Patient: Pamela*
“It was only one hamburger!” she shouts as I enter the room.
I pause, my fingers still grasping the doorknob. I feel a tightness in my chest, anticipating the unwelcome confrontation. Unable to imagine how this sentence pertains to me I hope that maybe she is on the phone and I can’t see the little white stick in her ear behind her fluffy red hair.
“I can’t believe you wrote that!” she shouts again, and this time, most definitely at me.
“Good morning, Pamela,” I say with a quiet, steady voice, hoping my words will soothe the tension. I reluctantly take another step forward and think back on our last visit together.
It was a couple of weeks ago and Pamela was crying. My medical assistant had just finished taking her vital signs, which included a weight, and stated them aloud. Pamela had immediately protested. “You are not supposed to tell me my weight!” she cried, “I’ve told you guys that so many times!”
I had listened then to Pamela as she recounted a life’s battle with weight loss. Her words came quickly, pressured. I could barely keep up. She does everything possible, she had repeated, but her clothes keep getting tighter and tighter.
My mind flashes over this scene as I take my seat before her today. “You seem upset, Pamela. What is wrong?” I ask kindly.
“It was only one hamburger!” she screams to the ceiling. There is a knock at the door, “Is everything okay, Dr. Monteiro?” my medical assistant inquires. “Yes, thank you.” The door closes gently.
“It was only one hamburger!” comes hurtling at me again. I am baffled. “I’m sorry, what….” and she quickly interjects. “You wrote like I’m always eating takeout, burgers, fries... But it was only one hamburger. How can you lie like that? Take that out of my chart. Now.”
I open her chart and glance over my last note: Patient is upset, describes an argument - having takeout at home when boyfriend… I now recall her story, which started with her ordering a burger, fries, and shake from her favorite takeout restaurant. And I now realize that Pamela had gone online after our last visit to read what I had written in the visit note.
Granting patients access to their own medical charts has proved a tremendous benefit. It facilitates a better understanding of clinical recommendations and decreases confused calls to the office. It empowers patients to take a more active role in their health. It can also shine a light on the truth, which for some people, like Pamela, is difficult to accept.
“And I wasn’t mad at anyone for telling me my weight,” she spat at me. I look at my old note again: Patient expresses frustration at learning her weight today.
“And I know I’m overweight but I am not obese!” I look at her BMI (basic metabolic index), a calculated number from height and weight automatically included in all charts, and see that it falls into the ‘obese’ category. If I do not document obesity as a medical problem, the billing department will do so and send me a message for incomplete documentation.
I look into her flushed face and say the only thing that I can. “I’m sorry.” She visibly softens just a touch.
Writing those sentences was automatic for me. I am required to document a patient’s concerns and encouraged to complete most of my documentation in the exam room. If I make a mistake, I welcome the opportunity to correct it and I advise all my patients to read their charts.
This time, however, there was no mistake. By reading her chart, Pamela was confronted with her own words and actions. It pained her to see ‘obesity’ and ‘takeout’ written about her.
“I’m sorry you’re upset,” I repeat, slightly hunched forward on my stool, trying to connect with her. “I know it’s hard to see obesity written, but with your height and weight, you have a BMI of 34, which is classified as obese. Having takeout once doesn’t mean you always do it, and maybe we can talk more about what you eat to help you with your weight concerns.”
“Just take all of that out of my chart, now,” she practically growls at me.
“No, I will not do that. The information there is accurate and true. Let’s focus on how we can get you feeling better.”
I quickly push myself backward as she leaps to her feet and heads for the door. “You are a lying, irresponsible doctor! What kind of doctor are you?” Her words bounce off the bare white walls as she storms out of the office.
​
I am left sitting alone on my stool, letting out a deep sigh, and wondering how I should document today’s visit.
​
​
Written by Jill A. Monteiro, MD, MBA
Published May 2020
​
*This is a true story and the names have been changed for privacy reasons.