I am a "very pleasant lady"

[HauntedBungalow]

... according to the consultant who wrote to my GP following an appointment. It says so on the first line of the letter.

I was feeling quite chuffed about this but when I told my cynical piss taking 21 yo son he said it probably meant I was a bit dozy. Surely not!

Does anyone know if "very pleasant lady" means fragrant and nice, or if it means thick?

I've obviously disinherited the son, regardless. (Not so dozy now am I? Twat.)

I saw one of my letters to my GP from my physio after my first appointment. " LilacTurtle is a pleasant woman..." I thought, WTH? I wasn't pleasant, I wasn't unpleasant. It was a medical appointment which was straight forward and matter of fact.

It is amusing when you move practices due to moving cities and ask for a copy of all your notes. I know they are all electronic now but 15 years ago I got them all on paper.

One was slightly annoying. "The appointment was in less than ideal circumstances due to the presence of a toddler who was restless." Well, the toddler wasn't restless until after an hour after my appointment time. You run an hour and a half late, the toddler will struggle. I had to bring them and it wouldn't have been an issue if they had been reasonably on time.

They say that as code for "not a hypochondriac time wasting nightmare"

Do you know what? I think we should all start doing exactly that. I was at the surgery this week waiting for a blood test. Frankly I did not even know my GPs were still working because I have not seen them for 6 years and there are three and they each apparently work 3 half days a week. They have a system where your name is called via an electronic announcement. I have a funny surname and the electronic announcement does not actually pronounce it correctly. Anyway, my GP came storming (no other word for it) into the room and barked at a very elderly gentleman with 2 hearing aids that he had been called already and was now wasting her time. It was pretty fucking obvious he simply had not heard or understood the announcement.

Anyway i went home and said to DH that I HAD finally seen evidence of our GP in the surgery as up till then we were not sure if she was ever physically present.

I'm sure some of my letters could easily say I saw this indomitable old bag in clinic today.

But seriously, I think our past experiences shape our future ones.

I recall my booking in appointment where the midwife needed to see my breasts which I thought was unusual until saw the booking letter that said x had a subtotal thyroidectomy in 1990 and also claims to have had a breast lump surgically removed. It went on to say x claims to have planned this pregnancy. I really wish I'd made a follow up appointment to challenge the letter with the GP and note that it was not my fault the breast surgeon either hadn't written to them or their staff were behind with filing. I miscarried my first baby and recall the GP saying "oh did you want it?".

The kindest way of looking upon things is that some clinicians have no filter and less common sense.

I like the idea of writing one back.

Someone really needs to set up a "trip advisor" style review website for the NHS!

Claims doesn't mean they think you are lying, it's just another way of saying "self reported" so to show the information is coming from the patient rather than from other medical notes.

"tells me" or "told me" or even "said" would be more polite.

@godmum56 indeed and it's a ohrase that would not be acceptable in any other sector.

It’s not formal enough. You have to keep in my mind a £400 an hour barrister could be picking apart what you said in court one day so you err on the side of caution.

I write “pt reports” which is accurate or “complains of” or “pt denies x symptom”. “Pt tells me” sounds wrong when you’ve been trained how to communicate to people professionally in any medical profession, there’s a military like hierarchy the public aren’t always aware of and we have to tip toe around some professions.

Once it was mentioned in a MSK letter that I told him my brother is a physiotherapist. I think it was a not so subtle, ‘She checks everything we say with her brother…’

Pt reports is a lot more police than pt claims. "Claims" has a ring of potential deceit. I am well aware of professional hierarchies and in any other profession the patient would be the client and therefore worthy of respect because you need them to pay the bill. I think clinicians forget that the patient has already paid the bill, albeit indirectly.

My barrister dh would never, ever be discourteous to a client because business would dry up.

🤷🏻‍♀️ That’s how we do it, it’s working for us and we all know what we mean when we read a letter off another profession this way.

If I had a letter off someone saying “pt tells me” I’d think it unprofessional and too informal.

Recently a lot of referrals off Drs just state the symptoms and rough duration they’ve been happening. You can tell they haven’t got time.

Yes they do but they say gentleman. Which is better than one letter I saw from the 1960’s in a patients paper file that described a perfectly normal man I’d just treated as a “tall, thin gentleman of below average intelligence”. Harsh.

I am frequently embarrassed at how some of my NHS colleagues speak to patients. I want to say, why did you choose this job if you dislike people so much??

I would never say ‘claims’. Of course it implies somebody isn’t telling the truth. I used to advise my junior doctors not to, when they wrote ‘patient denies having x/y’ because again it looked like they were saying the patient wasn’t being honest. Words really matter.

Decades ago when professionals wrote each other letters it was fine to use jargon that they all understood and which gave words a meaning they don't have in standard English. Now that patients are routinely copied into correspondence surely it makes sense to write in something much more like plain English. I agree with others that 'patient claims to have had a bad back for several years' makes it sound like the starting point is to assume that patient is lying. Mentally I'm already supplying the 'and yet patient has supported himself by working as a painter and decorator throughout this period!'

I'm with @taxguru, though, in wondering why these referral letters are even necessary now, even if despatched by email rather than posted. I was very pleased to see when last at an Urgent Care Centre that the X-ray department attached to Urgent Care and the ED was sending the x-rays through by email. This shouldn't have been surprising in 2023, but we're always hearing how bad the NHS IT systems are. Why on earth can't information be shared between health professionals by using a common electronic records system that each HCP updates as necessary? This is what the rest of the world does already, and has done for decades. There can be hardly any patients left now* who don't routinely use a mobile phone so appointments could be sent by text rather than letter (as was done for my COVID vaccination appointments - so much more efficient).

*My mother is one, but she's nearly 92 and an outlier even amongst her friends and neighbours of a similar age. The vast majority of them are on WhatsApp, Facebook etc and can send and receive texts and emails.

I have been a consultant for many years and I am perfectly happy to write that Ms X stated that, reported that, said that, felt, discussed etc etc. Plenty of other words to use.

Actually I think referral letters from GPs are a thing of the past in most places and specialties. Usually it's a tick box electronic form and a cut and paste of the last consultation notes that I get.

Secondary care Drs do still write letters back though. I am under no illusion that GPs actually read them. I have a clear medication and Plan section and bold anything the GP needs to action. GPs don't have time to read a huge missive.

We can't necessarily see each other's notes though. Hospitals usually don't have the same electronic notes systems as GPs and even if they do sharing consents between organisations often mean we still can't see what GPs write and they can't see hospital notes hence letters and referral forms still existing.

My letters are all the notes I will write for a consultation so they are for me next time, the patient, anyone else seeing the patient in future and arse covering medico legal reasons. It's quite an art to cover all bases.

Forms of words like 'complains of' and 'denied' are just how we've been taught since medical school to say things and practiced for years and it's hard to change such habits and traditions. I expect lawyers and others have similar conventions too.

My doctor friend told me they write it on every letter, UNLESS the person is a bit batshit. 😂😂😂

As others have said, in mental health these letters are written to the patient now as patients have full access to their mental health notes on request. As mental health assessments in secondary care are often several hours long and take a history going all the way back to childhood-plus are definitely going be read by other professionals, it can be quite an art form to compose a letter that a) reassures the patient that I listened to them about their relationship with their brother in 1963 b) doesn’t annoy them too much by going into too much detail from information they didn’t tell me (from notes, GP referral, A&E etc) and is c) medically actually useful! Plus, I have to include a mental state exam which really can be a character assassination, if not careful.

All in all, these letters are a bit of a minefield and can take hours to write.
Part of me misses the old days when we wrote letters to other professionals full of jargon, but honestly this is better and gives patients so much more information and control in a speciality which doesn’t have the best record of that. Those letters were quicker though.

I think it is true that GPs do not necessarily read letters from consultants.

My Ds was diagnosed with ADHD and the psychiatrist wrote to our GP a total of 5 times to the GP about a shared care plan with no response. When we ran out of medication and I was standing in front of the receptionist saying 'what is going on?' the GP said 'wtaf are you talking about?'(It was Christmas eve) and our psychiatrist went bat shit crazy and not only called the GP, but then rang me and had a massive rant about the fact she had been writing with no response at that point for 9 months. She also said to me 'You need a new GP, is what you need'. Which I expect is pretty strong for one HC professional to say to a patient about another.

My most recent one was “I saw this intelligent lady” - is that sarcasm or did the consultant think I am intelligent?

Mother after my own heart.

Feeling cute generous, might put the kids up for adoption later. I dunno.

DH just reminded me of a letter his urologist sent to the GP. “On examination the genitalia were unremarkable”. UNREMARKABLE!!!! Oh the shame ….. 😂