Medical Letters Code

Several people have suggested, sometimes seriously, sometimes in amusement, that the letters doctors write to each other about patients might contain coded messages. The Notes and Queries section of the Guardian has this as a topic right now:

theguardian.com/lifeandstyl...

(Remember, this is a live topic, so responses are increasing. You might wish to go back and look more than once.)

29 Replies

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  • I imagine they mean exactly that - the person they were dealing with was pleasant. Wonder whether if they think the patient is mean and nastty they just leave a blank 'This _____ patient' and let the doc draw their own conclusion, also agree with the guy who thought someone years ago had written that and his students / underlings had just copied them.

  • Ha! After today's very good consult with an NHS Endo, I finished up by moaning about my weight and that I'd gone from a size 10 with low body fat to size 18.

    With a flourish I produced an A4 size photo of me on a mountain bike hooning down Dunkery Beacon on Exmoor looking fit and skinny. That shocked him!!

    Can't wait to see what gets written in his letter, lol

  • Yes It will be interesting to seeing his comments :-)

  • What did he have to say when you produced the photograph? I hope he was sympathetic and is going to work out how to get you back to your size 10.

  • Fruitandnutcase - he said that my metabolism was working faster on my previous higher dose of T3, I of course said my metabolism wasn't working at all!! Am now taking the dose that he wanted me to take all along.

    I deliberately took along a photo as am absolutely sick of medics rolling their eyes whenever I mention my weight. Also added that I still ride my bike twice a week.

    So basically he won't do anything although as I mentioned it was a very good consult apart from the weight issue.

  • Honestly! Pity it spoiled an otherwise good consultation.

  • Thanks Fruitandnutcase.

  • Well my letter (post x-ray finding extras) began 'this pleasant lady' and I immediately got suspicious/paranoid....

    Yes I'm now pretty unpleasant (to look at) but still proud! (back then I was hopeful I'd be back to normal within weeks) funnily enough I don't want to look back in time now... makes no odds...

  • Well I feel a little better knowing the comment on my letter is quite common, not so paranoid as Spareribs mentions. thanks Rod.

  • I used to run the computer system for a large GP surgery, and most consultants have a standard form of words which they use for the start of each letter. The scanning team used to have a sixth sense when it came to unusual terminology. Some was amusing, some was a red flag for bad news. I am not going to feed anyone's paranoia by giving examples because a red flag comment by one doc might be pretty normal for another.

    What I will say is that in my experience doctors do genuinely care, but cannot allow themselves to drown in their patients' emotions. So they often come over as more uninterested and uncaring than they really are. They also feel they are cogs in a system with relatively little room for their own judgement. But I have seen them go crazy when they think a patient is in immediate danger, spending hours on the phone to get them in to see a particular specialist, rather than trusting to AandE for example.

    I find its better to assume they mean well, but lack the wherewithal, than to imagine some deliberate malevolence.

  • Thanks for posting - it is very easy to see all the negative stories and never see them counter-balanced by positive. I guess that sometimes, probably quite often, the patients who benefit from such extraordinary efforts never know. Hence they can never write about them.

    We do, though, see some stories of individual doctors taking up the cudgels on behalf of patients. Sadly, it often seems to mean one doctor strongly disagreeing with another doctor - and it being a matter of luck which one ultimately prevails. Things like a consultant saying a patient needs liothyronine and a GP refusing to prescribe.

  • But if we assume,quite reasonably, that the GP who refuses to prescribe liiothyonine has the best of intentions then something else has to be going on.

    Here ate some options

    1. Pressure not to prescribe, on cost grounds, either from partners, or the CCG.

    2 A genuine belief that it is not necessary, presumably because they have been brainwashed.

    What I find so odd is that the driug manufacturers who stand to make so much more from T3 than Levo are not busily trying to brainwash the medics that T3 is THE answer. They could package it up with in a novel combination and flog it as the new answer, but no-one seems interested.

    I think we may just have, in western medicine, a reincarnation of the mediaeval church where heresy is so strong a concept. Bear in mind that there are nearly as many of our American cousins suffering in the same way as we do, even though they are fully paid up insured goldmines.

    I expect they are all delightful ladies and pleasant chaps over there too!

  • It may be genuine but it's rather patronising. I've never been called 'a pleasant lady' and I don't think I'd care to be. It's a bit like 'nice', damning with feint praise! lol

  • I totally agree! I've been called "a pleasant lady" on letters before and it just makes me squirm and feel patronised. It usually seems to be men who write it. Women generally just stick to the basic facts.

  • Yes, it is rather squirmy, isn't it. It's like those doctors that pat you on the arm and call you 'my dear'. Ugh! lol

  • I'd quite like 'nice' cos it actually means precise! It is a bit arcane using pleasan etc but one needs to worry when it is NfN (Normal for Norfolk!)

  • lol I've never heard NfN before! And what exactly IS normal for Norfolk?

    Trouble with 'nice' is that people these days use it when they can't think of anything more positive to say but don't want to be rude (honest?). So you never really know exactly what people mean.

  • I think it is a snide reference to it being a backward county full of inbreeding. Mind ŷou it does have the highest level of this in the uk according to recent research. And that is a good question in fact what is normal full stop?

    Yes nice has become a meaningless word in general useage but I still use it in its correct sense - signing off as Nicely Nutty of Norwich :-)

  • lol How rude! I am, and always will be, wherever I live, Disgusted, Tunbridge Wells! (Well, I was born there.)

  • I've was called a "lovely lady" once, I choose to believe that the doctor was being truthful.

  • Well, that's lovely - 'lovely' - much better than 'pleasant' or 'nice'.

  • Are you a 'pleasant man' Rod?

    well I know you are.... but are you officially labelled as such?...

    ( just testing if it's a female thing...)

  • arg! devastated after watching homesman film - can't do emotion anymore!

  • Actually, the only one I can remember was "pleasant chap" - which surprised me. The chap bit, of course - I am not pleasant and immediately recognised it as a special code sometimes known as "s.a.r.c.a.s.m" :-) :-) :-)

  • Code NFN Normal for Norfolk

  • Awesome! And so apt!

  • An endearing look at Normal for Norfolk, that you might enjoy reading:

    literarynorfolk.co.uk/norma...

  • I think the supposition of inbreeding (in a genetic sense) for Norfolk is based on limited surnames in the county. I was amazed to read this article about using surnames:

    le.ac.uk/genetics/maj4/Surn...

    It guess it might help explain why diabetes is much more prevalent in children in Norfolk...than elsewhere (2x national average)

  • Well, I'm a bit inbreed, myself. Even though I do come from London (well, Penge, actually). My mother and father were second cousins - and I've never forgiven them for it! A double dose of hypo! lol

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