to wonder why consultants comment on people's personalities?

[EverythingYouDoIsaBalloon]

Not a TAAT but I just read a post on a different thread that mentioned someone experiencing this, and it reminded me that I've heard about it several times over the past couple of years.

In 2023 I fractured my shoulder and as it wasn't a straightforward fracture I was referred to a consultant, who wrote in one of this reports that I was a 'very pleasant lady'. While that was nice to read, it baffled me a little as I didn't see the relevance.

Then a friend of DH's said a consultant had referred to him as a 'pleasant gentleman'. (Different part of the country, no chance it was the same person.)

Then another friend said she'd been referred to as a 'lovely lady' when seen for stomach problems.

Don't get me wrong, compliments are always nice. I just find it a bit strange in a health context. 🤔 I've wondered whether it's some sort of code for 'cooperative patient' or something along those lines, but then I can be a bit of a cynic at times.

Has anyone else experienced this, or does anyone know why it's done?

Its code for there being no obvious unusual features that might suggest a chromosome problem etc. If the patient is going to see the report, I imagine its preferable to state "good looking" rather than "not deformed".

Once upon a time when patients couldn't access their notes, it was relatively normal to write sexist, classist mean shit about people. Then the rules got changed and so euphemisms such as "pleasant" meaning normal became commonplace.

Women usually got the worst of it, with "this rather silly lady" and "this enormous woman".

I think a GP might have written that about my mum (and definitely thought it) when I was 15 and she came with me to discuss my heavy periods. I was shedding clots and going through sanitary towels at an alarming rate, and had been for a while, unfortunately I was too embarrassed to tell anyone at first. He was very patronising/dismissive, came out with some crap along the lines of 'mothers always worry, it's fine, she's young, it'll settle down', patted us (metaphorically) on our heads and sent us on our way.

We requested a second opinion and tests revealed severe anaemia. Never went back to that doctor.

Can't say I've seen much in the way of outrage. Some indignation, yes, re certain terminology being used, but not outrage. But I do take your point about dramatic personality changes.

Maybe it implies you will cooperate with the guidance given? I agree though, it does seem like unnecessary ‘fluff’.

I am a doctor and I can assure you that it's not code and this would not be appropriate. If there is nothing in the patient's physical appearance to suggest a chromosome disorder then we would either write that the physical examination was normal, or potentially something like "there were no features on examination to suggest a chromosome disorder".

You can be unattractive and not have a chromosome disorder, and good-looking does not mean free of genetic disease.

What kind of "doctor" are you"?

I will always remember the wording of a letter sent to me about a patient, which began with : "I had the pleasure of meeting with this man today, who has a most unusual personality....

It did make me laugh, but it was unecessary. There are circumstances where an indication of the personality style of the patient is helpful, though. Treatment is a colaborative process and it can give you an indication of how well the patient is likely be able to engage with treatment.

Agree.

If there are doctors that use ‘codes’, I don’t want to work with them. Using straight clinical language is not judgemental or offensive.

Do doctors really use these? How on earth would those hold up in coroner’s court??

I had a mental health crisis and I overheard one of the paramedics on the phone to the mental health people saying 'ive got a lovely lady here' I thought it was very odd at the time but presume now she meant I wasn't kicking off and being violent or something? It was strange though

Edited to add I haven't RTFT so my comment may not be relevant but just struck me as off at the time

• odd not off

It’s a poorly hidden code so that the next person dealing with you knows you are not a pain in the arse and how to approach things. I’ve had a few referrals over the years and they always say something like “a pleasant and intelligent lady who works as a [my field of practice] lawyer”. I am pretty sure it’s a way of saying that I will understand things, won’t be a pain in the arse, but to be cautious in case I am litigious.

Just to add - am not at all litigious on my own behalf but can see why they’d want to warn others in case I was!

I'm a consultant physician.

Before patients had the legal access to their own medical records (there was a change in the law, around 1988) the medics did make some amusing entries.

A number of acronyms were used. Here of some I have come accross:

PFO= pissed and fell over
LMF= lack of moral fibre
GOK =god only knows
NFN= normal for Norfolk (ref. mental state examinations of patients belonging to that county).

I read a letter from my dads oncologist that said 'he is supported by a very capable daughter' I translated this as don't try and bullshit her, she will cause a fuss.

Trust me, I am on your side. I’ve observed some difficult patients, AND always appreciated the care I have received

I our case it was used alongside the clinical language which makes sense when considering that a variety of people with different levels of knowledge may read the report: the patient themselves, family, teachers, social worker, GP and so on. So, "a good looking boy with no dysmorphic features" was used in this context. Its meant to be a gentler, more person centred approach. It doesn't mean that there are no chromosomal or genetic issues just that it was not immediately obvious at the time of the examination and that further investigation may/may not be needed depending on the situation.

I used to work at a senior level in special needs for a large city. I always rolled my eyes when Educational Psychologists reports on children with seriously challenging behaviour issues (their files would contain sometimes shocking descriptions of violence they'd inflicted on family and professionals alike) began "Luke is a delightful boy..."

I just got a letter at the weekend that said "it was a pleasure to talk to this delightful lady" 😁

And you've never come across this before?

If I read that I would interpret it as 'mum has done her research from reliable sources, attends every appointment and listens and consistently follows all professional advice given to the best of her ability'.

That's the problem with phrases like this, everyone will interpret them differently, and why I try not to use them in my reports.

Medic nephew tells us it's code for "this is a normal person who won't bite your ankles". They have other codes for more "interesting " patients...

I would read this as the fainting wasn't directly observed by him so he only has your or your friends' word of what happened. You could have hit your head and knocked yourself out but thought you'd fainted first.

Or else he was actually being a judgy arse...

Oh dear. They didn't like you 😹

Are you a doctor or nurse @CarefulN0w ? That is so interesting to hear and doesn't surprise me in the slightest. Worlds apart from now where everything is live on the system and can be audited to high heaven and as you say viewed by the patient.