Patient Denies

 I've become reluctantly familiar with the medical establishment. For years, I was, as one of my primary care doctors once joked, "as healthy as a horse."  Not anymore.

Over the last several years there has been a shift in medical record keeping, due partly to the increased use of electronic records and partly to patient demands for access to their own personal medical records.  With the advent of the Patient Portal test results, visit notes, and after visit summaries are readily available to read, often within hours of the encounter.

One of the terms I've had to adjust to is "patient denies."  Every visit requires an assessment, a list of questions about my current status--pain, falls, safety, mood, etc.  In the after visit summaries my responses are recorded as "patient denies pain,"  "patient denies recent falls," and so on.  It always makes me feel like the nurse doesn't quite believe me.  Sure, she denies pain, but is she really in pain?  Why can't they say "patient reports no pain"?  Or even better, "patient has no pain."  There is an implication in "denies" that seems to say, "there could be pain, but she won't admit it."

Then, as if that isn't disturbing enough to read every month, there are the myriad modifiers available.  Extensive, widespread, severe, multiple, innumerable. In one type of scan I receive there is interest in the extent to which various structures have uptake of the contrast agent.  Those that do exhibit "markedly avid uptake."  Avid, there are avid sports fans, or avid birders, or avid readers.  As the dictionary defines it: characterized by enthusiasm and vigorous pursuit : very eager and enthusiastic.  Gotta love those eager little tumors!

The one I like, though, is "unremarkable."  For the record, I have an "unremarkable gallbladder."  And, my kidneys have "no significant abnormality noted."  So, there is some abnormality, but it's not significant???  But, I really like "stable."  Or, even better, "significantly decreased."

I've debated the value of being able to read test results before meeting with the physician. On the one hand, getting the results sooner can be reassuring and relieve the anxiety of waiting. But, on the other hand, without proper interpretation the reports can be terrifying.  About every third word is a medical term I need to google--mesentery, hyperattenuating, hypoattenuating, hepatomegaly, hypodensity, granuloma, atelectasis!  I should have a medical degree by now!!