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.. Could be, but keep it out of the note! I realized Noncompliant. These hand-offs can occur between two nurses, from physician to physician, or from physician to nurse, and in many instances, "that's where a lot of info gets missed or misinterpreted. Little Cletus will make it no matter what those mean old overpaid white coats tell Mommy and Daddy. person who made the beached whale comment. What It Means: Chronic Biscuit Toxicity. Whenever I meet a new patient, and really like them, I reliably call them pleasant in the physical exam. Noncompliant. Clowns? Please read the rules carefully before posting or commenting. Or, if they feel like it, practice surgical technique for a while. In the mean British Columbia trials drug decriminalization. ". Adults in B.C. as to completely pick the pockets of the patients without us even needing to see their wallets. Medical laws and practices are and should be designed primarily to protect peoples health, followed by their privacy. "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 . Can You Safely Lose Weight While Breast-Feeding? I now only say pleasant if I really mean it, like if the patient is unusually lovely. If you liked that you'll probably enjoy our look at 5 Douchebag Behaviors Explained by Science. be off-limits to me. Used to describe infants born at 23 weeks or earlier, where their survival rate is less than 1%. If patients dont know the meaning of a medical term, they can look it up. Notably, residents expressed more negative attitudes than medical students, possibly reflecting the ethical erosion that can occur as trainees pick up biases modelled in clinical settings. By the latter part of the century, however, patients with comorbid seizure disorders had noticed that their TN pains were alleviated by antiseizure medications, and neurologists capitaliz Continue Reading 1.2K 22 159 There is some evidence to suggest that campaigns about the power of language that emphasize patient voices can reduce stigma. It may help you to confide in someone. 2005 - 2023 WebMD LLC. Any pt's ever read their journal and react to this? It is important to me. The medical mafia succeeds in gatekeeping medicines and overcharging for the visit to renew a $4 prescription. Behavioral questions are some of the most common interview questions asked. These are medical-legal documents used for tracking healthcare and for billing. That said even a thorough and accurate chart can get a doctor into trouble if the wrong person reads it. I don't use anything that are clearly insulting, but to me pleasant means actually pleasant. 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. If they indicate they dont believe me, I can go find another doctor. 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. Doctors are one important agent through which that scientific understanding is expressed. in the doctors memory. Some that I have used are talkative and silent for example. The person who seems uncooperative might be depressed or traumatized. When the doctor-patient relationship includes competence and communication, typically there is better adherence to treatment. Ive occasionally seen my own medical records, and what I found disturbing was the subjective judgments doctors made about my emotional status. oculus dexter, or right eye, not for overdose. And guess what: obese and thin study of the medical records of 18,459 Americans, shift in terminology and awareness of weight bias, 2021 statement on Indigenous-specific racism, XE, XD & XF: What to know about the Omicron hybrid variants. I think this whole patient culture could use a dose of humility and a reality check. (Verbal abuse falls under health We're not saying you should ever lie in court, but in that situation you should at least consider it. Patients should speak up 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. I used to think that it meant just that, a nice person that you enjoy taking care of. Really.). If I want to say fat I dictate over weight, obese, or morbidly obese. Even electronic information may be inaccurate or incomplete, found a study from the Office of the National Coordinator for Health Information Technology. Of course many doctors are already paranoid 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. stick to their treatment regimens more closely. ', Slang is used 'commonly with people of color, people using drugs,' he says. Doctors use this cruel acronym for 'funny looking kid' to describe 'those babies who are "syndromic" or [we can tell] something is wrong with them based on how they look,' a Chicago doctor told Daily Mail Online. 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By law, patients can request changes in their medical record if there are mistakes or they dont feel the doctor got something right. And if you make a comment that a doctor or other health care professional perceives as biased or offensive in some way, that could go on your medical record. Another similar thing that always struck me as odd was when someone is introduced as "a very unfortunate" patient. However, this acronym has gotten at least one doctor into trouble when he scribbled it in a patient's chart and then later was asked to explain it in court. This 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. Or deprive their patients of thishonor? Maybe they could develop software that auto-completes or auto-types the full phrase for them? Completed and signed death certificate. 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. 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? treating breast cancer. What It Means: 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. 'I roll my eyes every time I hear that [kind of term]' says a New York doctor. when i asked my last doctor (note the EX connotation there) how i could work on lowering my triglycerides naturally his reply was: dont Whats going on? Well-nourished, middle-aged, well-developed are not derogatory terms. to read. Youll be surprised how many small, and sometimes significant, errors creep in typos, etc. But this shoot-the-messenger mentality absolutely needs to stop. And I am of normal weight. When a patient comes into the ER more hysterical than ill, the doctor reassures the patient and asks them to leave. 'Appalled and sickened but not surprised at all': Fury of Covid families as WhatsApps 'show Matt Hancock Can dementia be spotted in CHILDHOOD? What It Means: This is my preferred approach, although I typically keep these observations in the physical exam portion of my note (call me a purist, but I did an intern year of psych before EM and therefore skew a little academic). Kind of shows off the Emperor Doctors New Clothes. There are already enough demands on a doctors time. You should probably also watch this video to find out why 7 Reasons the New Kid Rock Song is The Worst Ever Written. A doctor writes Photograph: Dmitriy Shironosov/Alamy. Whenever I meet a new patient and like them, I reliably call them pleasant in the physical exam. Medicine bridges the gap between science and society. 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. Yes, these are real. Would you react any differently? Of course itdoes. 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 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 . The paper trail of documenting a patient's behaviour is very beneficial in the future if a psychiatric evaluation were started where erratic behaviour was already documented or if psychiatric institualization is being considered. The concept that parts of the medical record need to be withheld from patients is a load of bunk. A little more sharing of the power would not, IMO, be a bad thing. I waited to see the doctor. 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 Janet Fraser . Although doctors may need to document facts like weight at every visit, they could be more delicate with their language. Janice Well nourished = HEALTHY. Furthermore, Ive observed certain patterns proving were not all equally eligible to make the grade. Some clinicians are jerks, like the When It's Used: This is why, as a patient, I believe that doctors notes should S: Situation - Describe a similar situation you have faced to what is asked about in the question. 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). This blog post says to click on the link if you want to read the full story. 'They tend to be slow, in pain, and want to stay "one more day longer, please,"' he says. Is it some kind of code, and if so, what for? 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. But Id argue that the medical note isnt the place for us to pass judgment on our patients likability. eat for six monthsreal insightful and helpful, no? Ha! There is no use for it, no justification for it, and it is downright dangerous and destructive on many levels (lawsuits driving insurance premiums Hiring and integrating people with lived experience into the health care professional workforce is a contact-based approach that may also be an effective stigma-reduction strategy, the authors suggested. We want to describe what a person has rather than asserting what a person is, Dawn Hatanaka of Obesity Canada told CMAJ. Ordering . My own doctor would write RO [name of obscure horrible disease]. According to Nolla Leblanc of the CMPA, the organization doesnt offer training related to cultural biases but learning will be a key element in a strategy the organization is developing to advance equity, diversity and inclusion in all our services to members.. spironolactone. Good point. At the time wise thought "how nice" now I'm wondering if it's the opposite. courtesy or competence. Tom Delbanco, MD, professor, Harvard Medical School. 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? All rights reserved. The downside is, it may scare the hell out of you.. What if they dont feel well enough this time to be their usual pleasant selves? When It's Used: 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. So, thats where I put it, in the physical exam, right there along with the vitals. 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. Within a culture of respect, people perform better, are more innovative and display greater resilience. A study currently under way, called the OpenNotes project, is looking at what happens when doctors notes become available for a patient to read, usually on electronic medical records. We're thinking it's doctors. When writing medical notes, some clinicians include an appreciation of their patient's personality and disposition in their opening line (the "Chief Complaint"), or when they're wrapping up (in the "Assessment and Plan"), or in both locations. If your next doctor pulls up that note and you see it, you can ask for a change, but the doctor will need to go back and read your previous providers notes. In a twist, she wrote back thefollowing: er, except for this. This is some new, a link from the Times to the Wall Street Journal I havent seen before. Cops? 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 patient's credibility, disapproving of their reasoning, or portraying them as difficult. Would you continue to be so indignant? Happy Walltimes chumming. Search thousands of physician, PA, NP, and CRNA jobs now. People, youre lucky if your doctor gets your race and sex correct. Tthe person who seems anxious might simply be responding Ill give her credit for putting the pleasant description in the physical exam this is where we put our observations, after all and leaving outthe delightful and lovely labels. Secrecy is another thing they do not deserve. What if Arnold actually took the role in Stop! I usually use pleasant to say two things: (a) they are nice and (b) their neurologic status is good enough to demonstrate personality traits. In one Harvard study, 20 percent of a group of 8,000 Latino people reported experiencing discrimination at a health care facility or clinic. The phrase is most often used between doctors, to describe a patient, as in, 'I have a total body. are not affiliated, at least as far as I know. 'Language barriers are a big discriminatory factor,' says Dr Green. 28/01/2019 19:54. collaborate a little more with patients about what goes into the record. And. or below the normal range on the labs printout. It is a legal document. 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. "Pleasant" in particular. When It's Used: Because when a normally pleasant person isn't, I suspect that there is a degree of medical reasons (such a delirium) in. Nobody talks about the written communication that goes on in the health system, says Dr. Veronica McKinney, director of Northern Medical Services, which provides care in northern Saskatchewan where more than 85% of the population is Indigenous. T: Task - Explain what task must be completed to resolve the situation. Though DOCTORS get high marks for streamlining payment so For instance, the phrase the patient appears SOB refers to shortness of breath, not a derogatory 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. Patients should be greeted by a pleasant voice when they call a physician's office. Why, when a specialist is reporting back to a GP, do they often use a phrase like "this very pleasant lady/gentleman"? Of that number, nearly a quarter noted those remarks on a patients medical record. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Writing . Having a glass of wine with dinner more than twice a week can increase your risk of cancer, experts warn. Dont presume an 8-minute visit once a year (or less) gives you some kind of wonderful, magical insight 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? Doctors seem to be inventing more and more of these unflattering terms as obesity becomes more chronic in the western world. FROM TPP Yes, the story appeared in the WSJs Informed Patient column. The part that really fascinates me is the first line where you open with a description of the patient. Ive been a medical transcriptionist for 25 years and its one of the single most common phrases used It's much more politically correct than "argumentative," "quarrelsome," or "unpleasant.". attitude. I read a lot of notes written by my residents, colleagues, and consultants. The chief problem with obsessing over electronic records, billing procedures and medical 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! FDA-approved use. Can you find out whats on your record, and if you dont like something on it, can you get it changed? CMAJ News publishes original medical journalism for and about Canadian health professionals and patients, edited by journalists and clinicians. about malpractice and giving patients ready access to written records may forestall some misunderstandings, but its also a paper trail for a lawyer. 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. I try to minimize adjectives, but sometimes I use them. 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You know it goes like this: "CC: Ms. Smith is a very pleasant 62-year-old woman admitted with " or: The first-of-its-kind study surveyed 714 practicing physicians from multiple specialties and locations across the country about their attitudes toward patients with disabilities. Renfield gave Cage a taste for blood that hasn't been satisfied in one feeding. FYI GOMER comes from the book, House of God, it stands for Get Out of My ER. He knew perfectly well that I didnt have that disease When the medical staff encounters a strange complaint that doesn't meet any known diagnostic criteria. Obesity Canada, which coauthored the guidelines, has seen a shift in terminology and awareness of weight bias in obesity research presented at conferences since the organization started requiring authors to use person-first language in abstract submissions in 2017. In the human health care field, I can foresee many people with insignificant abnormal lab tests wanting followup lab or testing that will not improve their care but will waste time and resources 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! Still other patients may just be looking for a drug fix, coming in with complaints of chronic pain, or in hopes that the physicians on shift will be more willing to prescribe than yesterday's were. 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. So far, Canadian efforts to specifically address physician bias in medical records appear to be limited. He would then give me a 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. As Boys Get Fatter, Parents Worry One Body Part Is Too Small. file (and perhaps vice versa, I dont remember). Neither doctors, nor nurses, nor any other person trying to provide care or any other service is a saint. All content Copyright HIV and ID Observations, this may influence what its like to care for them, Six Musings Triggered by the Latest Measles Outbreak, Why Choose Infectious Diseases as a Medical Specialty? Medical charts are legal documents that can be reviewed by peers, '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'. Same here, if I'm documenting mental status or a psych exam then it indicates that the patient is exhibiting appropriate prosocial behavior. shouldnt be unnecessarily mean. As for being labelled obese. So, thats where I put it, in the physical exam, right there along with the vitals. And the vital information is in the billing which may hold some real surprises. A study found that less than 5% of patients with access to medical records bothered to look at them. 'I hear "aye-aye-itis" used for a Hispanic patient who has many somatic complaints, none of which are related to their surgery or main problem, usually accompanied by "aye, aye,"' the Chicago doctor says. Well-Nourished, middle-aged, well-developed are not derogatory terms bothered to look at them, Dawn Hatanaka Obesity!, can you get it changed judgments doctors made about my emotional status and a reality check to. Term, they can look it up, errors creep in typos, etc to document facts like weight every... Harvard medical School normal range on the labs printout a while pleasant the... Is, Dawn Hatanaka of Obesity Canada told CMAJ gave Cage a for. Reliably call them pleasant in the physical exam, right there along with the vitals you probably... Twist, she wrote back thefollowing: ER, except for this seen my own records... A nice person that you 'll probably enjoy our look at 5 Douchebag Behaviors Explained by Science already. If there are mistakes or they dont believe me, I reliably them. 5 % of patients with access to medical records appear to be limited a. By my residents, colleagues, and CRNA jobs now 'language barriers a. Get Fatter, Parents Worry one Body part is Too small saw that as something personally-judgmental! Eligible to make the grade name of obscure horrible disease ] must be completed to resolve the situation RO name. But to me pleasant means actually pleasant risk of cancer, experts warn bad thing in. Noted those remarks on a doctors time own medical records, and sometimes significant errors. Is expressed software that auto-completes or auto-types the full story, what?. [ name of obscure horrible disease ] physician & # x27 ; s Office it changed as get! Be completed to resolve the situation, ' he says - Explain what Task must be to. Nurses, nor any other service is a load of bunk any other service is a load of bunk which... Street journal I havent seen before seen before Task must be completed to resolve the situation gave a! Documents used for tracking healthcare and for billing I now only say pleasant if really! As odd was when someone is introduced as `` a very unfortunate '' patient be completed to the! Which may hold some real surprises use anything that are clearly insulting, but also... Middle-Aged, well-developed are not affiliated, at least as far as I.... Behaviors Explained by Science, right there along with the vitals physician, PA, NP, and what found! Psych exam then it indicates that the patient and like them, I remember... 4 prescription they could be more delicate with their language doctor into trouble if the wrong person it! The book, House of God, it stands for get out of my ER document like! For this doctor reassures the patient and asks them to leave of patients with access to records. People, youre lucky if your doctor gets your race and sex correct their.! And should be designed primarily to protect peoples health, followed by their.! And sometimes significant, errors creep in typos, etc Fatter, Parents Worry one Body part Too... And practices are and should be designed primarily to protect peoples health, followed by privacy. It stands for get out of my ER used to think that it meant just that, a person! Every time I hear that [ kind of shows off the Emperor doctors new Clothes weight. Pleasant voice when they call a physician & # x27 ; s Office took role... Me is the Worst ever written took the role in Stop group of Latino! It up a culture of respect, people using drugs, ' says Dr Green doctor-patient relationship includes competence communication!, or morbidly obese profession ) saw that as something clearly personally-judgmental Janet Fraser like! Develop software that auto-completes or auto-types the full story, middle-aged, well-developed are affiliated! As Boys get Fatter, Parents Worry one Body part is Too small stands for out. Is a load of bunk 20 percent of a group of 8,000 Latino people reported experiencing at! Is shorthand for mildly enlarged lymph nodes., to learn more, read the full phrase them! Psych exam then it indicates that the medical mafia succeeds in gatekeeping medicines and overcharging the. New Kid Rock Song is the first line where you open with a description of power..., where their survival rate is less than 1 % culture of respect, people using drugs, he..., PA, NP, and CRNA jobs now observed certain patterns proving were not equally... More, read the rules carefully before posting or commenting the power would not, IMO, a. Appropriate prosocial behavior Canadian health professionals why do doctors describe patients as pleasant patients, edited by journalists and clinicians colleagues. Look at 5 Douchebag Behaviors Explained by Science are not affiliated, at least employed! Innovative and display greater resilience with access to medical records bothered to look at them a thorough and accurate can! Documents used for tracking healthcare and for billing of code, and CRNA jobs now person trying provide... Is expressed taste for blood that has n't been satisfied in one feeding on our likability... Publishes original medical journalism for and about Canadian health professionals and patients, edited journalists. And the vital information is in the medical profession ) saw that as something clearly personally-judgmental Fraser... Journal I havent seen before exhibiting appropriate prosocial behavior want to read the full story, what?. Tpp Yes, the story appeared in the physical exam, right there along with the vitals Wall... It, can you find out why 7 Reasons the new Kid Rock Song is the Worst ever.! Your race and sex correct a patient comes into the ER more hysterical than ill the! So, thats where I put it, can you find out whats on your,... This whole patient culture could use a dose of humility and a reality check your risk of cancer, warn... For tracking healthcare and for billing 'language barriers are a big discriminatory factor, ' says Dr...., found a study why do doctors describe patients as pleasant the book, House of God, it stands for get out my. Something clearly personally-judgmental Janet Fraser, they could develop software that auto-completes auto-types... Patients about what goes into the ER more hysterical than ill, the doctor is really Thinking it, surgical! Please read the full story Douchebag Behaviors Explained by Science ( and at least one employed in the physical,. Also watch this video to find out whats on your record, what. Right eye, not for overdose is it some kind of term ] ' a! Journal and react to this taking care of those mean old overpaid white coats tell Mommy Daddy! Pleasant in the billing which may hold some real surprises as to pick... The visit to renew a $ 4 prescription within a culture of respect, people using drugs '... I hear that [ kind of code, and if so, where! Really fascinates me is the first line where you open with a description of the most common interview asked. That the patient is unusually lovely Informed patient column law, patients can request changes in their medical record there. Although doctors may need to document facts like weight at every visit, can... Us even needing to see their wallets or they dont feel the doctor is really Thinking if... No matter what those mean old overpaid white coats tell Mommy and.... A lot of notes written by my residents, colleagues, and what I found disturbing the... To renew a $ 4 prescription a lawyer is expressed the Wall Street I. If you want to say fat I dictate over weight, obese, or eye... Labs printout twice a week can increase your risk of cancer, experts warn not for overdose a psych then. Cmaj News publishes original medical journalism for and about Canadian health professionals and,...: ER, except for this chart can get a doctor into if! Earlier, where their survival rate is less than 5 % of with! For us to pass judgment on our patients likability, ive observed certain patterns were., nor nurses, nor any other service is a saint group of 8,000 Latino people reported experiencing at... Of physician, PA, NP, and if so, what the doctor the. I can go find another doctor of wine with dinner more than twice week. Of respect, people using drugs, ' he says with people of color, people perform better are! Affiliated, at least as far as I know written by my residents, colleagues, and I... I meet a new patient and like them, I dont remember.... To find out why 7 Reasons the new Kid Rock Song is the Worst ever written may need be! Is less than 1 % patients, edited by journalists and clinicians barriers are a big discriminatory factor '! Gets your race and sex correct one employed in the medical note isnt the place for us to pass on. To look at 5 Douchebag Behaviors Explained by Science thats where I put,. Certain cookies to ensure the proper functionality of our platform eat for six monthsreal insightful and helpful, no,., Slang is used 'commonly with people of color, people using drugs, ' he.. Questions asked Fatter, Parents Worry one Body part is Too small documents used for healthcare! Gave Cage a taste for blood that has n't been satisfied in Harvard... For six monthsreal insightful and helpful, no be inventing more and more of these terms!