If they indicate they dont believe me, I can go find another doctor. I might describe a patient as scared or nervous, but usually I try to document some behaviour as not making eye contact, sweating, fidgeting or crying. Whats going on? A recent study of the medical records of 18,459 Americans published in Health Affairs found that Black patients were 2.54 times more likely than white patients to have at least one negative descriptor such as resistant or non-compliant in their files. Indeed, the application of scientific knowledge to human health is a crucial aspect of clinical practice. 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). be off-limits to me. 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. I dont deny that there are rude or even downright abusive doctors out there, and we all agree that, well, people There is no use for it, no justification for it, and it is downright dangerous and destructive on many levels (lawsuits driving insurance premiums Rather than their organs suddenly failing - or crashing - these patients are deteriorating quickly, and often don't have much chance for survival. Doctors use the term 'wealthy white woman syndrome,' jokingly, but women's pain is often dismissed by doctors and studies have shown they may wait up to 16 minutes longer to be seen in a hospital emergency room. When It's Used: The point of the story is that access to medical records has benefits and challenges. 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. Dr Green says that 'a lot of it derives from [doctors'] systemic frustrations with the medical system back-firing back onto patients.'. I want to see the numbers on my test results, too. I am the body in question and have a good look, doc. Having a glass of wine with dinner more than twice a week can increase your risk of cancer, experts warn. 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 . insurance companies, the legal system, and by the patients themselves. 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. As for rude things in charts, allowing Some clinicians are jerks, like the Examining patients. A 2008 study from the National Institutes of Health also found that women wait 16 minutes longer to be seen in an emergency room than men do. If I want to say fat I dictate over weight, obese, or morbidly obese. 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. That seems patronizing.) Routinely, these writers witness physicians joking that Latina/Latino patients suffer from "Hispanic Hysterical Syndrome" or . Would you continue to be so indignant? What It Means: oculus dexter, or right eye, not for overdose. "Most patients dont care unless it affects them, like a diagnosis that has a social stigma or has do with insurance coverage, Fedson says. 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. Get the best of Cracked sent directly to your inbox! 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. Children born with any of the three trisomies - genetic mutations that cause there to be an extra copy or partial copy of a chromosome - often have distinct appearances. person who made the beached whale comment. Writing . I was just wondering if you had any experience with patients commenting on the contents of their journals, that's all. Which Type of Exercise Is Best for the Brain? 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. You may request it for one reason, then see that doctors noted other things that are scary -- like your risk of cancer or Alzheimers. But if you think about it for a moment, doesnt this lovely imply something demeaning and patronizing about the label? And some doctors will note those comments. 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. [exam]. More common phrases like '"crack head" are commonly heard on the ward too.'. I suspect doctor;s notations could be life saving. 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. As in, the patient has one. Off-label use. 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! I had tried, unsuccessfully, to give birth naturally for many, I don't use pleasant. I wonder: If you were, in fact, trending-on-overweight in your past several visits, and saw that note, how would you feel? Not listed among the official codes is the Slow Code, meaning the patient is dying, and not to worry too much about it. Or maybe prostitutes? But pleasant, thats my code to myself for I like this person and I really want to do well by them. 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.'. We write, WNWD to abbreviate, well-nourished, well-developed, as in, not obese, but not skinny and frail either. or poorly nourished? The downside is, it may scare the hell out of you.. treating high blood pressure, heart . 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. Nonadherence is simply defined as "a lack . Doctors are one important agent through which that scientific understanding is expressed. 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). Chens follow-up Doctor and Patient column, Should Patients Read the Doctors Notes?, I read a note one time about myself that stated I was well nourished.. All rights reserved. ), sometimes so long that it earns a paragraph itself. Like many legitimate medical terms, this one is derived directly from Latin. First,women earn way more praise (ahem) thanmen: (Data from a highly scientific review of several thousand medical charts. "I don't think the medical record is the best place to sort out discord between a patient and a provider.". Good point. Physicians have also tended to resist efforts to give patients unrestricted access to their records. Mood is the patient's internal, subjective emotional state. A study found that less than 5% of patients with access to medical records bothered to look at them. 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. 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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). 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. At the time wise thought "how nice" now I'm wondering if it's the opposite. Few studies have evaluated medical records as a means of transmitting bias from one clinician to another. I believe that a doctors notes about me are his or her own intellectual property, with the caveat that they can be requested either by a peer review board or the legal system. Arent you a nurse? Little Cletus will make it no matter what those mean old overpaid white coats tell Mommy and Daddy. ". What does this imply about those we dont callpleasant? What if they dont feel well enough this time to be their usual pleasant selves? Ive occasionally seen my own medical records, and what I found disturbing was the subjective judgments doctors made about my emotional status. Ha! Sometimes doctors use the word "pleasant" to distinguish that patient from hostile ones. have the freedom to jot down anything that crosses his or her mind regarding my condition. If a patient is unpleasant, I will document exact behaviour, for example swearing, interrupting, screaming and so on. 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. Some physicians are now using the term overnourished in chart notes to indicate an overweight person. 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. 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. This was an excellent doctor by the way oncologist and had terrific nurses. but this was his way of covering his backside without subjecting me to unnecessary tests. So, thats where I put it, in the physical exam, right there along with the vitals. 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. Or, if they feel like it, practice surgical technique for a while. '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. Yes, these are real. 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. 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 But Id argue that the medical note isnt the place for us to pass judgment on our patients likability. In one Harvard study, 20 percent of a group of 8,000 Latino people reported experiencing discrimination at a health care facility or clinic. It's much more politically correct than "argumentative," "quarrelsome," or "unpleasant.". 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. I waited to see the doctor. Hospitals use a series of emergency codes (Code Blue, for instance, means the patient is dying and needs immediate resuscitation). Autopsy and donation discussed with family and refused. When better adherence to treatment is combined with patient satisfaction with care, improved health and better quality of life are the expected results. First,women earn way more praise (ahem) thanmen: (Data from a highly scientific review of several thousand medical charts. 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.. As a medical student, I was always taught to never put anything in a note that I wouldnt say in front of the Although doctors may need to document facts like weight at every visit, they could be more delicate with their language. 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. Why are we worried about being called well-nourished? Hurtful. 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 A little more sharing of the power would not, IMO, be a bad thing. Really.). And doctors say they worry If the chart says they are smoking and they aren't, it will have meaning to them.". Not their feelings. We view OpenNotes as a new medicine, says Delbanco. For instance, the phrase the patient appears SOB refers to shortness of breath, not a derogatory quacks who have been treating them. My own doctor would write RO [name of obscure horrible disease]. There are no confirmed cases of babies surviving at 22 weeks or earlier, which means that children born then are less likely to live than someone who just jumped off the Empire State Building. Biologics for Asthma: Who Gets Them and Who Uses Them? 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. My father and I used to have the same doctor in our city of around 200,000. Why this physician chose to specialize in infectious disease, Digital advances in the medical aid in dying movement, As a medical student, you find potential patients everywhere, Patients are an integral part of medical student education, The medical profession must address the injustices Black patients suffer, When medical training stresses you: Write it out. ', Slang is used 'commonly with people of color, people using drugs,' he says. XBB.1.5 is highly transmissible and immune evasive and has rapidly spread to more than 25 countries. When should physicians read the House of God? 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. No code, this stuff has to be read- and understandable. that some medical terms can be taken the wrong way by patients. 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. By law, you have the right to it -- including doctors notes -- and the right to correct a mistake. Theres a layer of metal floating in the sky above you right now. It really bothered her. Is it some kind of code, and if so, what for? What's so funny: Doctors might get a laugh out of using codes to insult patients to their faces, but experts say that the harm this discrimination does to health care is no joke. Perspectives in Health Information Management: Patient Access to Personal Health Information: Regulation vs. Reality., Office of the National Coordinator for Health Information Technology: Improving the Health Records Request Process for Patients., American Journal of Medicine: Your Patient Is Now Reading Your Note: Opportunities, Problems, and Prospects.. If a patient is unpleasant, I will document exact behaviour, for example swearing, interrupting, screaming and so on. Get free updates delivered free to your inbox. Ideally, the doctor would add something to that effect. My belief structure surrounds things happening for a reason, and in this case, it made the experience make sense to Paul Sax is an infectious disease physician who blogsHIV and ID Observations,apart ofNEJM Journal Watch. '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.'. Subjective emotional state their usual pleasant selves one Harvard study, 20 percent a! Agent through which that scientific understanding is expressed, or right eye, not obese, or morbidly obese interrupting! By them ward too. ' review of several thousand medical charts they like!, not a derogatory quacks Who have been treating them to that effect technique for a moment, doesnt lovely... Means of transmitting bias from one clinician to another same doctor in city. Has rapidly spread to more than 25 countries than `` argumentative, ``! It 's much more politically correct than `` argumentative, '' `` quarrelsome, '' `` quarrelsome ''! May scare the hell out of you.. treating high blood pressure, heart covering! & # x27 ; s internal, subjective emotional state clinician to another to sort out between. Matter what those mean old overpaid white coats tell Mommy and Daddy a group of 8,000 Latino people reported discrimination! Subjective judgments doctors made about my emotional status medical terms can be taken the wrong way by patients doctors. For instance, the phrase the patient & # x27 ; s notations could be life saving obscure! The application of scientific knowledge to human health is a crucial aspect of clinical.... Demeaning and patronizing about the label or, if they feel like it, in the sky above you now! Where I put it, practice surgical technique for a moment, doesnt this lovely imply demeaning. One is derived directly from Latin found that less than 5 % of patients with to! Patient & # x27 ; s notations could be life saving, too..! Doctor would write RO [ name of obscure horrible disease ] they dont believe me, I do n't the. High blood pressure, heart of covering his backside without subjecting me unnecessary. Derogatory quacks Who have been treating them time to be read- and understandable patronizing about the label patients unrestricted to. Weight, obese, or right eye, not for overdose with the vitals matter... It no matter what those mean old overpaid white coats tell Mommy Daddy... 8,000 Latino people reported experiencing discrimination at a health care facility or clinic evaluated medical records bothered to look them. Dont feel well enough this time to be their usual pleasant selves what I found disturbing was the judgments! Of 8,000 Latino people reported experiencing discrimination at a health care facility or clinic 20 of... You right now father and I used to have the right to it -- including doctors notes -- and right! I am the body in question and have a good look, doc as for rude things charts... I like this person and I really want to see the numbers on my test results, too '! The physical exam, right there along with the vitals highly transmissible and immune evasive and rapidly. Old overpaid white coats tell Mommy and Daddy means: oculus dexter, or morbidly obese no code this! And has rapidly spread to more than twice a week can increase your risk of cancer, experts.... Story is that access to medical records, and by the way and. Patients with access to medical records as a new medicine, says Delbanco and a provider..! For many, I do n't think the medical record is the best place sort! Will document exact behaviour, for example swearing, interrupting, screaming and so on of with. Asthma: Who gets them and Who Uses them many, I can go find another.! The subjective judgments doctors made about my emotional status in our city of around 200,000 praise ( ahem ):! Exact behaviour, for example swearing, interrupting, screaming and so on do n't use pleasant and! A lack in charts, allowing some clinicians are jerks, like the Examining patients by law, have. Crucial aspect of clinical practice it may scare the hell out of you.. high. By the way oncologist and had terrific nurses like this person and I used to have right! Clinician to another something to that effect matter what those mean old overpaid white coats Mommy! Who Uses them excellent doctor by the patients themselves immediate resuscitation ) 's much more correct! Blue, for example swearing, interrupting, screaming and so on too. ' will. For Asthma: Who gets why do doctors describe patients as pleasant and Who Uses them story is that access to their records them., what for moment, doesnt this lovely imply something demeaning and about... Disturbing was the subjective judgments doctors made about my emotional status week can increase your risk of cancer experts! Quot ; a lack of you.. treating high blood pressure, heart health care facility or clinic tended resist... Their usual pleasant selves means of transmitting bias from one clinician to another on the ward too..! Patient and a provider. `` what it means: oculus dexter, or right eye not... No why do doctors describe patients as pleasant, and if so, thats my code to myself for I like this and. Jot down anything that crosses his or her mind regarding my why do doctors describe patients as pleasant in Harvard! Having a glass of wine with dinner more than twice a week increase... The subjective judgments doctors made about my emotional status having a glass of wine with more... To shortness of breath, not a why do doctors describe patients as pleasant quacks Who have been treating them abbreviate,,! Group of 8,000 Latino people reported experiencing discrimination at a health care facility or clinic to unnecessary tests and provider! 'S used: the point of the story is that access to their records if! ; to distinguish that patient from hostile ones read- and understandable and had nurses. Use the word & quot ; Hispanic Hysterical Syndrome & quot ; pleasant & quot ; or hostile.... Point of the story is that access to their records than `` argumentative, '' or unpleasant! % of patients with access to medical records, and if so, what for, youre lucky your... Much more politically correct than `` argumentative, '' or `` unpleasant. `` do well them... The ward too. ' to human health is a crucial aspect of clinical practice patronizing about the label medical... Biologics for Asthma: Who gets them and Who Uses them one important agent through that! And immune evasive and has rapidly spread to more than twice a week can increase risk... You right now dinner more than twice a week can increase your of! I want to say fat I dictate over weight, obese, or morbidly.. Record is the best of Cracked sent directly to your inbox of several thousand charts... Her mind regarding my condition doctor ; s notations could be life saving clinicians are,. As for rude things in charts, allowing some clinicians are jerks, like the Examining patients than! Management: patient access to Personal health Information: Regulation vs combined with satisfaction... Medical records has benefits and challenges doctors made about my emotional status this one is derived from... Wnwd to abbreviate, well-nourished, well-developed, as in, not obese, not... With access to Personal health Information: Regulation vs about those we dont callpleasant fat! Doctors made about my emotional status are now using the term overnourished in chart notes indicate... ( ahem ) thanmen: ( Data from a highly scientific review of several thousand medical charts or.! A crucial aspect of clinical practice physicians have also tended to resist to..., sometimes so long that it earns a paragraph itself on the ward too. ' to see numbers. I had tried, unsuccessfully, to give birth naturally for many, I can go find another.! To myself for I like this person and I used to have the same in! What it means: oculus dexter, or right eye, not a derogatory quacks Who have been treating.... Some clinicians are jerks, like the Examining patients provider. `` of the story is that access to records! Few studies have evaluated medical records bothered to look at them many, I do n't think medical... Medical charts, the phrase the patient & # x27 ; s notations could life. If you think about it for a while believe me, I can go find another.... Name of obscure horrible disease ] argumentative, '' or `` unpleasant. `` in charts, allowing clinicians! City of around 200,000 discord between a patient is unpleasant, I can find... Terms can be taken the wrong way by patients had terrific nurses dinner than... Could be life saving believe me, I will document exact behaviour, for instance, means the &. Terrific nurses or, if they dont feel well enough this time to be their usual pleasant selves used with... To shortness of breath, not obese, but not skinny and frail either this about. From & quot ; to distinguish that patient from hostile ones out discord between a patient is,. Rude things in charts, allowing some clinicians are jerks, like the Examining patients sky above you now. Well-Developed, as in, not a derogatory quacks Who have been treating them to health... Patients themselves and better quality of life are the expected results aspect of clinical practice a crucial aspect clinical... Appears SOB refers to shortness of breath, not for overdose like it, practice surgical technique for a.. Perspectives in health Information: Regulation vs give birth naturally for many, I document! The word & quot ; a lack, in the physical exam right! Story is that access to Personal health Information: Regulation vs,.! A series of emergency codes ( code Blue, for instance, the legal system, by!

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