To wonder why doctors always refer to a patient as pleasant

[Beatinghearts]

I find it strange these nothing particularly pleasant about me. I’m polite but not overly so.

I got "this pleasant well informed lawyer" recently. Doesnt take much to crack that code

DP got 'pleasant chap' even though usually he's as stubborn as anything.

I am a psychiatrist and the exact words you use to describe someone's demeanour in psychiatry are actually an important part of the mental state examination. I do use pleasant, but only if the person evoked a certain reaction in me, ie a pleasant feeling.

Massively worth mentioning. Lots of these phrases seem odd when there is nothing noteworthy but are understandable if you think of the reverse. For example average height, seems odd but that may mean they don't suspect growth difficulties and some conditions would have impacts on growth and height might impact on certain treatments and conditions. If someone was very tall or very small then it would need to be documented, and you are then just making a comment that you have checked that (even if the result was bland!)

Its the same as you might record someone has normal blood pressure, to show you considered that and the result was unremarkable.

Appropriately dressed and well kempt is a good example of this. The opposite would give you cause for concern, if they aren't appropriately dressed that might be due to mental health concerns, memory concerns risks of self neglect, poor housing etc. Its important to note that those warning signs weren't present as it would be to note if they are

Part difficulty is that doctors can be asked questions about the appointment much later when they can't remember the patient at all, both if the patient returns, by other consultants but also in investigations, inquests and coroners hearing.

If someone asks if you were concerned about self neglect, its very hard to explain why you weren't without that "appropriately dressed" bit. If there is a note about being clean, then you would be able to say that as part of your reasoning.

Equally if you are asked a year later in court how someone was in an appointment 12 months ago, pleasant gives you something to go off

I know some places use colour codes on the notes eg yellow for rude.

Come to think of it, a social worker once wrote she was "sick of" me. I was 17 and had been assigned to her for counselling after being drugged and raped. The notes came up later in a court case. I don't think they'd write that any more though undoubtedly they feel it!

@AllTheUsernamesAreAlreadyTaken

Where are you getting these letters from? Do you get sent copies automatically or are you accessing them through freedom of information?

For me it sometimes helps to bring a new doctor or surgeon up to date at a first appointment. I have three current conditions, being treated at five different hospitals and they can’t always see records. Being able to show the surgeon giving me a second opinion the last letter from the original surgeon helped him to grasp exactly what was going on. I also have a couple of files with the letters stored in to ensure that that nothing is missed.

@ShowOfHands the ‘blue of eye’ phrase reminds me of some of the descriptions of my Grandad noted on his army records from WWII. I must dig them out again.

One of my husband’s letter’s was hugely effusive- think he had extremely pleasant/charming. He is very good at talking though so they probably had quite a fun appointment. I think I had distressed and irritable in my post natal notes for my first😂 essentially my baby wasn’t feeding and I was getting no help while being stuck on post natal for what felt like an eternity so not really a surprise.

Apologies that was meant to quote someone who was asking why it would be important.

Lots of these observations can be as important as blood pressure etc. Handedness impacts function, so its important to know if you are doing anything related to upper limbs including neurology type stuff

Comments about speaking English at home, might be to clue people in that the language is their second and they might need some communication checking, equally its probably important developmentally as kids who speak second languages can appear "behind" in one when they are not

Hand dominance - Neurologists / Orthopeadics
Clothes - Mental Health Team
Employment - Neurologists or Dermatologist (I work outside)

Always delightful, pleasant, or charming.

I’ve no experience of this personally, but it strikes me as odd and unprofessional. A throwback to a very different relationship with patients, that I would be very uncomfortable with.

Dear James,
Thank you for agreeing to see this miserable, fat old goat who complains about everything. They have nothing better to do that scour random websites to contradict my clinical advice, so I would be grateful if you could reinforce they are a whingeing hypochondriac.

Your Aye
Michael.

Just feels a bit less acceptable somehow.

@Natsku

Slightly disappointed they don't write things like that here in Finland, just the medical stuff (though its often noted that 'patient is stressed' in my notes) but for some reason with my children they always write down that they speak English at home, not sure of the medical relevance of that.

IME (Germany in my case but I think the attitudes are quite similar) it's the slight - suspicion is not quite the right word - significance put on anything other than monolingualism in very monolingual cultures. It's 'inclusion of a life circumstance which is not the norm', iyswim.

Ah, I did wonder, Ceeceebloomingdale! My sarcasmometer isn't great first thing in the morning

We received a letter from a consultant about a pleasant gentleman and we all said " really?" as he was anything but to the surgery staff.

We've also received consultant letters about "this patient" about someone who can be difficult.

Basically you just need some stock phrases that when your manager, gmc, inquest, pals department etc asks you possibly years later what that persons demeanour was that you have an answer

@Minthambug

Apologies that was meant to quote someone who was asking why it would be important.

Lots of these observations can be as important as blood pressure etc. Handedness impacts function, so its important to know if you are doing anything related to upper limbs including neurology type stuff

Comments about speaking English at home, might be to clue people in that the language is their second and they might need some communication checking, equally its probably important developmentally as kids who speak second languages can appear "behind" in one when they are not

And yes to the last paragraph of this, though these ideas sometimes stem from a misunderstanding of what bilingualism is (there isn' actually a second language, but two first ones).

I've been described as pleasant and on one occassion interesting - I suspect the latter was not a compliment!!

I've seen some medical letters in my job and I've seen

• Mystifying
• Charming
• Determined
• Informed
• Quiet
• Vociferous
• She was unusually well informed on the variety of ailments she reported. (I suspected from this last it was some kind of code for suspected Munchausen )

@Welshmaenad

It's just doctorese that indicates you aren't an arsehole and you've never told them they should say thanks to patients for paying their wages.

My consultant described me as "determined" in a recent write up. He loves me really, he just knows me very well!

"Determined" made me lol

My daughter (3) has been described by nursery staff in this way. I know exactly what they mean

@LemonRoses that really made me laugh 😆

@TheKeatingFive completely disagree that it’s unprofessional. As mentioned up thread it’s a legitimate aspect of the mental state examination. Not just relevant in MH settings, a MSE can be helpful in many areas and most medics should be able to complete a basic one. It’s our job to notice these details.

*an MSE

After giving birth to my daughter, I had to stay in for observation for 48 hours.
After 48 hours and being told all was well, I just needed the sign off from a doctor, I packed up the room, stripped the bedding and folded it neatly.
My husband came to visit/ collect me and walked past a huddle of midwives and overheard “oh she’s made it perfectly clear she’s ready to go home. She’s stripped her bed and cleaned the en suite!”
He knew who they’d be talking about before he opened my door 😂😂

I worked in the NHS pre strict data protection I once read a letter that started, "you will not thank me for sending you this patient"

Pleasant - not an arsehole and the referral is appropriate.

"This famous actress" I've seen once - code for "ask her about her career and she will be nice as pie"

There are other medical 'shorthand' that is mainly dropped from written communications but still exists in hospitals.

If you ever hear, "Transferred to ward 13" it means the patient has died, 'ward 13' is code for the morgue.

I actually think that's quite sensible, on a ward you may have several HCPs visiting to take blood, perform tests or even deliver mail. It gets the message across and if 3-4 people have come looking for the same patient it doesn't sound like 3-4 people have died.

Less common and never written these days NFN - normal for Norfolk and FUBAR - f*ed up beyond all recognition.

DH was once described as "this charming gentleman geologist who was mobile without a stick". He was 65 at the time and it was a post blood cancer follow up appointment - so not orthopedics or something like that.
We still laugh about it now and as we're getting older we make jokes to each other when we're struggling physically with a task saying "Oh well at least you're still mobile without a stick!"

@recklessgran

DH was once described as "this charming gentleman geologist who was mobile without a stick". He was 65 at the time and it was a post blood cancer follow up appointment - so not orthopedics or something like that. We still laugh about it now and as we're getting older we make jokes to each other when we're struggling physically with a task saying "Oh well at least you're still mobile without a stick!"

😂

They are being polite.