Apr 30, 2010

Thanking The Doctor, Not The Chart

"How do I avoid my thank you note being scanned into my medical records?"

Doctor D recently got an email from a patient who was horrified to find that a thank you note she wrote her doctor had been filed in her chart. WTF? Why the heck would a doctor stick a personal display of gratitude in the chart with a bunch of lab results?

Yes, we doctors are kind of obsessive about our records. The record is supposed to log every interaction we have with our patients. Most docs don't count a thank you note as a medical encounter, but some docs are just going to err on the side of being anal and put anything in there. (It's not our fault that we are meticulous about records. We live in constant fear of lawyers who are out to use medical records to destroy us.)

One question you may want to ask yourself:
Is is so bad to have your thank you note on the medical chart?

It may be odd, but it usually isn't a real problem? Unless your note is creepy, having a note on the chart makes you look like an awesome person to anyone who sees the chart later.

But if you are a private person who doesn't like your feelings being preserved in a permanent record there are a few strategies you can use to keep that Hallmark card out of your chart:
  • 1) Don't mention details of your treatment or symptoms: Just stick with your feelings of gratitude. If you say, "Thank you so much doctor, but I just wanted you to know that since my treatment I've had this funny tingling in my fingers..." then you have just asked about your medical symptoms and therefore an MD is legally bound to keep record of these symptomsusually by scanning the entire note into the chart. Keeping off the medical stuff will avoid forcing your doctor's hand on this.
  • 2) Ask to keep it off your chart: Most doctors want to respect your wishes. If you say "don't file it" then as long as it isn't very medical in nature we will try to leave it out of the chart. Of course, there are some anal doctors that just can't help but stick everything in the chart, and for those doctors there is always option #3.
  • 3) Ask the doc, "If I send you a thank you card will it end up in my chart?" If doc says "Yes" and you feel strongly about your card not entering the record, then express your thanks verbally. Despite what the gift card industry would have you believe, you can sometimes say it just as well without a card.
  • 4) Say "Thank You" with an interpretive dance. There is absolutely no way to enter dancing into the medical record! On second thought, don't do that—it might come across as creepy.
Have you ever been frustrated to find you doctor charting personal communications that you felt shouldn't be in the medical record? Have any of you health professionals felt like you had to file a thank you?

As always Doctor D loves to hear your thoughts and stories in the comments!


Pissed Off Patient said...

I vote for interpretive dance because that would be seriously amusing.


tracy said...

Ha, ha..."interpretive dance"....i guess that would be okay...my lovely internest already knows i'm crazy...! i mean, he's the one with the staple removers... ;)

tracy said...

Well, now that you know i'm a nut...i was in a looney bin once and saw a thank you note i had written to a really nice, understanding psychiatrist i had seen while i was there...a rare hospital type that actually l i s t e n s to you.....in my chart...it really upset me....but now i know why it was there. Thanks, Dr. D for the explanation.

PS A super nice nurse snitched the note back for me...and i got rid of it...

tracy said...

No, it wasn't creepy...the note.

Anonymous said...

I once saw a thank you note of mine in my chart. It bothered me that something I'd sent in a spirit of warm gratitude had apparently been received as a document that could be used against me in the highly unlikely event that I would sue. But then I noticed that it was a photocopy, so I thought maybe that meant the doctor had kept the letter in the spirit I'd sent it, but copied it just to be anal. Or who knows.

At the time, I was seeing several doctors in that office and I hoped that the others wouldn't see the letter, make comparisons, and, by contrast, feel "unthanked" by me.

I basically feel that when I send someone a letter, they are free to do with it whatever they choose. But it does seem odd for someone to receive a private message and then leave it where their coworkers can read it.

WarmSocks said...

If I thought that a thank-you note would end up in my chart, I wouldn't write one.

It makes sense that if the note isn't just thanks, but goes into a report of symptoms or treatment, then that might need to be documented. However, the spirit of appreciation behind a simple, heartfelt thank-you seem to preclude it being part of a cold, clinical chart filled with facts and figures. If the doctor wants to keep thank-you notes, there should be a separate folder.

Thank you, Doctor D, for this series and giving us more to think about.

Anonymous said...

I still want to know how doctors thank their patients. Do you even believe that doctors should thank their patients? Just curious.

Anonymous said...

@Anonymous 9:01 pm

It feels strange to imagine a doctor thanking a patient. As a patient, I would never expect it. A doctor once expressed appreciation for my being pleasant throughout a series of not-fun treatments. That was very kind of her, and I guess it was sort of like a thank-you. But I think it would be setting the bar pretty low to expect thanks just for being a reasonably compliant and cheerful patient. I can easily see how a doctor might go above and beyond the call of duty (and thereby merit special thanks), but it's not so clear to me how a patient would be extraordinary in the role of patient.

Doctor D said...

Anonymous 9:01 pm:

I couldn't agree more.

Doctor's should definitely thank their patients. In the end they are the reason we have this profession. We docs make a very generous livelihood by caring for patients, but often that care is uncomfortable and embarrassing for them.

I thank patients who have dealt with a lot of crap from the medical system (often at my hands) for their graciousness. I also thank the ones who have taught me incredible lessons in humanity with their courage and kindness.

Most of my thanks is expressed verbally, with the emphasis of delayed gratitude. I rarely give gifts because it seems trite and almost insulting to give a token considering the financial cost of visiting me.

The biggest gift I give is my free time--stuff that isn't an official part of the job. I had a patient dying of AIDS. He asked that I be there with his family when he went. Spending my off day at the hospice home with my family was the last gift to an amazing patient who taught me so much.

Anonymous said...

now i'd like to know what the patients have taught you, that would be an interesting topic/series...

Post a Comment