To find my report from breast clinic condescending?

[duletty]

I’m 44, had breastfeeding pain for a few months and then found a large lump on the underside of my arm near arm pit.
Gp arranged a quick appointment (was three weeks when usually a two week wait)....
Any way after mammogram and ultrasound they said it was cysts and calcification, so all good.
Got letter today outlining results and it said:
“Saw the this delightful lady in clinic today”......etc etc
I find this language unprofessional and it pissed me off that it was shitty code like a child’s school report.
I have to write reports for EHCPs and use appropriate professional language do it set me on edge.
Am I being precious?

When the NHS is clinically and ethically perfect, perhaps we can give time and attention to this kind of issue.

Change begets change. A more professional approach to patients should be encouraged and would shift attitudes elsewhere. Plus it’s an easy fix compared to many.

A rather old fashioned way of referring to you but is probably intended to alert other doctors that you are a decent human being. It's not professional and personally haven't seen this in years but it wouldn't worry me

When I got discharged from the fracture clinic after breaking my elbow, my letter started "I saw the very pleasant Zingally in clinic today..."

I also just figured it was doctor-speak for "not a total wanker".

I feel sure that if you actually looked into it, it’s far more prevalent with male drs, female patients than the other way around

I don’t know why you feel sure that’s the case when this thread contains many instances of male patients described in exactly the same way. And when a doctor says all medical students are taught to do it.

@zingally

When I got discharged from the fracture clinic after breaking my elbow, my letter started "I saw the very pleasant Zingally in clinic today..."

I also just figured it was doctor-speak for "not a total wanker".

Almost but not really. It’s just a way of the doctor recognising the actual person they consulted as they know they’re going to be reading the letter too.

There’s no hidden code or meaning, some doctors do it and some don’t. It’s been massively overanalysed in this thread. Truth is 99% doctors skim through these letters for the relevant diagnosis and treatment anyway, they don’t care if you’re charm personified or a grumpy arse, their mind is on the medicine. The prose is purely for the patients benefit.

It’s been massively overanalysed in this thread.

How dismissive of those pointing out that they find it inappropriate and unprofessional.

Change begets change. A more professional approach to patients should be encouraged and would shift attitudes elsewhere. Plus it’s an easy fix compared to many.

This is an excellent point. We know we have an issue with medical paternalism and bias affecting access to healthcare and health outcomes in this country - particularly around women’s health but is exists across the spectrum. So why not solve the easy things? Why don’t HCPs look at threads like this and say ‘hey, there’s zero benefit to this practice and actually it might come across like my view on their personality is relevant here. Maybe I’ll stop.’ What is there deeper in the system that is leading HCPs to dismiss (this is just the way it is, it doesn’t mean anything) rather than consider?

The ‘you’re getting it for free [at point of use] so you should just shut up and be grateful’ argument that envelops NHS services is also so odd. It’s applied to nearly no other public service. ‘Listen, I know you’d prefer if the pothole that just broke your axle was filled in, but you’re not paying for it directly and there are worse problems on other roads, so how about you just be grateful there’s a road at all, hmm?’

When the practice is compared to practices in other professions, it has not been over analysed. It has been identified as a practice that is out of step with all other professions and rightly noted that it is antiquated, subjective and potentially judgemental.

If I were dealing with an equality claim and there were documents referred to in witness statements referring to some staff as "this delightful employee" and to some staff as "this employee" it could be evidence that some staff are treated differently to others. There may also be some analysis done around the following:

were a higher percentage of white staff referred to a delightful;
were a higher percentage of heterosexual staff referred to as delighteful;
were a higher percentage of men referrest to as delightful
were a higher percentage of younger people referred to as delightful

It's the sort of thing that matters hugely and increasingly so in a litigious and politically correct society. If the management structures of the NHS don't recognise that when one considers the amount of money the NHS spends on so-called equality and diversity, and it quite extraordinary it is a practice that continues. Apart from being potentially patronising to the patient it is fraught with risk. Equality Impact Assessment anyone?

@JassyRadlett

It’s been massively overanalysed in this thread.

How dismissive of those pointing out that they find it inappropriate and unprofessional.

Fair enough and I’ve read through the posts - hasn’t changed my point of view though.

Fair enough and I’ve read through the posts - hasn’t changed my point of view though.

I’m quite interested to know why you consider it professional?

@JassyRadlett

Fair enough and I’ve read through the posts - hasn’t changed my point of view though.

I’m quite interested to know why you consider it professional?

Where did she say she did? Nothing’s changed my mind either. Professionalism doesn’t come into it, it’s so trivial it doesn’t even register on my radar.

Would people be happy if they knew that patients who are regarded in a negative manner achieve worse outcomes than patients who are seen in a positive light?

Some types of patient are more popular than others. Look at the treatment women in particular receive. Women's pain is more likely to be dismissed than mens. Women who are having a heart attack are more likely to be overlooked. Research has been conducted in these areas.

On the whole, I don't find doctors to be particularly flexible or open minded. They can be very challenging to deal with and their own personal views are more likely to influence treatment than a nurse's individual care for example. Nurses are expected to remain objective however.

I worked in comms for many years - letters should stick to information and never wander into personal opinions that have no direct bearing on the matter in hand.

I find some hospital consultants have struggled to hide their immense irritation with my middle child. He has been the subject of many hospital letters over the years and has never been described as "delightful" "intelligent" and "well-behaved" as my eldest child has.

It's pretty fucking obvious that people find my middle child's disability a bit too challenging. He has received poorer care and had worse outcomes than my eldest child too, which makes me sad and angry in equal measure.

@JassyRadlett I never said it was professional; however I don’t think professionalism and friendliness/social niceties are mutually exclusive.

@MrsBobDylan, I genuinely sorry to hear your sons experience. There’s no doubt that the NHS and it’s staff need education and training on how to deal with situations and patients they will come across. There are some doctors/medical professionals who just don’t have people skills or are utterly incapable of leaving their own prejudice to one side. I used to work with profoundly deaf and blind people and witnessed a side to people I really wish I didn’t know existed.

I still don’t believe that the inclusion of a vaguely personal adjective in a letter is worthy of stamping out when there are a lot of patients who really do appreciate being referred to in that way. This is only common practice because that’s the feedback that was received over time.

That does raise questions about how sincere it is but how many social conventions are offered with true sincerity?

I never said it was professional; however I don’t think professionalism and friendliness/social niceties are mutually exclusive.

I’m all for the social niceties in the right time and the right place.

But it is neither of those things. It is a professional letter from one professional to another about the patient, not to them. Including a description of your opinion of the patient’s demeanour or personality, unless it is relevant to the medical matter, has no benefit for either medical professional and at best a mixed impact on the patient.

This doesn’t take place in isolation. Against a backdrop where we know the opinions of medical professionals on the personalities and backgrounds of their patients affect the care they are offered, people defending a practice where doctors actively comment on their patients’ personalities to other medical professionals is really worrying.

@TigerDroveAgain

My funniest moment was “what sort of law do you do” before even a hello from a consultant - I was Completely fine but a bit old for a first pregnancy and had had ovarian cancer.

His face when I said “clinical negligence “ was a picture. I soon corrected it to something much more boring!

Well, an aside. 10 years ago, a patient turned up in ED with a swollen lower leg, hot, infectious looking. Came in from working in the Middle East.

Their first remark to everyone who'd listen was that their sibling was a DM journalist (you've been warned, people).... But - They may very well have benefitted, long term, from immediate surgical intervention. It was a deep, angry infection, threatening bone, (as ascertained by an MR scan). Which they didn't get, because the potential surgeon went 'Not touching that, given that threat, IV antibiotics only'.

He told me as much.

The bloke continues to come in. His leg is entirely functional but not aesthetic.

Be careful when throwing your 'professional might' around.

It is unnecessary and unprofessional.

IMO there is still and expectation that patients will defer to the drs at all times and not ask annoying questions. this sort of language / letter simply feeds into this.

God forbid you are a woman and dare ask questions about your diagnosis or treatment - the amount of patronising that has gone on when I haven't immediately agreed with the dr and asked for research / more data / information has been an eye opener.

Yes but on that note @miljea I went into labour at 27 weeks and had to explain DH couldn't come straight away because he was in court. Next thing Head midwife at the bedside sympathetically stroking my hand and purring how stressful it must be for me. "Oh not really one gets used to it but it's a bit like being a single parent without money problems". Her jaw dropped. And then the penny dropped and I managed to stammer "he's the prosecution against (household name). And she had the cheek to tell me off for causing concern amongst the staff.

I think it's unprofessional and dated to write such things in medical letters. I once saw in notes 'I met this delightful farmers wife..' and thought WTF has her husbands profession got to do with her medical condition?!

I find it so strange too. my son has had hospital reports saying he is a handsome boy. Like wtf. What's his looks got to do with his medical issues. Would they put hes an ugly boy? So odd.

@yewHedge it is 'nice' but it is very unprofessional.

I’m a nurse and see this all the time in letters and it’s completely unnecessary but pretty much means you are a very pleasant patient and he felt the need to point that out as the majority of people might be pains in the arses he sees .

Or she I would hope ichifanni. Says it all really. I saw Mrs Roses in clinic on x y z.

The letters should, in my opinion:

1. Avoid unnecessary judgements like the patient being "delightful" or not. Then it's inevitable that people in great pain, trauma etc might not come across as delightful and be hurt by the obvious omission of the flattering judgy adjective.

2. If the patient presents in a particular way that needs to be included for medical grounds, do it in a tactful way. NOT "This nervous lady ..." or whatever.

3. Be much briefer and to the point. Only relevant info such as tests, results, diagnoses, treatment, advice etc

4. Not printed on paper and posted, but kept digitally. SECURELY.

5. Patient should have access if they want.

Actually, all the letters are a waste of time and resources. We don't get them after seeing our GP and don't need them after seeing other doctors either.

In other countries with comparable GDP etc, seeing a specialist is far more common, quicker and normalised. Only the NHS acts like God and the population is expected to praise it unquestioningly.

I got a consultant's letter today and I'm very upset that he didn't remark on my delightfulness. I thought I was utterly charming.