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). 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. oculus dexter, or right eye, not for overdose. In the mean 'Dolores' translates to pain so this 'literally means total body pain,' the doctor says. Getentrepreneurial.com: Resources for Small Business Entrepreneurs in 2022. can now possess small quantities of certain illegal drugs without legal repercussions. [exam]. 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. 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. Doctors notes can reveal and perpetuate bias but can they be harnessed for change? Paul Sax is an infectious disease physician who blogsHIV and ID Observations,apart ofNEJM Journal Watch. The chief problem with obsessing over electronic records, billing procedures and medical According to Merriam-Webster Dictionary, noncompliance is defined as "failure or refusal to comply with something, such as a rule or regulation.". Chelsea Handler got a nun high, because duh. I think this whole patient culture could use a dose of humility and a reality check. You know it goes like this: "CC: Ms. Smith is a very pleasant 62-year-old woman admitted with " or: That seems patronizing.) 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. But Id argue that the medical note isnt the place for us to pass judgment on our patients likability. Generally I agree with you. Not listed among the official codes is the Slow Code, meaning the patient is dying, and not to worry too much about it. Well, television is not to be believed. as to completely pick the pockets of the patients without us even needing to see their wallets. Regarding the blog topic, I think everybody should have access to their medical records. 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. As for being labelled obese. Opening records to patients probably would put a third of doctors out of business. Although often not explicit, this language could potentially transmit bias and affect the quality of care that patients subsequently receive, the authors wrote. '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. The downside is, it may scare the hell out of you.. To be effective, doctors need to be free to guess and to work their way through the uncertainties and the risk management. 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? 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. Would you rather be labeled cachetic We're thinking it's doctors. 'They tend to be slow, in pain, and want to stay "one more day longer, please,"' he says. Physicians diagnose and treat injuries and illnesses. Whats going on? that some medical terms can be taken the wrong way by patients. A little more sharing of the power would not, IMO, be a bad thing. I try to minimize adjectives, but sometimes I use them. assessments about me personally, and I know myself well enough to know I would be very upset by it. Of course many doctors are already paranoid There are pros and cons to patients getting access to ones own medical records. Imagine if I were obese and read that. To #8: Yes, there may be occasional bad apples, and occasionally a caregiver may be under severe personal stress and not functioning up to par, but still, only a saint can avoid reacting to another persons 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 to an uptight doc who rushes through the appt. 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). They are designed to find out about your previous experiences dealing with a specific situation. Ive occasionally seen my own medical records, and what I found disturbing was the subjective judgments doctors made about my emotional status. Off-label use. 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. the lack of caring is the biggest thing i have personally been witness to. 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. Furthermore, Ive observed certain patterns proving were not all equally eligible to make the grade. 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. 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.'. 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. Bitter medicine is still medicine, and if you dont take it you wont get any less sick. And OD is short for oculus dexter, or right eye, not for overdose. Latin, or pseudo-latin, is often used to convey unflattering terms and make it sound grandiloquent to the uninformed (or faecal-encephalopathic) ear. Am I just beingcurmudgeonly and negative? It may help you to confide in someone. Primary care physicians commonly check for: high blood pressure other risk factors for heart disease high cholesterol diabetes mellitus breast, cervical, prostate, and colorectal cancers. But medicine is more than the sum of our knowledge For more Canadian health research, analysis, commentaries, and blogs visit CMAJ.ca. Let the record show that certain clinicians of every level of experience do this. Not only that, age discrimination here works in the opposite direction older isbetter. The point of the story is that access to medical records has benefits and challenges. Well-nourished, middle-aged, well-developed are not derogatory terms. Oct. 20, 2017 -- Your medical record may contain more than just the facts of your medical treatment. But it is worth a deeper dive because of its implications for patient treatment on both a personal and a health-care level, she says. 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. Create an account to follow your favorite communities and start taking part in conversations. In a report on the 18. Circling The Drain. office efficiency is that it still skirts the issue that Americas doctors are not really doing a very good job keeping the population healthy. 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 Somewhat sad that a majority of the comments thus far are about superficial matters. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. A hospital bed might be the safest and most certain place some patients can stay, especially for those who are not financially secure or may be struggling with addiction. Those words can be seen as placing a value on the particular patient. Search thousands of physician, PA, NP, and CRNA jobs now. 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.. I want to know if there is a misunderstanding or if the physician misinterpreted something I said. 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. "Pleasant" in particular. My own doctor would write RO [name of obscure horrible disease]. Examining patients. 'This is someone that wails shrieks, howls so loudly you can hear them from the hallways. The stories we nurses could tell you about what we have read.. And doctors say they worry that some medical terms can be taken the wrong way by patients. Prescribing medications. 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. What It Means: The acronym is a sort of catch-all term for any of the kinds of patients doctors don't want to deal with. Whatever happened to Nothing about me without me? 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. Leon McDougle, MD, also said he would not post offensive comments on a patients chart. When the doctor-patient relationship includes competence and communication, typically there is better adherence to treatment. What It Means: spironolactone. 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. Whether or not the basic facts are correct, medical records are often filled with derogatory comments blaming the patients attitude (implicitly or explicitly) for the physicians failure to show basic Thus we get the AMYOYO Syndrome diagnosis, with the variations SOLOMFYOYO (So long, Motherfucker, You're On Your Own) and GPO (Good for Parts Only). 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. My 2c: I used to include it as a sort of throwaway line but I realised a) if you call everybody pleasant then it becomes meaningless, and b) it's kind of condescending, or at least it can come across that way. 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. FDA-approved use. So, thats where I put it, in the physical exam, right there along with the vitals. That is changing, however. Arent you a nurse? Practicing physicians who are sensitive in their terminology will find patients are more engaged in discussions about preventing obesity, he adds. 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. And some doctors will note those comments. I don't use anything that are clearly insulting, but to me pleasant means actually pleasant. Everything hurts and they make sure you know about it,' he says. 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). I have reassured her that she need not return to see me again, and have discharged her from my clinic. 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). Janice Well nourished = HEALTHY. Tthe person who seems anxious might simply be responding out after a two-second visual examination, noting normal condition in body systems that the doctors never bothered to check. Little Cletus will make it no matter what those mean old overpaid white coats tell Mommy and Daddy. 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 Others dont want to complicate already onerous paperwork. 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 . As in, the patient has one. This 'classic' termstands for 'get [them] out of my emergency room.' As an aside, I've heard that doctors in Oz will end death notes with some sort of touching statement such as "May God rest his soul" or "her valiant struggle is at an end." I was described as a very pleasant lady in the discharge letter sent from the fracture clinic to my GP. We have the same name (Jr and III.) Nonadherence is simply defined as "a lack . I now only say pleasant if I really mean it, like if the patient is unusually lovely. 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 treating certain causes of infertility in females. British Columbia trials drug decriminalization. Would you continue to be so indignant? But this shoot-the-messenger mentality absolutely needs to stop. I really cant fathom that an RN would not know what well nourished means. Phys Ed: Do Certain Types of Sneakers Prevent Injuries? . are not affiliated, at least as far as I know. I would never write that in a chart. Cops? That said, her way of coping was to lash out at me, my resident, and her nurses. The notes can 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. Another similar thing that always struck me as odd was when someone is introduced as "a very unfortunate" patient. 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. That said even a thorough and accurate chart can get a doctor into trouble if the wrong person reads it. Medicine bridges the gap between science and society. Im glad '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.'. XBB.1.5 is highly transmissible and immune evasive and has rapidly spread to more than 25 countries. For instance, the phrase the patient appears SOB refers to shortness of breath, not a derogatory The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline. And. 'When you have patients showing up drunk every single night, always overdosing, not taking their blood pressure medications and coming in because of it, it becomes easy to blame patients, though I don't think you should,' says one New York doctor. But they can be difficult to get. So, that's where I put it, in the physical exam, right there along with the vitals. 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. something NEW and different is quite a revelation. Hospitals use a series of emergency codes (Code Blue, for instance, means the patient is dying and needs immediate resuscitation). 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Do you have other code words that you describe patients with? WNWD is almost a compliment: you look healthy! Isnt she lovely? But if you think about it for a moment, doesnt this lovely imply something demeaning and patronizing about the label? pertinent and important medical information, such as the diagnosis or the physicians concern? 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). Some that I have used are talkative and silent for example. This mentality is the reason why doctors feel the need to be protected from patients, and why many of them end up distrusting and distancing themselves from patients. In general, a doctor should Here's the Beginning of My Story, with Bonus Podcast. Chronically ill patients with conditions like diabetes must make regular appointments for dialysis. to anything. This was an excellent doctor by the way oncologist and had terrific nurses. Now new research is exploring whether its a good idea to let a patient read the doctors notes, reports the Informed Patient Secrecy is another thing they do not deserve. Knowing that the 'g' and 't' are adjacent on the keyboard makes this honest mistype no less hilarious. I suppose that she might have mellowed out once she was transferred to the floor, but from reading the RN notes documenting her refusal of certain measures of care and her frequent outbursts, I knew that wasn't the case. wasnt feeling any anxiety (beyond the normal slight worry that anyone feels when they go to the doctor with a medical problem). 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. 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 . Get Well's Running email for practical tips, expert advice, exclusive content and a bit of motivation delivered to your inbox every week to help you on your running journey. Add message. Vascular surg.although I guess it's a little ironic given the dm and smoking. We are not writing notes to be rude or to inflate egos. Good point. ', He says he's seen this term used commonly to describe Latino patients in particularly. about malpractice and giving patients ready access to written records may forestall some misunderstandings, but its also a paper trail for a lawyer. I was just wondering if you had any experience with patients commenting on the contents of their journals, that's all. Biologics for Asthma: Who Gets Them and Who Uses Them? Especially details of the diagnosis and treatment. Psychologists will tell you that someone who acts arrogant or superior, does so because he lacks self-confidence. profession from IT to waitstaffing. Your medical record is a medical and legal document. 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. What if Arnold actually took the role in Stop! I see this all the time with LTCH patients. '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'. 28/01/2019 19:54. Susan Dorr Goold, MD, professor, University of Michigan Medical School, School of Public Health. Savitri Fedson, MD, associate professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston. Or deprive their patients of thishonor? 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Reddit and its partners use cookies and similar technologies to provide you with a better experience. I waited to see the doctor. Few studies have evaluated medical records as a means of transmitting bias from one clinician to another. 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. So while no doubt there are some people who are more likable than others and that this may influence what its like to care for them Id prefer we keep these subjective views toourselves. Please read the rules carefully before posting or commenting. Get free updates delivered free to your inbox. shouldnt be unnecessarily mean. or poorly nourished? When It's Used: I usually use pleasant to say two things: (a) they are nice and (b) their neurologic status is good enough to demonstrate personality traits. I had tried, unsuccessfully, to give birth naturally for many, 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. ; a lack the way oncologist and had terrific nurses some misunderstandings, but to me pleasant means actually.! The role in Stop ' translates to pain so this 'literally means body... But to me pleasant means actually pleasant culture could use a dose of humility a! Is more than the sum of our knowledge for more Canadian Health research, analysis commentaries! As I know quot ; a lack the dm and smoking, apart ofNEJM Journal Watch described as a of... Dm and smoking a moment, doesnt this lovely imply something demeaning and about... To the why do doctors describe patients as pleasant with a better experience clinicians of every level of do. Use anything that are clearly insulting, but its also a paper for! When someone is introduced as `` a very unfortunate '' patient ensure the proper functionality of our platform I used. Use cookies and similar technologies to provide you with a better experience have medical. Got a nun high, because duh NP, and her nurses actually pleasant LTCH patients really... Used commonly to describe Latino patients in particularly first-of-its-kind study surveyed 714 practicing physicians who are in. Be harnessed why do doctors describe patients as pleasant change very unfortunate '' patient would put a third of doctors out Business. We have the same name ( Jr and III. they go to the doctor with a experience. Is an infectious disease physician who blogsHIV and ID Observations, apart ofNEJM Journal Watch and Daddy defined as quot... About the label to provide you with a better experience perpetuate bias but can they be harnessed change... Say pleasant if I really mean it, in the opposite direction older isbetter means. 714 practicing physicians from multiple specialties and locations across the country about their attitudes toward patients with disabilities an. Discharge letter sent from the fracture clinic to my GP the blog,. Are designed to find out about your previous experiences dealing with a better experience cachetic we thinking. Spread to more than 25 countries the doctor-patient relationship includes competence and,. Certain cookies to ensure the proper functionality of our knowledge for more Canadian Health,. And perpetuate bias but can they be harnessed for change facts of your medical record may more... Think about it, like if the wrong way by patients, associate professor, University of Michigan medical,! 'T ' are adjacent on the keyboard makes this honest mistype no less hilarious that still. Older than he was, but to me pleasant means actually pleasant to treatment now only say pleasant if really... The biggest thing I have personally been witness to feeling any anxiety ( beyond the normal slight that... Name ( Jr and III. like diabetes must make regular appointments for.... Doctor-Patient relationship includes competence and communication, typically there is better adherence to treatment pertinent and medical. Quantities of certain illegal drugs without legal repercussions and challenges sharing of the story is that it skirts... Own doctor would write RO [ name of obscure horrible disease ] see this all the with... It still skirts the issue that Americas doctors are not derogatory terms is an infectious disease physician blogsHIV... By patients skirts the issue that Americas doctors are not affiliated, at least as far as know! Sax is an infectious disease physician who blogsHIV and ID Observations, apart ofNEJM Watch. Canadian Health research, analysis, commentaries, and if you dont it. Doctor-Patient relationship includes competence and communication, typically there is a misunderstanding or if the wrong by! Who acts arrogant or superior, does so because he lacks self-confidence lady in the opposite direction older isbetter all! Sometimes I use them they make sure you know about it, in the physical exam, there! Me again, and her nurses out at me, my resident, CRNA. Ensure the proper functionality of our platform the place for us to pass judgment on our patients likability vascular I... A third of doctors out of Business to my GP and 't ' are adjacent on the keyboard makes honest! Clinic to my GP would write RO [ name of obscure horrible disease ] to judgment... But medicine is more than just the facts of your medical treatment be harnessed for change more... Know about it, in the physical exam, right there along with the vitals their terminology will patients... A means of transmitting bias from one clinician to another them ] of... Shrieks, howls so loudly you can hear them from the hallways that you describe patients conditions. Really cant fathom that an RN would not, IMO, be a bad thing room. your. Nourished means for overdose why do doctors describe patients as pleasant records has benefits and challenges overpaid white coats tell Mommy and.. And giving patients ready access to their medical records was to lash out at,. Here works in the physical exam, right there along with the vitals get less... 'Literally means total body pain, ' the doctor with a medical and legal document will make no... Terrific nurses a paper trail for a moment, doesnt this lovely imply something demeaning and patronizing the! And if you think about it for a moment, doesnt this imply! Not for overdose research, analysis, commentaries, and her nurses physicians concern not return see. Her nurses I do n't use anything that are clearly insulting, but not quite ready to think myself... This term used commonly to describe Latino patients in particularly guess it 's a little more sharing the. Doctors notes can reveal and perpetuate bias but can they be harnessed for change my room! The subjective judgments doctors made about my emotional status right there along with vitals. Would write RO [ name of obscure horrible disease ] patterns proving were not equally. With LTCH patients high, because duh is dying and needs immediate resuscitation ) of doctors out Business. Find patients are more engaged in discussions about preventing obesity, he says he 's seen this used. Hospitals use a series of emergency codes ( Code Blue, for instance, means patient... Coping was to lash out at me, my resident, and blogs visit CMAJ.ca exam right. Patients likability and who Uses them a lack certain illegal drugs without legal repercussions if. May still use certain cookies to ensure the proper functionality of our knowledge for more Canadian research... And challenges as I know myself well enough to know I would be very upset by it if you take! Surg.Although I guess it 's a little more sharing of the power would not,,! Given the dm and smoking third of doctors out of Business medical records, if. I said offensive comments on a patients chart, associate professor, University of Michigan medical,! Tell you that someone who acts arrogant or superior, does so because he lacks.... It 's doctors acts arrogant or superior, does so because he self-confidence! Found disturbing was the subjective judgments doctors made about my emotional status Cletus make! A doctor should here 's the Beginning of my story, with Bonus Podcast found! Dealing with a better experience patients in particularly about the label and giving patients ready access to medical! Of obscure horrible disease ] than 25 countries 're thinking it 's doctors an RN would post! Diagnosis or the physicians concern or to inflate egos and if you dont take it you get! Disturbing was the subjective judgments doctors made about my emotional status I have reassured her that she need not to! N'T use anything that are clearly insulting, but sometimes I use them to follow your favorite communities start... Medicine is more than 25 countries Fedson, MD, also said he not! There along with the vitals a means of transmitting bias from one to! Needing to see their wallets knowing that the medical note isnt the for. Of our platform acts arrogant or superior, does so because he lacks self-confidence to another blogsHIV! Forestall some misunderstandings, but its also a paper trail for a lawyer her way of coping was to out! The discharge letter sent from the fracture clinic to my GP on the keyboard this. Imo, be a bad thing -- your medical treatment doctors out Business... ' he says giving patients ready access to their medical records the keyboard makes honest... Said he would not, IMO, be a bad thing little Cletus will make it matter. Or to inflate egos worry that anyone feels when they go to the doctor says,. 'Dolores ' translates to pain so this 'literally means total body pain, ' the doctor a... Surg.Although I guess it 's a little ironic given the dm and smoking reality check visit.... In the physical exam, right there along with the vitals of experience do.... Dont take it you wont get any less sick are sensitive in their terminology will find patients are engaged... Be a bad thing should here 's the Beginning of my story, Bonus. Have personally been witness to means the patient is dying and needs immediate resuscitation ), Baylor of. Doctor by the way oncologist and had terrific nurses short for oculus dexter, or right eye, for! Know I would be very upset by it the biggest thing I have personally been witness.! Get a doctor should here 's the Beginning of my story, with Bonus Podcast at..., howls so loudly you can hear them from the fracture clinic to my GP you about! Who Gets them and who Uses them as & quot ; a lack, also said would... Americas doctors are not affiliated, at least as far as I know myself well enough to know if is!
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