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.

it’s a legitimate aspect of the mental state examination.

I dont think that flies when it’s an odd code, designed to pass on information without the patient understanding the meaning.

Recording whether people are generally coping via by acknowledging external markers. Ok, I get that.

Making comments on their character/demeanour. No, not at all.

@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!"

That reminds me of my cousin's feedback on an airbnb - "lovely old couple". They're in their 50s! The hosts were young 😂

@TheKeatingFive

Demeanor is an important part of presentation though

If you are in pain then its not uncommon that you'd be irritable. Pleasant and engaging (which I frequently see) means that someone was able to follow a conversation etc. Pleasant marks the absence of many things that would be significant

@youvegottenminuteslynn

I'm a "charming right handed woman"

My DH is always some variation on charming/pleasant.

I, however, got “I saw this right-handed lady in my clinic today” from a neurologist. A neurologist I was seeing for migraine.

This annoyed me because he’s a friend of a friend so we bump into each other socially and he knows I AM FUCKING DELIGHTFUL.

My GP was sympathetic and said neurologists always write weird stuff and that all her letters contain the thinly veiled warning she’s a doctor!

I have had to be very straight to the point with numerous consultants and hospitals doctors over the years as so many have been patronising with absolutely zero understanding about my chronic health issues.

I fought to get several different things formally diagnosed as I kept getting fobbed off time after time.

Many, many do not like patients who ask questions. I'm on about simple questions. They seem to prefer patients that will agree with everything and not have an opinion or to actually advocate for their own health.

I am sure they have some lovely codewords for me! All because I got fed up of being fobbed off so many times which led to conditions getting so bad.

I'm sure a male wouldn't be considered bad for asking simple question to some doctors!

Never been rude and I've always been polite to them no matter how badly they've been...

Demeanor is an important part of presentation though

That may be. They’re also value judgements on personality. Therefore not particularly helpful in this context.

You might be irritable because you’re in pain. You might be irritable because you’re generally irritable, had a bad day, or are being patronised by a poor doctor.

So what you have is not particularly accurate ‘code’ that feels like it’s over stepped the boundaries of the doctors job. If you want to note ‘pain’ find a more accurate way of doing that.

I am sure they have some lovely codewords for me!

Yes, there’s an undercurrent of trying to ‘control’ the patient here that sits very badly with me.

@TheKeatingFive I actually do understand where you’re coming from and appreciate that you have a point.

I work in MH so I may be overly biased to observe and report on appearance, affect and general demeanour, but it really can and does speak volumes about how someone is doing. It’s particularly valuable if you’re seeing the same person regularly as any change might indicate all is not ok. I report on it as good practice and heaven forfend, to protect myself if things go wrong.

I comment on it in letters to aid communication with colleagues and because I believe it is relevant. I only do what I do for the good of the patient. Thankfully the days of old-school consultants being able to write whatever they damn please in the notes are on the way out. All notes can be scrutinised and can be read by the patient, so good clinicians will never put anything judgemental or overly subjective in writing.

I take it as a personal compliment and it makes my heart glad. Not sure if that means I have no self esteem or am an absolute narcissist. Probably both. But at least I’m pleasant.

I comment on it in letters to aid communication with colleagues and because I believe it is relevant. I only do what I do for the good of the patient.

I’m sure you do, but equally I’m sure plenty of others use it for their own ends. Or use it carelessly in ways that are unhelpful for the relationship with the patient.

Something like a tick box system where you can note observations would be far more appropriate than using loaded words like ‘irritable’ or even ‘pleasant’. Like it or not, they’re value laden, not terribly accurate in terms of what you want to communicate and quite clearly indicate the kind of behaviour that’s ‘desirable’ from patients. That last one is particularly problematic,

TheKeatingfive. I totally agree with you. Why use this code. If someone is irritable maybe ask them why? Are they in pain, worried, depressed, frustrated etc. Pleasant means nothing. It's a judgement and an opinion. Do other professions write this sort of thing? Do solicitors consulting barristers tell them the client is pleasant or delightful. Do architects to contracting companies? Such language creates a power imbalance and an air of superiority that doesn't feel in keeping with our times. If someone turns up to an appointment wearing filthy clothes and smells then maybe they could ask what's going on in their life and write about that not just touch on it in code.

To clarify re the patient referred with a comment on his "average height", his height wasn't remotely relevant to the referral. He had no underlying conditions or cause for concern (he was bereaved and seeking counselling for himself and young child!). Likewise, his eye colour was irrelevant too.

The added descriptions can be really useful for some of our services, particularly where MH is pertinent as presentation, speech patterns, eye contact and engagement form part of the larger picture.

Pleasant means nothing.

Exactly. What would we conclude from that? The person isn’t in pain/struggling mentally? Well we all know that’s rubbish.

Do other professions write this sort of thing?

Absolutely not.

Solicitors definitely do this too.

I’ve never seen anything like this from a solicitor.

so good clinicians will never put anything judgemental or overly subjective in writing.

I had a MBP diagnosis in a letter, by someone who wasn't qualified to diagnose such an illness - my GP received the copy and called me to say not to open it but it was too late.

The illness that the consultant was claiming was fabricated nearly killed me (cardiac arrest and flat line) just two weeks later. So unfortunately consultants do get away with writing whatever the hell they want on letters.

Well actually said consultant is not really getting away with it now - but it should never have been written, or thought, without thorough investigations.

@TheKeatingFive no, not at all, it's not a value judgement, nor (in psychiatry) is it a code for anything. This is different in other branches of medicine, sure.

Mental state assessment does not assess personality, it asseses the current mental condition of the patient, which often tells you very little indeed or nothing about personality. My use of pleasant is a countertransference reference, not a value judgement, and would be understood by other psychiatrists as such.

It is true however that non-psychiatrists can use it as code to signal to other doctors that the patient is not a "troublemaker" or too "assertive" etc. I agree that in some cases that could be questionable...

Yep, doctors code.
Also I really like and enjoy many of my patients.
As a GP when I write letters I want to convey to the specialists some individuality and to help my patient through the medical system.

Mental state assessment does not assess personality, it asseses the current mental condition of the patient

I suspect this is a different thing to referring to a patient as ‘pleasant’ or whatever in a referral letter.

I was a legal secretary for 8 years and don't remember letters between lawyers that referred to clients as nice, casually dressed, pleasant etc. I'm not saying this language is never used but is it as widespread in legal circles and it is in medicine I wonder?

I'm almost always described as 'pleasant' or something similar, however I'm a biochemist so that definitely doesn't mean pushover. We usually have a right good discussion and I'm armed to the teeth with information. It's always a polite and respectful chat though, and well received (except for one GP in my surgery, who treats me like a total idiot and is really rude, I try to avoid her).

I got pleasant and well informed. What they don't know is that I'm a former medic

Would you rather them say. "Today I had the misfortune of meeting the complete arsehole that is......."

Would you rather them say. "Today I had the misfortune of meeting the complete arsehole that is.

Personally, I’d prefer they made no reference to how amenable or otherwise I was and focused on the issue at hand.