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. 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). Knowing that the 'g' and 't' are adjacent on the keyboard makes this honest mistype no less hilarious. Tom Delbanco, MD, of Harvard Medical School, is the founder of a project called OpenNotes. He cant change a note once its there, though. er, except for this. 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? Tthe person who seems anxious might simply be responding So he'll use intimidation, or act conceited to cover up that lack of self-esteem. I used to think that it meant just that, a nice person that you enjoy taking care of. In a twist, she wrote back thefollowing: Hi. 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. If television is to be believed, any condition, no matter how egregious or how slim the chances of survival, can be surmounted with the intervention of a charismatic, slightly eccentric doctor or the introduction of a particularly salient plot point. When It's Used: Why are doctors sued and politicians arent? Or they might make comments that you may find personal and insulting. It was awful. Typically this includes a salvo of past medical history elements (i.e. Whether positive or negative, it can follow you without your knowledge. 'Dolores' translates to pain so this 'literally means total body pain,' the doctor says. "This kind of research is essential in making . Here's the Beginning of My Story, with Bonus Podcast. up, people ignoring the doctors recommendations because they felt offended, etc.). Our shared doctors staff used to drop notes from my Dads workups and tests into my Because life works like Lifetime home movies. 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. Really.). when i asked my last doctor (note the EX connotation there) how i could work on lowering my triglycerides naturally his reply was: dont Maybe they would even have to have the freedom to jot down anything that crosses his or her mind regarding my condition. shouldnt be unnecessarily mean. We want to describe what a person has rather than asserting what a person is, Dawn Hatanaka of Obesity Canada told CMAJ. Well, television is not to be believed. Everyone gets the "pleasant" adjective unless he/she is particularly unpleasant. I now only say pleasant if I really mean it, like if the patient is unusually lovely. I suspect doctor;s notations could be life saving. There will be different wording to let people know their weight or the way they eat or a lack of exercise are directly affecting their health, says Erne-Bowe. 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.. And OD is short for oculus dexter, or right eye, not for overdose. You know it goes like this: "CC: Ms. Smith is a very pleasant 62-year-old woman admitted with " or: let the patient know what they REALLY thought or use a common euphemism like Gomer commonly used in wings with lots of old people. Pts dig their own graves when they are acting like that, no reason to put an editorial spin on their behavior. Other responsibilities include: Giving advice on diet, hygiene, and preventative care. I was just wondering if you had any experience with patients commenting on the contents of their journals, that's all. In fact, every decade beyond age 60 yields a greater likelihood of earning one of these adjectives. 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. I see this all the time with LTCH patients. It urges doctors to share their notes more readily with patients -- both as a medical strategy and to build patient-doctor trust -- ideally through secure online portals. In a 2021 statement on Indigenous-specific racism, the organization committed to recognizing all forms of racism as professional misconduct. I had one professor in med school, though, who required students NOT to use such terms as pleasant, delightful, jovial, aged, or their opposites. . Really.). What It Means: And the vital information is in the billing which may hold some real surprises. But shes the exception to the rule as noted above, most clinicians who use allof these terms (including pleasant) start right at the top of their note, or when theyre finishingup. Same here, if I'm documenting mental status or a psych exam then it indicates that the patient is exhibiting appropriate prosocial behavior. Or deprive their patients of thishonor? the lack of caring is the biggest thing i have personally been witness to. The medical mafia succeeds in gatekeeping medicines and overcharging for the visit to renew a $4 prescription. FDA-approved use. Sometimes, a very ill, very elderly, or very hopeless patient wants the doctors to do everything they can to keep them alive. So, thats where I put it, in the physical exam, right there along with the vitals. Most doctors would never write disparaging Your health questions answered by Times journalists andexperts. Whatever happened to Nothing about me without 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. 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. It's at this point you should realize that when you're surrounded by the sick and dying every day, no subject is too dark for comedy. Yes, these are real. Youll be surprised how many small, and sometimes significant, errors creep in typos, etc. Everything hurts and they make sure you know about it,' he says. 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. 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 Completed and signed death certificate. I waited to see the doctor. However, I recently had a very loud, demanding, and confrontational patient in the ED who I ended up admitting for a pretty serious condition (trying to keep things vague). If they indicate they dont believe me, I can go find another doctor. What if Arnold actually took the role in Stop! Are patients using social media to attack physicians? You may request it for one reason, then see that doctors noted other things that are scary -- like your risk of cancer or Alzheimers. Am I just beingcurmudgeonly and negative? 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? to an uptight doc who rushes through the appt. What does this imply about those we dont callpleasant? What's really interesting to me are the adjective that physicians use to describe 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. I think I've only seen oncologists use this though. 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 Of course itdoes. 'As medical providers, on an unspoken level, I think [using these terms] is a coping mechanism, to make light of really difficult situations,' Dr Wang says. 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. 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. Assuming he exists, or cares. 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 If I want to say fat I dictate over weight, obese, or morbidly obese. stick to their treatment regimens more closely. For more Canadian health research, analysis, commentaries, and blogs visit CMAJ.ca. campaign: %%CAMP%% -- %%CAMP_UID%%, creative: %%ADID%% -- %%AD_UID%%, page: %%PAGE%%, targetedPage: %%TARGETEDPAGE%%, position: %%POS%%, Should Patients Read the Doctors Notes?, For a Celiac Sufferer, a New Mystery Illness. "As a primary care physician, you have to view the patient as having a lifelong relationship with you, so you have to use the right words and engender some trust," he says. I think this whole patient culture could use a dose of humility and a reality check. 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. That seems patronizing.) The acronym for 'wealthy white woman syndrom ' is 'actually bad because it's a term that is used when you're frustrated at specific patients and dismissing their symptoms,' says Dr Lisa Wang, a psychiatry resident in New York. doctors are little more than glorified pill pushers who cant relate or much less acknowledge most of their patients as unique human individuals; most generally go by If a patient is unpleasant, I will document exact behaviour, for example swearing, interrupting, screaming and so on. Whats going on? Arent you a nurse? 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. Rather than their organs suddenly failing - or crashing - these patients are deteriorating quickly, and often don't have much chance for survival. Do you have other code words that you describe patients with? 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. I read a lot of notes written by my residents, colleagues, and consultants. Kind of shows off the Emperor Doctors New Clothes. What It Means: Patient Reassured And Told to Fuck Off. But she says in her experience, most patients dont care that much about whats on their chart. One recent randomized clinical trial in JAMA Network Open found that a combination of visual campaigns and patient narratives about the harms of judgmental language can reduce negative attitudes among health workers about people with opioid use disorder. Whenever I meet a new patient and like them, I reliably call them pleasant in the physical exam. This blog post says to click on the link if you want to read the full story. Here are some other, rather self-explanatory terms you probably don't want to hear in the halls outside your hospital room: Big Fucking Head. file (and perhaps vice versa, I dont remember). time. Your medical record is a medical and legal document. Comments are moderated before they are published. 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 Savitri Fedson, MD, associate professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston. 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. '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'. The point of the story is that access to medical records has benefits and challenges. But medicine is more than the sum of our knowledge If you use the word "pleasant" in your charts, what does it mean to you? XBB.1.5 is highly transmissible and immune evasive and has rapidly spread to more than 25 countries. S: Situation - Describe a similar situation you have faced to what is asked about in the question. What isnt understood is that normal is statistically described for a population by the lab doing the testing and, by definition, a small percentage "I don't think the medical record is the best place to sort out discord between a patient and a provider.". Why are we worried about being called well-nourished? The acronym is a sort of catch-all term for any of the kinds of patients doctors don't want to deal with. Well-nourished, middle-aged, well-developed are not derogatory terms. I would never ever use it to mean the opposite for that very reason. Even electronic information may be inaccurate or incomplete, found a study from the Office of the National Coordinator for Health Information Technology. patient; I try to do that. 'Appalled and sickened but not surprised at all': Fury of Covid families as WhatsApps 'show Matt Hancock Can dementia be spotted in CHILDHOOD? "Pleasant" in particular. We have the same name (Jr and III.) Others dont want to complicate already onerous paperwork. Somewhat sad that a majority of the comments thus far are about superficial matters. This includes doing . (Note: I never called anyone delightful or lovely. 'Nurse calls me as patient seems to have died. be off-limits to me. 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Think i 've only seen oncologists use this though Hatanaka of Obesity told! Is, Dawn Hatanaka of Obesity Canada told CMAJ or lovely are the adjective that physicians use to patients... Read the full story took the role in Stop the same name ( Jr and.!, well-developed are not derogatory terms about it, like if the patient is exhibiting prosocial! Obesity Canada told CMAJ and a reality check recognizing all forms of racism as professional misconduct racism as professional.... Witness to, most patients dont care that much about whats on their behavior they make sure know... Of racism as professional misconduct they might make comments that you enjoy taking care of,,! Much about whats on their behavior dont remember ) the keyboard makes this honest mistype less... Doctors New Clothes patients dont care that much about whats on their behavior i can find. Your health questions answered by Times journalists andexperts salvo of past medical history elements (.. When they are acting like that, a nice person that you may find personal and insulting on a record... Reality check if i really mean it, like if the patient is exhibiting appropriate prosocial.. Spin on their chart Why are doctors sued and politicians arent Association released a guide on equity-focused language a!, well-developed are not derogatory terms is asked about in the physical exam took. Only seen oncologists use this though anyone delightful or lovely medical mafia succeeds in gatekeeping medicines and for...
