As an attending and the program director in a university practice, I have the opportunity to read a lot of notes that other people have written. Many of these notes are written by residents and fellows, often from my own program. In doing so, I often come across a phrase in the opening line of a note that really irritates me, which might go something like this:
“Mrs. Smith is a very pleasant 54-year old woman who…”
Why does this bother me, you might ask?
- It immediately imparts a connotation in the note that this patient’s symptoms are to be “believed”, as opposed to other, less “pleasant” patients. The doc is probably going to be more inclined to help this patient. I explained to one trainee that I thought it should be changed in her future notes, and I explained why. Her explanation was that it was a “code” for her to remember that the patient was easier to deal with than many other patients she often sees in her practice. You can imagine how I took to that explanation…
- It implies that other patients are less pleasant. This same trainee uses “very pleasant” and “pleasant” in various notes. I sometimes wonder what it means if she doesn’t put either in the note.
- A patient’s consultation or progress note, and for that matter, the opening sentence in such a note, is not meant to be where a doctor imparts their values and judgments on the patient. Pleasantness (or perceived pleasantness) is really the patient’s affect. Therefore this descriptor really belongs best in the exam, if anywhere at all.
Other words are similarly inappropiate in this context; the word that most frequently comes to mind is “unfortunate”.
“Mrs. Smith is an unfortunate 54-year old woman…”
Although it may seem that you are empathizing with the patient, I doubt that a patient would want to actually see a doctor write in their note that they are “unfortunate”. The consequence of their problems may be unfortunate, but not the patient him or herself.
By no means do I intend to say that this issue is confined to trainees; I see the same descriptions among seasoned physicians. My best explanation for this is that no one really ever went over their notes, or that they were just never told to change it. If you find yourself saying this is your own notes, ask yourself why…and consider omitting it next time.