Mental health writing pet peeve -- what's wrong with "I"?

[Doctor Bagel]

Reading some notes from work, and what's up with MH professionals (usually not doctors but everyone else) using "this writer" all over the place instead of saying I. Are they taught that in school? Why is "I" such a bad thing to use. It's more active (and hence better) writing. Where the hell does this come from? It's especially common with LCSWs and NPs as far as I can determine.

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[Bartelby]

I think it's a carry over from so many other forms of writing where, for no apparent reason, you are berated for using "I" or "we." At the same time you are berated for using passive voice. Thus the acrobatics to awkwardly write as "this writer," "the researchers," etc.

I agree, it's annoying.

 

[deleted343839]

It must be related to training. I've seen social workers' notes that use "this social worker" or even "this worker." Either no one ever corrects it, or a supervisor insists that referring to yourself in the third person is more "professional."

I see passive constructions more often, though, and this doesn't seem to be discipline-specific.

 

[Doctor Bagel]

It must be related to training. I've seen social workers' notes that use "this social worker" or even "this worker." Either no one ever corrects it, or a supervisor insists that referring to yourself in the third person is more "professional."

I see passive constructions more often, though, and this doesn't seem to be discipline-specific.

I'm embarrassed by how passive my writing. Work in medicine is bad in some respects.

 

[birchswing]

Reading my CT scan report I couldn't figure out whether the word "suspect" was being used as an adjective or a verb because the radiologist used no subjects in the sentences. For example, "Suspect enostoses." Are they suspect (as in suspicious)? Or does he/she suspect that the images are of enostoses?

And that whole thing about the active voice being better than passive is BS handed down by frigid pedants. Do whatever is pleasing to the ear.

 

[FlowRate]

I feel like at some point I was either told not to reference self or simply never saw other people explicitly reference themselves. To get around it, I use a lot of declarative statements.

There's a great TLP article on this very subject, actually. Haven't had to write a note since I read the article, so will see how it feels once I get back on the wards.

It's likely that I've used "we" when writing consult notes that will end up being cosigned by a couple of people, though. Off topic, this reminds me of why I started putting explicit # THIS IS A MED STUDENT NOTE # warnings in our "work in progress" part of the EMR--it's not good when other services cheat and look at my prelim note and take it as the cards fellow's recs... No, that patient didn't actually need a TTE.

 

[deleted343839]

I think it's easy to default to describing your actions in the passive voice because the object of the sentence is usually more meaningful than the subject (obvious) or the verb (usually not very interesting). So you write what you did and then tack on "was provided," "was recommended," etc., and there's a complete sentence. It's no recipe for great prose, but I can hardly blame someone for moving on to the next thing versus taking time to polish a sentence that already gets the job done. If the note represents the work of multiple clinicians, then of course that makes the passive voice less excusable.

 

[lymphocyte]

I feel like at some point I was either told not to reference self or simply never saw other people explicitly reference themselves. To get around it, I use a lot of declarative statements.

There's a great TLP article on this very subject, actually. Haven't had to write a note since I read the article, so will see how it feels once I get back on the wards.

It's likely that I've used "we" when writing consult notes that will end up being cosigned by a couple of people, though. Off topic, this reminds me of why I started putting explicit # THIS IS A MED STUDENT NOTE # warnings in our "work in progress" part of the EMR--it's not good when other services cheat and look at my prelim note and take it as the cards fellow's recs... No, that patient didn't actually need a TTE.

Was this the article you were referring to? So much good content on his blog...

http://thelastpsychiatrist.com/2006/09/how_to_write_a_suicide_note.html

 

[Trismegistus4]

Not using the first person in formal writing is one of the first rules my 12th grade English teacher (my favorite teacher ever) taught us. At the time I thought it was dumb, and even wrote my first essay for the class about it--I entitled it something like "On One Particularly Absurd Restriction Placed on Writing Assignments by Teachers," written entirely in the third person, of course. I soon came to see the value in this rule, though, and learned to enjoy writing in a formal style. But by that I mean a literary formal style, not the dry, boring style of contemporary scientific research articles. Whatever you think of this rule, it has a long history in English. It would be interesting to know if it's the case in other languages too. I agree, though; all the "this writer" nonsense in clinical notes gets tiresome.

 

[Shikima]

I'm embarrassed by how passive my writing. Work in medicine is bad in some respects.

YOU SHOULD write better.

Have I helped with the guilt?

 

[erg923]

It must be related to training. I've seen social workers' notes that use "this social worker" or even "this worker." Either no one ever corrects it, or a supervisor insists that referring to yourself in the third person is more "professional."

I see passive constructions more often, though, and this doesn't seem to be discipline-specific.

I see this too, and its gotten completely silly. Not sure why "this provider" or "this writer" is more professional. If anything, its awkward, and sound less professional to me.

 

[Trismegistus4]

On the other hand, the rule that the passive voice should be avoided is totally valid. The reader is made uncomfortable by too much passive voice. Any sense of agency is obscured, and the idea of who precisely the actor of the sentence is is made unclear. The active voice should be used whenever possible. Otherwise, one's meaning will be lost, and readers will be confused.

 

[smalltownpsych]

This poster gets annoyed by reading it too. 😀
When writing formal research papers, we were trained to write "the researcher". It always felt a little weird writing in the third person, but that is what we had to do. In chart documentation, I am very specific as to who said what and did what as it is a legal document.

On a related note, am wondering what people think about people who frequently refer to themselves in the third person in oral communication? Seems to be a bit narcissistic IMO, but I haven't really looked into it much from a clinical standpoint.

 

[NickNaylor]

In my notes I write personally and from the my personal basis of observation. I use "I" and "we" all the time. The notes remain objective, but ultimately the assessment is based on my personal interaction with the patient during the interview. I see nothing wrong with being personal (while simultaneously maintaining objectivity) in your notes.

I agree that the diction of "this writer" and similar phrases is awkward and forced.

 

[Trismegistus4]

This poster gets annoyed by reading it too. 😀
When writing formal research papers, we were trained to write "the researcher". It always felt a little weird writing in the third person, but that is what we had to do. In chart documentation, I am very specific as to who said what and did what as it is a legal document.

On a related note, am wondering what people think about people who frequently refer to themselves in the third person in oral communication? Seems to be a bit narcissistic IMO, but I haven't really looked into it much from a clinical standpoint.

Who does that in oral communication?

"Get your hands off Jimmy! Don't touch Jimmy! Let go of Jimmy!"

 

[Shikima]

Who does that in oral communication?

"Get your hands off Jimmy! Don't touch Jimmy! Let go of Jimmy!"

You usually hear those statements when it's an uncomfortable situation in the men's room.

 

[AcronymAllergy]

I've been explicitly told in the past (i.e., while training) to not use "I" in chart notes. Don't remember what the rationale was behind it, other than it sounding "more professional."

 

[erg923]

I've been explicitly told in the past (i.e., while training) to not use "I" in chart notes. Don't remember what the rationale was behind it, other than it sounding "more professional."

Not sure where this is coming from, or if perhaps varies by setting? I review a lot of medical notes from psych and non psych in my side work. Most write a very normal, personal style in their charting of patients, as I think we should, frankly. I really only see "this writer" stuff in VA chart notes.

 

[WingedOx]

Force of habit. All the charts I'd read in training were 3rd person passive voice.

Ironically I tend to jump into first person when what I consider what I'm writing to be of particularly high importance, mainly because I'm trying to be as concise as possible in an already wordy formal document I'm using to cover my ass. It's all instinctual though. I seldom think about it.

"Based on this patient's presentation, I do not consider further prescribing of this medication appropriate clinical prescribing. My reasoning for this decision is based on the following:"

I can already picture my 11th grade AP English teacher taking another drag on her cigarette when I do that.

 

[deleted343839]

When writing formal research papers, we were trained to write "the researcher".

Sigh. WHY would anyone ever train you to do that when APA and AMA style manuals both explicitly recommend using the first person?

For the record, I'm here now on SDN to take a break from reviewing a good grant proposal that would be so much better if the writing weren't so tortured.

 

[Messerschmitts]

When I'm writing progress notes, I use "I", but sometimes I will say something like "physician and pt both agree that blah blah blah".

 

[OldPsychDoc]

I just write MD, SW, pt, RN, what have you...fewer keystrokes.
My English teacher isn't reading my progress notes.
(For that matter, I don't think anyone does--once the biller checks that I've documented the required number of elements, that is.)

 

[sunlioness]

On the other hand, the rule that the passive voice should be avoided is totally valid. The reader is made uncomfortable by too much passive voice. Any sense of agency is obscured, and the idea of who precisely the actor of the sentence is is made unclear. The active voice should be used whenever possible. Otherwise, one's meaning will be lost, and readers will be confused.

This was done nicely, sir.

 

[smalltownpsych]

Sigh. WHY would anyone ever train you to do that when APA and AMA style manuals both explicitly recommend using the first person?

For the record, I'm here now on SDN to take a break from reviewing a good grant proposal that would be so much better if the writing weren't so tortured.

http://blog.apastyle.org/apastyle/2009/09/use-of-first-person-in-apa-style.html According to this, APA does not preclude first person and recommends it for most situations for clarity, but he also said that it tends to be "hot spot" for some in the filed and some institutions ban it. I think my undergrad was in the banning of the first person camp. Makes sense since they were an odd bunch of non-practical social reformer types. I think it was allowed in my doctoral program, but I erred on the side of third person since you never know when one of those strange "how dare you write about yourself in the first person" types might be hiding on your IRB committee. The majority who don't really care will just think you are a little weird and won't be likely to penalize you.

 

[takeeacy]

I've heard that writing in passive voice is thought to be obfuscating. Is there some use for using passive voice in notes to potentially evade responsibility/minimize liability?

 

[hamstergang]

Was this the article you were referring to? So much good content on his blog...

http://thelastpsychiatrist.com/2006/09/how_to_write_a_suicide_note.html

That's the article I read that gave me confidence to write "I" in my notes. Things are much smoother now.

Is there some use for using passive voice in notes to potentially evade responsibility/minimize liability?

When I avoid "I" or use passive voice, it is sometimes to make myself feel like I'm not responsible for something I don't quite want to say.

 

[Ceke2002]

Wait, writing notes in the third person? Okay, that's a little...weird. I'm just looking at the copy of the documents I have from when my Mum was detained because of delirium, and whilst it's a pre-printed form that just needs to be dated and signed, it doesn't say 'The Doctor has examined this patient', or 'A Physician examined the patient', or 'This Doctor has examined the patient, and this Doctor feels that *insert decision*' - It's quite clearly printed as 'I', as in 'I have examined this patient', 'I therefore order that the person be involuntarily treated' (etc etc). Writing in third person? I'm getting flashbacks to Seinfeld episodes. 😵

 

[Bartelby]

I've heard that writing in passive voice is thought to be obfuscating. Is there some use for using passive voice in notes to potentially evade responsibility/minimize liability?

Having difficult to follow notes will probably only hurt you in any legal review. You're aiming for clear, concise and comprehensive (enough).

 

[Trismegistus4]

I've heard that writing in passive voice is thought to be obfuscating. Is there some use for using passive voice in notes to potentially evade responsibility/minimize liability?

It's true. By using the passive voice, liability can be minimized, and responsibility evaded. For example, instead of "I asked the patient if he had any suicidal ideations," the phrasing "the patient was asked if he had any suicidal ideations" should be used. Or, instead of "I informed the patient of the risks of possible side effects, including sedation, weight gain, and tardive dyskenisia," something like "the patient was informed of possible side effects" can be written. If this simple standard is adhered to, virtually no lawsuits will be filed, or if they are, you will quickly be absolved of any wrongdoing, because, with the identification of an active agent in those sentences having been avoided, a dereliction of duty will not be able to be established by the plaintiff.

It is hoped that this information was useful to you. If so, a consulting fee of $200 an hour can be paid to me.

 

[Salpingo]

Reading some notes from work, and what's up with MH professionals (usually not doctors but everyone else) using "this writer" all over the place instead of saying I. Are they taught that in school? Why is "I" such a bad thing to use. It's more active (and hence better) writing. Where the hell does this come from? It's especially common with LCSWs and NPs as far as I can determine.

I know its an attempt to make the writing more clinical/impersonal, but it always seems to be in the context of an interaction way too personal/boundary crossing. Like "the patient thanked the writer profusely for services provided, then kissed the writer's hand. The writer graciously accepted the acknowledgement of the writer's amazing mental health skillz. The patient then asked the writer out on a date, and the writer explained that the writer had to wash the writer's hair that night."

 

[WingedOx]

I know its an attempt to make the writing more clinical/impersonal, but it always seems to be in the context of an interaction way too personal/boundary crossing. Like "the patient thanked the writer profusely for services provided, then kissed the writer's hand. The writer graciously accepted the acknowledgement of the writer's amazing mental health skillz. The patient then asked the writer out on a date, and the writer explained that the writer had to wash the writer's hair that night."

"the writer, after receiving unwanted physical contact from patient, felt reminded of why he prefers telepsych."

 

[Doctor Bagel]

I've heard that writing in passive voice is thought to be obfuscating. Is there some use for using passive voice in notes to potentially evade responsibility/minimize liability?

As mentioned above, it probably doesn't work, but yeah, I get more passive in my writing if I don't know what the hell I'm doing or I feel uncomfortable about something. One might, perhaps, it's possible, etc., etc., etc. But then we are in the field where we really don't know anything (or that much) so all the qualifiers and uncertainty make sense.

 

[shan564]

This writer loves this thread.

Yes, this is also a huge pet peeve of this writer. This writer has even noticed some of his colleagues (i.e. other residents) doing the same thing, even though they were never trained to do that - this writer thinks that they're just adopting what they see some of the SWs and RNs doing.

(OK, I'm done with that now)

I feel like writing "I," "my," etc is quite a powerful tool in my documentation, and I probably use it sometimes even when it's not entirely necessary. I like to say things like "my impression is" or "although I have previously observed" or "in my conversation with the patient's PCP" or "I suspect that" or "patient is overly familiar with me" or "patient asks me specifically about (personal question)" or "patient has a delusion that I am trying to pull out his teeth" or "patient confused me with a different Dr. same-last-name who was her pulmonologist 20 years ago," etc. I think that it helps to add value to the narrative that I am trying to portray about my patient's condition, whether that means trying to insert my professional opinion, giving a better description of MSE findings, etc etc.

 

[Doctor Bagel]

I just write MD, SW, pt, RN, what have you...fewer keystrokes.
My English teacher isn't reading my progress notes.
(For that matter, I don't think anyone does--once the biller checks that I've documented the required number of elements, that is.)

I is fewer keystrokes than MD. 🙂

OK, other pet peeve although not just psych writing related -- using "myself" when "me" is the right word. Similarly to I, there's this notion that "me" is always wrong when in fact it's more likely to be right than "myself" most of the time.

 

[WisNeuro]

I'd just prefer if people actually just proofread their notes and actually included meaningful information. For example, referring me a patient for "memory loss" when no where in the note, or even the chart for that matter, is the memory loss explained or elucidated upon. Whether or not they use "I" or "this writer" is usually the least of my concerns when reviewing chart notes.

 

[Trismegistus4]

I is fewer keystrokes than MD. 🙂

OK, other pet peeve although not just psych writing related -- using "myself" when "me" is the right word. Similarly to I, there's this notion that "me" is always wrong when in fact it's more likely to be right than "myself" most of the time.

I first noticed this when I worked in the corporate world in the early 2000's, and it's always bothered myself too. I think the aversion to "me" comes from the fact that in early childhood we have to drill into kids to use "I" instead of "me" as the subject of a sentence, and because of this people form the impression early on that "me" is sort of a dumb, primitive-sounding word.

 

[Shikima]

I first noticed this when I worked in the corporate world in the early 2000's, and it's always bothered myself too. I think the aversion to "me" comes from the fact that in early childhood we have to drill into kids to use "I" instead of "me" as the subject of a sentence, and because of this people form the impression early on that "me" is sort of a dumb, primitive-sounding word.

zug zug. me no want to.

 

[GUH]

I'm embarrassed by how passive my writing. Work in medicine is bad in some respects.

"The passiveness of my writing disturbs me"
😉

 

[Trismegistus4]

"The passiveness of my writing disturbs me"
😉

Many famous movie quotes could be improved by some of the tips from this thread. Allow this writer to demonstrate:

"Frankly, my dear, a damn is not given by myself."

"An offer he can't refuse is gonna be made to him by myself."

"This writer coulda been a contenda!"

"Toto, it is felt that we're not in Kansas anymore!"

"The truth can't be handled by you!"

"This writer was had by you at 'hello.'"

"Show myself the money!"

 

[Doctor Bagel]

This SDN poster is in love with this thread.

 

[OldPsychDoc]

This SDN poster is in love with this thread.

Incorrect! It should be written as: "This thread was loved by this SDN poster."

 

[HarryMTieboutMD]

I have only seen non physicians do this (and not just on psychiatry). Most of the MDs write "I" in their notes

 

[takeeacy]

It's true. By using the passive voice, liability can be minimized, and responsibility evaded. For example, instead of "I asked the patient if he had any suicidal ideations," the phrasing "the patient was asked if he had any suicidal ideations" should be used. Or, instead of "I informed the patient of the risks of possible side effects, including sedation, weight gain, and tardive dyskenisia," something like "the patient was informed of possible side effects" can be written. If this simple standard is adhered to, virtually no lawsuits will be filed, or if they are, you will quickly be absolved of any wrongdoing, because, with the identification of an active agent in those sentences having been avoided, a dereliction of duty will not be able to be established by the plaintiff.

It is hoped that this information was useful to you. If so, a consulting fee of $200 an hour can be paid to me.

Sorry, how sarcastic was this comment? Can't tell if I'm demonstrating magical thinking haha

 

[Ceke2002]

So does anyone in the US use the word 'whilst', or is that more of a 'British' thing?

 

[sunlioness]

So does anyone in the US use the word 'whilst', or is that more of a 'British' thing?

It's British.

Any American using it sounds affected and is probably using it incorrectly. And I laugh at them.


Sent from my iPhone using Tapatalk

 

[Trismegistus4]

Sorry, how sarcastic was this comment? Can't tell if I'm demonstrating magical thinking haha

No sarcasm was intended. This forum is populated by posters of the highest caliber. Every post should be taken with the utmost seriousness. Protection from litigation by usage of the passive voice in one's notes is virtually guaranteed. If magical thinking is suspected, an appointment with a psychiatrist should be scheduled. If more information is desired, a private message can be sent to myself.

 

[smalltownpsych]

I just use an extensive lexicon of technical jargon and obscure words to obfuscate and confuse anyone who may by happenstance peruse my ostentatious and prolific documentation of a variety of characterological and eschatological complaints such as dysthymia, normative male alexothymia, affective instability, pathological internalized object relations, ethnocentric, and maybe even a dab or two of psychasthenia. That way I feel completely immune to litigation for failing to do anything about suicidal patients.

p.s. I'm not even sure what eschatological means or if it is even a real word and I think o might have spelled alexithymia wrong. Some days I just like to compete with the spellcheck too. Hah! What do you mean you don't know that word? Stupid computer!

 

[notdeadyet]

My English teacher isn't reading my progress notes.
(For that matter, I don't think anyone does--once the biller checks that I've documented the required number of elements, that is.)

For the sake of the young'uns, however, I strongly urge the following:

Write your notes as if they are going to be read aloud in court some day.

They probably won't, but they very well might. And while you might want to dance like no one's watching, you sure as hell chart like someone's reading. Doing forensics now on malpractice cases and I cringe at the number of "clever" doctors and doctors that get snarky and downright nasty in their notes. Probably felt good at the time but may potentially cost them later.

RE: "this writer"- I'll do that the same day I start calling patients "clients." I use "I" in my charting when it's necessary to identify myself. I don't use passive voice in order to avoid doing so. I just attempt to write in whatever way is most clear to the reader. Anything else is just artifice, in my book.

 

[OldPsychDoc]

For the sake of the young'uns, however, I strongly urge the following:

Write your notes as if they are going to be read aloud in court some day.

They probably won't, but they very well might. And while you might want to dance like no one's watching, you sure as hell chart like someone's reading. Doing forensics now on malpractice cases and I cringe at the number of "clever" doctors and doctors that get snarky and downright nasty in their notes. Probably felt good at the time but may potentially cost them later.

RE: "this writer"- I'll do that the same day I start calling patients "clients." I use "I" in my charting when it's necessary to identify myself. I don't use passive voice in order to avoid doing so. I just attempt to write in whatever way is most clear to the reader. Anything else is just artifice, in my book.

Fully agree--my point was more aimed at brevity in reference to persons. Stick to facts.

 

[Guyton]

I could care less about stylistic preferences in the writing. I just want information.

I just got a referral for a discharge from the state hospital. The "discharge summary" consists of a demographic face sheet and a five sentence assessment. No hospital course, no diagnosis, no medication list. Even the five sentence assessment is suspect, since it manages two inconsistent statements in five lines.