I work in the medical field and read a lot of chart notes. Different specialties have different styles of charting, and even lower level professionals (not doctors or mid level providers) end up...
I work in the medical field and read a lot of chart notes. Different specialties have different styles of charting, and even lower level professionals (not doctors or mid level providers) end up leaving their fingerprints on patients medical records. There are certainly biases that can be associated with a medical record like this, even if it’s just documentation from a medical assistant about a patient cursing at them on the phone. My own note in that situation usually looks something like, “patient informed prior authorization for their treatment is under review, we have submitted it to their insurance company yesterday AM. Pt expressed significant frustration at the delays in their care.”
Some of the examples given in the article do seem unnecessarily derogatory or irrelevant to the patient’s treatment. However, at least to me, not all of them.
I’ve seen chart notes saying things like, “patient eating turkey sandwich, reports 12/10 pain, no apparent distress.” And then has all vitals WNL and no other indications for administering narcotics.
I wouldn’t be surprised if this patient is not given additional pain medication.
While the comment about then eating a sandwich might seem to be a bit of a non sequitur, it serves to illustrate that it is extremely unlikely the patient is actually in significant distress.
Other things like recording giving the patient a cab or bus fare voucher might be necessary but can also inform other people of the patient situation and help them plan to accommodate their needs. Similar thing with noting the patient presents with a relative who is translating for them.
All that said, I don’t doubt that there are people at all levels of the medical field who would make negative assumptions about a patient due to these type of notes, And I will certainly be taking that into consideration in the future.
It is both hard and needed for generalists to give feedback to specialists. It's an important conversation imho. I hear what you are saying. I am not a medical professional at all but In the era...
It is both hard and needed for generalists to give feedback to specialists. It's an important conversation imho.
I hear what you are saying. I am not a medical professional at all but In the era when blogs were popular, I found ems and nursing blogs to be fascinating and I am aware of some of the common frustrations and problem patients in ways that I wasn't before reading those stories. However, I think the article makes an important point about how an overtly racist (or sexist) medical professional can poison a chart for future use and also how unconscious bias is something that many of us need to overcome. I am happy you got something from the article that might be useful.
As a specialist, comments in the referring medical chart, such as noncompliance, transportation or financial issues, or frustration with slow work up often help guide and tailor my consultation...
As a specialist, comments in the referring medical chart, such as noncompliance, transportation or financial issues, or frustration with slow work up often help guide and tailor my consultation with the patient, helping us jointly decide on a course of treatment. This is irrespective of race 99% of the time and far more often involves socioeconomic status.
Which is why it's a challenge for nonspecialists to provide feedback to specialists. However, as the article points out, overt racists can hide their hateful attitudes using professional jargon to...
Which is why it's a challenge for nonspecialists to provide feedback to specialists. However, as the article points out, overt racists can hide their hateful attitudes using professional jargon to the detriment of black people and unconscious racists can believe myths about different pain tolerance etc.
This is pretty discouraging but I am happy to see people committed to shine light on the issue. I am married to a black man who suffers from debilitating, chronic pain that has (for nearly three...
This is pretty discouraging but I am happy to see people committed to shine light on the issue. I am married to a black man who suffers from debilitating, chronic pain that has (for nearly three years) remained undiagnosed despite dozens of doctors. I have no reason to think there had been any bias in his care, but yikes, it does hit close to home.
There's a Seinfeld episode about this. S8E5: "While consulting her doctor about a rash, Elaine notices that her medical chart notes her as "difficult". When Elaine objects to the description, he...
There's a Seinfeld episode about this.
S8E5: "While consulting her doctor about a rash, Elaine notices that her medical chart notes her as "difficult". When Elaine objects to the description, he dismisses her without examining the rash. Elaine tries to sneak her file out of the doctor's office, but he catches her and takes it back. She tries other doctors, but her chart is passed on to her newer providers and they likewise refuse her treatment."
Yes. I debated whether to also include sexism in the title, but followed the primary theme of this article. The same dynamic applies to women and other groups who face discrimination.
Yes. I debated whether to also include sexism in the title, but followed the primary theme of this article. The same dynamic applies to women and other groups who face discrimination.
I have a female family member who's had a serious problem with this. Doctors just won't listen. One doctor put an incorrect diagnosis at one point dismissing the issue, and now her primary care...
I have a female family member who's had a serious problem with this. Doctors just won't listen. One doctor put an incorrect diagnosis at one point dismissing the issue, and now her primary care doctor just assumes the other doctor is correct and won't even discuss the matter.
This is exacerbated by doctors being bad about going in and filling in their charts. She's had a couple of really good specialists on exactly what she has, and has gotten good feedback from them... but they're horrible charters. They'd go weeks/months without charting it, then when they went in later and finally did it, they remembered so little that the resulting chart was so devoid of information as to be next to useless. The doctors seem to consider charting beneath their time (they've got important patients to diagnose) without considering that the lack of charting has real and serious medical implications on their patients.
I work in the medical field and read a lot of chart notes. Different specialties have different styles of charting, and even lower level professionals (not doctors or mid level providers) end up leaving their fingerprints on patients medical records. There are certainly biases that can be associated with a medical record like this, even if it’s just documentation from a medical assistant about a patient cursing at them on the phone. My own note in that situation usually looks something like, “patient informed prior authorization for their treatment is under review, we have submitted it to their insurance company yesterday AM. Pt expressed significant frustration at the delays in their care.”
Some of the examples given in the article do seem unnecessarily derogatory or irrelevant to the patient’s treatment. However, at least to me, not all of them.
I’ve seen chart notes saying things like, “patient eating turkey sandwich, reports 12/10 pain, no apparent distress.” And then has all vitals WNL and no other indications for administering narcotics.
I wouldn’t be surprised if this patient is not given additional pain medication.
While the comment about then eating a sandwich might seem to be a bit of a non sequitur, it serves to illustrate that it is extremely unlikely the patient is actually in significant distress.
Other things like recording giving the patient a cab or bus fare voucher might be necessary but can also inform other people of the patient situation and help them plan to accommodate their needs. Similar thing with noting the patient presents with a relative who is translating for them.
All that said, I don’t doubt that there are people at all levels of the medical field who would make negative assumptions about a patient due to these type of notes, And I will certainly be taking that into consideration in the future.
It is both hard and needed for generalists to give feedback to specialists. It's an important conversation imho.
I hear what you are saying. I am not a medical professional at all but In the era when blogs were popular, I found ems and nursing blogs to be fascinating and I am aware of some of the common frustrations and problem patients in ways that I wasn't before reading those stories. However, I think the article makes an important point about how an overtly racist (or sexist) medical professional can poison a chart for future use and also how unconscious bias is something that many of us need to overcome. I am happy you got something from the article that might be useful.
As a specialist, comments in the referring medical chart, such as noncompliance, transportation or financial issues, or frustration with slow work up often help guide and tailor my consultation with the patient, helping us jointly decide on a course of treatment. This is irrespective of race 99% of the time and far more often involves socioeconomic status.
Which is why it's a challenge for nonspecialists to provide feedback to specialists. However, as the article points out, overt racists can hide their hateful attitudes using professional jargon to the detriment of black people and unconscious racists can believe myths about different pain tolerance etc.
This is pretty discouraging but I am happy to see people committed to shine light on the issue. I am married to a black man who suffers from debilitating, chronic pain that has (for nearly three years) remained undiagnosed despite dozens of doctors. I have no reason to think there had been any bias in his care, but yikes, it does hit close to home.
There's a Seinfeld episode about this.
S8E5: "While consulting her doctor about a rash, Elaine notices that her medical chart notes her as "difficult". When Elaine objects to the description, he dismisses her without examining the rash. Elaine tries to sneak her file out of the doctor's office, but he catches her and takes it back. She tries other doctors, but her chart is passed on to her newer providers and they likewise refuse her treatment."
Yes. I debated whether to also include sexism in the title, but followed the primary theme of this article. The same dynamic applies to women and other groups who face discrimination.
I have a female family member who's had a serious problem with this. Doctors just won't listen. One doctor put an incorrect diagnosis at one point dismissing the issue, and now her primary care doctor just assumes the other doctor is correct and won't even discuss the matter.
This is exacerbated by doctors being bad about going in and filling in their charts. She's had a couple of really good specialists on exactly what she has, and has gotten good feedback from them... but they're horrible charters. They'd go weeks/months without charting it, then when they went in later and finally did it, they remembered so little that the resulting chart was so devoid of information as to be next to useless. The doctors seem to consider charting beneath their time (they've got important patients to diagnose) without considering that the lack of charting has real and serious medical implications on their patients.