Since when did "pleasant" become a euphemism for "fat"?

It is a perk of my employment that I get to root through the medical records of complete strangers. I use these records as material for writing libelous words about them.

Today I was reading the story of Jane Roe. Jane is 23 years old, and suffers from neck pain, shoulder pain, back pain, knee pain, a couple of DSM-IV classifications, and an addiction to narcotic painkillers. From past experience I suspected that with these complaints at such a young age, Jane must must be a complete whopper. I decided to test this hypothesis. I would find out how much Jane weighed.

But I had to read well over 150 pages of material to learn the truth. Her doctors were happy to discuss what a pleasant person Jane is, but they were reticent about her weight.

“Jane Roe is admitted to the emergency room after sustaining a _______. She is a pleasant WF who is…”

“Ms. Roe is a pleasant caucasian woman who presents complaining of…”

“Jane Roe is referred by Dr. Doe for evaluation of back pain. Ms. Roe is a pleasant young woman who reports…”

“Patient is a pleasant, normocephalic female who is seen for multiple symptoms including…” I’ll digress for those who don’t speak Latin or Greek to say that normocephalic means “normal headed.” I’ve found that this term is used primarily by neurologists and pediatricians, who must meet so many people with abnormal heads that they feel it remarkable when a person with a convex skull walks into the examining room.

“I have been asked by Dr. Doe to evaluate Ms. Roe for admission into the chronic pain program. Ms. Roe is a pleasant…”

Only Ms. Roe isn’t pleasant. At all.

I’ll digress again to say that toradol is a very effective pain killer that does work, but it has unpleasant side effects and, I’m told, doesn’t give the right sort of buzz.

Then I get to Dr. Jones. Dr. Jones is old school and doesn’t mince words.

"Mrs. Roe is a morbidly obese woman presenting with multiple, non-specific complaints of chronic pain.

Height: 5’3" Weight: 255 lbs."

I knew it! And Dr. Jones never once mentioned how pleasant she was.

I’ve seen the word “pleasant” in a ton of medical records, and I’d say that well over 50% of the people described as pleasant have a severe weight problem. Are fat people naturally jolly, or have we become such a nation of cowards that doctors are afraid someone will read that they’re calling their patients fat?

I’m fat and i’m a jerk. Do i win something?

Seems a reasonable fear right now, doesn’t it?

Well, since you can request your own medical records fairly easily, that’s probably your reason why right there. I just think those doctors are trying to avoid conflict.

Only my love. Kinda disappointing, huh?

“Is there a larger model for the obese?”


Her complaint, filed about a year ago, was initially investigated by a panel of the New Hampshire Board of Medicine, which recommended that Bennett be sent a confidential letter of concern. The board rejected the suggestion in December and asked the attorney general’s office to investigate.

Bennett rejected that office’s proposal that he attend a medical education course and acknowledge that he made a mistake.

Jesus H. Christ!

Morbidly obese has a medical definition, doesn’t it? To differentiate from regular obese and just overweight? It seems to me they shouldn’t have to worry about using medical terms in a medical record. Now, if they said “Jane Roe is a major league porker. Oh my fucking god I lost my stethascope in her chins and when I tried to find it I got sucked in up to the elbow”… there might be grounds for a lawsuit. Unless the described events actually happened.

Out of curiousity, what are the side effects of Toradol? When I was on it, it had a notable lack of side effects. As in no buzz at all.

Doctors have no business giving people health advice.

Hahaha, I’m totally going to get a prescription for that now.

I’ve had occasion to peruse LOTS of medical records, too. I always thought the inclusion of behavioral desciptors was just part of the clinical E&M documentation. I assumed docs were recording the patient’s apparent state of mind, coherence, and ability to interact with other people, basically. It’s not so much a compliment to the patient as it is documentation of the apparent absence of other (possibly psychosocial) symptoms that might affect a diagnosis.
But that’s just me speculatin’.

Loved your take on the inclusion of ‘normocephalic’. :) Whenever I see random stuff like that, I always wonder why they don’t include ALL the patient’s normal traits. “Mr Baumgarten is a delightful, normocephalic, bipedal, symmetric, does-not-look-like-a-duck, two-arms-having 84 YO gentleman complaining of chest pain but otherwise in good spirits.”


I think this is pure comedy gold.

Do doctors ever get to write things like, “She’s a huge bitch. And huge modifies both the bitch and stands alone as well.”

It’s all about alliteration: Pleasantly plump, corpulently cute, lardy lovelies.

I want doctors to write in cockney rhyming slang.

Based on the notes I’ve written, and the ones I’ve read, “pleasant” usually means more or less just that - pleasant, with most of the implications that Old Man Gravy mentions above. The only thing close to a euphemism I’ve seen is “well nourished”, but that can often mean “not anorexic”. When I read “pleasant” in a note, I don’t think “overweight”.

Pleasant is not an absolute, eternal state like bipedal, in that people can be perfectly pleasant in one interaction, and unpleasant (such as the ER incident mentioned above) at other times. As for “normocephalic” and its close cousin “atraumatic” - often NC/AT - they’re both things that tell you something medically true about a patient, and take essentially zero time to observe. They are often part of the all inclusive medical student note, and for most specialties drop out of the note after training. Both peds and neuro have reasons that they might be more relevant (little soft heads, for example, are often not normocephalic, particularly after a vaginal delivery), but that’s not my area, so I’m just speculating.

Looks like the Doc won out in the end:

I’ve read a shitload of medical files over the last 10+ years. “Well-nourished” is the generally accepted euphemism.