Cases: Are You Confused, or Are You From Alabama?

This is a real excerpt from a discharge summary I dictated recently:

This is a nice 88 year old man who returned home from a road trip on the day of admission.  He had stayed at a Motel 6 motel in [another town] and had subsequently seen an advertisement offering the chance to win a free stay at the chain of hotels by completing a customer satisfaction survey.  When he was within a few blocks of his home, he noticed there was another Motel 6 on his way and decided to go to the motel to obtain a copy of the survey.  However, when he made his request at the front desk, the staff at Motel 6 thought he was confused.  Specifically, the EMT notes suggested that he kept repeating "town and country, town and country" over and over again; this was taken as a sign of altered mental status even though the patient later explained to me, "They was asking me where I lived, and I told 'em, Town and Country Mobile Home Park."  The next thing he knew, he was being taken away by EMTs and brought to the emergency room where, based on the EMT history of "altered mental status," he was admitted for observation...

...After some discussion among the staff and with the patient of the events leading up to his admission, it became apparent that what was described as a confusional state was actually a misunderstanding.  The patient--who, at baseline, speaks in a fairly broad Southern accent, is noticeably hard of hearing, and has an extremely discursive conversational style--probably appeared confused to an unfamiliar and inpatient motel staff.

Dx:  Slightly befuddled 88 year-old man from Alabama

Dispo:  Home. Do not return to Motel 6.

Comments

[Jocelyn]

Dr. Chan - funny story!
But your first sentence reminded me of a question I've often wondered about. Why do some docs, when dictating their notes, comment on the personality or disposition of the patient? (For example, "This nice 88 year old gentleman...")

I have heard doctors dictate notes like this about me, with similarly complimentary language, which makes me chuckle slightly to think of what the dictation looks like in the end. But I work in health research with vulnerable patients - I know how language on charts can label people. Words like "cranky" spoken about an older patient, for example.

Is this a practice doctors just do to amuse? Or is it a part of the workup?

[Theresa]

Motel 6 should keep you on retainer as a translator!

[Leigh Ann Hubbard]

Oh my goodness! That poor man. Thanks so much for sharing the story. Being from the South myself, this makes me chuckle and shudder at the same time. Perhaps we need to start employing translators for you Yanks. Ha! ;-)

Great title, too.

Man, I feel bad for that guy. Kinda scary, actually.

Leigh Ann Hubbard
Managing Editor
James Hubbard's My Family Doctor