Nothing for months, and then two posts in a row. I can’t say this is because life has slowed enough to be able to reflect on it, but neither is there anything so pressing that I can’t indulge in some work-avoidance.
And this one is about work: the work I do supervising residents–young doctors in training in the specialty of psychiatry. Psychiatry is a discipline which depends very much on words: the words the patient uses, the words we use to describe how the patient uses words, uses gesture, uses voice, to communicate. Sometimes, that’s describing a refusal to do any of the above. “Patient refused to talk to us” doesn’t tell me much; “patient rolled over to face the wall and would not speak” says rather more.
Daily notes describe how patients are doing, what they are doing, what they say and what we can discern of what they feel;Â we list what we think is the diagnosis, and what we’re going to do about it.
Mostly, I co-sign the notes the residents write. I am rather particular about what my name goes on. I do not wish to put my name at the bottom of something incoherent or ill-informed (or not formed at all). I can tolerate non-native idiom; some of our residents are not native speakers. But I do like them to make sense; I don’t like to have to stop to re-read and figure out what was meant. Good prose is like a window-pane (Robert Graves, I think). Right up there with “Omit unnecessary words.” (Strunk & White). So here is the instruction I give them. It is not complete, but it soothes my soul and perhaps makes them pay a little more attention to what they are putting on paper–I mean, into pixels. You might note that spelling is a particular concern; that’s a topic for another time.
1. Itâ€™s â€œakathisiaâ€. Also, if you ever use it, itâ€™s â€œguaiacâ€
2. â€œlooseâ€ vs. â€œloseâ€, â€œaffectâ€ vs. â€œeffectâ€, â€œtoâ€ vs. â€œtooâ€.
3. Include heading â€œstaff commentsâ€ but not the teaching statement itself or the heading for it. (ATTENDING STAFF [not you] IS REQUIRED TO PUT THAT IN)
4. You could write out â€œside effectsâ€, then I wouldnâ€™t have to. You could write out â€œMedical Psychiatry unitâ€ (or even â€œMedPsychâ€) and then I wouldnâ€™t have to. And some reader years hence will understand what you said.
5. Inpatients, GAF not over 35 at admit and it should be higher (usually) at discharge. List both on discharge, e.g., â€œGAF at admit 30, at discharge 50â€ If going to Partial, there are rules for what score is appropriate.
6. Itâ€™s â€œColaceâ€ (not â€œColaseâ€). â€œdocusateâ€ is ok.
7. Pomrehn, Chatham Oaks, Abbe, Penn
I repeat: Chatham (â€œthâ€ not â€œtâ€ and not â€œttâ€), Oaks (not â€œOakesâ€)
8. Consults: faculty/staff physician requesting is the FACULTY ATTENDING. You still sign the consult order.
9. Get over the quotation marks if youâ€™re not quoting someone (although the use throughout this memo is correct).
10. There is nothing wrong with the verb â€œsaid.â€ In an appropriate context, you might substitute â€œaskedâ€, or rarely, â€œsaid loudlyâ€. Most other verbs describing speech are unnecessary most of the time. â€œPerâ€ is not a synonym for â€œsaidâ€, you might try â€œreportedâ€.
11. Bad grammar is nauseous. Unwashed patients and their effluvia are sometimes nauseous. Otherwise, persons are nauseated.
12. Contractions are not generally used in formal prose. Medical records are a form of formal prose.
13. Paragraphs are a useful device for conveying information. I recommend them in all but the shortest discharge summaries for the hospital course. I like them in admission histories also.
Evidence of mellowing or softening of brain:
I do not insist on correct punctuation for â€œegâ€ and â€œieâ€, though I am tempted.
(itâ€™s â€œi.e.,â€ â€œe.g.,â€). I try not to wince at â€œdifferent thanâ€, or use of â€œlikeâ€ for â€œasâ€.