Saying a Patient “Refused” vs “Declined”
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- Опубліковано 8 вер 2021
- Little words can actually make a huge difference in how a patient is perceived by other people reading the chart!
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My favorite one is when I read the notes and it says I refused something that was never discussed.
The audacity 😂
Souvenirs if you ask me 😂
I checked the notes after a visit for the first time recently and was shocked because what is written is so not what the experience was.
Makes me never want to go to get a regular check up ever again.
Lol the main thing being that the notes state that I admitted to having a “high sugar diet” but the nurse who seen me asked me what I ate *recently* and I said fruit.
Wtf?? 🤣 I get that fruit is sugary. But that’s not high sugar diet for all the time. Way to lie on me.
Or the notes saying they fully examined you? Like you didn't even listen to my lungs let alone press on my stomach, look in my ears or ask about any of the 50 other things you have listed. I had no idea about that until I went to 2 Drs appointments two days in a row.
The second day was because I was still feeling ill from my regular check-up (wasn't there for that but told them). So when I went back and saw a different Dr they said "but it shows everything looked fine and you didn't mention these issues yesterday." I was like excuse me? She showed me. I told her that was all incorrect. I found out they even do it in the ER. They must hate us having access to our EMR now.
@@anniemouse1 yep, it's infuriating. I had an ER doc write that I denied pain...when I was there for excruciating pain. When I tried to report the doc for lying in my record I was told it wasn't a lie because what he said matched what he wrote. Like oh, so his lie isn't a lie because he wrote it down?
@@waffles3629 it's sad... It's like the Dr is always right. And sometimes I can see why they'd want to believe that, but other times no. Especially when it's stuff that is of no benefit to us to lie about.
Refused sounds more like "NO AND YOU CAN'T MAKE ME" whereas declined sounds more like "no thank you :)"
It would be even better to provide the reason the patient declined (if available). "declined due to cost of the drug", "declined because he/she took the drug in the past with intolerable side effects" etc.
Also at this time it's important as they may take up the option later.
So why aren't they required to give some short note as to the reason for a patients response? This seems really important!
And patients have the right to decline
Yes! I like to use refused when it's with notes like that I thoroughly explained the consequences of not going to the er and strongly advised them to go, and still patient refused. Vs patient with sprain declined care, promised to go to Dr if things don't get better within a few days.. so happy he shared this...
Nice to hear you say this. I saw the word "refused" several times in my chart and felt that it was insinuating that I was "wrongly refusing" and not that I declined for legitimate reasons.
A lot of doctors really do throw a fit if you show any sign of autonomy, or even if you do what they say and it doesnt work out. Like 9 out of 10 doctors ive met were really callous.
Same here. I didn't eant to take medicine in ER because i react badly to it and there are many alternatives. They just wrote refused and thus later claimed i faked my symptoms. Rhis was in germany, so not usa exclusive
I'm so glad that there are physicians who are bringing light to this issue on social media. As a physician myself who just finished residency and is about to start my first job, bias is often passed along medical professionals who share patients due to language that implies a patient is noncompliant when they have valid reasons for not necessarily agreeing with what the physician prescribes or discusses with them. Key point for those of us in the medical field: look up research discussing wording that transmits negative bias against patients and why that diminishes quality of care, it's a great place to start. Another key point for us: listen to the patient, and if they don't agree with something you suggest, ask why, don't assume.
Your patients are going to be fortunate for your care and understanding ❣️👍🏽🫶🏾
Please consider preparing your own offering via video around this matter to Dr Been (online medical education videos) for example.
Heart and emotional intelligence needs endorsement in the healing professions. The alopathic approach is well in need of changes to make it useful and desirable to people today and in the future.
Utilising platforms that the pharmaceutical industry has not got control/influence (as yet... and hopefully for awhile) to educate each other towards more wholistic practice of medicine... can only have more benefits for more people.
In My Medically Non-educated but Chronically Experienced Opinion.
Okay, "Chronically Experienced" is my new favorite descriptor 😂
Signed,
A Chronically Experienced, now Current Med Student
Nurse of 40 years-I thought all had been lost in terms of listening, patient sensitivity, and medical bias and then I saw your comment😊. Hope you can influence other healthcare workers!
The same thing happens at schools.
One teacher writes, "student disruptive," and each subsequent teacher gets a bias and ends up vowing the child as disruptive, so they chart it again.
Worked with a student like that. He was a bright child, but wouldn't sit still, & do his work.
Didn't actually disrupt the class, just wiggled a lot.
So one day, offered to help him at his work. Turns out, he was illiterate. It was the end of 5th grade, and he couldn't write his name.
His wiggling was his embarrassment. His refusal to do his work was because he couldn't.
Long story short, he got into special Ed and LOVED it. Said it made him feel good to be the smartest kid in the class instead of the "stupidest" .
By the end of 6th grade he was reading high 3rd grade level and was excited because they were holding him back another year before sending him to Jr high so he could get up to grade level.
Because of the bias, everyone thought he was a bad child, but he was very sweet and very smart and had fallen through the cracks.
The other thing I picked up on is what you said at the end "AT THIS TIME"
Those 3 words in paperwork also make a huge difference to the way the paperwork is interpreted.
Exactly. It leaves the door open for the treatment or medication to be offered at a later time without bias.
Also there's a huge difference between "refused" and "requested amendment" in the example given they're requesting that they get their meds in the morning because it improves their QOL. Paperwork containing a request is more likely to be considered. A refusal they will just come back at the same time the next day to try and give him his meds.
Unless you know specifically that the patient will change their position later then you are making it up and the three words are meaningless.
Be careful with those three words. Stating them too often makes you sound like a Valley Girl telling a story ... "Like and then, like and then, like and then."
@@erinwojcik4771Its a medical report as long as it conveys the proper information it doesn’t matter how it sounds it’s not ment to be entertaining its ment for medical professionals to communicate with each other
I appreciate this. My mom was labeled as "noncompliant" because she couldn't afford her heart meds and didn't take them.
I was labeled non compliant for forgetting to take new meds-have a TBI causing extreme short term memory impairment
Honestly some people in medicine are less than caring and understanding. Had a similar experience
@@opallunar it’s just stupid. I saw that doctor write it down on a paper form, I grabbed it and saw “noncompliant” on it and lost my mind. After being thru SO MUCH, I was sick of their stupidity. I obviously needed to think of a way to remember them, given my condition/diagnosis but instead of suggesting things to help he stupidly wrote noncompliant. Unbelievable. (Wish I could FORGET these idiots! Haha)
@@opallunar I’m very sorry you went thru that. Demeaning and disrespectful
@@opallunar And simply writing “noncompliant” is NOT ACCURATE. To me, it’s also LAZY. Words matter. And descriptions in a chart totally affect how doctors and nurses perceive the patient in the future! Grrrrrr
Gotta show this one to my boss. It’s such a great point and people 100% get treated poorly because they become labelled as “difficult” or “argumentative”, when they just want to do something in their own time.
Or can't afford to do it in the way the healthcare system in the U.S. is set up. If you have private insurance, you might have a $20 copay for your PCP, but a specialist copay is $50. Yet to go to the specialist, your insurance might require a referral, meaning that the first specialist visit is actually going to cost you $70. And that's not counting percentage deductibles that might be part of the cost of seeing a specialist, depending on your insurance coverage.
Thank you for stating this. My mom just passed from cancer. She ended up in a tremendous amount of pain unfortunately and when she was going through chemo and everything she was unbelievably sick. She declined certain medications that would make things worse at certain times, or with certain medications. She was taking a lot of medication, and she was scheduled to take a medication that would reduce her blood pressure, but was also scheduled to take medicine that although not specifically intended to raise it, would do so. A few of the nurses treated her like crap and I overheard them talking shit about her down the hallway. Simply because she wanted to reschedule one or the other. The nurse she spoke to (was very sweet to my mom) very nicely told us, and I quote, "That's perfectly fine sweetheart, and it makes sense. I'll just note that you refuse this one."
She was very young, and she personally was very attentive and nice to us. But that puts a lot of perspective on why some of the other nurses thought my mom was being stubborn and difficult. That particular nurse likely made this exact mistake and it left a negative impression with the other nurses who were helping out, or those who came to relieve her on shift. I didn't understand why some of them were so dismissive when my mom was asking for assistance. - sigh - "Ma'am, this is why we told you that you needed - insert name of medication here -."
When she would try to explain why, they were already passive aggressively trying to help her and not really paying attention.
I understand nurses work very hard, but I would also urge all of you to please take an extra few seconds to speak with your patients. Some of them just didn't seem to care AT ALL, while others who asked questions AND LISTENED really seemed to like my mom. My mom was a no nonsense kind of person, who will give you back exactly what you give her. She could be an absolute angel or a demon depending on how people treated her. This was intensified when she was sick. The nurses who actually tended to her and spoke with her about what she was actually feeling, ended up loving her to death. The ones who were talking shit about her down the hall, hated her and she ended up being stubborn with them because she could see they couldn't give a single fuck. She didn't trust them...
It's a two way street guys... Just try to remember that when you're dealing with someone who's sick beyond belief and in tremendous pain. Sometimes, all they need is to see that you care.
I'm so sorry for your loss. As a nurse of 24 years, I apologize for the nasty nurses being rude to your mother. I find all too commonly that many nurses don't consider the mental state of someone being that sick, is dealing with. They are pushed by the hospital to get patients in and out as quickly as possible. I'm constantly calling my team out on this. We had one patient that was dying from cancer, her husband had early dementia, and her son was mentally disabled. I knew she was extremely worried about whom would care for her son after she was gone. I went through her relatives with her (in her cell phone) and her brother told her, "don't worry about Justin. He'll always be welcome in my home. You need to rest your mind and not worry anymore." She went on hospice and passed away 24 hours later. I miss her so much. My team recently dealt with a patient with a "end it all attempt." My team seemed frozen, had no clue how to treat this patient, or handle this type of situation. To me, he's a human struggling and needed extra care and consideration. He's in outpatient daily therapy now. He's young and has a family. I'm so glad God decided it wasn't his time.❤
So sorry for your loss. I’ve dealt with nurses like you described. It’s unbelievable that some nurses & technicians can be so impatient & uncaring towards sick and elderly people. They better pray no one treats them the way they’ve treated their patients!
This beautifully stated comment sums up my entire life!!! 😢 Be it the medical profession or children's services. I never refused anything other than them removing my children from my home, love, and care. I've been saying this exact thing, refusal and denial not being the same thing. And that when you add, "Not at this time", it gives the denial a lot more weight. "They" refused to hear me. My Constitutional Rights have been violated by these agencies for all of my adult life.
Your Mom sounds a lot like me. I am so sorry for your loss🫂🕊️
As a new grad nurse who has used "refused" in my charting, I'll now use "declined". Thank you!
Don't forget to also chart the reason why. Context is key
While you're at it, don't chart "patient noncompliance" as a diagnosis. I told my doctor my depression was making it difficult to treat a minor physical condition (he wanted me to take a med multiple times a day and I could only manage once) and in my chart that's what he wrote. It didn't even say what the "noncompliance" was for! Here I thought being honest about my difficulty would help him figure out a better alternative treatment, but I guess he cared more about covering his ass.
@@pendlera2959What they call non compliance I call one of the many symptoms I need treated. I have to "refuse" medication and treatment until I'm well enough to try, I'm listed as "non compliant" for having my health foremost in mind when the doctor doesn't and we're the problem? (tone sarcastic)
I came here also to include the why reason. Sometimes even the doctor doesn’t know that ancillary or specialty services can remove the barrier to care that they’re documenting :)
So when we all stop writing refused and start writing declined, the connotation and bias will be the same. What will we change it to next?
Thank you for this. I declined an antibiotic that I know I’m allergic to in the hospital and when I finally saw the doctor she looked at my chart and said “well if you want to get better you shouldn’t be refusing antibiotics.” Apparently they didn’t even write why I had declined to take it! Yeah…I know I’m already in the hospital and everything but I would still like to avoid another anaphylactic episode, if possible.
"And you won't be a doctor for much longer if you force me to take something that will kill me"
You think that's a problem try getting consent from a deaf one....they are labelled horrendously and do not know it unless they FOI their medical notes.
@@katecourt9896 what?
I've a very similar experience sadly
Please keep avoiding hospitals. It's crowded enough without people trying to label overworked professionals as trying to kill them.
Thank you!! I work in a hospital and there have been times where patients are asleep when they are supposed to get meds or do blood draws and the nurses will chart it as “patient refused” THE PATIENT WAS ASLEEP, we couldn’t wake them up. It bugs me seeing that be put on the charts when the patient has been overall cooperative
When at the pharmacy picking up my medication, i was asked if I had any questions for the pharmacist. I said no i don't, thank you." And they put "refused medical council". As a psych patient, this seemed concerning to me. I read that as I refused to speak to the pharmacist, when in actuality I just didnt have any questions as I'd been taking the med for a while. After watching this, now I'm more concerned.
Maybe next time say you do have a question...ask what the pharmacist would want to know if he/she were you. Who knows what they will say, but at least no one can say you refused to be counseled!
A note like this is no big deal - the pharmacist just has to say they offered. If you know your medication, nothing has changed with it (no dosage adjustments, no brand name to generic, etc), and no new side effects, then there's nothing to worry about. Take it from someone who's in your same position.
@@hgdellinger That's kind of the point of the whole video, having the word "refused" on your chart can have a huge impact on your future care. I would ask them to rephrase a comment like that!
As a disabled person this means so much to me. We sometimes HAVE to refuse things when we know more about our condition than emergency professionals treating us (not their fault, rare disease, emergency treatment) but the terminology can curse us going forward when it’s already so hard. I cried when I saw this. It helps
I am sorry to hear about your struggles. I have a chronic illness and most drs I speak to do not understand the complexity of it... it's very frustrating for me and drs hate it when I'm trying to explain how all my other symptoms /problems are related to this.
Ever been told that whatever is happening CANNOT be happening "because the book said........."? That one drives me nuts
The worst way they do that is when they pull the degree card and say something about medical knowledge from Google. Meanwhile you've lived with the condition for decades, know other people with it and their experiences, and the doctor spent twenty minutes on it in a lecture years ago.
@@SAOS451316 I'm not sure.... I used to think that. But for the past 4yrs I have been told by several doctors that I am smart and I will figure it out, just call them if I find something I think might work and they will write the prescription. I tell people I'm a Google doctor. They don't help at all anymore and that is scarier than before.
@@goodolearkygal5746lol had this happen to me during a pap smear. explained to the gynecologist that i had a condition that can make non-painful things painful, she kinda laughed it off. when i experienced pain during it and reacted to said pain she said “well this SHOULDN’T hurt!” like that was going to make my body stop producing pain.
Sometimes reading your medical notes seems almost like reading a police report.
That's why I'm scared to try it! 😰
Sadly lots of nurses who want to power trip on the job actually mean for it to. We are here to figure out want is wrong, understanding and care… Not interrogations full of threats and passed on negative opinions about us. I dread going to hospitals and doctors visits in general for this exact reason. They tell us to go routinely and go to the ER in emergencies then treat people like this. It’s control and abuse.
well you should hear what we leave out!! Some patients are truly a nightmare to deal with.
😭😭😭😭😭😭😭
You nailed it 😢
No kidding, I was in the hospital for almost 3 months after brain surgery and it detailed everything including strapping me down to a bed. They did however failed to mention that a nurse sexually assaulted me.
Me side eyeing the doctor who assaulted me and then put in my chart that I refused care and was a difficult patient. The bs he wrote in my chart got me so much more mistreatment and lack of care along with lots of horrible remarks like "despite your kicking and screaming we'll treat you". I'm thankful for my mental health doctors who listened to me and put in effort to get some of those things removed or edited to reflect what actually happened.
This cannot be said enough. This is such an important message for medical providers to heed.
This is such a good point... After having my baby I left the hospital after one night (it was always my plan to stay as short amount of time as possible because of covid, my husband could only visit for one hour a day and I find hospitals to be the least restful places on this planet)... Anyway, right before leaving they did a blood test and the results came back AFTER I had done all the paperwork, signed everything, packed, my husband was outside waiting etc. They told me I still had a high CRP and had to take antibiotics, told me go to my doctor for a prescription and that was that. I thought nothing of it. In my documentation it just said that the patient insisted on leaving the hospital despite the exam results... Depicting it as if I had refused to comply with their suggestion I should stay longer to take antibiotics at the hospital.
How innacurate a description is that?!
I broke my leg in 5 places, I was BIBA and had to wait for the swelling to go down before surgery and the medical notes said patient is walking well and walking was spelt incorrectly. Oh ! the things I have seen would make your hair curl.
You can always add a note to your medical record if you disagree with something.
I'm curious where you all come from cause in Germany as a patient you usually don't have access to the documentation made about you. I guess you could get access, if you really wanted to, since it's your data, but if that happens, it's very uncommon. I'm almost finished with nursing school and in those 3 years I've never had a patient ask for their documentation. They just get a letter in the end to give to their doctor.
@@komori-hime3512 most foi if they are really concerned and if 3 complaints are made on the same thing a Dr can be stood down until he has completed re-education.
@@komori-hime3512 I always ask for my documentation. Most people don't bother with it, but I have a history of being given inaccurate information, declined any addressing of my concerns, and getting sicker because of that. So it helps for me to know exactly what they're notating about me because they put down inaccurate info so often
Thank you for this excellent distinction between the two! I often have to chart that a patient "refused" an ultrasound and have been looking for a professional way to differentiate between "patient would rather not because they don't know if their insurance will cover it" and "patient got tired of yelling at me so they progressed to biting"
😂😂
LEGIT. I often say declined, because it feels rude to say refused, especially when a patient who lacks capacity is making the right decision for them as they know it (ie BP cuff hurts, I'll rip it off and hit anyone who comes near me), but like, that requires a lot of writing to explain so that the next person who gets the cuff thrown in their face knows that there hasn't been a sudden deterioration.
THIS, I work at the front desk and so I often hear the story of why they chose not to get a procedure at this time
the worst ones are when they say pt is refusing to get a procedure when the reality is that they can't personally pay and have been bounced back and forth by several financial institutions about whether they will or will not pay for this MRI, and the patient CANNOT afford the $8000 it will cost on their own
When I was a kid, I had a severe allergic reaction, and the ambulance tried to start IV benadryl, but the IV failed. They tried again, another failure. At this point, my mom was freaking out and wanted me to get to the childrens hospital with people who were specialists at getting IVs in little kid's arms.
It got charted as "parent refused IV."
So there was a good few minutes spent in the ICU trying to convince the hospital that she wasnt actually refusing IV Benadryl, rather refusing to watch her kid die sitting in an ambulance in front of her house when there is a well equipped childrens hospital just down the road. Saying something like "declined 3rd IV attempt in ambulance, preferred transport" would have been so much more clear for communicating the actual intent.
Same! In the lab I always used refused even if it was “hey the doc says I’m being discharged today and the last three days of labs all looked good” vs “no I’m very anxious about blood draws and you’re not doing a good job of calming me down” vs “this patient is a staff safety risk now due to their chosen method of refusing lab work via hands and teeth”. If I were to ever return to phlebotomy I know how to differentiate now
This needs to be talked about more!!
This is a great video. As a patient I really appreciate seeing a doctor that not only understands that but strives to educate on it.
I have scribed for a doc who typically documented "patient preferred to hold off on this option for now" which is wordier but I do like its implication
you know...because of the implication....
It opens people who read it to ask about their concerns, which is best for everybody involved.
@Emily I like that. I’m broke and uninsured. When I do see a doctor I often have to wait on procedures others might agree to immediately, and either borrow the money or save up till I can afford it. So, I am only declining temporarily.
@@T123456788 I see what you did there😎
@Emily as someone with no insurance I thank you! If I'm at a point where I'm in an ER/doc's office, clearly I'm in a bad place and I want to get better. Unfortunately I can't always afford everything.
My gp threatened to write down that I "refused" to take a pregnancy test for nausea despite the fact that I told him repeatedly I hadn't had sex with anyone who could possibly get me pregnant in literally years, my cycle was stopped for years, and the nausea was a reocurring symptom from childhood 🥴 thank you for posting this so that I know which terms to use/request to advocate for myself as a patient.
I hate the way they force pregnancy tests for every single thing, like unless it’s the messiah I’m definitely not pregnant!😂
@@TheSongBirdRainStar for real!! I promise the plastic hasn't been blessed by any priest 😜
@@TheSongBirdRainStarTo be fair it's because making sure is a lot safer than not making sure. Medical professionals can get in trouble if the patient really end up being truly pregnant especially if the woman eventually has to go through life threatening pregnancy (ecoptic pregnancy, ect.) and died..It is annoying to have peegnancy tests with the health condition you have but there are legal reasons because there were times the unthinkable did happen at one point.
@@bmona7550 A lot of procedures and medicines also cant be given if theres reason to suspect pregnancy.
He threatened you? Did you say "so what, go ahead"? If I saw that in a patient's chart, I'd just chuckle and keep reading for information that would actually be useful for something.
I hope the younger people going into the medical feild see videos and comments like this, stories of people who deserve better, and strive to be better themselves. Ive seen very few drs that were actually trying to help people instead of handling cases. I understand that they are busy and stressed but my moms cancer was marked in her patient file for years before anyone actually told her
This is what I've been saying for years! Thank you!
I started nursing school this year and I appreciate this kind of PSA just as much as your comedy content, I learn a lot. Thank you!
Same, I’m gonna remember this one
Good luck! I hope you do well!
I'm m type 1 diabetic, i see my nurses/doctors a *lot* . So I'm definitely close with, and extreemly appreciate, all of the nurses for both my PCP and endo.
I mean, I speak with the nurses more than the doctors themselves. I do my best to remember their names, but I'm really bad with names, so I always try to be as civil and understanding as possible with all nurses!
I'd say nurses have some of the best stories. When you get the rare opportunity to chat for a few minutes with one, it's really an eye opener and almost always a good time.
I appreciate what you, and all medical professionals are doing, especially in times like this 😃
Starting PA school and I'm going to remember this advice.
Good luck! I just started my third year!
Now that patients are client are consumers I wonder what patients think of their new labels..?
As a nurse, you've only documented half the info if you don't say why something was refused.
My favorite ones to document, Pt refused dressing change, stating "F you and get the F out of my room"
@@BlissyAcKc lmao
@@BlissyAcKc I love quotations! I've been told my nursing notes are informative and entertaining. But the credit truly goes to those colorful patients!
@@BlissyAcKc “Will continue to monitor”
@@BlissyAcKc lol yup 😆I've heard that a time or two
I work in a group home and I saw this video a couple years ago and changed the way I chart because of it. Thanks!
Thank you. I agree. Maybe teach doctors that pain patients aren't addicts too. That would be awesome!
It's horrible, I can't trust doctors anymore. I went to an urgentcare for severe bursitis that was painful even sitting still and a terrible doctor came in and pushing my arm far past when I said it was painful. Very rough and mean, she left me crying in more pain than I was before. No doubt she thought I was a drug addict but if you think of every patient that way you're going to hurt people who just need your help.
Right. And someone with extreme side effects from their meds isn't trying to "refuse" their meds, they're just asking for relief
From now on I'll ask the nurses to say declined instead of refused!
I've so been there, being labeled drug seeking! I take Tramadol daily. My primary care dr. was back-pedaling after he prescribed it, so I voluntarily switched from 3x a day to 2x. What a mistake! I'm now 'seen' (tele-appts via phone, no video, since COVID began) by a pain mgmt dr. When I was rear-ended & had whiplash, I asked for my 3rd dose back & was denied bc " it's a dangerous opiod!" Anytime I miss a dose, or if I've been hospitalized, I set the pills aside, so I have them when I really need them. I'm not an addict, as I've been out of them when I just couldn't get to the pharmacy due to illness or car trouble. Yes, I hurt a lot more, but I'm not freaking out or calling to get a ride there in desperation. Normally, I take 2 50mg tablets every 12 hrs. And there are months that I don't need any extra pills. When I really need more, I'll try to take just one extra tablet & that's usually enough. I don't think most drs understand how exhausting & debilitating pain really is. I still hurt when I take my meds; it's just not so bad that I can't focus on anything else. I keep it at bay by keeping my mind busy, so if it's too much to ignore, it can quickly get out of hand. Now, if I told any of my drs this, I would be labeled non-compliant & drug seeking. No, I'm just seeking to keep the pain manageable, that's all.
I've also seen people in the US say they were noted as 'refusing' medication... That they couldn't afford. What they actually said was "Doctor this isn't covered by my insurance and it's thousands of dollars!" And it had to be charted as "refused X medication" which can lead to issues down the line when they seek treatment for things and can be labeled 'noncompliant'.
You can even be charted as refusing a medication you were never offered. Or refusing a medication you are currently taking every day, and have been taking for years.
It can definitely lead to bias...not cool..
I've got had friends - some who were MDs themselves!- documented as refusing medications that it said IN THEIR FILES and on their Medic Alert bracelets that they were wearing at the time THEY WERE ALLERGIC TO and the Attending never got so much as a formal reprimand!
The american system is completely doomed and kills countless of us every single year.
I'm dealing with this now. I lost my insurance and couldn't afford a CPAP machine at 1,000+$/month and now that I have insurance again, it's showing up as "non compliant with machine" on my medical records and might prevent me from getting another machine.
Always bugs me to see “patient admitted xyz”, I would always rather chart patient “endorsed”, “noted”, or “reported”. People admit to things they feel guilty about, it’s a negative connotation
How would you feel about it being used like this? ‘Patient admits he has been drinking more heavily over last month, and would like assistance with that’.
@@archervine8064 "Reported" is still better. Was the patient forced under duress by the meducal practitioners to ADMIT that? NO. Seeking appropriate medical care, they REPORTED IT, like any other cognizant patient seeking medical assistance giving relevant medical history information. They are not a willful child being threatened with the belt unless they ADMIT their wrongs. Verbiage is so important and directly correlates to respect and the compassion that is necessary to display in a medical context.
@@rayajayce2034 well said
I think charting a 'pt admitted xyz' is more appropriate if it was a direct response to a question. Whereas, 'pt reported xyz' would be volunteered info that wasn't specific inquiry.
@@joycecreceliusUtube I suppose it ultimately comes down to accuracy. I still think ‘admits’ might be appropriate if the patient was reluctant for whatever reason to divulge the information, ‘reports’ is pretty neutral, and ‘volunteers’ would suggest the patient offered the information, in the example I have that they may have even specifically made the appointment to address their alcohol use.
Thank you! I'm so glad a medical professional is speaking up for patients in this regard.
As a person with complex chronic illnesses - thank you for making this. I have corrected a resident doctor who told her attending my current situation incorrectly while constantly using the word "refuses" nonstop. They were not near me & I hadn't met the attending yet, so I understood he had just been basically told I'm an underweight (gastroparesis & MCAS) patient "refusing" protein & meal replacement drinks that I already have. Absolutely the wrong way of saying that. Yes, I had drinks at home I stopped drinking, but the reason is because they were all making me sick & I don't have unlimited resources (just SNAP) to buy new & really expensive types that might sit better. I can try new ones as my SNAP budget allows - that's it. If I pick a couple cases that disagree with me, am I supposed to make myself sick & exacerbate my conditions to drink them anyway? It would feel like the equivalent of a "normal" person getting food-borne illness poisoning & the symptoms will be similar. Am I really "refusing" nutrition if the exact type referenced makes me physically more ill?
PS - I keep "hyperaccusis" off of my medical chart. 😂 High fives to 2 or 3 peeps who will both read this entire comment *&* get my little joke at the end. 🙃
one of my “favorite” experiences was reading the notes of my visit and seeing that i “refused the pelvic exam” after i asked the MALE doctor for a female nurse to be present while he did the exam, and the doctor refused to do it unless it was just the two of us,,, yeah found a new gynecologist after that
Yeah that's weird that he wanted to be alone only
Should’ve filed a complaint. Wtf is that 😨
What the fuck. That’s illegal. He needs to be reported for that.
Ewww... he sounds criminal
😮damn😮
When we chart that a medication on the MAR on EPIC is not given, “patient refused” is an option on the drop down menu but no “patient declined”. It would help if these software companies were aware and made changes
Exactly. If feels silly with stuff like panadol, like putting refused on panadol is a bit much.
Edit: Actually worse than that, the prompt will come up saying we have to tell the MO. For refusal. Of panadol...
Soooooo, panadol is…..? 😅
But you can add a reason under the nurse’s notes section
@@tealablu3759 acetaminophen
@@classicambo9781 ah ty
This is awesome. You are a great doctor. You should do more vids on how you see these things and help doctors listen to patients better.. ive loved your vids for years but this info style makes me so happy! Thank you!
I cannot overstate how much I wanted to send a CD of my adhesion separation to the 15 years of doctors who told me it was my depression and I was refusing treatment. I was wanting treatment *in addition to* not exclusive of!
That's why so many of us don't trust medical personnel. They misrepresent what we are actually saying. I'm pleased to see this addressed.
And the reason it happens, is cause these ppl are frequently learning a crazy ton of medical stuff but a lot of very basic human and social stuff just doesn't happen Amongst others, cause they're too busy learning and practicing to socialise (with ppl outside the field who sometimes learn this difference)
Especially for Black, Brown, mixed and queer people.
They just changed the word, but have not addressed the problem.
I used to trust med pros until they all wouldn't listen, completely ignored, or heard me but thought it was in my head.
@@KxNOxUTAyeah, idc if they aren't being trained properly, they need to LISTEN and take their patients SERIOUSLY
I'm allergic to a lot of things and have been labeled as "refusing" a lot of ER medications when admitted
oh, yep, I "refuse" maxolon. my reaction to that medication is literal bells palsy, just give me the damn zofran.
Same, I’ve been documented “refusing” amoxicillin… something I’m deadly allergic to.
Me too!
Gives me hope, thank you.
I have all kinds of notes on my charts, and I can tell when providers read them before they meet me. It's very obvious.
It is rare and refreshing to hear someone advocate for patients. Thank you.
I remember a nurse saying I "refused" taking anything for pain while healing from surgery while I was not in pain lol. Always wondered why they didn't say "declined".
"Patient reported to be painfree"
@@KxNOxUTApatient admitted to being painfree
This reminds me of a diff case where i got all four of my wisdom teeth removed bcuz one had abscessed and id admitted to my pain bein about a 2... And the dentist still insisted on prescribin me vicodin for it, which i at no pt needed. Bet if this had been at a hospital they wudve tried to give me a vic pill immediately and then noted that id "refused medication" xD
@@SylviaRustyFae what is wrong with USA and trying to give people opioids for everything
@@SylviaRustyFae they do this because it’s easier (on you) to keep pain under control than to get it under control, which in turn helps your body heal faster if it isn’t fighting pain. The dose for a pain level of 2 is different than the dose for a pain leaves of 6 or 8. There really is a lot of science behind it. They’ll also prescribe for “breakthrough pain,” which is pain between scheduled doses, if needed. Noting that you refused meds is important if you suddenly have severe pain, as it narrows the diagnosis, I.e., acute post surgical pain versus infection.
A similar thing. “Patient failed 7 day course of Augmentin”. No, the medication failed the patient.
Interesting, can you elaborate? Was that charting language used to convey that the patient didn't complete the course or that the course didn't fix the problem?
@@ItsAsparageese I should also state I don’t think any connotation of blame is intended whatsoever. I think typically it’s used when the medication either didn’t solve the problem or there were side effects the patient couldn’t tolerate. But, those are 2 pretty different things and it’s more accurate and informative to say ‘patient is still febrile after 7 days of Augmentin’, say.
@@archervine8064 Fascinating, yeah it's weird how it can be so nonspecific. There's a huge difference between "the treatment was completed and it failed" and "the treatment wasn't tolerated well and wasn't completed", crazy to think the two things could end up being charted with the same language. I get that the most important pragmatic thing is to get on with the next plan phase but like ... Yikes. Thanks for raising this example!
@@ItsAsparageese I wish I had a solution to propose but there are probably many reasons - limited specific training, time constraints on charting, and the fact medical students and residents have so much material to learn already, to name a few.
Maybe subsidize medical education, and implement a somewhat more relaxed 5 year med school program where communications is more in the curriculum?
@@archervine8064 I LOVE that idea. It's a shame it would be so hard to implement, but I think it's the ideal and fundamentally simplest solution. We really can't relegate communication (and all the other soft skills that clinicians need to be learning that are related to this topic) to "let's hope most physicians have conversations about this and occasionally add it into their CEUs" status. But yeah, I agree with every word you said and I'm grateful that at least we live in an era where these things are being brought up and addressed more and more all the time.
Learning how to write clinical notes for the first time, I’m new to the therapy field, this is definitely something I’ll keep in mind now cuz I’ve experienced both ends of the refused vs declined spectrum now and yeah, i can see how they’re wildly different
As a potential consumer of medical care, I appreciate this tiktok (and this doctor) a lot :)
This is so true. I’m a specialized lawyer for medical law and deal with a lot of malpractice cases on a daily basis. The specific wording of medical notes can make a huuuuuuge difference!
My wife reviews patient charts at her hospital as part of her job in quality control/chart abstraction. She's finding some new (read young) nurses are using text speak in chart notes. She's been trying to hammer into their heads that nursing notes are not just for medical records. They become legal documents that could become used in lawsuits, etc.
It should be required law to allow patients to ‘request edit’ in ‘my chart’ notes. My after visit notes in mycart almost 40
percent of time have errors and about 10 percent of the time have significant errors. Like patient tried xyz as a solution, when I had told the doctor we had not yet tried that approach.
@@jplum7708people review them?!? OMG how then do they end up with sooooo many errors in them??
@@jplum7708🤦🏻♀️
“Doctor refused to accept the term ‘refused’ “
CTM 😂
😂😂😂😂
@@srodriguez721 Do you think this is funny or are you challenged?
@@user-us9wu1xk1zAs someone who has worked with many doctors I not only find this funny but rather hilarious as evidenced by my 4 laughing emojis. I am not challenged are you?
Wow, I never thought about it from this angle. Thank you so much!
Thank you for this. This is empathy at its core. It’s these little things that will go a long way to systematically restore trust in the medical field.
That "refused" label is so passive aggressive😂
So is “Patient denies (insert negative thing here)”
@@bluemarlin8138 ooh yes! Really misses the nuance
Well done! Many years ago I used to teach a course, "Charting with the jury in mind". Words matter.
Do you happen to have resources for that course? I would love to read/ watch those!
@@gwennyrj Same. I used to chart and now I do disability hearings. I see all kinds of nonsense in medical charts.
@jshepard152 I would really love to learn more about this. My daughter has been very sick and I feel like the doctor notes have submarined her care.
@@gwennyrj
I believe it could happen.
@gwennyrj Unfortunately, I jettisoned my notes and slides when I retired. The basic premise was to teach people to chart their observations in unequivocal language. Opinions should be flagged as such and entirely distinct from observations. I urged people to be careful of the language used to avoid any taint of bias and to use Latin whenever possible. It can be hard to write careful notes when caring for multiple pts. and running under the clock; I urged people to think before charting, work from separate notes taken while with the pt, and to proofread anything returned from dictation. All of this is pretty dated now; everything is computerized. Medical staff are expected to write on the fly and have it be 100% accurate. While Tech may seem to save time, I'm not sure this modality results in better quality of care. Sometimes in re-reading my notes before charting, I'd suddenly see some pattern or link that hadn't occurred to me while I was with the patient.
thank you for taking about this!!! so much. As a person with a chronic illness that causes me to basically grow up in hospitals and for most my life would spend 6 months out of the year inpatient. There has many times where I woudl "refuse" meds for various legitimate reasons (a medication was trying to be given when I'm supposed to be premedicated with a separate medication prior to receiving another medication, but no premed was ordered, or a medication was the wrong dose, or I had some valid question I needed answered before I felt comfortable taking the medication etc) a lot of times the nurse would just chart that I refused the meds, when in reality I very much wanted to take the medications I just needed X or Y to happen first. Well every time they would chart that I refused I would then get a very uncomfortable confrontation by a resident during rounds about me being difficult and I'd have to clear things up so they could understand that I wasn't being difficult I just needed clarification or t he order set amended. After experiencing those scenarios many times now what I do if I need to decline a med for whatever reason is try and explain my reason for doing so in excruciating detail and kindly asking the assigned RN to not simply chart that I refused but rather explain why I'm currently declining the medication. Usually if the RN is understanding enough they'll do so. But even then I've had RN's that for whatever reason want to just chart "patient refused"....
Thank you for this
I find the distinction very important
A lot of things get charted like this: refused, non compliant, history of drug abuse when it was 20-30 years ago! A lot leads to biases in the way we treat these patients, what therapies we offer etc! Thanks for making this
THIS!! As a doctor, this is the reason why I do not complain about certain things (as a patient) cos they go onto the note and re enforce biases.
If I must go to see my doctor, it must be that I am very unwell.
Cos these things get added to PMH that just puts up a wall of bias.
I try my best not to be bias or judge patients. I try to look at things individually.
And listing things that aren't relevant to their current history. I work in mental health, a lot of people with history with the service get referred back to mental health even if they presented for a medical concern 🙄
Ugh yes. This. I spent 7-8 years on painkillers because of severe chronic migraines that didn't respond to medications, and had an a$$ Dr labeled me as a "drug seeker" & "narcotic addicted" in my conditions list of my chart probably about 6 yrs back. It comes up FREQUENTLY when I go to the ER since then... "you know we won't give you painkillers, right?" Even when I've already asked for torodol/phenergan/benadryl & fluids for intractable migraines. There needs to be a way to age those kinds of "diagnoses" out so pts can get less biased care.
“Distant history of drug abuse” if documented at all.
@@Gingernat089 In my case, it wasn't even abuse. I literally just was on them for years, but this one Dr saw the old prescriptions in my history when I had come in for an urgent/same-day appt for something, and he diagnosed me as a drug seeker/addict. It has come back to bite me in the ass SO MANY TIMES, until I don't believe my quality of care is remotely the same as the times when a provider doesn't see that "diagnosis" in my list.
Medical records can really screw a person over.
Can you give some examples of this?
EXAMPLE: A Dr asked me what exercise I loved to do. I said, "I love to bike. I used to bike all the time but I can no longer do that. I'm in too much pain and am in bed most of the time."
However, What the Dr wrote was, "Patient bikes for exercise except on those days when her pain is too great."
My entire chart for 2-yrs said nothing about inability to do ADLs. It said nothing that I was 20+ hrs in bed. So I couldn't go forward with any request of Disability after the short-term disability ran out and I was still unable to return to work.
@@LifeBetweenTheDash My mom was sueing for an arm injury. In her medical records it showed that she fell off the porch while walking the dog. It made it sound like the dog could have pulled her and caused the injury. In reality she fell off the porch while letting the dog outside. Bad wording on her part. The dog had nothing to do with her slipping on ice and landing on her back not even bumping her arm and was also a long time ago.
They can! I was denied insurance with a couple different companies because of an old doctor visit I went to, claimed I didn't come back for a follow up exam.... That I was never even aware that I was supposed to make.. I was so stressed out, thankfully the 3rd company insured me. I think they still charged me more for what I believe was considered a 'pre existing medical condition'. Ridiculous.
Another example.. ;) I went to a doctor who basically forced me to go to physical therapy for a very mild case of TMJ. (I complied because of my last comment- being denied medical insurance that I didn't go to an appointment the doctor wanted me to go to...) There they dislocated my jaw. I've been in horrible pain for over 5 years. When I went to another doctor office immediately after I got my jaw dislocated, they put in my chart that I had a history of severe TMJ... As I could barely open my mouth and made horrific noises of my bones crushing against each other.. so my hopes of being able to sue the place that dislocated my jaw could never move forward, as the 2nd Dr office said I have a history of SEVERE TMJ -- which I didn't and they wouldn't correct it, as they said 'history' just means prior to coming to their office... And the first place that sent me there- as they got commission, lied in their report that I went there for TMJ, when that was Not the case. They just asked me to open my mouth 3 times and there was a small pop noise the 3rd time. Evil scam artists. Ruining people's lives for extra money. :(
Thank you so much for pointing this out. Words do matter
Thank you so much for bringing this up. We can always do better… our patients deserve it.
A lot of times I see “refused” on notes for things that were never discussed with me and I’ve now lost all hope in doctors in general. You’re one of the few good ones.
You should only lose your hope for US doctors
@@milton7763no it't universal
@@milton7763 Most people who live in the U.S. will never be able to move to another country and get proper healthcare, so U.S. doctors are the only doctors we will ever see, so they might as well be 'all doctors' considering we will never be able to access different (and likely more competent) ones.
@@milton7763 The ones in the UK are in a similar vein. Imvho.
@@milton7763 you should be ashamed to whitewash this kind of care under single-payer systems, especially as those often operate via limitation of other medical options.
I also love "patient denied pain"
like you know he's in pain but he's in denial 🤣
Even better "patient denied pain" when the patients chief complaint was...passing out from pain. When I tried to report the doctor to the hospital for lying in his report I was told it wasn't a lie because what he said matched my chart. Like you don't say, what he said matched what he wrote? I mean it's not like he couldn't lie about the same thing twice.
He isn't in denial, he is just built differently, he can choose.
I study rhetoric and it's really genuinely fascinating to watch experts in other fields that I think of as way "smarter" than me (partly because society says so) catch up on how important things like word choice and impact over intent are. Love this example, even a small change can be really powerful!
This was the best advice I was ever given as a scribe! Very often the PCP I worked with asked me to note why they said no, because the next conversation can really help or hurt a patient feel supported and understood.
Publix makes me check the box for “Patient refused counseling” every 30 days if I don’t want to ask the pharmacist questions about the medication I’ve been on since the day I was born.
I became disabled at 23(almost 29 now) and I'm always on anywhere between 20-35 medications at any given time. Before I moved into an AFH and had my medications delivered to the house, I had to go through the same thing and it was so annoying.
Thank you! I hate looking in my chart and seeing “patient refused” because usually I didn’t refuse I just needed further discussion to decide what was the best option for me and what I was realistically able to do for lots of reasons.
Thank you for such an awesome video. I was a hospice nurse for many years and truly did not like the word refused. Hospice patients have so little control in their lives. They have the right to decline anything!
Thank God someone said this, because I hate when I see the word "refused" in my chart. It's always given me a bad feeling like I was doing the wrong thing and I worried about how it would look to other doctors.
YES!! After my last surgery I was shocked when going through my records that it was charted that I refused to get up and walk when in reality I was in too much pain and even the doctor and nurse agreed I should just focus on pain management and just sitting up for the day and then walk the following day. “Declined” would have been much more appropriate in that situation.
Really, neither should be used in that case. It should simply note the first time you did walk ("Became ambulatory on Day 2") or note what you did achieve the first day ("Was able to sit upright most of day").
i had an extremely similar experience, after a pelvic surgery i sustained nurve damage to the legs and was unable to walk the day after the procedure due to the worst pain of my life and i just got noted down as refusing to walk.
one thing of note too is despite it being a super invasive reconstructive procedure that was 14 hours long for the first two days after surgery all i was given was gabapenten and Tylenol for the pain
@@ezurth I'm so sorry you experienced that. That's awful that they didn't control your pain!!
As someone who has been labeled as “refusing” a lot of treatments, thank you. I really mean that. Being chronically ill, this mix up happens way too often
SO often! When I’ve already tried something, or I’m allergic to it, or the treatment isn’t possible because to get there would take the entire day’s store of energy for something not as important as this other issue I have right now (but I reserve the right to circle back!). I can only handle so many medical appointments per week. Taking care of a chronic illness is a full time job, and I’m too sick to work!
I wonder how many times I've been labeled this by idiot doctors. Only 21 but i also have 21 years of medical trauma :D. I dont even knowingly decline stuff often. I just... Forget to do it. Or something more pressing came up. Or it's literally not available to me in my city and travel isnt possible rn.
Im glad i know what to look for when i eventually get all my medical records (takes too much spoons to do it).
Hope you have a low pain day and have the spoons for something fun! 🧡
And no one bothers to ask us why we "refuse"
I would make sure you too are using the word decline and explaining why and asking them to chart your explanation and make sure they write declined
holy crap, im glad people share the experience! ive had similar things written down on my charts from cancelling appointments due to being too sick or tired to come, or simply not having transportation available. im with you here!!
This will change my charting habits forever! Thank you for the perspective 😮❤
Thank you for this. I'm a long-term chronic pain patient, so I have a lot of interaction with medical professionals and health systems. Declined versus refused would have caused a very different experience for me in the past, and I hope to see this spread more.
I “refused” pain medication in the ER as a recovering addict and the nurse got SO ANGRY she angrily shoved a Covid swab so far up and so aggressively I bled for days after. I have PTSD from that day.
I'm so sorry. I've had terrible medical experiences too. I have a chronic illness and it tends to frustrate medical staff.
i'm sorry babe that's awful. you made the good and responsible decision even though it was hard and she punished you for it. you deserved better.
I hope you reported her
Wtf, I’m so sorry this happened to you 😭
Trying to force pain meds on a recovering addict who said no is insane, especially knowing that a lot of people get called drug seekers for seeking relief (not even necessarily meds, just general treatment) from conditions causing severe pain. It's so weird and so arbitrary.
You've influenced this nurse's charting. thanks.
Thank you nurse! 🙌🏻👏🏻
Oh thank God. There are too many unintentional monsters in meducal care. Hopefully you haven't created too many problems for past patients because of harsh chart verbiage in your earlier reports.
Refused to reschedule vs declined to reschedule. Thanks Doc!
THANK YOU! Every time I get admitted into hospital I have to fight with people to stop using the word “refused” when I’m simply requesting changes in scheduling of medications, dressing changes, etc. I REFUSE to be seen as combative and avoiding treatment when there are reasons being excluded from their reports.
The best statement to put in as a Dietitian: Diet education offered and declined. (I would always leave a hand out with a diet in question) but as dietitians we are trained to use very gentle language so that we don’t accidentally go outside our scope.
I love dietitians as a fat person because you guys are always so nice and understanding of our mental and physical stuggles. You actually go out there and try qnd help people instead of ridiculing others into losing weight. You use science instead of prejudice and i really admire that in a person. Thank you for what you do/did (sounds like you no longer work as one)!
When people are in hard places language can make a huge difference. Context, Tone, and implication can just massively change the emotional impact of a phrase.
When you want to convince someone of anything (be it diet, or literally anything else) you walk with them down a path, being friendly and letting them take their pace, or that's what I've found to work in my non doctory opinion. Throwing someone down a flight of stairs just makes them less receptive in the future.
As a fellow RD, I agree wholeheartedly with your statement 👏
You know the dietitians cause they always dress like they on their way to a corporate board meeting. LOL
@@FGuilt This is too funny...and true 😅 I'm so happy to be in a facility where I can wear scrubs and sneakers 👍
Let’s not forget that psych patients can be met with violence for showing even just the smallest amount of resistance, especially with things like this on their record.
Yeah no. Psych professionals have so much abuse they just "take" without reporting. Please go apply if you want to change things and don't just bitch about it here. There are PLENTY of positions open.
@@Swordsman99k as someone who has been abused by psychology, let’s hope you never end up in the situation I did. I won’t deny psych professionals take abuse, but that doesn’t negate the fact they dish it out too. I wonder how it feels to be a victim blamer, wanna tell me about it?
@@Swordsman99k friend, i hope you never have to be on the other end then. i've ended up with mental and physical damage cause of bad psych doctors and their notes on me.
@@spadealt456 Again, go apply if you want to make a difference. I was there too. I don't sit and bitch about it on the internet. Do. Something.
Why 😢😭
Yes! Thank you for spotlighting this. Important difference.
Ty! ❤ I hope every doctor in this country sees this and acts accordingly
Chronic illness patients like myself know we have to be extremely careful with what we say and do when seeking treatment because if we don't make an effort to agree to almost everything it can jeopardize our ability to get care at all.
That's so messed up. I can see that landing someone in a hospital, tbh: Got a bad reaction to this medicine and doctor doubles down on it, and you can't refuse? A recipie for disaster.
Omg yes. They act like we're rich. I know what works and don't cuz i've been down this road a million times and i'm not payimg for meds i know don't work and give me bad side effects just because you're a new doctor and want to start from scratch
As a dialysis patient I 100% agree with you. As a criminal justice student and true crime junkie, I'm deathly afraid to run across an "angel of death" who's looking for a"difficult" patient to exact revenge on
That’s horrifying!
Just had an issue with this. I’m chronically ill and have more disabilities that I can honestly keep track of… I had a blood patch procedure done recently to fix a CSF leak which turned into my biggest nightmare. Lost almost all movement in my right leg and was in excruciating pain, went to the ER and they wanted an MRI but machine was broken so they referred me to a different ER… go there and for some reason the doctor sees no need for an MRI. Send me home- I’m back in 7 hours vomiting from the pain and can’t walk. They tell me it’s probably an arthritis “flare up”, tell me to control my breathing and my anxiety because it’s “making things worse” and send me home. I try to make it through the night, I can’t, I end up peeing myself so I go to a new ER. They do an MRI finally, I have a hematoma lol. American health care is quite literally a nightmare.
I work at a law firm that handles a lot of cases that involve going through medical records and if your medical records are subject to legal scrutiny down the line, phrasing is so, so important!
Wow, the US is a dystopia in its own class
Same, I work in PI. Clients will tell us that they are still in pain after treatment but the doctors will write that they just stop coming to additional treatment. So Insurance will use that to claim they must’ve not been really hurt. No one talks about the fact that you don’t get paid, until after the settlement, and are going to treatment on hope you will get treated right. All of this, and we don’t know if the insurance company is going to actually pay out what they should for your pain and suffering. They have often said that a patient treated *too* much. So you have to choose to either miss out on work and go to therapy (and hopefully have enough in savings so that it won’t hurt you badly) or, miss therapy and maybe mess up your chance of getting a decent settlement... So yeah, sometimes people stop their treatment, because they literally can’t afford to continue treatment. Whether it’s time or money, and whether it’s on a lien or not. If you don’t have it you don’t have it.
I'm glad you brought this to ppls attention. I've seen this video previously and I've since used the term declined instead of refused. Such as resident declined shower due to being tired vs resident refused to shower. Thankyou!
It's a huge change I have made, even in field medicine with EMS it can make a huge difference
It is truly sad the way one doctor who doesn't understand you can ruin all your future interactions with every other doctor you have to deal with
Absolutely! That happened to both my adult daughters. I have, also, experienced bias by egotistical doctors and doctors who simply were not interested in patients they did not relate to. I choose doctors very wisely now, but my daughters don't like to make waves. They just refrain from getting medical care, unless it is an emergency, which concerns me. To make matters worse, whether by design or ignorance, are the doctors who push the Covid vaccines on everyone, and refuse to acknowledge all the reported side-effects.
Thank you. I decline meds at the wrong times or cheaper elsewhere or ALLERGY all the time. I shouldn’t get labeled as difficult when really someone was rushed or negligent.
As someone who has worked night shift, I always fought for patients to get their meds on their home schedule. I do their med reconciliation, and put a call put to pharmacy to note their home med times. With notice we can work it out pretty easily! And that's not being difficult. That'd just maintaining some sense of routine and order in a situation where everything else for the patient is in a state of flux.
This! I was labeled a drug seeker because I refused to take a medication I react badly to if they were sending me home. If they were going to admit then I was more open to it or if there was something else we could try but they gave me one option, take that and go home. Note: wasn’t even asking for narcotics, just not that drug
@@katherinestuckmeyer701 Ugh, same thing happened to me.
I'm severely allergic to most local anesthetics, many procedures I've had were literally biting down on a leather belt and trying not to scream. "Refused locals" always enraged me. Do they think I screamed my way through a procedure for the fun of it?!? The medication would KILL me! Of course I refused!
@@katherinestuckmeyer701 i was labeled a drug seeker at like 14 because i was in so much pain i wasnt sleeping and my mom asked about medication options (my mom has real bad teeth, so people assume shes on drugs). which really sucked in the long run because i ended up taking whatever i could get my hands on just to be able to function, which resulted in addiction and OD by 16 years old. and now im scared to go anywhere near any pain medication of any sort, so i just suffer 👍
Thanks for sharing this! It'sa great PSA for patients too, and just in general in life overall. Context is everything!
I admit. Saw this a few weeks ago and since then have been using the phrase "pt declined contrast" in my charting. Thank you. Had a pt decline contrast today even.
I think it’s more important to make sure the reason is documented rather than just refused or declined. I usually use neither and say “patient says he cannot afford …”, patient says “he prefers to take lasix in the am”, etc.
Yeah so this makes all of the sense in the world. There is no real difference between refuse/decline. The reason for the refusal/declining is the important information.
I think it's because the people typing up the medical reports are usually not the same people who are treating the patient. Transcriptionists, admin staff, etc, may not know why the patient turned a treatment down.
Yesssss! Similar reason I hate using "complained" instead of "reports" when it comes to patients letting us know whats wrong.
Good ole chief complaint
Quilty.. thanks for reminder..
"Patient states"
"non-compliance" because insurance wouldn't pay so didn't declare bankruptcy to get treatment
Thanks for looking out for us patients!
I was in a residential program and a tech was tacking notes on me and she said out loud“no i dont want to say refused, you declined” and i love her for that
The drop down in the charting EMR usually only has “refused” - might be part of the problem
That's an intentional hospital "CYA" always drops 100% of the circumstances in the patients laps, unfortunately they don't even know they have been thrown under the bus
I was just about to say this!
Our charts here are all written on paper. Your system sounds just as biased!
It's touching to see a physician actually care. I have a lot of problems and I rarely go to the dr because drs are horrible, expensive, and don't usually help. When I do go they look at me like an idiot for not going like I'm made of money or like their little medical field buddies actually do anything but collect a check.
I ruptured a disk in my back, got MRI. Doctor comes in (first I see him) sits down says "computer won't open the scan file so I can't see your MRI, but I don't see anything wrong so you're fine".....
I know what you mean by doctors suck. (I say they're like mechanics, some are good, some are wtf)
This is how words can be negative neutral and positive.
A Nurse with his eyes on his better judgment.
From One to another, Respect ✊ "
This is so important! For example, I often read nurses reports that say "refused to bathe" and later understand the patient merely preffered a family member to help with their shower and not a nurse...
Any subsequent nurses reading that report might believe that they had a "difficult" or noncompliant patient on their hands, when in fact that is not the case.
..and what is it with not investigating the issue of 'non-compliance' anyway? ...like someone will go into hospital, keen or desperate for help and then for 'no reasonable reason', refuse medical help...(? very unlikely)
HIGHLY TRAINED: and paid people (medical professionals) surely have several brain cells working for them? - they could ask 'why don't you want this treatment?'
or
'why am I being led by this system into ticking this one box, with no space for a context of the patient's position?'.
HOSPITAL: No, we don't need (an) understanding....
😵💫
@@sandrabeltman9418nah they all had 6 hours of sleep and needs to work overtime.
Its too harsh to say thT 😢
My charts from the emergency C-section birth of my twins say I left the hospital "against medical advice" about 18 hours after delivery.
What it doesn't say is that my twins were born at 24 weeks and transferred immediately 3 hours away to another hospital, that had just called to tell me that one of them had massive bleeding on the brain and probably wouldn't survive the night.
All the nurses and doctors were supportive of my decision at the time, but years later, it looks like I'm an idiot that didn't want to be there.
@@kimberlyrichardson5943 unbelievable!
I’m not a doctor or nurse but I work in healthcare and I do a lot of documenting. Even when someone is absolutely rude or yells at me, I keep the documentation very neutral. Just feels professional to do that
People who are absolutely rude or who yell deserve hell.
Yes, I try to stick to the facts as much as possible! (I work in customer service.) If they were mean to me, I will usually write something like, "customer was upset about x, y, z" but that's the furthest I'll go. You can tell when someone was particularly litigious if I documented every single word I said and included upset!
@@PheelypNo, often they deserve compassion and empathy. While a patient may be speaking or behaving in a way that seems rude *to you* its more often than not justified by the way theyve been treated. A person can only take so much laziness, incompetentce, rejection and pain before they explode. Yes some people are karens and are rude and entitled for no reason, but often when a patient is to the point of yelling and screaming and demaning x, y, or z its because they need help and are tired of being ignored and overlooked, talked down to or treated like a child. I cant articulate the rage that fills me when im in chronic pain, been waiting to see a Dr for months and they dont gaf about actually helping me. They see you as a number on a list of patients that day, and want to solve your problems with as little work and effort as possible to move on to the next one. It's infuriating and meanwhile, Im still suffering! So fucking pardon me if im not a ray of fucking sunshine by the time I finally get seen by the umpteenth Dr who probably also wont do shit for me.
You should work in medicine bc you want to help people, if you want people to be nice to you, you picked the wrong field. Not saying it justifies everyone being an asshole, but you signed up for attitude when you decided to work in the american health care system.
@@RoyalReyna yep. I'm apparently "rude" for the way I interact with medical professionals. I don't make eye contact, sometimes I don't even look at them unless needed to (like they need to look in my eyes or something), my answers to questions are very blunt, and I sound aggravated. Why do I do this? Because I have PTSD from doctors (yes, multiple) and have a really hard time coping and regulating in medical situations.
And if I'm in pain and that pain is being completely disregarded I'm going to be very annoyed on top of all that. Like I'm pretty sure that's completely justified to be annoyed, mad, furious, etc when in pain.
Unfortunately a lot of medical professionals take this very personally, even when they know my past. Because they didn't do that to me so I should trust them. Which is the same thing the second doc who traumatized me said. Yeah, no, not happening, you need to earn it. No doc who has demanded my trust has ever earned it. Especially when they act like I'm having a panic attack just to make their lives harder. Every doc who has earned my trust didn't push for it, or disregard how hard it was for me. The best one asked me what she could do.
@@Pheelyp people are often having the worst day of their life when they interact with the healthcare system. And even if they’re not, they still may be experiencing a tremendous amount of pain or discomfort.
Beyond that, it’s irresponsible to let one’s emotions or biases colour their charting. It’s unprofessional and it could REALLY come back to bite the writer in the ass.
Thank you! Thank you! Thank you! For saying this-wording in the documentation is important and will affect the pt’s long term and current care. Lots of providers are very flippant about their documentation
I love what you're doing here. It's restoring my faith in the medical community
Medical personnal have so much power over our lives. Little changes like this can be the difference between a nightmare visit to an unconcerned doctor and a much-needed referral for further screening. Thank you doc.
This isn’t exclusive to medicine, word usage is important for clarity.
I recently had this argument with my sons school because they used the word ‘by’ NOT ‘before’ on a recent form for a trip to which my son missed out because he returned the slip ‘by’ the closing date instead of ‘before’ the closing date.
I would interpret “return form by [date]” to mean “no later than”, but English isn’t my first language. It’s also better practice to write the latest acceptable date rather than the earliest _unacceptable_ one, because of how people remember things.
@@ragnkja ….for someone who’s English isn’t great my friend, you seem to have grasped the concept better than my sons school….an educational establishment that teaches the English language 😂😂 common sense prevailed in the end, we recently received a letter about a different school trip…this time the letter had been written by an adult 🙄
@@callmetiger7186
You would have thought that the teachers had studied paedagogics, and therefore learnt a thing or two about how the human brain retains information.
While I’d say my English is reasonably good, I still have a foreigner’s tendency to miss nuances that are different in English than in my native language, unless I’ve already had those nuances explicitly explained to me.
Words have meaning, and schools of all places should get them right. I’d have sued.
@@danieldaniels7571well, you'd need losses to sue and i doubt not getting to go on a field trip caused significant financial loss for the child. i mean i could be wrong lmao.
i would certainly speak to someone about it because it's unfair.
Thank you for educating your peers
Context is everything,period.