Doctor's letters - personality evaluations

Hutan

Hutan

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Doctors' tendency to include a comment about the personality of the person they see in their clinical letters was noted on a Members' Only thread.

I googled to see if other people found the practice rather patronising, and certainly unnecessary. I found this:

Yes, Many People Are “Pleasant” or “Delightful,” Even “Lovely” — But Should That Be in the Medical Note?
Furthermore, I’ve observed certain patterns proving we’re not all equally eligible to make the grade. First, women earn way more “praise” (ahem) than men:
  • “Pleasant”: 60% women
  • “Delightful”: 75% women
  • “Lovely”: 90% women
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In fact, every decade beyond age 60 yields a greater likelihood of earning one of these adjectives. Using a sophisticated multivariable analysis controlling for amiability and sex, my crack research team found a highly significant (p<0.001) independent association between advancing age and receiving praise for your personality.

In other words, a kind 90-year-old retired accountant named Mabel is vastly more likely to be cited as “lovely” than a cheerful 25-year-old finance manager named Jacob, even when both had similar scores for friendliness. Is that fair?

But — if you think about it for a moment, doesn’t this “lovely” imply something demeaning and patronizing about the label? Of course it does.
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It's interesting to read the comments to this piece. Some say that they know that patients can get access to the letters, and they want them to know that they enjoyed meeting them. Others say that they put it in nearly all their letters, again because they know patients read them, and they want to offset any description they see as a criticism such as 'obese'.

A number of commenters acknowledge that the personality description serves as a code for themselves and their colleagues about whether the patient was or was not difficult. I find this pretty concerning. e.g.
Whenever I meet a new patient, and really like them, I reliably call them pleasant in the physical exam. (Note: I never ever called anyone delightful or lovely. That seems patronizing.) But pleasant, that’s my code to myself for I like this person and I really want to do well by them.
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It sounds as if the doctor's effort for their patient is dependent on how much they like them. I recall a study that found that we feel more favourably towards people we have helped. So, joining the dots, people that the doctor can't help, and who perhaps have come across as less than pleasant due to exasperation and exhaustion, will not receive the same quality of care.
 
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This is interesting - I've had this in my clinic letters and I thought it quite weird. It seems to be mostly neurologists who do it. I wondered whether they're just generally trying to appease patients as standard.

I'm lovely, of course. :angel:
 
I've never been described as lovely. Only ever pleasant or delightful. I hate the practice of doctors recording how they feel about me. I bought a copy of my GP medical records about 10 years ago, and some of the ones made available to me were from decades ago. When I was in my teens (1970s) a GP passed comment on my fashion sense, which I found offensive.
 
All I remember is a Long COVID doctor asked me about how I viewed my family dynamics — very much in confidence — (This was before I learnt about the psychobehavioural BS). So I kind of innocently answered the question. But then my GP recieved the letter and forwarded it to my parents.

Which felt like a breach of trust definitely.

Looking back on that letter, it contained more about my psychological situation than anything else, which was weird, given I had a normal psychological situation but was otherwise severely disabled. That’s the same letter that gave me the “CFS” diagnosis.

It also contained a lengthy rambling about how I had all these “complaints” but seemed fine when I met the doctor. (The appointment caused a 3 week crash)…
 
"Pleasant" was used to describe me by a consultant female rheumatologist for my disability work up for FM in the report to my family doc.

Maybe I reminded her of someone. Or she actually remembered my face because our paths crossed at the hospital exactly once and she shot me a meaningful glance (?)

I have no earthly idea what that the term means, whether it's a code for "middle class" or not disheveled or stark raving mad.

I assume it's a meaningless term that's gotten sucked up by a generation of docs. Or it meant: I looked "okay" at first glance, in that the doc can't see any obvious defect.
 
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I have been pleasant and well-presented, from urology to gynaecology, ENT to psychiatry. I have also just been a “young lady” to rheumatology and psychiatry. They all do it, its code for “normal” or “unlikely to have been a guest on Jerry Springer/Jeremy Kyle” or “she turned up and Ive nothing blandly nice to say, draw your own conclusions”.

The lies start in the first sentence “thank you for referring….”

It’s like school reports “Johnny is confident and friendly” = Johnny chats too much to his friends during lessons
 
The only time I noticed any comments being written about me were when soon after my parent who had years with very severe dementia died I decided I wanted to stop taking fluoxetine as the worry had been lifted. I had to go back a month later to confirm and then a couple of follow up appointments while I was gradually reducing the dose. I was a bit surprised when I got a copy of my records a year later for something else to see comments about me being clean and tidily dressed and my demeanour but I thought it was fairly relevant to record that as an indication I probably wasn’t struggling with coming off the medication.
 
As I mentioned on another thread, I was described as 'delightful' by an internist over 30 years ago when I was crying after I told him I couldn't walk at the start of my appointment. I didn't transition to delightful at any time during that appointment.
 
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