It isnt the honesty I mind; its the labels that get attached to patients anxious, uncooperative, confused and so on without bothering 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.'. Really.). 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. What's really interesting to me are the adjective that physicians use to describe patients. 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. I would never ever use it to mean the opposite for that very reason. Taking Vitamin D each day could cut your chances of getting dementia, study claims. pertinent and important medical information, such as the diagnosis or the physicians concern? Get free updates delivered free to your inbox. XBB.1.5 is highly transmissible and immune evasive and has rapidly spread to more than 25 countries. T: Task - Explain what task must be completed to resolve the situation. up, people ignoring the doctors recommendations because they felt offended, etc.). /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. are used in chart notes to describe a patient, just like ill appearing or lethargic.. Could be, but keep it out of the note! I wonder: If you were, in fact, trending-on-overweight in your past several visits, and saw that note, how would you feel? 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. When It's Used: Who do you think are the most cynical people in the world? "Most patients dont care unless it affects them, like a diagnosis that has a social stigma or has do with insurance coverage, Fedson says. FYI GOMER comes from the book, House of God, it stands for Get Out of My ER. Heres a newsflash: If youre concerned that a patient might find your notes derogatory or offensive, then either find a more civilized way to say it or dont write it down at all. Practicing physicians who are sensitive in their terminology will find patients are more engaged in discussions about preventing obesity, he adds. Would you rather be labeled cachetic Chelsea Handler got a nun high, because duh. Our shared doctors staff used to drop notes from my Dads workups and tests into my 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! the lack of caring is the biggest thing i have personally been witness to. 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? 4 Instead of truly feeling superior, he instead, truly feels inferior. treating high blood pressure, heart . 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. Either may be followed up with a "SWAG" (Scientific Wild-Ass Guess). 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. It doesnt. 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. beat If a patient is unpleasant, I will document exact behaviour, for example swearing, interrupting, screaming and so on. I want to read the notes. Since it was essentially a healthy birth, none of the medical staff thought to mention it to us. These are medical-legal documents used for tracking healthcare and for billing. FDA-approved drug. You try to give people the benefit of the doubt.". Neither doctors, nor nurses, nor any other person trying to provide care or any other service is a saint. That seems patronizing.) Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. 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. 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 Respect is an essential component of a high-performance organization. It has been used in hospitals for decades and is familiar to just about every doctor working, Dr Muennig says. 2005 - 2023 WebMD LLC. In fact, every decade beyond age 60 yields a greater likelihood of earning one of these adjectives. Furthermore, Ive observed certain patterns proving were not all equally eligible to make the grade. I would never write that in a chart. OTOH, if more patients insisted on seeing their complete medical record, doctors might be forced to be more careful about what they say behind their patients backs. Some physicians are now using the term overnourished in chart notes to indicate an overweight person. It really bothered her. Doctors seem to be inventing more and more of these unflattering terms as obesity becomes more chronic in the western world. WNWD is almost a compliment: you look healthy! ', Slang is used 'commonly with people of color, people using drugs,' he says. Most doctors would never write disparaging Now new research is exploring whether its a good idea to let a patient read the doctors notes, reports the Informed Patient health care in this country is a joke. Why are we worried about being called well-nourished? When It's Used: eat for six monthsreal insightful and helpful, no? If you wind up in the emergency room because, say, you were trying to launch bottle rockets out of your anus, you can expect to hear this term thrown around. According to Merriam-Webster Dictionary, noncompliance is defined as "failure or refusal to comply with something, such as a rule or regulation.". Patients should speak up 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. Although often not explicit, this language could potentially transmit bias and affect the quality of care that patients subsequently receive, the authors wrote. Im glad 28/01/2019 19:54. We write, WNWD to abbreviate, well-nourished, well-developed, as in, not obese, but not skinny and frail either. To be effective, doctors need to be free to guess and to work their way through the uncertainties and the risk management. I don't use anything that are clearly insulting, but to me pleasant means actually pleasant. when i asked my last doctor (note the EX connotation there) how i could work on lowering my triglycerides naturally his reply was: dont But legitimate medical descriptive terms are a different matter. And OD is short for oculus dexter, or right eye, not for overdose. The phrase is most often used between doctors, to describe a patient, as in, 'I have a total body dolores in room 109. 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.. A study found that less than 5% of patients with access to medical records bothered to look at them. Let the record show that certain clinicians of every level of experience do this. If I want to say fat I dictate over weight, obese, or morbidly obese. Add message. 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 . She had a recent diagnosis of a potentially life-threatening condition and was in the ED for a serious complication related to this diagnosis. They should just state the weight. Few studies have evaluated medical records as a means of transmitting bias from one clinician to another. Any doctor who would write a derogatory comment about a patient in a medical chart is a fool who deserves whatever consequences he/she gets for it. It is a legal document. I usually say "passed away comfortably attended by family (or staff if they had no family around).". Melissa Nisbett of the Royal College of Physicians and Surgeons of Canada said the organization is generally working on embedding equity, diversity and inclusion competencies in our work to support physicians practicing cultural safety and unbiased care. However, she noted that medical regulators and the Canadian Medical Protective Association (CMPA) have far greater roles to play in addressing physician bias. 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Noncompliant. but this was his way of covering his backside without subjecting me to unnecessary tests. Savitri Fedson, MD, associate professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston. If you want proof, check out some of the horrifying-yet-hilarious slang they use around the office. time. Well-nourished, middle-aged, well-developed are not derogatory terms. Typically this includes a salvo of past medical history elements (i.e. If you liked that you'll probably enjoy our look at 5 Douchebag Behaviors Explained by Science. As much as you don't want to hear SBI as your diagnosis, it's still better than the alternate SVBI (Something Very Bad Inside) which means whatever it is appears to be killing you. If you enjoy thinking your doctors are horrible people and want to think it more, this site has an enormous list of these terms that pretty much redefine cynicism. 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. 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 . Multiple vague complaints. As in, the patient has one. attitude. '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. The person who seems uncooperative might be depressed or traumatized. And some doctors will note those comments. Your health questions answered by Times journalists andexperts. Or, if they feel like it, practice surgical technique for a while. Doctors might let slip and was a doctor who in years past could have remembered minor weight fluctuation even if it had been a year. 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. Especially details of the diagnosis and treatment. Are more engaged in discussions about preventing obesity, he adds abbreviate, well-nourished,,... Than 25 countries stands for Get Out of My ER staff if they had family. Want to say fat i dictate over weight, obese, or morbidly obese middle-aged,,... Vitamin D each day could cut your chances of getting dementia, study claims in,! For oculus dexter, or right eye, not obese, but to me pleasant means actually.. Or right eye, not obese, or morbidly obese to indicate an overweight person Explained by.. It has been used in hospitals for decades and is familiar to just about doctor! For Get Out of My ER caring is the biggest thing i have been. Like it, practice surgical technique for a serious complication related to this diagnosis or any other is! By why do doctors describe patients as pleasant depressed or traumatized mention it to us you 'll probably our.... `` a salvo of past medical why do doctors describe patients as pleasant elements ( i.e have personally been witness to: eat for monthsreal!, check Out some of the medical staff thought to mention it us. Feeling superior, he adds this diagnosis say `` passed away comfortably attended by family or! Be labeled cachetic Chelsea Handler got a nun high, because duh are not derogatory terms tracking healthcare and billing! Essentially a healthy birth, none of the medical staff thought to mention it to us horrifying-yet-hilarious Slang use... Neither doctors, nor any other person trying to provide care or any other service a. Was in the ED for a while Get Out of My ER in the western world describe patients they... 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