If a person is 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? As a physician I can log onto the EMR and read my PCPs notes about me, but I never do. I usually say "passed away comfortably attended by family (or staff if they had no family around).". If the chart says they are smoking and they aren't, it will have meaning to them.". Few studies have evaluated medical records as a means of transmitting bias from one clinician to another. Pts dig their own graves when they are acting like that, no reason to put an editorial spin on their behavior. Theres an App for That. He cant change a note once its there, though. . When It's Used: Some argue that greater transparency would lead to unnecessary conflict with patients who might be confused or upset by what they read in their files. The larger issue is the amount of time I waste when clients request a copy of blood test results and want an explanation as to why I told them the tests were normal, when there was a laboratory value a point above 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. can now possess small quantities of certain illegal drugs without legal repercussions. I had one professor in med school, though, who required students NOT to use such terms as pleasant, delightful, jovial, aged, or their opposites. Multiple vague complaints. treating high blood pressure, heart . The article also includes a fun glossary of common terms doctors might scribble in notes. Motorcycle. The thing you have to be careful about is that the chart is a legal document, she says. When It's Used: The phrase is most often used between doctors, to describe a patient, as in, 'I have a total body. Meanwhile, Fleur-Ange Lefebvre of the Federation of Medical Regulatory Authorities of Canada said that her organization is not specifically addressing physicians use of stigmatizing language at this time. Comments that a patient appeared anxious , or was obese, are not intended to be insults, but descriptions of what the doctor is observing. When It's Used: 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. Noncompliant. 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). Of course, itdoes. Executioners? But if you think about it for a moment, doesnt this lovely imply something demeaning and patronizing about the label? Add message. We write, WNWD to abbreviate, well-nourished, well-developed, as in, not obese, but not skinny and frail either. 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. Fellow swede here. 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? What It Means: Patient Reassured And Told to Fuck Off. 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. I see this all the time with LTCH patients. The move toward open notes is one reason several doctors said they would be reluctant to document an offensive comment on a patients record. 28/01/2019 19:54. Vascular surg.although I guess it's a little ironic given the dm and smoking. The acronym is a sort of catch-all term for any of the kinds of patients doctors don't want to deal with. eat for six monthsreal insightful and helpful, no? T: Task - Explain what task must be completed to resolve the situation. Because life works like Lifetime home movies. Whether positive or negative, it can follow you without your knowledge. He would then give me a 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 Ordering . Seeing it in your medical records might be a good clue bat. 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. 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. Isnt she lovely? Get the best of Cracked sent directly to your inbox! This was an excellent doctor by the way oncologist and had terrific nurses. Rather than their organs suddenly failing - or crashing - these patients are deteriorating quickly, and often don't have much chance for survival. specifically, mental/psychological health.). Really.). Post your answers and new questions below or email them to nq@theguardian.com. Renfield gave Cage a taste for blood that hasn't been satisfied in one feeding. It has been used in hospitals for decades and is familiar to just about every doctor working, Dr Muennig says. also give me a clue into the doctors attitude. Having a glass of wine with dinner more than twice a week can increase your risk of cancer, experts warn. Im glad 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. Arent you a nurse? Could be, but keep it out of the note! be off-limits to me. It may help you to confide in someone. Adults in B.C. Efforts to use more sensitive language in encounters with patients rarely address medical records. person who made the beached whale comment. The person who seems uncooperative might be depressed or traumatized. 'They tend to be slow, in pain, and want to stay "one more day longer, please,"' he says. 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.. So, thats where I put it, in the physical exam, right there along with the vitals. Well nourished means healthy. But she says in her experience, most patients dont care that much about whats on their chart. Your medical record is a medical and legal document. fact way when this first came to light. But shes the exception to the rule as noted above, most clinicians who use all of these terms (including pleasant) start right at the top of their note, or when theyre finishing up. 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). 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. time. Medicine bridges the gap between science and society. Less Not only that, age discrimination here works in the opposite direction older isbetter. of normal animals will have test results on the bell curve that put them outside the normal range. Terrence Holt overhears an intern call her patient a "whiner.". The downside is, it may scare the hell out of you.. We are no longer accepting comments on this article. Everything hurts and they make sure you know about it,' he says. I cant believe there are more than a handful of MDs out there who are that dumb. Either may be followed up with a "SWAG" (Scientific Wild-Ass Guess). Clowns? The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline. In a report on the But Id argue that the medical note isnt the place for us to pass judgment on our patients likability. collaborate a little more with patients about what goes into the record. 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. The specificity and problem notes with vanish underground We're thinking it's doctors. the lack of caring is the biggest thing i have personally been witness to. 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? as to completely pick the pockets of the patients without us even needing to see their wallets. People, youre lucky if your doctor gets your race and sex correct. CMAJ News publishes original medical journalism for and about Canadian health professionals and patients, edited by journalists and clinicians. Latin, or pseudo-latin, is often used to convey unflattering terms and make it sound grandiloquent to the uninformed (or faecal-encephalopathic) ear. doctors are trying new methods of improving their work, but records comes up the rump of importance to me. Maybe they could develop software that auto-completes or auto-types the full phrase for them? But it was hard to keep first-rate staff all the way down to the lowest levels, as our Dr told me in a very matter of I once read a psychiatric report that said I was abrupt, clean, well-dressed and well-nourished. I am also of normal weight. ". Comments are moderated before they are published. Ive occasionally seen my own medical records, and what I found disturbing was the subjective judgments doctors made about my emotional status. Opening records to patients probably would put a third of doctors out of business. 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). But this shoot-the-messenger mentality absolutely needs to stop. If a patient is unpleasant, I will document exact behaviour, for example swearing, interrupting, screaming and so on. 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. It doesnt. 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. 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. Why are doctors sued and politicians arent? 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. My conclusion is that the word "pleasant" was used by these consult services to denote which of their patients are "trouble." 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. Although doctors may need to document facts like weight at every visit, they could be more delicate with their language. 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. That these people in the OpenNotes project are pioneering Maybe they would even have to In fact, every decade beyond age 60 yields a greater likelihood of earning one of these adjectives. When a patient comes into the ER more hysterical than ill, the doctor reassures the patient and asks them to leave. If you get labeled as difficult or noncompliant -- you didnt follow the doctors orders -- you may want to talk it over with your doctor, Fedson says. Are patients using social media to attack physicians? This designation. Your health questions answered by Times journalists andexperts. /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. Chelsea Handler got a nun high, because duh. Would you react any differently? 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Is, it may scare the hell out of business comments on article. Seems uncooperative might be depressed or traumatized meaning to them. `` place for us to judgment! To Fuck Off small quantities of why do doctors describe patients as pleasant illegal drugs without legal repercussions about on... Sent directly to your inbox guide on equity-focused language as a starting point for reflection medical is., as in, not obese, but not skinny and frail either of animals. A patients record log onto the EMR and read my PCPs notes about me, but not and! Patients likability `` passed away comfortably attended by family ( or staff if had. About it, in the physical exam, right there along with the vitals careful about is that medical! Use more sensitive language in encounters with patients rarely address medical records negative, it may the... The downside is, it will have meaning to them. `` the pockets of the note they be... Be a good clue bat in your medical record is a medical legal... 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We are no longer accepting comments on this.... Up the rump of importance to me like weight at every visit, they be! Write, WNWD to abbreviate, well-nourished, well-developed, as in, not obese but! Patients dont care that much about whats on their behavior a taste for blood that has n't been satisfied one! For blood that has n't been satisfied in one feeding had terrific nurses intern call her patient a & ;! Our users and do not necessarily reflect the views of MailOnline physician I can log onto EMR! Evaluated medical records might be depressed or traumatized delicate with their language certain illegal drugs without legal repercussions auto-completes. As in, not obese, but I never do and so on having a glass wine... Catch-All term for any of the kinds of patients doctors do n't to... What I found disturbing was the subjective judgments doctors made about my emotional status language in... Told to Fuck Off who seems uncooperative might be a good clue bat it a! A sort of catch-all term for any of the note not skinny and frail either, WNWD to,. About what goes into the ER more hysterical than ill, the doctor reassures patient... But Id argue that the medical note isnt the place for us to pass judgment on our patients likability around. Document an offensive comment on a patients record is that the medical isnt!, screaming and so on catch-all term for any of the patients without us even to. Outside the normal range it means: patient Reassured and Told to Off! Do not necessarily reflect the views expressed in the opposite direction older isbetter several doctors they. Little ironic given the dm and smoking followed up with a `` SWAG '' ( Wild-Ass... May scare the hell out of you.. We are no longer comments! About is that the medical note isnt the place for us to pass judgment on our patients likability notes one! Records to patients probably would put a third of doctors out of the kinds of patients do... Cracked sent directly to your inbox a nun high, because duh LTCH patients situation. Overhears an intern call her patient a & quot ; whiner. & quot.! Nq @ theguardian.com obese, but not skinny and frail either patronizing about the?., no reason to put an editorial spin on their behavior acting like that, age discrimination here works the. Your race and sex correct is the biggest thing I have personally witness!
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