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I have been sent a copy of a letter from a consultant cardiac surgeon to a consultant cardiologist about a suggested heart bypass for me

He describes me as "this 79 year old" which seems to me to be saying "is it really worth it?"

An earlier letter from another consultant cardiologist to the GP describes me as "charming"!

Co-incidentally a cousin of mine who is some 5 years older and suffers from cancer of the lower bowel and is a priest says that he too is described as being "charming"

All the consultants I have seen seem fixated on the fact that I am a retired solicitor and spend time on questioning me on the sort of work I did and it is always referred to in the letters between medical professionals

Am I alone in finding all this as a bit odd Will I find a notice over my hospital bed saying "Beware! Charming elderly retired solicitor"?

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It's just how they write letters, all Consultants do it, I suppose it gives the reader a bit of background.

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Thanks for responding

I know that consultants do it but should they

I t comes across as patronising and demeaning and I think behind it there is a coded message

I think that "charming" means "fairly harmless" as opposed to "a Rottweiler"

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I would rather have "charming or pleasant lady" than This or The Patient which is very blunt and unfriendly. To be honest just getting a letter is a bonus 😉

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They are probably trying to build a rapport with you.

I have been described as being delightful, a pleasant lady.

From one doctor ' that it was indeed a pleasure to review me in clinic.'

My former profession is also made reference to along with my voluntary work. It is in my instance a professional courtesy.

My age is also given too.

When a doctor says you are charming, delightful or pleasant they actually mean it.

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Thanks for responding

The BMC have guidelines for the medical profession in making medical notes and reports

I can't find my notes but from memory they say that they should be "legible, accurate, clear, concise and relevant"

Nurses are warned not to put in "snarky" remarks such as "tried to contact Dr Smith but he was unavailable AS USUAL!"

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Yes all of the above. They should also be contemporanious or written as soon as possible after the clinic and be a truthful and honest account of the consultation too.

The Medical defense union advises no ambigious abbreviations or using 'jokey' language open to interpretation and liable to affect their doctor relationship if the patient read the comments at a later date.

Doctors need to remember that as patients we have the right to obtain a copy of our notes.

If you do not wish to be addressed in this way which for some can be perceived as benevolent paternalism I suggest you challenge the language used with the individuals using the language in their letters.

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They must have all been on the same letter-writing course. My cardiologist also referred to me as "this charming lady" . Now, I know I'm no spring chicken at 65 but it made me feel like an old maid !!

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Thanks for responding

Remember that we are talking about reports on patients written to other people and the law on defamation is particularly relevant -is the written material "liable to reduce the subject in the estimation of right-thinking people generally?"

Superficially it is complimentary but the law recognises that words can have a "special meaning"

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Be glad you arent described as " morbidly obese"... that happened to a friend

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🤭🤭

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Umm not a nice phrase at all. Although when I had my first child they described me as " an elderly primagravida" . I was the ripe old age of 35 , I wasn't very flattered.

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I was 22 and was described as that in 1968/9

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Oh my goodness!!

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Many years ago my gynaecologist said to me “I would not advise a 7 month uterus to travel”!

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Thanks for responding

I think the words used are clearly actionable

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I doubt that they are have a clinical definition.

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My friend was much amused in the maternity ward to find her file had a big red dot on it - she read it to find "husband a solicitor" written in capitals.....

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😂😂😂

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Well, hopefully they did everything by the book then , in case he sued !!!

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Friend is ex nurse - she knows it's because of the threat of litigation!!

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Thanks for responding

Yes this is an example of the kind of snarky remark that nurses are not meant to make

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But It is not really their job to make judgemental remarks about vulnerable patients who are imparting confidential information

It seems to be overstepping the boundaries of professional integrity and they should confine their observations to clinical matters

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I am referred to as a “ charming lady farmer” which frankly seems a bit patronising.... and let’s face it,irrelevant. Seems we are all “charming”

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I think it's just background stuff when they ask about your occupational etc. My husband has had letters from different consultants on various issues & they are a always written in the same way & give his age etc. They also mention his very supportive wife... me!! Probably another way of saying interferring & bossy!! That's OK though, they're looking after my husband very well & that's what matters, I don't think they're really being judgemental though.

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Thanks for responding

You are very understanding! But it is so superior of the medical profession-they come from another planet!

How would you describe your consultant if you wrote about him to your GP? It is not exactly a level playing field

Some years ago there was a big fuss about hospital spokesmen referring to patients by their Christian or first names as they do in USA and the practice was dropped

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I completely get what your saying, some consultants deem themselves very superior & unapproachable, but not all of them. My husband has recently seen 4 different consultants recently, 3 of them were issues not heart related & I can truly say they were lovely & caring, taking the time to explain etc. His own cardiac consultant is also very nice, again giving us all the info required to make informed decisions. The ones I find that could be a bit more forthcoming are the registrars/specialist Dr's, who not quite at the top of their game yet! We don't usually find out their thoughts until we get a copy of the letter to GP. However, the heart nurse & GP are very supportive & always helpful in explaining things. I'm not so much understanding! just grateful that he's so well looked after having had a lot of bad experiences in the early stages of this heart journey.

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I also have a very special relationship of trust between myself and my Cardiologist of 7 years.

It is relationship of equal partners with mutual respect.

When someone uses my first name I use theirs. My Profs of Cardiology included.

Head of Cardiology uses Mrs...I always use Dr in response

I have also encountered some very discourteous, rude and arrogant Cardiologists whose behaviour I always challenge.

Letters of apology follow.....

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I've got bad hearing & can never quite catch their name, usually spend half the appt trying to read their name tag but eyes are not too great either!! Now I just wait for the letter to come through & hope we see the same cardiologist next time, hadn't happened yet but we live in hope!

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It's just the way they speak I have two consultants.

I also have a Red dot on my file with Bin man in capitals!

The colour denotes type of case.

But each consultant or secretary may have their own key.

Think it's just to help with rapport.

Even months down the line both my consultants and surgeon remember me and what my job is and because I am fit considering the issue I had.

Just a bullet point.

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Maybe it’s to remind them to notify DVLA if your condition dictates it at any time. I think occupation and age can be clinically relevant.

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Thanks for responding

I am really at a loss for words

I think it is awful for them to do that

Rumpole of the Bailey would have a field day against the Health Authority if he ever got his hands on that

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You are reading too much into it all . It’s just the way they write their letters. It all feels a bit ‘old school’ but all of the letters I have seen from consultants to my GP describe me as a ‘charming man’. I’m always slightly amused by the choice of words.

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Thanks for responding

I hear what you say but is "charming" relevant?

It's a bit like Jonathan what's his name on the Royal Family "What is it for?"

If the patient were black or a Jew or gay you can bet your boots that it would never get mentioned in any reports or medical notes unless it had direct relevance to their medical condition or treatment

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Again, you are reading too much into it - its just a form of manners and no more than that

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My dad had a triple bypass last year at the age of 86. Before the op, there were a lot of questions enquiring about his lifestyle and the level of family support after the operation. For the lifestyle questions, they were obviously trying to ascertain if the investment would be worthwhile (my words, slightly cold way of putting it I guess). The process wasn’t always the most pleasant, and some medical staff should probably hone their social skills a tad, but the main thing was he was deemed fit and a good enough prospect for a bypass.

Good luck to you. I felt quite queasy reading about the op, but it wasn’t so bad and all went well. I think my dad had googled stories of patients (no doubt much younger) being all back to normal within two months, and he got fairly down about his much longer recovery time. However, he is definitely getting there and justifying the medical team’s decision to perform the op.

Good luck.

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Thanks for responding

So pleased for your father -I feel some hope

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You’re welcome, and I think if you’ve been deemed fit for the operation, you can feel more than some hope.

Everyone’s different, but I think you’ll have gathered that recovery for someone in their 70s and 80s is a slower process than a younger patient. I only see my dad every few weeks alas but I can definitely see huge improvements every time. But for him, and my mother, it still seems to be slow progress 7 months after the op. There have been hiccups in that time, and he did make comments such as “do you think I’ll ever get better!” But improve he certainly has, so I think you should be optimistic about the op and recovery.

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I too, have always thought the letters are written in a odd way. I have often had ' it was a delight to meet this charming lady in clinic today'. I feel glad to have brought such joy to my cardiologist!

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Thanks for responding

I think too that the medical profession have been advised to think how the report would sound if read out to a judge and jury in a court of law!

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My post angioplasty report described as a ‘young man’- at 57, I’m holding on to that😀!

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I only got ‘relatively young’ when I was younger than that - perhaps I hadn’t aged well...

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Thanks for responding

All the personnel in the operating theatres look so young that I wonder who is meant to be in charge!

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It's just a style they adopt. In reality I prefer it to another clinic I attend where the letters are short to the point of abruptness.

The time to worry is when you see PITA on your notes! :)

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What is PITA?

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Pain in the a***!

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Ha, I'll keep an eye out for that one!

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Thanks for responding

I think it worse if they put DNR

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Can you assure me that you are not suggesting that PTIA refers to me?

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I hope that this is not supposed to refer to me personally! Can you put my mind at rest?

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Of course not. It was posted in a light hearted way. Doctors did use it in the past on notes but would no longer do so as patients can ask to see their notes these days!

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I believe that in medical parlance there are only two types of patient. There are "charming" patients, and there are "difficult" patients. The bar for getting into the "charming" category is actually set pretty low, all you have to do is not be "difficult"!

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Third category

'Challenging'

You can of course be a delightfully charming challenging patient!

Doctors try to manage their difficult and challenging patients in 3 possible ways.

1. Discharge them.

2. Refer them to another Consultant

3. Behave in a way that means the patient asks to be referred to another Consultant

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Thanks for this

In the legal world difficult clients are always very early for appointments, they always have another problem as well as the one they have made the appointment for, they will never agree to settle a case and want to fight to the bitter end, and they never want to pay

(and the rest)

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Some delightful and charming patients live with complex challenging and difficult to treat conditions.

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IT could have been objectionable or basket case - These letters are usually a true reflection of the patiend and the very first information that is recorded is ones age. I do believe we do get sensative to our age however, this letter is from one consultant to another so quite clearly you are not being written off - rather he describes you are a posative, well rounded professional that knows what will be done to him, is not ga ga (sorry no offence) and clearly is a going concern.

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Thanks for responding

I appreciate what you say

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Enjoy the compliments !!

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Thanks for responding-I am sure that you are right!

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I think it’s a code. I was a “very pleasant 68 year old”.

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Aren't you? :)

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Not usually! 🤣But I do think that these subjective descriptions don’t sit well with the science of medicine.

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Thanks for responding-I have noted your exchange with MichaelJH and I agree with you that these remarks are out of place

There was a doctor reprimanded by the GMC for saying to women patients after examining them "magnificent breasts ma'am"

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One of my doctors must be a trainee consultant. When I leave her office she says "Always a pleasure".

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And when I walk in to see my GP HIs greeting is always "Hello Trouble"

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Thanks for responding-I don't like that remark of the doctor

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Suppose it’s better than saying: I saw this arrogant, bigoted, gentleman today...

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Thanks for responding but I think that description better suits the consultant

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Can you assure me that you are not suggesting that this description refers to me?

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Of course not refering to you. Merely stating your coded wording of “saw this nice gentleman today,” which is better than having a coded wording of saw this arrogant, egotistical, gentleman today. Obviously, no offense, just humouring your point!

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Thanks very much for that-obviously I misunderstood and took it the wrong way!

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Great, well done good sir!

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This made me laugh a lot. Since my own by-pass (20 years ago) I have become used to being described as a "charming elderly gentleman", which makes my wife snort. I think you are right. It's a kind of code suggesting that you don't spit, you don't or can't bite, that you don't have very large, tattooed relatives with baseball bats and that there is a remote chance of your understanding what is happening to you. The chitter chatter in consultations is surely the result of being told during training that silences can be experienced as menacing by patients - which I think they are. Having experienced old fashioned lofty consultants who regard you as a disease rather than a person, even the clumsy attempts to put you at your ease are kindly and should be welcomed.

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Thanks for the response

It is comforting to see that I am not the only one described as charming and I suspect it is the product of a barrister advising in a civil case but it also has a coded meaning

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My 67 year old husband was described as delightful (not quite sure where that came from!!!). Don't read too much into the compliments. The underlying bit I'm reading from your consultant's comments is that you're a sensible bloke. Good luck with everything xxx

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Well thanks for that

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I was quite chuffed when my Consultant's letter to my GP described me as "this charming lady" until the next time I was in his consulting room and saw a letter on his desk describing another patient in the same terms

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Thanks for responding

I think your reaction was entirely proper

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I find that sort of attitude very condescending and totally out of place in a medical report. I woudl say something

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Thanks for responding

I would say something if I didn't fear a reprisal on the operating table!

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J bn b dibsnjoh zpvoh nbo!

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Um.. still trying to work that one out 😯

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Me too.??????

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Michael's learning a foreign language and he put his homework here by mistake?

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Ha. Not new medication just been approved then!!

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Boe J bn b ufsz qmfbtbou zpvoh mbez!

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Oh no, it's catching!

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I’ve always had a bit of background included in the letters I’ve seen... really not fussed what they call me or say as they kept me alive and whatever makes them happy is fine by me...

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Thanks for responding

Yes I feel that way too- I just want to present my body for them to work on and forget about me as an individual

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You started something off didn't you. I've got tears 😂. Brilliant responses. What do you make of the consultant who sets out his furniture so that he is very safe behind his desk, the husband opposite but not close enough to shake hands and the wife on a chair in the corner. Me! And it happened each time we saw him!

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My husbands Dr didn't even have a chair for me, I perched on a small ledge that was about a foot from the floor. I didn't mind, was quite happy I could still perch at my age!! "

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He;s had a bad experience with a patient at an early stage in his career if he sets his furniture out like that - if it was a really bad experience the open door would be behind him and the patient would be on the other side of the desk??????????????

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Sadly he has moved on but I'll bear that in mind in future. X

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Thanks for responding

I love this-rather like the white coated pharmacists floating about in the background in the chemists with all the airs and graces of hospital consultants yet beyond reach visually or verbally

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Ps: my husband never gets above "pleasant" what does he need to do to up his game & get to charming!!

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Probably get an older consultant? They seem to be the ones fixated on the bland "charming" adjective. Younger ones go for delightful.....

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My husband has no hope then, he's had all age ranges!!

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In his latest letter, my HF Consultant called me pleasant, but I'm sure the surgeon called me charming last autumn. They're both at least in their 50s (like me), so maybe I'm going downhill :)

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Ha ha, it was a definate "pleasant" in the last letter that went on to say "we really must consider putting this man on Entresto" any idea where "this man" is on the sliding scale??

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Oh dear, I'd expect it to be "this gentleman". It could be serious... Or maybe the consultant was just in a hurry :)

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I thought it was more "exasperation" he'd had real trouble finding the results of recent ct scans on the computer, luckily we had the results letters with us!! I kinda thought he said get "this man" on Entresto & hopefully we won't have to see him & his bossy wife again. Ha ha, it didn't work

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Well I have to say that anything that bears the hint of kindness is a welcome change from the tirade I usually get at home - you mean old git to argumentative to I can't understand what I saw in you etc.........A huge wallet I reply and so it goes on - we have been married 46 years this year although I tell everyone that we were married in 1973 but only 17 years were happy ones! On a more serious note, it is probably a fact that the consultant wants to be liked just as much as we do. When they have saved my life they can actually call me what they want to, but if given a choice charming, educated, humerous, brave and with much character can do for a start

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Thankyou everyone for a hilarious thread . As I'm reading this my partner is quietly reading his newspaper... and he thinks I've totally lost the plot as I'm laughing so much !!!😆😆😆

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I was described as a very pleasant lady, however beware what you say as in two examples: I let slip that aged 19 I occasionally smoked when out for the evening and stipulated I did not inhale ever. It was just something to do with my hands. I am now down as “having been a regular smoker “ !

The other was my pulse rises on Fitbit when preparing for dog walk to park, my dog has social issues & we need to avoid others. When all I said was we prefer to walk away from other dogs as some are aggressive & I prefer not to be confrontational. The cardiologist actually said that’s their view too when out with their dog.

I am still waiting for my report from 7 day heart monitor, it’s now nearly 6 weeks.

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I have never noticed in any of the letters to my GP that I am referred to as anything but "this (my age) woman".. hmmmm I am curious now, i am going to dig them out to have a look.

I will be suprised if they do refer to me as something as it shows a familiarity I feel which by the way I dont have with any of the numerous consultants and nurses I have seen.

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I have always wondered if the words ‘charming’, ‘delightful’ etc were codes. Anyway much better that than ignorant or stupid! Take it at face value and be pleased

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"in Internet slang, a troll is someone who posts...extraneous off-topic messages on an on-line community such as an on-line discussion forum, chat room, or blog, with the primary intent of … disrupting normal on-topic discussion."

In my own view it is the equivalent of inappropriate giggling, pulling faces or making extravagant gestures in order to make trouble or distract attention

A Heart Star ought to be above this sort of thing

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Apologies if I caused any offence or if you thought I was trying to high-jack your thread. Your original post was about coded messages and I did insert a few posts using a trivial code referring to such things as “charming gentleman”. The intention was to inject a little humour as a sense of humour helps one cope with heart issues that can be quite terrifying at times. A number of members interpreted the encoding and found it amusing. Having worked in IT (currently medical software) for nearly forty years in no way do I feel it fits in the definition of trolling.

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Apologies accepted I hear what you say and understand your position

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After reading this thread and smiling a lot I just fished out my letters from Cardiology and I have been Pleasant, and Charming so moved up the scale a little. Yesterday I saw a very nice Young Lady Cardiologist ( sexist ) Who greeted me with so" Very Nice to Meet You, " back ground conversation it took me 2 hours to read your notes I feel I know you very well.!!

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Yes this thread has been a smiley one!

I bumped into my Cardiologist of 7 years yesterday

He greets me in the following way, takes my hand presses his cheek to both of mine as old friends would greet each other.

Saying he was going to phone me and I had saved him a job.

He was just so pleased to see I had managed to stay out of hospital whilst he was away on holiday.

Does this demonstrate that doctors are human too and actually they mean it when they say we are delightful or charming?

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I want this cardiologist for my husband, what a lovely caring person. You must feel very pleased Knowing you're under his care.

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I know how fortunate I am.

I take my knitting to my appointments he always runs at least an hour or more late.

However he always responds to my emails promptly.

If I could I would clone him for you all!

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