“Well nourished” appears to be fairly standard medical terminology when assessing someone you don’t know anything about. I saw it once on a triage nurse’s notes when I went to the ER for something that I’ve now forgotten. It’s not a euphemism for anything (I’m not obese), just part of a general health assessment. To my knowledge, however, I’ve never been described as “supple”. 
Disturbingly (to me at least) it’s boilerplate in the UK as well. Annoyingly pervasive.
j
I don’t write that kind of note, but I read them from time to time.
I’ve had a pet theory (based on nothing really, I’ve not tried to correlate with fact or asked any primary doctors) that while “pleasant patient” is generic, “very pleasant patient” might be code for annoying.
It’s not just the ED that uses “well known to”. “Well known to psychiatry” is also fairly common. You have to spend quite a lot of time admitted to the hospital before internal medicine admission notes start to say “well known to our service” but it happens. Alternate phasing from the ED includes “multiple recent ED visits for same”. If my ED note includes a painful level of detail about the number of recent visits, the number and type of imaging studies performed, the number of clinics the patient has been referred to and whether or not they kept those appointments or list of all recent prescriptions for controlled substances then either the patient really irritated me or I’m covering my ass in anticipation of a formal complaint.
I get a kick out of it when I see it refer to someone who is morbidly obese (a HUGE percentage of the individuals whose records I review.)
Well nourished is one of a list of standard descriptors we all learned in medical school for the general appearance portion of the physical exam. It may have been more useful to note a patient’s well nourished appearance in the past when people were more likely to suffer from diseases related to malnutrition. Now it’s pretty meaningless because different doctors use it to mean anything from healthy body weight to a euphemism for obesity. Other general assessment phrases: well groomed, appears older/younger than stated age, in no acute distress.
Supple as opposed to stiff. With a shoulder injury, it actually makes sense to note that your neck is supple. : )
~Max
Not in my experience.
That makes sense. Especially since the injury was in my shoulder and can certainly stiffen muscles in your neck. When I was doing physical therapy after the surgery, at one point or another the therapist made the exact same comment. Not in her notes, she said it to me.
Thanks for reality check.
LOL in NAD = little old lady in no acute distress
Not in current use, I suspect.
When surgeons refer to morbid obesity in a consult or op note, it could be to facilitate applying for a billing adjustment, due to the complexity of an operation in such cases.
I"ve certainly had this in the standard letter back from the hospital specialist to my GP (we’re routinely copied in on these). I can hardly object to being called a “pleasant gentleman” but it was both patronising and irrelevant (about the same time, there was a fuss when the hospital reported back on a child patient who’d been brought along by the father, described as “stepping manfully into the breach” because his wife was at work).
It’s one thing to indicate something of the patient’s character if it’s likely to affect how best to respond to them (“Mr. X is keen to keep abreast of developments in the treatment of his condition” = “he will bring you every damnfool quackery he’s found on the internet”): but it’s quite another to drag in irrelevant personal comment.
At one time, before patient access to records, they could be full of such remarks: famously, NFN = “Normal for Norfolk” - which was widely supposed to be a hotbed of incest and inbreeding. There are plenty of others:
Describing a patient as “very pleasant” is extremely common 'round these parts. Also very common: “I had the pleasure of meeting Mr. Smith…”.
Two favorite errors I recall discovering are both from decades ago, back when all notes were handwritten:
An order to “Please remove penis”. (it was supposed to read “please remove foley catheter”).
And:
“Patient admits to being depressed but says that it doesn’t bother him”.
mmm
Must say that in the ER, extraneous comments are kept to a minimum. Too busy. And consultants look for the detailed admission note first anyway. It’s too bad, since ER docs still have all the best stories.
FWIW
If a patient is moving around to much for a good MRI or ultrasound exam, instead of saying that a patient was belligerent or intoxicated or claustrophobic or in too much pain or a jerk wad or whatever, I say, “The patient was unable to cooperate with the exam”.
If the problem is that they are obese, I say " large body habitus ".
Sometimes you can say a lot by saying very little.
I had a heart attack over ten years ago, and had some issues and questions immediately following that had me going in to my primary care clinic a few times.
Long story short, I once butted heads with a physician who was under some misconceptions for reasons unbeknownst, treated me pretty disrespectfully right off the bat, and responded angrily when I attempted to correct his misinformation. I felt that we had been able to turn the conversation around, however, once I redirected the discussion to my actual medical concerns. This turns out to have been a misjudgment on my part.
Skipping what amounts to a shaggy dog tale, I had to have a lawyer get my records from around that time, and saw what that doc had written down about our meeting. It was a doozy. He neglected to mention why I was there, but he did include three or four long paragraphs that would have garnered applause in the Pit, but would have been scrapped by the producers at Fox for being too far afield in terms of “alternate facts”. He impugned my character, insulted my intelligence, and maligned my cognitive capabilities. Quite a far cry from “well-nourished”, he was unsubtle as a ball-peen hammer. I was stunned.
Interestingly, and the reason for my posting in this thread, I saw another physician the very next day for a followup. Her brief notes simply noted the reason for my visit and that I received a prescription. She followed that line with the following statement: “pt. is pleasant, alert, and oriented.”
And that’s all she wrote.
I’ve always wanted to sneak “Pupils round, regular and reactive to light” into an autopsy report, to see if anyone was paying attention.
nevermind
WNL = “we never looked”
PS- this website is hard to work sometimes. Very cranky… I mean extremely pleasant.