Why are doctors so hung up on the negative?
If you ask my doctors what is important about me, they are likely to say something like this:
Josh is an obese 66-year-old man with essential hypertension, sleep apnea, vitreous detachment in both eyes, and history of prostate cancer.
Why so negative?
If you ask anybody else I interact with, they start with the positive. You know, something like “Josh is intelligent, analytical, a talented editor, highly experienced with knowledge of the publishing industry, and extremely sensitive to the psyches of writers and authors. He’s dedicated to his wife and his family and has an entertainingly twisted sense of humor.”
There are plenty of things I’m bad at — no one would call me a snappy dresser, for example — but at least people don’t usually start with the negatives.
What belongs in my chart
I’m not an idiot; I understand why disease conditions need to be in my chart. They’re how I differ from other patients, and any medical professional treating me needs to be aware of them when diagnosing me and recommending treatments.
But I want some positive things added to my chart, too.
- Always asks about the well-being of medical professionals working with him and acknowledges their generosity, their expertise, and the difficulty of their work.
- Carefully follows treatment instructions with discipline and observes and self-reports the results meticulously, allowing for a more precise adjustment of treatment options.
- Successfully avoids behaviors that undermine treatments like drinking, drug use, and poor sleep habits.
- Extremely analytical and knowledgeable regarding medical issues, for a lay person.
- Understands higher and more fundamental goals of treatments and works with medical staff to collaborate on treatment ideas to accomplish those higher goals.
- Responds intelligently to treatment options presented in the form of probabilities.
- Ran a nutrition- and health-focused nonprofit that helped thousands of patients with wellness and weight loss.
- Focuses on rational action rather than emotional responses to bad news.
- Funny. Interactions generate a small smile even on the toughest days.
I always got really good report cards at school. I desperately want to be recognized for my accomplishments, not just my flaws. I want my chart not to be such a downer!
But seriously, wouldn’t it help a medical professional creating a treatment to know these things about me? Might it change how they worked with me or recommended to me? (When I told my urologist I had a background in probability and statistics, he immediately started communicating with me at a more useful level regarding treatment options.)
What would you like to see added to your chart?
EPIC Systems, are you listening?
1. Doctors are busy; they don’t have time to note these niceties.
2. It’s more efficient to focus on the essentials — what the next doctor needs to know.
3. Praising someone’s personality is subjective; noting that someone has had cancer is objective.
4. Including subjective observations opens a doctor up to liability.
Fascinating. All I’m asking for is to be treated as a human being and not a bundle of symptoms and syndromes. After all, I am the customer here. Why is the system designed to make things as easy as possible for the doctor and not for me?
It’s been my experience that medical professionals who know more about patients’ abilities and tendencies are able to use that information to make better recommendations and prescriptions. A doctor who is unaware of these qualities is going to do a worse job for the patient, for example, recommending courses of action that the patient is unlikely to follow (“Just eat right and exercise.”).
Agreed, Josh. I don’t need my doctor to note in my chart that I have a nice smile and volunteer to hold babies in the NICU. I would love her noting in my chart that I appreciate being able to ask clarifying questions during an appointment and that I respond well to straightforward conversations.
I agree with Jonathan on this one, Josh. I recently made corrections to the “visit summary” from a doctor visit — I’d be happy if they got the info they claim to want correct. I bring my own 1-page medical history with me to every appointment. But now, I’d like to reverse your theme. I recently got a teeth cleaning from a new hygienist, very young, quiet, and polite. But her mastery of the suction tube was exceptional. She’d remove saliva, then remove the tube and put it down. Over and over. It required me to anticipate her movements, and we worked in sync and developed rapport. I didn’t experience the anxiety of choking on my rapidly filling mouth or have to endure the agony of a poorly placed tube cutting into my gum or the pain of a hygienist leaning on the tube. Afterwards, I made a point of telling her, “Shelby, I’m in my 70s. And you are without a doubt, the best hygienist I’ve ever had.” Imagine someone telling you something like that at the start of your career, especially if you are a quiet person, just trying to do a good job… I imagined her telling her parents, her mentor, her friends, and perhaps the dentist what I’d said. I hope they want to know why.
I deeply appreciate this commentary, as well as the insightful notes from other commenters.
Medical professionals care about these topics. Please see:
* Park J, Saha S, Chee B, Taylor J, Beach MC. Physician Use of Stigmatizing Language in Patient Medical Records. JAMA Netw Open. 2021;4(7):e2117052. doi:10.1001/jamanetworkopen.2021.17052
* Himmelstein G, Bates D, Zhou L. Examination of Stigmatizing Language in the Electronic Health Record. JAMA Netw Open. 2022;5(1):e2144967. doi:10.1001/jamanetworkopen.2021.44967
* Collier K, Gupta A, Vinson A. Motivating change in resident language use through narrative medicine workshops. BMC Med Educ. 2022;22(1):663. doi:10.1186/s12909-022-03721-z
Please notice in the review by Park, et al., that excessive use of positive language (compliments) can occasionally be problematic, just as use of negative language is considered problematic.
That said, I suspect this would be a welcome and accurate closure to your last encounter note: “We had a pleasant discussion in which Mr Bernoff displayed humor and insight about his medical issues.”
I agree, Josh, but I expect that for most doctors, and most aliments, a quick summary of the most salient points is all that is needed to make decisions and move on. Your situation appears more complex. And certainly you, and your readers here, are the sort who think more, work more, expect more. I bet your notes for your own clients are more like the way you wish your medical charts were. Ha! I recognize myself in all but one and a half of your list of positive things. (I’m only sometimes funny.) And I do those things not just because I greatly enjoy interacting with the people who work on me, but also because I know (like you say) that I’ll get better treatment. Kinda the same thing, come to think of it, when I deal with the people who work on my automobiles and my house and who print my artwork.