Children's Doctor

Pediatric Reflections

Summer 2014

Catherine Bonita, MD

Catherine Bonita, MD, sees patients in the CHOP Care Network Primary Care Flourtown, Pennsylvania, practice.

Making a Note of It

Summer is here and with it comes the arrival of eager medical students and residents who will be spending their days (and nights) working diligently at honing their clinical skills and mastering the art of the medical note. As a student and resident, I enjoyed writing notes. I majored in history so I enjoyed retelling the patient’s story. I was proud of my notes and thought they conveyed everything about the patient’s present illness all in story-like fashion. Until one day during my intern year, my attending matter-of-factly informed me that my notes were too story-like. What? Too story-like? Doesn’t the Oxford Dictionary define art as the expression of human creative skill and imagination? Brevity, terseness, facts. This is the stuff of a proper medical note, my attending explained. I was deflated. But where would I convey sentiment and emotion? Where would I demonstrate joy over my overweight patient’s success in losing weight? Where would I express dismay over my patient’s struggle with a new diabetes diagnosis?

Fast-forward 6 years. I completed my residency and was moving on from a job in Philly to a suburban practice, CHOP Care Network Flourtown. During that time, I had successfully revised my idea of what the medical note ought to be. My notes were concise and factual, followed the S.O.A.P. format to a T, just as I was taught. But then I met a new colleague in my practice. She was and remains, effervescent and ebullient, an animated person and clinician. She saw my 3rd daughter at her newborn visit and on the visit summary, I read “Wowowowowow!!!!! Gorgeous, smart, and kind!!!!” I was taken aback. I saw exclamation points. I read elation and emotion. She was emotive in her notes and not afraid to be.

Over time, I began to realize that I did not have to be so restrained. Yes, it is vital to construct the medical note in a factual, objective manner. It is the story about the patient, and not about me and my feelings, after all. But I found that in my notes, particularly in my visit summary (ie, patient instructions), I have an outlet for conveying sentiment. I can tell my patient how proud I am of her, to keep up the hard work on making healthy choices, encourage the overwhelmed, breastfeeding mother whose baby is not gaining adequate weight, and, simply, in a few words, let the patient and family know I care. And, for me, that is what the joy of being a physician is all about: the relationship between the doctor and the patient. It is medicine’s humanity that drives me. So don’t be too surprised, if you read one of my notes and see exclamation points. At least, having read this, you might just know where I’m coming from.

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