👋 I've decided I need to change my GP so I need to have notes disputing GP records of consultations added so my new GP isn't led up the garden path.
Some on the notes are WTF?!? (excuse my French)...but this one has really got me going:
'casually dressed'
I was wearing a jumper and jeans. The GP was wearing t-shirt and jeans. Flashbacks come in handy sometimes!!! 😂😂😂
Is this some kind of code ?
xxx 😈
My husband - a former healthcare professional at consultant level is sitting here with a real WTF expression his face! What the hell has it to do with anyone what one wears to go to the GP? Unless there it was code for - she hadn't got herself up to the 99s so she mustn't be particularly well...
Found this...not for the faint-hearted 😱
messybeast.com/dragonqueen/...
OMG and WTF combined with brass knobs?! Ditto to PMRpro. I was about to vent myself in an update about the problem I’m having accessing clinical letters about me. I honestly think that Dr code this needs to be tackled head on.
We all know that sometimes our friends, family, neighbours and colleagues will discuss us behind our backs. Of course we can guess that GPs and hospital staff will do this too - with raised eyebrows about that “blasted Mrs you know who..” eyebrows raised etc.
But to put it in a patient’s notes in the form of comments about your state of dress????! Unbelievable frankly and worth raising with the Practice manager in letter form - then print off a copy to give your new GP so it goes on your notes that you won’t have this kind of utterly irrelevant nonsense written about you!
I do know from personal experience that they can’t amend anything on your notes retrospectively. But they can add your comments in response to your notes and I’m sure most GPs would find this a helpful lesson in sticking only to clinical matters where our medical records/ notes are concerned.🤐🙄🤬xx
PS at a brief glance I extracted the FFFs once from a GP friend when I went for a cuppa with her aged 39, fat and newly diagnosed with gallbladder disease!! She even choked into her cuppa with ill suppressed laughter when I told her my new diagnosis. So I literally threatened to pour mine cooling tea over her head if she didn’t explain to me the cause of her evident mirth!! Sometimes better not to know??! X
It's absolutely profane, those acronyms, I could only glimpse at it !😡
Thanks Twitchytoes! I'm working my way through my GP records to add a correction to almost every one before moving GP. I know it will make me appear even more 'PMH' than described in the notes - due to misdiagnosis, the default position 😤 - but I need to get GPs to understand the distress they have caused by first acknowledging they got it wrong...for 10+ years.
I have my medical records up to the beginning of last year, so yes, it will be interesting to find out if requesting my records had made a difference to the note-keeping! 😁😳😋 xxx
I would say, having seen a great deal of PIP reports over the years, that what he was doing was to try and discount some of the more strange symptoms we all get, that added up come to something that is usually called Fibromyalgia, Functional Neurological Disorder or CFS until it is proven not to be - ie I was diagnosed as having FM in 2007 - I have said all along that it wasn't, as my pain isn't like that of someone with FM - it took 11 years but now I know that it was Sjogrens all along and I finally feel vindicated!
Your state of dress will also indicate your mood - if you can be bothered to clean yourself up to go to the docs etc if you hair hasn't been washed for months or the appropriateness of your dress, eg - you haven't gone in your PJ's etc .... it's not right, but sadly it is an indicator for them of how you are coping or not etc x
Thanks Lottagelady! Glad they got there in the end for you...FM, FND, CFS never crossed my GPS' minds: they had me firmly - and wrongly, there is evidence in my notes to the contrary! - in the PMH bracket! Also I have no joint pain, my SLE has been mainly rash and fatigue with nose involvement to an unknown degree...
That's fascinating about state of dress...my GP turns up for afternoon appointments the straight from the cowshed and throws his Barbour on the hygienically-lined inspection bench (he subsides his farm by medical practice!) 😧😷😬 xxx
Casually dressed is an important observation . If for example you turned up, mid-summer in full arctic gear then there’s likely to be an issue.
For me, clinically, this is important. If I had a referral I’d want to know what your eye contact was like, we’re you clean and well kempt.
Ultimately though this is about continuity, so if there is a change then it can be noticed easily and a time frame available.
Nothing sinister I promise!
Yes, those of us who evaluate patients — whether a nurse, doctor, psychologist— are taught to observe dress, speech, hygiene and demeanor. It is all important in the assessment for many reasons. When I asked my rheumatologist if he could skip the neuro exam last time I was in, his response was, « The neuro exam starts as you are walking in the room. »
Thanks Jim , that's incredibly insightful! My notes are peppered with 'neat, tidy', 'calm' (only occasionally in a doctor's surgery 😬), 'good eye contact', 'alert', 'speaking in full sentences' 🤣...💩
What would no eye contact mean, other than autism??
Continuity would be a very fine thing, as over the 10+ years of SLE & nasal manifestations, my dress code remained casual, neat and tidy, and my eye contact good, however my facial appearance deteriorated from healthy and wholesome, to 'you look terrible' a clinical diagnosis I had from two GP's. It is factually accurate as I am now a zombie 🧟💀, in looks and feel, after my nose has partially collapsed from inflammation and (a childhood fracture), my eyes are sunken from decades of sinus purulence without treatment and my eyelids swollen. 🙄 Anyone made a claim for medical negligence? 🤑🤑🤑
Any chance of a consultation with you Jim? 😟😋😁 mo xxx
Avoidance of eye contact could perhaps be viewed as a sign of being in denial or unwilling to acknowledge the reality of what we are being told rather than autistic tendencies - which are, of course, also possible - given the huge spectrum of autistic disorders? I say this because I have a son with Aspergers who actually does make quite good eye contact! X
Nurse practitioner across the pond here, but when I hear “no eye contact”, “poorly groomed”, etc my first thought is I need to evaluate for depression or worsening depression. Of course there are other reasons but when I see a patient who won’t make good eye contact, I have to “pull information” out of or who is poorly groomed, often there is underlying reasons such as depression, substance abuse, yes...autism but that’s more with a child that would be a concern, an adult with autism we would already have that diagnosis also listed in the medical record too.
Hope that helps, but one system we always chart on is general appearance, which includes demeanor, dress, level of alertness etc. it is very helpful to a clinician and I promise 98% of the time nothing bad is meant by it and when we are trying to code speak it wouldn’t be “casual dress”, that just implies you are taking care of appearance appropriately, like said earlier, no artic coats or bikinis lol. Hope that helps. 
Thanks for that!...wish the GP at my surgery that dresses in a t-shirt and jeans - albeit very expensive ones - would smarten herself up and I'd feel she was a little more engaged with her work LOL! xxx
Haha yes I agree! That to me sounds like by coming to surgery dressed that way he is outwardly implying that being there as a doctor is not his top priority! Doesn’t sound the most professional.
There's another who dresses like a farmer, which is what he is...his GP work is to subsidise his farm! xxx
🤦🏼♀️ That’s just not right, particularly that patients are hearing basically “this isn’t what I want to be doing, it is literally just a pay check so I can work my farm”.... goodness gracious that is very unprofessional.
I think it is important to always dress for the part, well groomed and well dressed and wearing the white jacket and when in with the patient they need to be your soul focus. The patient is why we are there, we as providers put up with so much crap from administration and insurances BECAUSE we want to take care of patients. It is sad to me when that isn’t the case and I’m sorry you have had such experiences.
Ah doctors in the UK ditched the white coat years ago and student docs in hospitals wear a stethoscope round their neck to distinguish themselves from any other scruffy teenager....and for medics, the patient is just an irritating distraction from the disease they want to treat...when I was diagnosed, doc said 'you have lupus - go and read about it' and turned back to his computer...but I don't think that's at all unusual in approach.. xxx
I glad they got there in the end Lou, sometimes they just don't get it when it's as plain as the nose on your face ! 😂 xxx
I got "neat and casually dressed" in my PIP. It is, as others said, likely to mean "normal".
There are some really cruel acronyms GPS and consultants had to drop when there became the opportunity to read them. The mildest were things like FLK for "funny looking kid" or NF (insert first letter of grotty area)
Consultants letter to GPS would be along the line if "Thank you for sending this feckless female to me" .
😱
I had “blinks repeatedly- sicca (Sjögren’s)?” on my old GP’s patient summary well before being rediagnosed!
😂 x
We could play a new game of writing a letter to the GP following a visit to the consultant. All the best buzz words "casually dressed" "maintained eye contact while speaking and listening" "demonstrated superb computer skills by switching it on" "Sumna cum laude for reading notes beforehand"
Hints and tips like "could benefit from beginners' or refresher course in connective tissue disorders, but managed to look neither confused nor break out in sweat"
Going to lie down in a dark room now 😂
YAAAY! 🤗 🤩 Mine after my last Rheumy review would go like this:
Dear Dr Barking
I saw this 32-year-old male today at my clinic. He was neat, tidy and expensively dressed.
He was agitated, sweating, confused, had incoherent speech and showed erratic behaviour (he attempted to leave the consulting room on two occasions). His pupils were dilated and he avoided eye contact, and appeared to have temporal-spatial orientation problems. There may have been code yellow.
I would strongly recommend immediate transfer to a different department, perhaps potted plants.
Yours
M.
*it's all true, after I mentioned vasculitis 😂😂😂😂😂. Thank you Lupiknits, my how you've cheered my day! 😘
Oh you and lupiknits have really made me laugh!! It might be a very good experience for them all to receive such a letter!
If it's any comfort I now have all my hospital records and found some cognitive testing results from the midst of an earlier brain lupus flare where they wrote to my GPs (not me) to say 'if she'd paid attention and listened to the instructions she may have performed better' 'a strong tendency towards impulsivity rendered some tests less valid' I can remember my GP actually crying with laughter when she read me some of the letter. I must admit I didn't listen to her instructions though and thought the quicker I do the tests the quicker I can get of there so she probably had a point! And one of them was all the words you can say beginning with F in a minute. I never say that word but it was ALL I could think about, every time I opened my mouth so I did badly on that one too. I blame the lupus. In the brain. Good excuse!!
🍾🥇😂
That's a cracker! Even more scarily it's true!
This could be a fun game. My next rheumy appt is next month. I shall consider a follow up letter ( for us, anyway)
In my past life we had annual assessments. Some braver managers asked for 360 degree assessments. Patients' letters to GPS might be an interesting variation of this.
The CQC do go into detail when they visit. Some of our letters would provide interesting info I'm sure.
Appearance, presentation, eye-contact, tone and manner of speaking are all related to mental health red flags.
If it read, "appeared unkempt, minimal eye contact. Unable to maintain ability to complete sentences. Erratic thoughts and poor tone of voice noted."
Then they are red flags for mental health problems. A doctor or nurse will by habit commence their assessment of you as soon as they set eyes on you, ie the A,B,Cs etc. I don't think there is anything sinister in a doctor documenting that you are approximately dressed, its more of a clinical observation about one element of your health.
Thanks Happytulip, that's really good to know! 😀👏
A,B,Cs - Airway, Breathing, Circulation? mo xxx
Yup
How ridiculous they are supposed to write ONLY about your medical presentations & conditions! That is a real NO NO
Not in the assessment portion of the note, they assess multiple systems, many without you knowing. Gait for instance, general appearance, labored breathing etc. and in the assessment or exam portion of your note they do report on this. The doctor note is for them, other providers and insurance companies (well in the US lol), and it is true you may not like everything that is said, which is why they typically don’t volunteer to give those boys out haha. But it is important they document things according to them and trust me if you are requesting corrections to parts of notes other than “no I never had this surgery you listed” or “actually I did have a brain scan and you reported I didn’t” etc you WILL be labeled in code one way or another, not trying to be mean just telling you like it is.
No, there are no ‘codes’ other than disease codes which are used to gather data by public health. Observations are just that. So for example, if you always used to wear buttoned up blouse but now T shirt, your clinician may observe that you are struggling with buttons hence only able to put on your T shirt. It could also be about change in your circumstances, so if you turn up in pyjama bottoms, you maybe feeling down and don’t care what you put on, etc... also, GP records cannot be changed. EVER. You can request for your notes, letters, info to be added, but that will be an administrative comment & not clinical. This means it is attached to your notes but it is not part of your clinical notrs. Please also note that the records (UK only) do not belong to you nor your GP. They are the property of NHS ENGLAND. Hope this helps and take care
Thanks Kikica, that's useful...I'm hoping to have the inaccurate part of GP records changed from incorrect 'health anxiety' to SLE diagnosed by dsDNA (and other blood tests) for my ongoing care, as the last time I went, the locum decided on insomnia due to stress (ie health anxiety - writ big in the flagged section of my notes) rather than figuring out it was due to an obscure interaction between HCQ and a sleep aid that can be fatal, uh
The new Data Protection Act allows for inaccurate material to be changed/removed from medical notes, but remains to be seen how this work in practice as GP notes are their record of events..
GPs are all contractors in Scotland so possibly their records are all their own?
I did stumble across a list of doctor's acronyms that includes commonly used GP abbreviations, such as TATT:
messybeast.com/dragonqueen/...
patient.info/doctor/Fatigue...
Great to have your input, thanks! xxx
I don’t think you can change diagnosis... narrative can be added but it cannot be deleted. Sorry
That's what I've read, but I met with the Medical Director of the local general as he's the GMC Revalidation Officer for my named GP, and he agreed that for someone to have 'health anxiety' rather than SLE flagged as their health problem is DANGEROUS, but as GPs are autonomous, there is nothing he or anyone could do about it....??? xxx
PS nope - same in scotland re records. Although the health boards work differently, it’s still the same NHS so to speak
Found this in the Information Commissioner's website:
Example
A doctor finds that a patient has a particular illness and notes it in their medical records. Sometime later, this diagnosis is found to be wrong. It is likely that the medical records should include both the initial diagnosis and the final findings because this gives an accurate record of the patient’s medical treatment. As long as the medical record contains the up-to-date findings, and this is made clear in the record, it would be difficult to argue that the record is inaccurate and should be corrected.
......I had something from 1983 as a 'current problem'....GP removed it from that section, and now has it under 'comments' on the system xxx
ESA,JSA,Doctors notes plus DLA to PIP!
Notes for upcoming GP appointment 
Sun sensitivity - in Australia
Lost For Words!!!!!!!
