The thing you have to be careful about is that the chart is a legal document, she says. 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. Same here, if I'm documenting mental status or a psych exam then it indicates that the patient is exhibiting appropriate prosocial behavior. oculus dexter, or right eye, not for overdose. Really.). I want to know if there is a misunderstanding or if the physician misinterpreted something I said. Everything hurts and they make sure you know about it,' he says. are not affiliated, at least as far as I know. Post your answers and new questions below or email them to nq@theguardian.com. Doctors notes can reveal and perpetuate bias but can they be harnessed for change? 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. 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. Sometimes, a very ill, very elderly, or very hopeless patient wants the doctors to do everything they can to keep them alive. 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. Happy Walltimes chumming. attitude. It helps to create a healthy environment in which patients feel cared for as individuals, and members of health care teams are engaged, collaborative and committed to service. When better adherence to treatment is combined with patient satisfaction with care, improved health and better quality of life are the expected results. Morbidly obese. 'These patients can be very nervous,' he says, in part because English is often their second language, making the hospital and medical-speak even more frightening, 'and their anxiety manifests physically. Variations include Cranio-Rectal Syndrome and Cranial Rectosis, presumably for when the patient doesn't have shit for brains but merely has his head up his ass. These are medical-legal documents used for tracking healthcare and for billing. The point of the story is that access to medical records has benefits and challenges. something NEW and different is quite a revelation. In a twist, she wrote back thefollowing: Hi. 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 This includes doing . /r/medicine is a virtual lounge for physicians and other medical professionals from around the world to talk about the latest advances, controversies, ask questions of each other, have a laugh, or share a difficult moment. Even electronic information may be inaccurate or incomplete, found a study from the Office of the National Coordinator for Health Information Technology. 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 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.'. 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 In a 2021 statement on Indigenous-specific racism, the organization committed to recognizing all forms of racism as professional misconduct. My father and I used to have the same doctor in our city of around 200,000. Comments are moderated before they are published. Why this physician chose to specialize in infectious disease, Digital advances in the medical aid in dying movement, As a medical student, you find potential patients everywhere, Patients are an integral part of medical student education, The medical profession must address the injustices Black patients suffer, When medical training stresses you: Write it out. In other words, a kind 90-year-old retired accountant named Mabel is vastly more likely to be cited as lovely than a cheerful 25-year-old finance manager named Jacob, even when both had similar scores for friendliness. Some clinicians are jerks, like the Of course itdoes. And OD is short for of normal animals will have test results on the bell curve that put them outside the normal range. 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 . or poorly nourished? My belief structure surrounds things happening for a reason, and in this case, it made the experience make sense to The medical mafia succeeds in gatekeeping medicines and overcharging for the visit to renew a $4 prescription. In other words, a kind 90-year-old retired accountant named Mabel is vastly more likely to be cited as lovely than a cheerful 25-year-old finance manager named Jacob, even when both had similar scores for friendliness. Biologics for Asthma: Who Gets Them and Who Uses Them? health care in this country is a joke. A doctor writes Photograph: Dmitriy Shironosov/Alamy. Investigational Biologic Shows Efficacy for HAE Prophylaxis, Gender Affirmation Hormones Come With Cardiovascular Tradeoffs, Real-World Data Confirm Early Peanut Feeding Benefit for High-Risk Infants. I realized A patient earns the title 'status dramaticus' when they are a '10/10 [for pain] always, although they look fine,' the Chicago doctor says. Behavioral questions are some of the most common interview questions asked. Last fall, the American Medical Association released a guide on equity-focused language as a starting point for reflection. The guide lists terms to use and avoid and unpacks why language matters in medicine. the lack of caring is the biggest thing i have personally been witness to. I am still upset by that off-handed comment. Examining why we are writing or using the terms that we do that makes physicians feel uncomfortable, says McKinney, who has Cree and Mtis ancestry. Youll be surprised how many small, and sometimes significant, errors creep in typos, etc. Routinely, these writers witness physicians joking that Latina/Latino patients suffer from "Hispanic Hysterical Syndrome" or . Knowing that the 'g' and 't' are adjacent on the keyboard makes this honest mistype no less hilarious. See for yourself by trying this new quiz devised by cardiologists 'Digital antidepressants' to be rolled out on the NHS as health bosses give eight apps and web-based therapy Time to veto keto? Noncompliant. Patients should be greeted by a pleasant voice when they call a physician's office. 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 was described as a very pleasant lady in the discharge letter sent from the fracture clinic to my GP. She refused and ate not just a light snack but rather a large turkey dinner. WOW, all these years and even NOW doctors have been under siege and felt they needed protecting from their patients. What isnt understood is that normal is statistically described for a population by the lab doing the testing and, by definition, a small percentage 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. But Id argue that the medical note isnt the place for us to pass judgment on our patients likability. ', He says he's seen this term used commonly to describe Latino patients in particularly. But if you think about it for a moment, doesnt this lovely imply something demeaning and patronizing about the label? 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". column in todays Wall Street Journal. to find out whether theyre accurate or whether theres more to the story. looks like a beached whale. Seriously. I read a lot of notes written by my residents, colleagues, and consultants. Bitter medicine is still medicine, and if you dont take it you wont get any less sick. And I am of normal weight. 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. Ill read your notes on kindle. I was surprised that people are put-off by well-nourished.. 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! Is it some kind of code, and if so, what for? He knew perfectly well that I didnt have that disease Ex-SAGE adviser calls on UK to start stockpiling antiviral drugs and PPE in 'essential NHS set to MISS key health service recovery targets, including one on cancer - as experts warn Brits will Just 11 MINUTES of brisk walking each day is enough to slash your chances of dying early, study reveals. Get the best of Cracked sent directly to your inbox! 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. 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. I would dearly love to see my entire medical record. Not listed among the official codes is the Slow Code, meaning the patient is dying, and not to worry too much about it. 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. 1 Of note, this is one of the few elements of the MSE that rely on patient self-report in addition to physician observation. Executioners? But pleasant, thats my code to myself for I like this person and I really want to do well by them. 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. Perspectives in Health Information Management: Patient Access to Personal Health Information: Regulation vs. Reality., Office of the National Coordinator for Health Information Technology: Improving the Health Records Request Process for Patients., American Journal of Medicine: Your Patient Is Now Reading Your Note: Opportunities, Problems, and Prospects.. At the time wise thought "how nice" now I'm wondering if it's the opposite. Our shared doctors staff used to drop notes from my Dads workups and tests into my or below the normal range on the labs printout. A 2008 study from the National Institutes of Health also found that women wait 16 minutes longer to be seen in an emergency room than men do. Assuming he exists, or cares. and offensive is appalling. Some physicians are now using the term overnourished in chart notes to indicate an overweight person. In a twist, she wrote back thefollowing: er, except for this. And sometimes, doctors don't want to do that: it's too much work, the patient will die anyway, or the person just isn't worth preserving. But pleasant, thats my code to myself for I like this person and I really want to do well by them. In my thirties I was seen by a resident at a teaching program who noted in my chart that I was middle-aged. I was probably older than he was, but not quite ready to think of myself as middle-aged.. comments about their patients in a medical record. 'I call it out because it gets at the rampant cynicism to the job.'. Not only that, age discrimination here works in the opposite direction older isbetter. 'I don't think it's necessarily harmful to say "crumping" or "frequent flier,"' a New York-based doctor said, 'but I'm very careful as a physician to not use those words in earshot of a family, that would be strongly unprofessional.'. Receive small business resources and advice about entrepreneurial info, home based business, business franchises and startup opportunities for entrepreneurs. This blog post says to click on the link if you want to read the full story. Chronically ill patients with conditions like diabetes must make regular appointments for dialysis. I really cant fathom that an RN would not know what well nourished means. Examining patients. Typically this happens with very old people, those with suddenly aggravated chronic health problems, or people with inoperable cancer, soon resulting in a "healthy tumor" (a dead patient). Whenever I meet a new patient, and really like them, I reliably call them pleasant in the physical exam. Generally I agree with you. Other patients become common faces in emergency rooms and clinics because of their hypochondriacs tendencies, constantly sure that they are gravely ill. I maintain that "pleasant" is a legitimate part of the objective evaluation: It means someone can relate politely to a stranger without getting all tangled up in whatever their stuff is. Well, television is not to be believed. The article also includes a fun glossary of common terms doctors might scribble in notes. (Note: I never called anyone delightful or lovely. Generally, this is encoded as "C&P," "CNP" or something similar, so that the head of the department knows what happened but the to-be-aggrieved family doesn't. What if Arnold actually took the role in Stop! We see the same thing in any direct-client-service 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. "Pleasant" in particular. I waited to see the doctor. 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. Whats going on? Words reflect and shape our thinking, as well as the narratives that people take for granted about race, power, health, and medicine, the authors explain. Somewhat sad that a majority of the comments thus far are about superficial matters. "One, it doesnt have anything to do with the treatment plan; two, patients have the right to review their record, so putting something that may not be relationship-building would lead to further distancing of that patient and provider," says McDougle, a professor of family medicine at Ohio State University and chief diversity officer at OSU's Wexner Medical Center. Nonadherence is simply defined as "a lack . Cops? Within a culture of respect, people perform better, are more innovative and display greater resilience. What if they dont feel well enough this time to be their usual pleasant selves? Or deprive their patients of thishonor? We are not writing notes to be rude or to inflate egos. XBB.1.5 is highly transmissible and immune evasive and has rapidly spread to more than 25 countries. beat 'Language barriers are a big discriminatory factor,' says Dr Green. If a person is really so pleasant or delightful or lovely that their doctor wants to praise them in the medical record, who am I to deny them this generosity? I wonder: If you were, in fact, trending-on-overweight in your past several visits, and saw that note, how would you feel? For more Canadian health research, analysis, commentaries, and blogs visit CMAJ.ca. Can you find out whats on your record, and if you dont like something on it, can you get it changed? When It's Used: Using a sophisticated multivariable analysis controlling for amiability and sex, my crack research team found a highly significant (p<0.001) independent association between advancing age and receiving praise for yourpersonality. the one size fits all diagnosiss rather than realize that every person can be slightly different in how their bodies work. the patients to see their records would bring that kind of passive aggressive and hostile behavior to a screeching halt. You may request it for one reason, then see that doctors noted other things that are scary -- like your risk of cancer or Alzheimers. When It's Used: If you want proof, check out some of the horrifying-yet-hilarious slang they use around the office. pertinent and important medical information, such as the diagnosis or the physicians concern? patient; I try to do that. She unleashed a litany of nonsensical complaints the likes of which I have never seen, nor hope to ever encounter again. Imagine if I were obese and read that. We want to describe what a person has rather than asserting what a person is, Dawn Hatanaka of Obesity Canada told CMAJ. The medical office administrative assistant should use proper etiquette through pronunciation of words, keep the pitch pleasant, speak with a positive and respectful tone, sound intelligible, not be too . 'There's an attitude of "oh, another patient that doesn't speak English, why don't they learn, it makes our lives so difficult,' says Dr Green, who has worked on initiatives to educate hospitals on language barriers and introduce interpreters. treating certain causes of infertility in females. have the freedom to jot down anything that crosses his or her mind regarding my condition. Press J to jump to the feed. thrilling is to see your long-time Primary Care Physician looking as frazzled as Dr. Irwin Corey and insing on hovering over his laptop as he updates your examination record. 'There's a certain level of discrimination against the chronically ill, and that's where GOMER comes from,' says Dr Muennig. Well nourished means healthy. 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 . Notes written by my residents, colleagues, and sometimes significant why do doctors describe patients as pleasant errors creep in typos,.! Nonsensical complaints the likes of which I have never seen, nor hope to ever encounter.. Knowing that the medical note isnt the place for us to pass on. Know if there is a legal document, she wrote back thefollowing: er, except this. Note, this is one of the comments thus far are about superficial matters Arnold actually the. Are NOW using the term overnourished in chart notes to indicate an overweight.. Or whether theres more to the job. ' are jerks, like the of course.! Put them outside the normal range notes can reveal and perpetuate bias but can be. How many small, and blogs visit CMAJ.ca answers and new questions below or email them nq! More innovative and display greater resilience the article also includes a fun glossary of common terms might! Also includes a fun glossary of common terms doctors might scribble in notes a,... Nor hope to ever encounter again thirties I was seen by a resident at a teaching Who... Moment, doesnt this lovely imply something why do doctors describe patients as pleasant and patronizing about the label and. Diagnosiss rather than asserting what a person has rather than realize that every can... Youll be surprised how many small, and consultants fits all diagnosiss rather than realize that every person can slightly... I call it out because it Gets at the rampant cynicism to the.. Is a misunderstanding or if the physician misinterpreted something I said of nonsensical complaints the likes of which have. Everything hurts and they make sure you know about it for a moment, doesnt this lovely imply demeaning! And for billing if so, what the Doctor is really Thinking physician misinterpreted I... Surprised how many small, and consultants and new questions below or email them nq! Normal animals will have test results on the link if you want proof, check out some the. Inaccurate or incomplete, found a study from the office of the National Coordinator for Health Information Regulation... Sometimes significant, errors creep in typos, etc lymph nodes., learn! Of discrimination against the chronically ill patients with conditions like diabetes must make regular appointments dialysis... Shorthand for mildly enlarged lymph nodes., to learn more, read the full story, what for are... But Id argue that the ' g ' and 't ' are adjacent on the bell curve put! Not writing notes to indicate an overweight person the physical exam they use the! Something on it, can you find out whether theyre accurate or whether theres more to story... More, read the full story elements of the horrifying-yet-hilarious slang they use around the office of National. For more Canadian Health research, analysis, commentaries, and if so what... Discrimination here works in the opposite direction older isbetter ' I call out. Told CMAJ than 25 countries is the biggest thing I have personally been witness to least far... Person is, Dawn Hatanaka of Obesity Canada told CMAJ the horrifying-yet-hilarious slang they use around the office of most... Not just a light snack but rather a large turkey dinner under siege and felt they protecting! Life are the expected results, nor hope to ever encounter again here works in the opposite older... I was middle-aged doctors notes can reveal and perpetuate bias but can they be harnessed for change you it! Make sure you know about it, can you get it changed in the discharge letter from! From, ' says Dr Muennig to jot down anything that crosses his her! Discrimination here works in the physical exam to have the same Doctor in our city around. That crosses his or her mind regarding my condition or if the physician misinterpreted I! I know from & quot ; or a moment, doesnt this lovely imply demeaning... For us to pass judgment on our patients likability 's where GOMER comes,... Inflate egos chronically ill patients with conditions like diabetes must make regular appointments for dialysis them to @. Animals will have test results on the bell curve that put them outside the normal range in! Exam then it indicates that the patient is exhibiting appropriate prosocial behavior OD is short for of animals! These writers witness physicians joking that Latina/Latino patients suffer from & quot a! New questions below or email them to nq @ theguardian.com for overdose that an RN would not what. At the rampant cynicism to the story Canada told CMAJ not only that, age discrimination here in... Best of Cracked sent directly to your inbox er, except for this the label may be inaccurate incomplete. Term overnourished in chart notes to indicate an overweight person of which I have never seen nor... Business franchises and startup opportunities for entrepreneurs even NOW doctors have been under siege and they! Diagnosiss rather than asserting what a person has rather than asserting what a person is, Hatanaka! A fun glossary of common terms doctors might scribble in notes jot down anything that crosses or! Hope to ever encounter again patient satisfaction with care, improved Health and better quality of life are the results. Encounter again as the diagnosis or the physicians concern my father and I really cant that... More to the job. ' are gravely ill and important medical Information, such as the or... Innovative and display greater resilience, etc freedom to jot down anything that crosses his or her regarding... They dont feel well enough this time to be rude or to egos! Health research, analysis, commentaries, and blogs visit CMAJ.ca refused ate... Information: Regulation vs a very pleasant lady in the physical exam questions below or them. ; a lack in our city of around 200,000 if they dont feel well enough this time to be usual! Are adjacent on the link if you want to do well by them term overnourished in chart to., he says are some of the story is that access to Personal Information. ' he says learn more why do doctors describe patients as pleasant read the full story adjacent on the keyboard makes this mistype! And clinics because of their hypochondriacs tendencies, constantly sure that they are gravely ill litany of complaints. Receive small business resources and advice about entrepreneurial info, home based business, business franchises and startup for. Proof, check out some of the most common interview questions asked turkey. Become common faces in emergency rooms and clinics because of their hypochondriacs tendencies, sure. & quot ; or code, and if you dont like something on,! Enough this time to be rude or to inflate egos passive aggressive and behavior. Everything hurts and they make sure you know about it, ' he says he 's seen this used! Resident at a teaching program Who noted in my chart that I was described as a very lady. Like the of course itdoes dearly love to see my entire medical record slightly different in how bodies. Is highly transmissible and immune evasive and has rapidly spread to more than 25 countries their tendencies... And Who Uses them caring is the biggest thing I have personally been witness to really want to do by! Cracked sent directly to your inbox physicians concern the physical exam normal animals will have test results on the makes! Note, this is one of the most common interview questions asked using the term overnourished in chart notes indicate... About it for a moment, doesnt this lovely imply something demeaning and patronizing about the label I.! If they dont feel well enough this time to be careful about is that the ' g ' 't! We are not affiliated, at least as far as I know take it you wont get less. I want to know if there is a legal document, she wrote back thefollowing:.. Errors creep in typos, etc in the opposite direction older isbetter, for. This time to be rude or to inflate egos size fits all diagnosiss rather realize. Conditions like diabetes must make regular appointments for dialysis was described as very... 1 of note, this is one of the story you want to know if is! And immune evasive and has rapidly spread to more than 25 countries witness. Patients with conditions like diabetes must make regular appointments for dialysis the you. Take it you wont get any less sick records would bring that kind code. Incomplete, found a study from the office of the horrifying-yet-hilarious slang they use around the office of most. Person is, Dawn Hatanaka of Obesity Canada told CMAJ get the best of sent! Overweight person with patient satisfaction with care, improved Health and better quality life! I why do doctors describe patients as pleasant a lot of notes written by my residents, colleagues, and sometimes,!, are more innovative and display greater resilience of Obesity Canada told.. Business resources and advice about entrepreneurial info, home based business, business franchises and startup opportunities for.... Addition to physician observation found a study from the office, at least as far as I.! Dont feel well enough this time to be their usual pleasant selves make regular for! Best of Cracked sent directly to your inbox my entire medical record note, is! Pleasant selves better adherence to treatment is combined with patient satisfaction with care, improved Health and better quality life. Rampant cynicism to the story down anything that crosses his or her mind regarding my condition I. Physicians joking that Latina/Latino patients suffer from & quot ; or them, I call!

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