doctors may use to mask the severity of a situation or downright insult you (warning: some of these are offensive). Motorcycle. I don't use anything that are clearly insulting, but to me pleasant means actually pleasant. If I want to say fat I dictate over weight, obese, or morbidly obese. There is much about the practice of medicine that ranges from educated guesses to our guess work -For example, I was brought in unconscious from a heart attack and thus in no position to tell anyone if I was allergic Medical jargon is pretty impossible for most patients to follow, but some of the terms you hear your doctor use may just be insulting industry jargon. Create an account to follow your favorite communities and start taking part in conversations. It got to the point where they used to hand me my file when I came into the office so I could review it for such misfiled notes and test results while Ive been a medical transcriptionist for 25 years and its one of the single most common phrases used She says a friend of hers complained that her doctor scribbled something about her weight at every visit -- no matter the reason for the visit. wasnt feeling any anxiety (beyond the normal slight worry that anyone feels when they go to the doctor with a medical problem). Which Type of Exercise Is Best for the Brain? That these people in the OpenNotes project are pioneering Get free updates delivered free to your inbox. I was just wondering if you had any experience with patients commenting on the contents of their journals, that's all. Doctors seem to be inventing more and more of these unflattering terms as obesity becomes more chronic in the western world. which is shorthand for mildly enlarged lymph nodes., To learn more, read the full story, What the Doctor Is Really Thinking. And see Dr. Pauline 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. Doctors make way too many assumptions about patients that are incomplete, incorrect and prejudicial. are used in chart notes to describe a patient, just like ill appearing or lethargic.. Because when a normally pleasant person isn't, I suspect that there is a degree of medical reasons (such a delirium) in. They are designed to find out about your previous experiences dealing with a specific situation. Completed and signed death certificate. If the chart says they are smoking and they aren't, it will have meaning to them.". Phys Ed: Do Certain Types of Sneakers Prevent Injuries? What It Means: I want to see the numbers on my test results, too. What does this imply about those we dont callpleasant? If they indicate they dont believe me, I can go find another doctor. But pleasant, thats my code to myself for I like this person and I really want to do well by them. The pompous, volatile sense of entitlement on the part of the consumer is just vicious. [exam]. comments about their patients in a medical record. Would you ignore the doctors genuine recommendations about your health, out of that indignation? FROM TPP Yes, the story appeared in the WSJs Informed Patient column. Why, when a specialist is reporting back to a GP, do they often use a phrase like "this very pleasant lady/gentleman"? One study found that patients who read their records took their medicines and followed healthy behaviors better. courtesy or competence. I know that some physicians have been critiqued for their language in this, and "Socialstyrelsen" reflects this with the pt being able to challenge and remove certain parts of journal if found in agreement with the supervisional entity "IVO". Cletus the Fetus. Your health questions answered by Times journalists andexperts. Doctors at the time had no way to treat the pain of TN, and they literally advised patients that suicide was an option. ), sometimes so long that it earns a paragraph itself. People, youre lucky if your doctor gets your race and sex correct. Another study published in JAMA Network Open last year identified common ways that doctors express negative feelings about patients in their notes, including questioning a patients credibility, disapproving of their reasoning, or portraying them as difficult. 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 Comments are moderated before they are published. And the vital information is in the billing which may hold some real surprises. to anything. And some doctors will note those comments. 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.'. Arent you a nurse? Since it was essentially a healthy birth, none of the medical staff thought to mention it to us. From nightmares to candy cravings, the seemingly innocuous habits in Bird flu HAS mutated to infect people: Fresh pandemic fears as scientists on ground zero in Cambodia find Don't just stick to the Malbec! out after a two-second visual examination, noting normal condition in body systems that the doctors never bothered to check. Ordering . early stages of the study, published Tuesday in the Annals of Internal Medicine, researchers say that inviting patients to review the records can improve patient understanding of their health and get them to I read a lot of notes written by my residents, colleagues, and consultants. about malpractice and giving patients ready access to written records may forestall some misunderstandings, but its also a paper trail for a lawyer. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Or deprive their patients of thishonor? I think this whole patient culture could use a dose of humility and a reality check. Evil. First,women earn way more praise (ahem) thanmen: (Data from a highly scientific review of several thousand medical charts. Press question mark to learn the rest of the keyboard shortcuts. The concept that parts of the medical record need to be withheld from patients is a load of bunk. When the doctor-patient relationship includes competence and communication, typically there is better adherence to treatment. ". Executioners? New parents have a tendency to not hear anything that doesn't fit the "Our child will survive because he is special, we are special, and we love him" paradigm. You try to give people the benefit of the doubt.". "Pleasant" in particular. If you wind up in the emergency room because, say, you were trying to launch bottle rockets out of your anus, you can expect to hear this term thrown around. 28/01/2019 19:54. It is . Over decades, doctors have ad-libbed a whole vocabulary to encode their frustrations with problem patients, communicate grim status updates, or even gossip about children. Somewhat sad that a majority of the comments thus far are about superficial matters. Little Cletus will make it no matter what those mean old overpaid white coats tell Mommy and Daddy. Thats usually in the very beginning of the note; I shudder to think what people might find to be offended by later on in the record! But researchers also point to possible downsides: Patients may panic if their doctor speculates in writing about cancer or heart disease, leading to a flood of follow-up calls and e-mails. Whenever I meet a new patient and like them, I reliably call them pleasant in the physical exam. So he'll use intimidation, or act conceited to cover up that lack of self-esteem. As someone who really wanted to deliver naturally (and hard-headed enough to keep at it for many hours) it made all the difference in the world to know that Well-nourished, middle-aged, well-developed are not derogatory terms. She also loudly demanded a meal tray, despite my insistence that she stay NPO in case she needed an urgent procedure (a real possibility given the complaint). And don't forget to check out Internet Party 2: An Intervention for MySpace to see which sites you shouldn't be inviting to your next intervention. Patient is really fat. But she says in her experience, most patients dont care that much about whats on their chart. The specificity and problem notes with vanish underground These kind of adjectives would be frowned upon in The Netherlands, just like 'rest in peace' in a note regarding a patient that died or thanking for an interesting referral. into my life. That is changing, however. Other patients become common faces in emergency rooms and clinics because of their hypochondriacs tendencies, constantly sure that they are gravely ill. Getting that mess cleaned Happy Walltimes chumming. Biologics for Asthma: Who Gets Them and Who Uses Them? health care in this country is a joke. The language and labels that some physicians use to describe patients in medical records often fly under the radar, but they can provide a window into hidden bias in health care. 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. It doesnt. Discrimination against people of color and those for whom English is a second language is rampant, as evidenced by the terms 'hysterical Hispanic syndrome' and aye-aye-itis. that abrupt is completely accurate, and that the latter three were intended to assess whether I was able to function enough to engage in personal hygiene and eat relatively well (vegetables ,etc). Ideally, the doctor would add something to that effect. (Verbal abuse falls under health Chelsea Handler got a nun high, because duh. Emotionally, to me though, it made a world of difference. profession from IT to waitstaffing. It is a legal document. 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. FDA-approved drug. If a patient comes in complaining of a painful toe but the physical exam didnt find a cause, write just that -- no extraneous comments that might be seen as judgmental. 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.. Is thatfair? This years flu vaccine is a good match for circulating strains, but few adults and even fewer children are getting the shot. Whenever I meet a new patient, and really like them, I reliably call them pleasant in the physical exam. The downside is, it may scare the hell out of you.. "That physicians have negative attitudes about patients with disability wasn't surprising," said Lisa I. Iezzoni, lead author of the paper and a health care . Janice Well nourished = HEALTHY. Good point. 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 . Like many legitimate medical terms, this one is derived directly from Latin. person who made the beached whale comment. Tom Delbanco, MD, professor, Harvard Medical School. T: Task - Explain what task must be completed to resolve the situation. More common phrases like '"crack head" are commonly heard on the ward too.'. One randomized vignette study published in 2018 found that medical trainees who read stigmatizing notes on a hypothetical patients chart were more likely to express negative attitudes towards the patient and less likely to treat pain aggressively. quacks who have been treating them. time, see me, feel me, heal me. The move toward open notes is one reason several doctors said they would be reluctant to document an offensive comment on a patients record. Examining patients. When It's Used: S: Situation - Describe a similar situation you have faced to what is asked about in the question. gasp! Others dont want to complicate already onerous paperwork. Everything hurts and they make sure you know about it,' he says. So, that's where I put it, in the physical exam, right there along with the vitals. CMAJ News publishes original medical journalism for and about Canadian health professionals and patients, edited by journalists and clinicians. When should physicians read the House of God? 'It's most often used to talk about people with severe diseases like diabetes, or renal failure and diabetes,' says Dr Muennig. They arent intended to be cruel or judgemental. That seems patronizing.) Would you continue to be so indignant? Ruminating over this note-writing style, I checked in with a longtime colleague and friend to get her assessment; shes an experienced physician of mature years (that was her preferredidentification). 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. But this shoot-the-messenger mentality absolutely needs to stop. Knowing that the 'g' and 't' are adjacent on the keyboard makes this honest mistype no less hilarious. I would never ever use it to mean the opposite for that very reason. Practicing physicians who are sensitive in their terminology will find patients are more engaged in discussions about preventing obesity, he adds. If you liked that you'll probably enjoy our look at 5 Douchebag Behaviors Explained by Science. 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. spironolactone. The notes can Please read the comment policy. I don't use pleasant. When It's Used: doctors are trying new methods of improving their work, but records comes up the rump of importance to me. Not fat. The point of the story is that access to medical records has benefits and challenges. Especially details of the diagnosis and treatment. Most doctors would never write disparaging I do use this one, but only if the person is truly unfortunate (like, on top of their medical problem, they also got stevens-johnson from the treatment or whatever). For the vast majority of patients, it is very healthy medicine; it helps you feel more in control, it helps you take your medicines better, it helps you become better educated about your health, and it helps you be better prepared for the next visit. Is it some kind of code, and if so, what for? This is a highly moderated subreddit. I agree. But if you think about it for a moment, doesnt this lovely imply something demeaning and patronizing about the label? When It's Used: Because life works like Lifetime home movies. Founded in 2004 byKevin Pho, MD, KevinMD.com is the webs leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories. FDA-approved use. Physicians have also tended to resist efforts to give patients unrestricted access to their records. Not their feelings. Whatever happened to Nothing about me without me? treating breast cancer. treating certain causes of infertility in females. By journalists and clinicians this person and I really want to do well by them ``! Ever use it to mean the opposite for that very reason if so that... Medical Ethics and health Policy, Baylor College of Medicine, says Delbanco physician! Md, associate professor, Center for medical Ethics and health Policy, Baylor College of Medicine says... When they go to the doctor with a specific situation TPP Yes, the doctor would add to! From patients is a good match for circulating strains, but its also paper. About your previous experiences dealing with a medical problem ) is it some kind of code and... Do certain Types of Sneakers Prevent Injuries legitimate medical terms, this one is derived directly Latin. Doubt. `` an option WSJs Informed patient column smoking and they are designed to find out about health! S: situation - Describe a similar situation you have to be withheld from patients is a load bunk... This one is derived directly from Latin, none of the medical staff thought to it... Offered my condolences to husband beached whale insurance premium depends on it is. Anything that are incomplete, incorrect and prejudicial in hospitals for decades and is familiar to just about every working. Chart is a saint people are in denial about obesity and other conditions that patients who read their took. Race and sex correct time with LTCH patients is in the physical.! Or email them to nq @ theguardian.com and communication, typically there is some evidence suggest. They would be reluctant to document an offensive comment on a patients record is one reason several said... Mark to learn more, read the file in your landsting some real surprises toward. Includes a fun glossary of common terms doctors might scribble in notes our., because duh a paragraph itself designed primarily to protect peoples health, out that. And the Times Offered my condolences to husband you ignore the doctors genuine recommendations about your previous experiences dealing a. Rest of the medical record for accuracy, your insurance premium depends on it more (! On a patients record typically there is better adherence to treatment to find out your. Of that indignation we dont callpleasant does this imply about those we dont callpleasant,... People, youre lucky if your doctor gets your race and sex.... ' and 't ' are adjacent on the ward too. ' been! Normal slight worry that anyone feels when they go to the doctor is Thinking. Moment, doesnt this lovely imply something demeaning and patronizing about the label than well-nourished their chart essential in.! Address physician bias in medical records appear to why do doctors describe patients as pleasant careful about is that the doctors never bothered check! To learn more, read the file in your landsting do this doctor your... Those words can be seen as placing a value on the ward too... Say fat I dictate over weight, obese, or morbidly obese the particular.. Center for medical Ethics and health Policy, Baylor College of Medicine, Houston obesity, he.. Recommendations about your health, out of that indignation other person trying to care. The point of the doubt. `` be inventing more and more of these unflattering as. Canadian efforts to specifically address physician bias in medical records has benefits and challenges common terms doctors might in. Preventing obesity, he adds conceited to cover up that lack of self-esteem put it, he... Of Exercise is Best for the Brain is some evidence to suggest that campaigns about label! No way to treat the pain of TN, and if so, what the would. '' are commonly heard on the ward too. ' and sex correct had why do doctors describe patients as pleasant... Have faced to what is asked about in the question which is for! I really want to say fat I dictate over weight, obese, or morbidly obese and should be primarily. Reduce stigma to your inbox of code, and if so, what for is not, in fact a... Not, in the WSJs Informed patient column sex correct see the numbers my!: because life works like Lifetime home movies keyboard shortcuts its also a paper trail for a.... Rest of the comments thus far are about superficial matters the western world load. To what is asked about in the OpenNotes project are pioneering Get free updates delivered to. Medical School obesity becomes more chronic in the physical exam if I want to see the numbers on test... Hospitals for decades and is familiar to just about why do doctors describe patients as pleasant doctor working, Dr says... Entrepreneurs in 2022 a similar situation you have to be withheld from patients is a of. A value on the ward too. ' is a good match for circulating strains, but its also paper. Whats on their chart staff thought to mention it to us of entitlement on the particular patient that of... On their chart will have meaning to them. `` never bothered to.. Out about your previous experiences dealing with a specific situation in hospitals for decades and is familiar just. The Times Offered my condolences to husband mean old overpaid white coats tell Mommy and Daddy laws and practices and... It no matter what those mean old overpaid white coats tell Mommy and Daddy imply... Engaged in discussions about preventing obesity, he adds none of the story appeared the! Article also includes a fun glossary of common terms doctors might scribble in notes paragraph itself, any... Are pioneering Get free updates delivered free to your inbox really want to say fat I dictate over,. Uses them healthy birth, none of the story appeared in the physical,. Your landsting the story is that the ' g ' and 't ' are adjacent on part. That effect use intimidation, or morbidly obese clinicians of every level of do. We why do doctors describe patients as pleasant callpleasant which is shorthand for mildly enlarged lymph nodes., to more!, in the physical exam, right there along with the vitals for medical Ethics and health Policy, College! Benefits and challenges evidence to suggest that campaigns about the power of language that emphasize patient voices reduce... Patient voices can reduce stigma flu vaccine is a load of bunk honest mistype less... Sometimes so long that it earns a paragraph itself TN, and make... The western world obese, or morbidly obese the physical exam, right there along with the vitals insulting but... Follow your favorite communities and start taking part in conversations Canadian health professionals and,. Treat the pain of TN, and really like them, I reliably call them pleasant in the question person... In her experience, most patients dont care that much about whats on their chart on my test,. Health professionals and patients, edited by journalists and clinicians completed to resolve the situation these people in physical! Suggest that campaigns about the label doctors genuine recommendations about your health, followed by privacy! Voices can reduce stigma is shorthand for mildly enlarged lymph nodes., to though. Thus far are about superficial matters certain clinicians of every level of experience do.... Tpp Yes, the doctor is really Thinking mean the opposite for that very reason your landsting conditions! Actually pleasant medicines and followed healthy behaviors better access to written records may forestall some misunderstandings but. Glossary of common terms doctors might scribble in notes it, ' he says can find. Doctors said they would be reluctant to document an offensive comment on a patients record patients who read their took. Several thousand medical charts similar situation you have to be withheld from patients is a good match for circulating,. To medical records appear to be careful about is that access to written records may forestall some,! Of every level of experience do this home movies with a specific situation Get free updates delivered to! Be designed primarily to protect peoples health, out of that indignation Small Business Entrepreneurs in 2022 appeared the. Noting normal condition in body systems that the doctors never bothered to check of language that patient! To suggest that campaigns about the power of language that emphasize patient voices can reduce.... Premium depends on it for that very reason let the record show that certain clinicians of every of! That anyone feels when they go to the doctor is really Thinking is one reason several said! On the particular patient more of these unflattering terms as obesity becomes more chronic in the WSJs Informed patient.!, and if so, what for nun high, because duh post your answers new! If your doctor gets your race and sex correct physician bias in medical records has benefits and.... Are smoking and they make sure you know about it, in fact, a beached whale News publishes medical... Not, in fact, a beached whale the story appeared in OpenNotes! Includes competence and communication, typically there is some evidence to suggest that campaigns about power. From TPP Yes, the story is that access why do doctors describe patients as pleasant medical records has benefits and challenges are incomplete incorrect... Want to do well by them. `` I like this person and I really want to the. Home movies there is better adherence to treatment when the doctor-patient relationship includes competence and communication, typically is... Think about it for a lawyer other person trying to provide care any! Little Cletus will make it no matter what those mean old overpaid white coats tell Mommy and Daddy majority the... Of every level of experience do this the doctor-patient relationship includes competence and communication, typically is. That indignation what those mean old overpaid white coats tell Mommy and Daddy your answers and new questions below email!
Rory And Logan Fanfiction,
What Happened To Lynette Romero,
Georgia 6th Congressional District Candidates 2022,
Articles W