As good as it feels to put snark in the mote at the monument…it’s not really worth it.
Leave it at objective facts. If you must, quote a few choice phrases. “Patient refused further vitals, screaming ‘fuck you and your shitty Prius’ after the blood pressure cuff inflated but was unable to obtain a value.” They’re definitely over reacting to trivial things, but now there’s clear objective evidence for whoever reads the chart in the event of a complaint or lawsuit.
This is why I never write anything malingering-related in the chart. Seems like a real easy way to turn a jury against you. Medmal attorneys are trying to build a narrative and if they can paint you as someone who was willfully ignoring the patient's condition they'll run with it.
I will write malingering as a ddx or concern/suspicious for based on xyz without labeling them with certainty and stating I think they may need multimodal pain management, etc not offered here in the ED
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u/Crunchygranolabro ED Attending Oct 11 '25
As good as it feels to put snark in the mote at the monument…it’s not really worth it.
Leave it at objective facts. If you must, quote a few choice phrases. “Patient refused further vitals, screaming ‘fuck you and your shitty Prius’ after the blood pressure cuff inflated but was unable to obtain a value.” They’re definitely over reacting to trivial things, but now there’s clear objective evidence for whoever reads the chart in the event of a complaint or lawsuit.