Friday, November 16, 2012

Pleasant

Attending: "Are you ready to present your patient?"

Resident: "Oh sure. This was a.... very pleasant 46 year old man--"

Me: "Very pleasant. Wow."

This particular resident always gave a little commentary on how pleasant the patient was as part of his presentation. Admittedly, I usually made a remark to that effect, muttering under my breath about how the patient was either a nightmare who drove me nuts or a generally nice person. But I never made it part of my presentation.

In my dictations, I used to put in little judgments about the patients' personality in my physical. "The patient was a [pleasant/anxious/rancid], well developed, well nourished man in no apparent distress." These days I just say everyone was pleasant. Unless they were really an asshole.

12 comments:

  1. Why is there a personality comment? Does it help in patient care in any way?

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    Replies
    1. Absolutely. It is a general indicated of how to best approach the patient, how receptive they will be to physician advice/recommendations, and how long we should bother to stay in the room. Different people need to be approached different ways.

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  2. Anon:

    It probably does help with patient care actually. Gives the other doctors a heads-up regarding how best to approach this patient so they can develop the best rapport. A very pleasant person - be a little more casual and smile, a less pleasant person - keep yourself very professional and slightly distant. From experience tends to be the way those types of patients prefer you to act.

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  3. As an MT, I find that (the pleasant stuff) totally silly. But it increases my line count. It would be fun to type "the patient was a totally toxic asshole who should get off his backside and do some walking." But you would probably get sued.

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  4. This made me laugh. :-) I found it very pleasant.

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  5. In my nurses notes, I have certain things I put in habitually, which I use as memory clues if I leave them out.

    For instance when I write that the patient is "A&Ox4, calm and cooperative, interacts appropriately," then they were. If I write that they were "A&Ox4 and calm," then they were impolite or disrespectful. Nobody else needs to know if the patient was grumpy, because IMO it's almost never relevant to their care, but this works to prompt my own memory in case I have to go back and read the note.

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  6. I saw "very pleasant" written REPEATEDLY in a chart the other day and couldn't wait to meet this patient. I was greatly disappointed.

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  7. And now patients read their own charts regularly, so that makes everything more interesting...

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  8. I consider letting the patient read the chart to be in the same category as an auto mechanic letting the customer fiddle with their tools while they fixed the customer's car. I understand why the customer in both cases would feel like fiddling with the tools. They're bored, they're curious, and they think they might be getting cheated because they don't understand what's going on but in both cases it's counterproductive to actually getting the job done.

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    Replies
    1. Yes, but the patient has the right to see their chart if they sign a release.

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  9. I always indicate in my notes under the "general" part of the physical if they are "pleasant and cooperative" or "otherwise."

    There has been a lot of "otherwise" lately...

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