What to Do if Your Doctor’s Notes Hurt Your Feelings

Are you a “poor historian,” “well nourished” or in need of a “time out”? As patients gain access to their own medical records, the notes left by doctors can sting.,

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Have you ever been insulted by your own medical records?

Medical jargon can be confusing, but it can also sometimes hurt a patient’s feelings. This week on Twitter, a group of health care workers shared stories of patients who became upset after reading the physician notes in their medical records.

One patient read the notes from her colonoscopy report, which included a reference to a “time out.” The woman reportedly was upset by this, and called her doctor saying she was “well behaved during the procedure and did not need a ‘time out.’”

The good news is that the patient wasn’t in trouble. What she didn’t realize is that the “time out” noted in her medical record referred to a crucial safety step that doctors are supposed to take before medical procedures and surgeries. Members of the medical team take a “time out” immediately before starting their work to triple check that the right procedure is being performed on the right patient and on the correct body part. (While medical errors can still happen, this protocol has drastically reduced “wrong site” surgeries, in which doctors mistakenly operate on the left leg, for example, rather than the right one.)

But misunderstandings like this are becoming more common as patients gain access to their electronic medical records. Many hospital systems now offer convenient portals where patients can check in for appointments, send notes to their doctor and read lab results and medical records.

A report titled, “Your Patient Is Now Reading Your Note,” from researchers at the University of Washington and Harvard Medical School, advised doctors to think about supportive language when making notes in a patient’s chart, and said that common medical jargon could be confusing or feel judgmental when read by patients.

For instance, medical records often describe the patient’s appearance. A patient may be insulted to see themselves described as “disheveled.” Instead, the report advised, be specific and say, “The patient’s shirt was untucked.”

Reading scary medical terms in the patient record can also be devastating to a lay person. A doctor may casually write that a patient has “renal failure.” A better description is “chronic kidney disease,” the report said.

The study noted that abbreviations commonly used in medicine could also be a problem, including:

SOB: The report advised doctors to write out “short of breath” to avoid offending the patient.

F/U: It’s better to avoid abbreviating the words “follow up” when noting a patient’s medical record.

OD: This abbreviation for the Latin term “oculus dexter,” or the right eye, can cause confusion.

In the recent Twitter discussion, health workers added to the list of potentially unsettling medical terms.

“Patient is a poor historian.” It’s not a criticism of the patient’s knowledge of history, but the way doctors often note that a patient can’t remember details of their own medical history.

“Patient is well nourished.” While it might sound unflattering, the term usually just means the patient isn’t malnourished.

“Denies recreational drug use.” A patient was upset by the phrase, because she thought that it implied she was lying about substance use.

“Dizziness and giddiness.” A patient was appalled by this description, but the terms are commonly used to describe a patient who feels unbalanced or lightheaded.

“Slow k OD” A patient’s wife saw this and thought it suggested a patient had overdosed. In this case, the shorthand actually meant the patient took a prescription potassium tablet once a day. (The letter “K” is the symbol for potassium on the periodic table.)

Going low carb for heart health

A new study, one of the largest and most rigorous trials of the subject to date, suggests that eating a diet low in carbohydrates and higher in fats may be beneficial for your cardiovascular health if you are overweight, reports my colleague Anahad O’Connor.

The new study, which was published in the American Journal of Clinical Nutrition, found that overweight and obese people who increased their fat intake and lowered the amount of refined carbohydrates in their diet — while still eating fiber-rich foods like fresh fruits, vegetables, nuts, beans and lentils — had greater improvements in their cardiovascular disease risk factors than those who followed a similar diet that was lower in fat and higher in carbs. Even people who replaced “healthy” whole grain carbs like brown rice and whole wheat bread with foods higher in fat showed striking improvements in a variety of metabolic disease risk factors.

The study suggests that eating fewer processed carbs while eating more fat can be good for your heart health, said Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University, who was not involved with the research. “I think this is an important study,” he said. “Most Americans still believe that low-fat foods are healthier for them, and this trial shows that at least for these outcomes, the high-fat, low-carb group did better.”

Read the full story:
Can a Low-Carb Diet Help Your Heart Health?

The latest on Covid vaccine booster shots

Last week’s newsletter advised everyone to “stay tuned” about potential changes in the recommendations for booster shots. Just hours after I shared that advice, the guidance from the Centers for Disease Control and Prevention changed again.

Eligibility for boosters now has been expanded to front line workers, including health care workers, first responders, grocery and food workers, postal and transit employees and many other occupations considered to be at higher risk for coming into contact with the coronavirus. The booster shots are authorized for those who received their second dose of the Pfizer-BioNTech vaccine at least six months ago. Advice on boosters for people who got Moderna or Johnson & Johnson shots is expected in the coming weeks.

But it’s important to note that the C.D.C. doesn’t actually recommend that everyone who is eligible go out and get a booster shot. The agency has advised people 65 and older, those in long-term care facilities and people 50 and older with at-risk conditions to get boosters. People who are eligible because of their occupation or because they have an underlying medical condition should weigh their individual risks and benefits — or talk to their doctor — to help them decide whether to get an additional shot. You can find more information from the C.D.C. here about eligibility for booster shots.

The lack of guidance for many of the people who are now eligible for boosters is frustrating, but for now, we’re all on our own when it comes to making decisions about a third shot. Personally, I’m not rushing to get a booster shot because I’m confident my vaccine is protecting me from severe illness with Covid-19. I’m planning to travel by plane in November, and I’m still deciding whether I should get a booster shot before my trip.

Read more about booster shots:
What to Know About Booster Shots

The Week in Well

Here are some stories you don’t want to miss:

Gretchen Reynolds shares why exercise is more important than weight loss.

Jane Brody writes about broken bones.

Anahad O’Connor explains how alcohol affects your heart rate.

Christina Caron reports on how to fend off winter depression.

And of course, we’ve got the Weekly Health Quiz.

Let’s keep the conversation going. Follow me on Facebook or Twitter for daily check-ins, or write to me at well_newsletter@nytimes.com.

Stay well!

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