My husband was a GP for 30 years, and if there was an unwritten code for letting fellow doctors know what to expect from a particular patient, he was never party to it - we both used to laugh when he told me how often a patient was described a 'this pleasant lady' (or gentleman, occasionally). When I had an aortic valve replacement, I received a copy of the letter the cardiac surgeon sent back to my own GP, adding a year to my age, but I was described as 'pleasant', too. Now that patients have a right to access their notes, the General Medical Council advises all medical practitioners not to write anything in the notes which they wouldn't want the patients to see, and the same will apply to the copy letters. And judging from a lot of posts inn this thread, the gallant use of the word 'pleasant' and other such adjectives is often well received. It's only because I know this is such a common phrase that I tend to perceive it as a rather irritating formality and even as rather patronising, but maybe I'm being too much of an Eeyore. Of course, the GMC guidelines are just that, as far as I'm aware, and consultants don't always take much notice of them (for example by calling patients 'tubby' or 'flabby'. My husband remembers a senior partner writing on the patient's notes: "Her husband has left her, and I can't say I'm surprised". But that was in the old days ...