Medical terms, such as "LOLFDGB" - Little Old Lady, Fall Down, Go Boom
August 23, 2006 9:32 AM Subscribe
I just got this from another person because I was trying to figure out what a notation was on a medical chart I was looking at: APTFRAN. It wasn't on the list, but I thought the rest of the list was interesting.
Incidentally, I finally has it explained to me. It meant "Apply Pillow to Face, Repeat as Needed."
posted by dios at 9:39 AM on August 23, 2006
Incidentally, I finally has it explained to me. It meant "Apply Pillow to Face, Repeat as Needed."
posted by dios at 9:39 AM on August 23, 2006
Wish there were references... some of the language I can believe, but BMT - Bowel-Movement Taco (faecal matter trapped in female genitalia)... sounds like the same apocryphal stuff as the Dirty Sanchez and the Hot Carl.
posted by chef_boyardee at 9:41 AM on August 23, 2006
posted by chef_boyardee at 9:41 AM on August 23, 2006
chef_boyardee, I thought that was an Alabama Hotpocket...
Also:
C&T Ward - Coma ward - "cabbages and turnips"
Morbid humour at its finest.
posted by slimepuppy at 9:45 AM on August 23, 2006
Also:
C&T Ward - Coma ward - "cabbages and turnips"
Morbid humour at its finest.
posted by slimepuppy at 9:45 AM on August 23, 2006
I wanted to laugh, I got depressed.
posted by pointilist at 9:47 AM on August 23, 2006
posted by pointilist at 9:47 AM on August 23, 2006
I can just hear it now.
Lawyer: Doctor, can you read highlighted section of the chart for me?
Doctor: Um yeah, it says FMPS.
Lawyer: And would you care to explain to the court what that means?
Doctor: [sweats audibly]
I do not doubt that this shit happens, but a responsible attending should point out that it doesn't belong in the chart. The chart is an effing legal document.
posted by ilsa at 9:53 AM on August 23, 2006
Lawyer: Doctor, can you read highlighted section of the chart for me?
Doctor: Um yeah, it says FMPS.
Lawyer: And would you care to explain to the court what that means?
Doctor: [sweats audibly]
I do not doubt that this shit happens, but a responsible attending should point out that it doesn't belong in the chart. The chart is an effing legal document.
posted by ilsa at 9:53 AM on August 23, 2006
dang, and I thought lawyers were jaded
posted by owhydididoit at 9:59 AM on August 23, 2006
posted by owhydididoit at 9:59 AM on August 23, 2006
it doesn't belong in the chart. The chart is an effing legal document.
Seconded. The other reason not to write one of these "fun" acronyms in the chart is that the chart may need to be understood years down the road if the patient is readmitted, by which time its meaning will likely have been forgotten.
There are enough standard acronyms as it is (e.g. SOB=short of breath; AOB=alcohol on breath etc.)
posted by Turtles all the way down at 10:02 AM on August 23, 2006
Seconded. The other reason not to write one of these "fun" acronyms in the chart is that the chart may need to be understood years down the road if the patient is readmitted, by which time its meaning will likely have been forgotten.
There are enough standard acronyms as it is (e.g. SOB=short of breath; AOB=alcohol on breath etc.)
posted by Turtles all the way down at 10:02 AM on August 23, 2006
Who gets to SEE their medical charts? And how often?
posted by agregoli at 10:03 AM on August 23, 2006
posted by agregoli at 10:03 AM on August 23, 2006
agregoli: By law you are entitled to see your medical chart. All you have to do is submit your request in writing. Furthermore if you see something wrong you have the right to get it corrected. This is all part of HIPAA.
posted by ilsa at 10:22 AM on August 23, 2006
posted by ilsa at 10:22 AM on August 23, 2006
Yea I can guarantee you that while some of this stuff might get thrown around by third-year students trying to sound cool, most of it will get you in huge trouble if it appears on your patient's chart.
That said, it is not uncommon for staff at urban trauma centers to record blunt trauma to the head as BBH (baseball bat to the head).
posted by Mister_A at 10:26 AM on August 23, 2006
That said, it is not uncommon for staff at urban trauma centers to record blunt trauma to the head as BBH (baseball bat to the head).
posted by Mister_A at 10:26 AM on August 23, 2006
The bible of medical (black) humor - The House of God - is still valid today (and should be required reading, IMHO, to teach doctors the changes that can happen to them as people if they're not careful).
posted by scblackman at 10:28 AM on August 23, 2006
posted by scblackman at 10:28 AM on August 23, 2006
Note the last paragraph:
"In the days when patients had no access to their own medical records, some slang recorded uncomplimentary or non-technical observations about them. ... Nowadays, such slang is considered unethical and its use is decreasing in hospitals and surgeries because of the dangers of being sued by patients."
Note further it was dios, not the linked page, that wrote "Doctor's slang that might be on your chart."
Do not get your PIAB.
posted by hal9k at 10:29 AM on August 23, 2006
"In the days when patients had no access to their own medical records, some slang recorded uncomplimentary or non-technical observations about them. ... Nowadays, such slang is considered unethical and its use is decreasing in hospitals and surgeries because of the dangers of being sued by patients."
Note further it was dios, not the linked page, that wrote "Doctor's slang that might be on your chart."
Do not get your PIAB.
posted by hal9k at 10:29 AM on August 23, 2006
I used to go out with a girl who worked in a hospital, and my favorite term she used was EDA, which meant Eatupwiththe DumbAss.
posted by buriednexttoyou at 10:30 AM on August 23, 2006
posted by buriednexttoyou at 10:30 AM on August 23, 2006
Ok, it's unprofessional...but if I had to do what doctors did all day long I'd want to vent with a bit of black humor too. Maybe not on a legally admissable document, but I can really understand where they're coming from
posted by Dormant Gorilla at 10:30 AM on August 23, 2006
posted by Dormant Gorilla at 10:30 AM on August 23, 2006
Penis In A Bear??! That doesn't make any sense.
posted by sonofsamiam at 10:30 AM on August 23, 2006
posted by sonofsamiam at 10:30 AM on August 23, 2006
Double Whopper with cheese....ick
I'm reminded of why I could never be a doctor.
posted by Andrew Brinton at 10:34 AM on August 23, 2006
I'm reminded of why I could never be a doctor.
posted by Andrew Brinton at 10:34 AM on August 23, 2006
SIG - (certain US regions) self-inflicted gerbil (anecdotal)
I don't want to know which US regions and we already know the anecdote.
posted by leftcoastbob at 10:39 AM on August 23, 2006
I don't want to know which US regions and we already know the anecdote.
posted by leftcoastbob at 10:39 AM on August 23, 2006
FLK is certainly used IRL - spoken, at least, not left on a chart.
posted by sohcahtoa at 10:42 AM on August 23, 2006
posted by sohcahtoa at 10:42 AM on August 23, 2006
it was dios, not the linked page, that wrote "Doctor's slang that might be on your chart."
Right. But I'm still glad dios brought the subject up. It's a wonderful list. F. F. Dig would be a terrific band (or hardcore singer's) name.
posted by LeLiLo at 10:54 AM on August 23, 2006
Right. But I'm still glad dios brought the subject up. It's a wonderful list. F. F. Dig would be a terrific band (or hardcore singer's) name.
posted by LeLiLo at 10:54 AM on August 23, 2006
For what it's worth, these kind of things do occur. After all, I did come across the one I mentioned above when reviewing the medical charts of a patient/plaintiff in a recently filed case. And I sat in a deposition where a doctor had to explain what FLK/NLP means (funny looking kid; normal looking parents).
As far as these being legal documents, that isn't much of a concern. Yeah, the treating physician may have to answer a question about them in a deposition and get a little embarassed, but they never are admitted at trial. Such comments would never effect a lawsuit in any way because they are always throw away comments. They are never actually included in a differential diagnosis, as the discharge diagnosis, or as the treatment protocol. They are just little asides stuck on records.
As such, they never effect a lawsuit. The Rules of Evidence (federal and states) only allow the admission of relevant evidence. A comment like that isn't relevant. And even if it was tagentially relevant to an issue (like say, gross negligence), the Rules of Evidence exclude evidence which may be relevant to a degree, but the prejudicial effect outweighs the probative value. Such comment are not relevant to any issue in a lawsuit and are not probative of any issue. As such, the evidence would be excluded at a trial. Assuming the case goes to trial (and that is a rare occurrence), there are usually "motions in limine" in which both parties ask the judge to exclude certain things from being mentioned at all in the presence of a jury. Something like these comments would surely be the subject of a motion in limine because they are not relevant, and, consequently, would never be mentioned or alluded to in front of a jury.
I just think they are interesting because they show doctors thoughts and the degree to which doctors are real human beings and not just robotic professionals.
posted by dios at 11:15 AM on August 23, 2006
As far as these being legal documents, that isn't much of a concern. Yeah, the treating physician may have to answer a question about them in a deposition and get a little embarassed, but they never are admitted at trial. Such comments would never effect a lawsuit in any way because they are always throw away comments. They are never actually included in a differential diagnosis, as the discharge diagnosis, or as the treatment protocol. They are just little asides stuck on records.
As such, they never effect a lawsuit. The Rules of Evidence (federal and states) only allow the admission of relevant evidence. A comment like that isn't relevant. And even if it was tagentially relevant to an issue (like say, gross negligence), the Rules of Evidence exclude evidence which may be relevant to a degree, but the prejudicial effect outweighs the probative value. Such comment are not relevant to any issue in a lawsuit and are not probative of any issue. As such, the evidence would be excluded at a trial. Assuming the case goes to trial (and that is a rare occurrence), there are usually "motions in limine" in which both parties ask the judge to exclude certain things from being mentioned at all in the presence of a jury. Something like these comments would surely be the subject of a motion in limine because they are not relevant, and, consequently, would never be mentioned or alluded to in front of a jury.
I just think they are interesting because they show doctors thoughts and the degree to which doctors are real human beings and not just robotic professionals.
posted by dios at 11:15 AM on August 23, 2006
Circling the drain is surprisingly absent, as that's been around forever, and still used, albeit in a fashion that tries not to sound too harsh but more as a means of summarizing a raft of bad news into something more concise.
And yes, charts are incredibly sterile documents for the most part, given the prospect of them re-emerging in a courtroom. Although 'well-nourished' is still commonly used in place of 'fat'.
On preview "FLK" is never meant as derogatory, believe it or not. It's a doc's way of stating that they have an unsettled feeling that there may be some sort of genetic anomaly that hasn't been picked up on and they are concerned.
posted by docpops at 11:18 AM on August 23, 2006
And yes, charts are incredibly sterile documents for the most part, given the prospect of them re-emerging in a courtroom. Although 'well-nourished' is still commonly used in place of 'fat'.
On preview "FLK" is never meant as derogatory, believe it or not. It's a doc's way of stating that they have an unsettled feeling that there may be some sort of genetic anomaly that hasn't been picked up on and they are concerned.
posted by docpops at 11:18 AM on August 23, 2006
I should note that I have seen tons of medical charts and these are, indeed extremely rare occurrences. One thing that occurs with a little more frequency than you would expect is when doctors bitch at each other on the chart.
Ex.:
Doctor A's entry: "Tried to read Dr. B's notes and couldn't because the writing is incomprehensible."
Doctor B's entry: "If Dr. A would have bothered to call me, I could have told him that the note indicated X."
Doctor A's entry: "Doctors should write in a manner so that I wouldn't have to sacrafice time tracking him down or completely reworking the patient up."
Stuff like that happens and that always funny.
posted by dios at 11:24 AM on August 23, 2006
Ex.:
Doctor A's entry: "Tried to read Dr. B's notes and couldn't because the writing is incomprehensible."
Doctor B's entry: "If Dr. A would have bothered to call me, I could have told him that the note indicated X."
Doctor A's entry: "Doctors should write in a manner so that I wouldn't have to sacrafice time tracking him down or completely reworking the patient up."
Stuff like that happens and that always funny.
posted by dios at 11:24 AM on August 23, 2006
One I've heard that isn't on this list is SOCMOB -- Standing On Corner Minding Own Business, which is of course what your average upstanding citizen is doing when suddenly stabbed/shot/hit with a bat by Some Dude (or possibly That Bitch). Got that from a stupid-patient-story thread on a medical forum somewhere...
posted by infidelpants at 11:27 AM on August 23, 2006
posted by infidelpants at 11:27 AM on August 23, 2006
Circling the drain is surprisingly absent, as that's been around forever, and still used, albeit in a fashion that tries not to sound too harsh but more as a means of summarizing a raft of bad news into something more concise.
posted by docpops
Actually it is, but listed under initials:
CTD - Circling the Drain (Close To Death)
posted by leftcoastbob at 11:29 AM on August 23, 2006
posted by docpops
Actually it is, but listed under initials:
CTD - Circling the Drain (Close To Death)
posted by leftcoastbob at 11:29 AM on August 23, 2006
I've worked in medical transcription for about fifteen years, on and off, and I can say pretty confidently that I've never seen any of this stuff dictated into a medical record. But I've also not worked with patients' charts in-hospital, so if we're talking about notes jotted by physicians or nurses onto pieces of paper, I got nothin'.
posted by cgc373 at 11:32 AM on August 23, 2006
posted by cgc373 at 11:32 AM on August 23, 2006
I remember 30+ years ago a doctor -- I think it was an OB/GYN -- bragging in a Reader's Digest article (ahem) that he wrote "pretty as hell" and "Breasts -- NICE!" in his charts, and bragged that "this is why nobody is allowed to see my charts!"
Nice....
posted by pax digita at 11:35 AM on August 23, 2006
Nice....
posted by pax digita at 11:35 AM on August 23, 2006
I've worked in medical transcription for about fifteen years, on and off, and I can say pretty confidently that I've never seen any of this stuff dictated into a medical record. But I've also not worked with patients' charts in-hospital, so if we're talking about notes jotted by physicians or nurses onto pieces of paper, I got nothin'.
posted by cgc373 at 1:32 PM CST on August 23
Yeah. This stuff appears rarely on the actual handwritten medical charts that are kept at the hospital. There is so much junk jotted on those things that its pretty easy to slip in a few of these.
posted by dios at 11:37 AM on August 23, 2006
posted by cgc373 at 1:32 PM CST on August 23
Yeah. This stuff appears rarely on the actual handwritten medical charts that are kept at the hospital. There is so much junk jotted on those things that its pretty easy to slip in a few of these.
posted by dios at 11:37 AM on August 23, 2006
I guess that if you see BTSOOM on your chart, it might be time to call the ol' priest over.
posted by clevershark at 12:24 PM on August 23, 2006
posted by clevershark at 12:24 PM on August 23, 2006
"Bobbing for apples - unblocking a badly constipated patient with one's finger"
It took all my powers not to laugh out loud at that one...
posted by clevershark at 12:38 PM on August 23, 2006
It took all my powers not to laugh out loud at that one...
posted by clevershark at 12:38 PM on August 23, 2006
Dios,
Could they be relevant if they say, indicated a course of treatment that wasn't referred to above? as in Exp: ALS - Absolute Loss of Sanity (nutcase) when they actually were Fine, but the effect of the statement led to how the patient was treated by the medical staff? Granted I am reaching here but I can see how one aside can "taint" the how everything else said by the patient is weighed..
posted by Elim at 3:14 PM on August 23, 2006
Could they be relevant if they say, indicated a course of treatment that wasn't referred to above? as in Exp: ALS - Absolute Loss of Sanity (nutcase) when they actually were Fine, but the effect of the statement led to how the patient was treated by the medical staff? Granted I am reaching here but I can see how one aside can "taint" the how everything else said by the patient is weighed..
posted by Elim at 3:14 PM on August 23, 2006
Man, this pisses me off.
I spend an inordinate amount of time in the Emergency Room at one of the most famous hospitals on the planet. I've spent the past 15 years eyeball-deep in the healthcare system as a provider. I have read more medical charts than I have novels.
I have never seen an entry like this anywhere in any medical chart I have reviewed, and I'll put my experience with raw chart tonnage up against anyone's in this thread, including that of dios.
If someone made one of these "humorous" entries in a patient's chart where I currently work, they'd find themselves in front of a review board and, at a minimum, answerable for it if not professionally censured.
Nursing charts, in particular, are continually reviewed by multiple nurses. Physician records are reviewed by multiple people. Any smartass who thinks they could use something like this and get away with it would be swiftly and unambiguously disabused of that notion.
If I sound pissed, it's because I am: this kind of "humor" perpetuates the stereotype that everyone in the healthcare industry is an anti-patient misanthrope who secretly ridicules everyone they encounter and/or work with. In my practical experience, I can count on one hand the number of people fitting this description I have encountered in the field of emergency medicine.
At least part of the problem with healthcare in this country is the perception that the providers of healthcare are, as a rule, burnt-out people-loathing assholes who live to be as condescending, rude, arrogant and misanthropic as possible.
While there certainly are individuals like that in healthcare, I will immediately stack healthcare up against any other industry and challenge you to find a higher incidence of misanthropy in it. There are assholes everywhere, and, while the plural of anecdote is not data, in my experience there are fewer genuine misanthropes in front-line medicine than there are in, say, the internet industry (another industry in which I've worked for the past 10 years).
Note that I'm not including the insurance industry or healthcare administration in that blanket defense, and for good reason: there be dragons, and I'll cheerfully admit that the world population of misanthropic unhelpful plain-out bastards seems to have found its niche(s).
The nurses and physicians with whom I have been and am privileged to work have been damn near uniformly dedicated to the art and craft of healing, and that includes such esoteric aspects of healing as taking an extra five minutes to listen to a patient's story, to comfort a mother frightened that her son passed out watching us start her IV, to ask the patients whether they're comfortable, whether they'd like another pillow or blanket, or a drink of water.
The healthcare industry in this country is badly, badly broken. It is patient-hostile, employee-hostile, inefficient, and at times positively Daliesque. The employees of the system are, 9 times out of 10, attempting desperately to transcend its flaws.
It would be nice to see that highlighted every once in a while.
[/rant]
posted by scrump at 5:22 PM on August 23, 2006 [3 favorites]
I spend an inordinate amount of time in the Emergency Room at one of the most famous hospitals on the planet. I've spent the past 15 years eyeball-deep in the healthcare system as a provider. I have read more medical charts than I have novels.
I have never seen an entry like this anywhere in any medical chart I have reviewed, and I'll put my experience with raw chart tonnage up against anyone's in this thread, including that of dios.
If someone made one of these "humorous" entries in a patient's chart where I currently work, they'd find themselves in front of a review board and, at a minimum, answerable for it if not professionally censured.
Nursing charts, in particular, are continually reviewed by multiple nurses. Physician records are reviewed by multiple people. Any smartass who thinks they could use something like this and get away with it would be swiftly and unambiguously disabused of that notion.
If I sound pissed, it's because I am: this kind of "humor" perpetuates the stereotype that everyone in the healthcare industry is an anti-patient misanthrope who secretly ridicules everyone they encounter and/or work with. In my practical experience, I can count on one hand the number of people fitting this description I have encountered in the field of emergency medicine.
At least part of the problem with healthcare in this country is the perception that the providers of healthcare are, as a rule, burnt-out people-loathing assholes who live to be as condescending, rude, arrogant and misanthropic as possible.
While there certainly are individuals like that in healthcare, I will immediately stack healthcare up against any other industry and challenge you to find a higher incidence of misanthropy in it. There are assholes everywhere, and, while the plural of anecdote is not data, in my experience there are fewer genuine misanthropes in front-line medicine than there are in, say, the internet industry (another industry in which I've worked for the past 10 years).
Note that I'm not including the insurance industry or healthcare administration in that blanket defense, and for good reason: there be dragons, and I'll cheerfully admit that the world population of misanthropic unhelpful plain-out bastards seems to have found its niche(s).
The nurses and physicians with whom I have been and am privileged to work have been damn near uniformly dedicated to the art and craft of healing, and that includes such esoteric aspects of healing as taking an extra five minutes to listen to a patient's story, to comfort a mother frightened that her son passed out watching us start her IV, to ask the patients whether they're comfortable, whether they'd like another pillow or blanket, or a drink of water.
The healthcare industry in this country is badly, badly broken. It is patient-hostile, employee-hostile, inefficient, and at times positively Daliesque. The employees of the system are, 9 times out of 10, attempting desperately to transcend its flaws.
It would be nice to see that highlighted every once in a while.
[/rant]
posted by scrump at 5:22 PM on August 23, 2006 [3 favorites]
Another doctor here. Count me as one who has never, ever seen anything like this in a chart. Moreover, it's only slightly less rare to hear them spoken. And even then, they're usually non-pejoritive things like"code brown"--something that gets said to a nurse or aide when you're examining a patient or sending one to surgery and they need to be cleaned up. Also, code pink, to me, was when someone's significant other came to the hospital for a visit.
There are not legions of doctors "letting off steam" or whatever spouting off these slang terms. In my experience, there's not even one.
Also, hear, hear to scrump, who put it much more eloquently than I did.
posted by ssmug at 5:47 PM on August 23, 2006
There are not legions of doctors "letting off steam" or whatever spouting off these slang terms. In my experience, there's not even one.
Also, hear, hear to scrump, who put it much more eloquently than I did.
posted by ssmug at 5:47 PM on August 23, 2006
scrump is dead right. We'd get killed for putting anything like this anywhere near a patient's records. Between HIPAA (that's one P, two As) and JCAHO, we're damn careful about how everything is documented within our hospital. We also like to do our jobs professionally.
posted by makonan at 6:08 PM on August 23, 2006
posted by makonan at 6:08 PM on August 23, 2006
I have to admit, I don't see that kind of stuff on a hospital chart any more. Even when I began practicing some 25 years ago it was a rarity.
Saying it, though - yeah, there has been an internal jargon found in certain institutions. Different cultures in different hospitals, with various levels of creativity and imagination, and - yes - black humor.
On the private charts of office physicians - again, a quarter century ago - there were all kinds of abbreviations, particularly in those of the older physicians. "These are notes for me, and nobody else," they'd say as they scribbled a couple of incomprehensible lines and shove them back into the rack to be filed.
I've heard of this kind of rannygazoo from British physicians, but I've never practiced in the NHS so I can't say whether the stories were apocryphal or not.
posted by Alwin at 6:16 PM on August 23, 2006
Saying it, though - yeah, there has been an internal jargon found in certain institutions. Different cultures in different hospitals, with various levels of creativity and imagination, and - yes - black humor.
On the private charts of office physicians - again, a quarter century ago - there were all kinds of abbreviations, particularly in those of the older physicians. "These are notes for me, and nobody else," they'd say as they scribbled a couple of incomprehensible lines and shove them back into the rack to be filed.
I've heard of this kind of rannygazoo from British physicians, but I've never practiced in the NHS so I can't say whether the stories were apocryphal or not.
posted by Alwin at 6:16 PM on August 23, 2006
I've heard stories about EMTs being cynical smartasses. If there's anything to that hearsay, I wouldn't be the least bit surprised to hear these words in an ambulance...
posted by jewzilla at 7:04 PM on August 23, 2006
posted by jewzilla at 7:04 PM on August 23, 2006
I've met a few arrogant doctors, physician's assistants, and med students, and yeah, they throw this stuff out there all the time at the barbecue. That's how I first found out about the Double Whopper with Cheese.
I've watched doctors calmly discuss their ideas on the different tanner stages when eyeing young women from across a party.
I, of course, would never reduce women to such clinically degrading terms, but I'm really not all that surprised that this goes on.
Doctors dehumanize their patients all the time, referring to them in an alphabet soup of TLAs and obscure latin terminology that distances them from the actual human being they're treating. It's even more understandable, given the sleep deprivation and workload that these guys are under.
I will, however, study up on a few of these TLAs to catch these guys in their little 'jokes' next time we're playing poker.
posted by snakey at 7:31 PM on August 23, 2006
I've watched doctors calmly discuss their ideas on the different tanner stages when eyeing young women from across a party.
I, of course, would never reduce women to such clinically degrading terms, but I'm really not all that surprised that this goes on.
Doctors dehumanize their patients all the time, referring to them in an alphabet soup of TLAs and obscure latin terminology that distances them from the actual human being they're treating. It's even more understandable, given the sleep deprivation and workload that these guys are under.
I will, however, study up on a few of these TLAs to catch these guys in their little 'jokes' next time we're playing poker.
posted by snakey at 7:31 PM on August 23, 2006
snakey - a NSFW on that Tanner Stages link would have been appreciated - more for the paedophilia aspect than the porn one. yes, yes, it's medical blah but IANAD.
posted by UbuRoivas at 8:17 PM on August 23, 2006
posted by UbuRoivas at 8:17 PM on August 23, 2006
jewzilla:
snakey:
I'm going to try to speak to your "dehumanization" comment, and I'd welcome additional input from the physicians reading this, because it's something that needs to be addressed. To the outside observer, a doctor (or a paramedic, or a nurse) can look like the coldest, most unfeeling bastard in the world when they're in the early phases of diagnosis. I'm sure we've all seen it, and many of us have encountered it:
There are several ways this can be interpreted. The most common one is
In those cases, if the physician makes an assumption not borne out by their own hands, eyes, ears and education, they don't make an ass out of you and me. They make a dead patient.
posted by scrump at 1:27 PM on August 24, 2006 [1 favorite]
I've heard stories about EMTs being cynical smartasses.Without being deliberately confrontational, how many EMTs and/or paramedics do you personally know? Popular culture, for some reason, seems to demand this particular pigeonhole be occupied by EMTs and paramedics, and it is wildly out of step with reality. There is a small minority of EMTs that are vocally burnt-out and patient-hostile, and, on my own authority, I will happily say that I'm certain 99% of their hostility comes from the working conditions under which they're forced to operate rather than their patients.
snakey:
Doctors dehumanize their patients all the time, referring to them in an alphabet soup of TLAs and obscure latin terminology that distances them from the actual human being they're treating.No, some doctors do. Doctors, as a general profession, do not. You are extending your "I've met a few arrogant doctors, physician's assistants, and med students," to an entire profession, with no justification whatsoever and in the face of reality as reported by those of us who actually work in healthcare.
I'm going to try to speak to your "dehumanization" comment, and I'd welcome additional input from the physicians reading this, because it's something that needs to be addressed. To the outside observer, a doctor (or a paramedic, or a nurse) can look like the coldest, most unfeeling bastard in the world when they're in the early phases of diagnosis. I'm sure we've all seen it, and many of us have encountered it:
Patient (in agonizing pain): "I came in last year and it was exactly like this, and they gave me morphine and phenergan and told me it was X"And so forth, and so on.
Doctor: "Okay." Goes on doing what they're doing.
There are several ways this can be interpreted. The most common one is
The doctor is dehumanizing the patient, and doesn't care what happens to them. They're probably not even listening.There's also
The doctor's burnt out, and they just don't care any more, the patient is just an annoyance to them.What I almost never hear said, except by people in frontline medicine, is
The doctor is processing what the patient is telling them, but trying to maintain objectivity while they complete their examination so that they do not commit the potentially fatal error of "seeking to find".There are hundreds of disorders that mimic each other with uncanny brilliance. In some cases, a potentially fatal disorder mimics a benign one, and the choice of treatment is critical.
In those cases, if the physician makes an assumption not borne out by their own hands, eyes, ears and education, they don't make an ass out of you and me. They make a dead patient.
posted by scrump at 1:27 PM on August 24, 2006 [1 favorite]
i've been in healthcare for over 15 years, and i've never seen this kind of thing in a chart...first of all, nobody's got the time for it, really...and also, doctors and others are constantly being asked to clarify documentation, particularly from insurance companies (and for patients, who more and more often these days--there must have been some aarp article on it, i swear--look through their records and send in lists of what they feel are appropriate corrections to letters/notes and such) so i don't think they would open themselves up for anything...
...i'm guessing that the time spent to compile this list is greater than the total time spent using cutesy abbreviations like this...
...on the other hand, as a transcriptionist i could tell some stories about stuff i've seen typed, stuff i've typed by accident, and stuff doctors will say (or do) on their dictated tapes...
posted by troybob at 1:47 PM on August 24, 2006
...i'm guessing that the time spent to compile this list is greater than the total time spent using cutesy abbreviations like this...
...on the other hand, as a transcriptionist i could tell some stories about stuff i've seen typed, stuff i've typed by accident, and stuff doctors will say (or do) on their dictated tapes...
posted by troybob at 1:47 PM on August 24, 2006
A lot of these are common in our E.R., but verbally -- I doubt any of us is stupid enough to write it in the chart. At least, I hope I don't work with anyone that stupid. Just last night, I called the nursing supervisor for a bed assignment and told her that the doc's diagnoses were lung cancer and an leaking 12-cm. abdominal aortic aneurysm (bad, bad news)... but the "real" diagnosis was CTD.
Two we use that aren't in the list are HMF & FDGB -- Hysterical Mother Figure and Fall Down, Go Boom
Along the same lines is my old blog name, I-Tach, as we'll as it's variants Oy-Tach and Tachylawdia.
posted by CodeBaloo at 2:09 PM on August 24, 2006
Two we use that aren't in the list are HMF & FDGB -- Hysterical Mother Figure and Fall Down, Go Boom
Along the same lines is my old blog name, I-Tach, as we'll as it's variants Oy-Tach and Tachylawdia.
posted by CodeBaloo at 2:09 PM on August 24, 2006
And just to show diversity of opinion within the ranks, contrary to scrump's assertion, I can reply to Jewzilla on my own authority, that not only are most EMTs cynical smartasses, most ER staff are as well. It's pretty hard to avoid after, say, the 300th time a stumbling-down-pissed-his-pants-and-puked-on-his-shirt drunk claims he's had "a coupla beers".
posted by CodeBaloo at 2:20 PM on August 24, 2006
posted by CodeBaloo at 2:20 PM on August 24, 2006
Whoops... re: FDGB not being listed... just saw the post title.
posted by CodeBaloo at 2:25 PM on August 24, 2006
posted by CodeBaloo at 2:25 PM on August 24, 2006
Hey scrump, I understand the importance of taking medical care seriously. That's exactly my point. Maybe if the doctors took it a little more seriously, iatrogenic deaths wouldn't be such a huge problem. Just the fact that this little list exists points to the problem.
Seems to me that most doctors needlessly pepper their speech with this jargon as though they're flashing the keys to their Porsche. The stupid joke TLAs only give 'em that many more opportunities.
I've also met massage therapists, accupuncturists and herbalists who can bust out the latin and the TLAs, too. But if anything, they take pains to explain those terms in a way that anybody can easily understand.
That reminds me, I know one MD who got into accupuncture specifically to avoid the snotty attitude and endless TLAs. He's a really cool guy.
posted by snakey at 9:02 PM on August 24, 2006
Seems to me that most doctors needlessly pepper their speech with this jargon as though they're flashing the keys to their Porsche. The stupid joke TLAs only give 'em that many more opportunities.
I've also met massage therapists, accupuncturists and herbalists who can bust out the latin and the TLAs, too. But if anything, they take pains to explain those terms in a way that anybody can easily understand.
That reminds me, I know one MD who got into accupuncture specifically to avoid the snotty attitude and endless TLAs. He's a really cool guy.
posted by snakey at 9:02 PM on August 24, 2006
Snakey, with the exception of four or five from that list ("appy" or "CABG" for example), these are not terms or TLA's any sane doctor or nurse would use in a discussion around a patient, or write in a chart, or similarly use them in a way they could come back and bite us. And in those exception cases where we slip up and say "appy" or "cabbage", we also explain what they mean.
posted by CodeBaloo at 3:50 AM on August 25, 2006
posted by CodeBaloo at 3:50 AM on August 25, 2006
snakey, your "observations" have zero credibility with me, and should have no credibility whatsoever with anyone else reading this thread.
Your citation goes to a website that says, in the first paragraph:
posted by scrump at 11:09 AM on August 25, 2006 [1 favorite]
Your citation goes to a website that says, in the first paragraph:
Shocking statistical evidence is cited by Gary Null PhD, Caroly Dean MD ND, Martin Feldman MD, Debora Rasio MD and Dorothy Smith PhD in their recent paper Death by Medicine - October 2003, released by the Nutrition Institute of America.Let me count the problems with this "citation":
- A Google search on "Nutrition Institute of America" reveals its true colors. It is neither peer-reviewed nor credible.
- This "study" was not published in a peer-reviewed journal. It was "released" by the Nutrition Institute. Had it been submitted to a peer-reviewed journal, it would have been subject to scientific scrutiny.
- The "study" itself is incoherent, poorly written, and the conclusions suspect in the extreme.
posted by scrump at 11:09 AM on August 25, 2006 [1 favorite]
OK, scrup, no biggie. Just making a point. I'm sure we can "Bury the hatchet."
If you want more conservative numbers, look up the Johns Hopkins study that places Iatrogenic death as the #3 leading cause of death in the US. I won't bother linking to it, because its not important anyway.
posted by snakey at 4:15 PM on August 27, 2006
If you want more conservative numbers, look up the Johns Hopkins study that places Iatrogenic death as the #3 leading cause of death in the US. I won't bother linking to it, because its not important anyway.
posted by snakey at 4:15 PM on August 27, 2006
OK, scrup, no biggie. Just making a point. I'm sure we can "Bury the hatchet."What I want is for you to actually back up your assertions in some way involving actual, serious science. "The Johns Hopkins study"? Which study, from which authors, from what journal? Using what methodology? Provide a citation.
If you want more conservative numbers, look up the Johns Hopkins study that places Iatrogenic death as the #3 leading cause of death in the US. I won't bother linking to it, because its not important anyway.
I'll say it again: if you want to be taken seriously, cite serious sources. I'm happy to wait while you marshal your argument, with supporting citations.
I, and anyone else reading this, have no obligations whatsoever regarding the validation of your arguments. You're the one making them: back them up. If you can't back them up, they're specious.
posted by scrump at 8:59 AM on August 28, 2006 [2 favorites]
The most entertaining thing in this thread is the denial of arrogance by the identified medics. A tall order will generally not be met. I guess that's part of the charm. Despite that I make one now, I respectfully ask that you shut the fuck up. Billy clubs should not be forcefully inserted into ones urethra.
posted by econous at 3:53 PM on August 28, 2006
posted by econous at 3:53 PM on August 28, 2006
econous: um, what?
No, I mean, seriously: what the hell are you talking about?
posted by scrump at 4:53 PM on August 28, 2006
No, I mean, seriously: what the hell are you talking about?
posted by scrump at 4:53 PM on August 28, 2006
scrump, I may have made an an egregious spelling error in my previous comment. Sorry for adding to your confusion. I honestly hope you can get over it. Perhaps the penultimate comment should belong to you. So shut up. Do it now. And stay that way.
posted by econous at 6:41 PM on August 28, 2006
posted by econous at 6:41 PM on August 28, 2006
So what color is the sky in your little world, scrump?
Whether it's the #1 or the #3 leading cause of death isn't important. If you don't think iatrogenic death is a serious problem, then there's no amount of data or studies I could use to convince you, anyway.
Google it if you want. Grab the abstract off PubMed. I'm not gonna be your monkey.
Better yet, go ahead and cite your own damn studies. Be an iatrogenic death apologist for all I care. I'm sure the other folks reading this thread would find it all so very entertaining.
posted by snakey at 7:48 PM on August 28, 2006
Whether it's the #1 or the #3 leading cause of death isn't important. If you don't think iatrogenic death is a serious problem, then there's no amount of data or studies I could use to convince you, anyway.
Google it if you want. Grab the abstract off PubMed. I'm not gonna be your monkey.
Better yet, go ahead and cite your own damn studies. Be an iatrogenic death apologist for all I care. I'm sure the other folks reading this thread would find it all so very entertaining.
posted by snakey at 7:48 PM on August 28, 2006
snakey: Are you hard of thinking, or what?
I'm not going to bother with your accusations, because none of them are remotely supported by anything I've posted here.
What I will say is that my position has nothing to do with the validity, or lack thereof, of iatrogenic injury as a problem. It has to do with the fact that you either can't or won't back your assertions up with credible evidence.
That's still the issue. And you still haven't addressed it.
posted by scrump at 9:17 AM on August 29, 2006 [1 favorite]
I'm not going to bother with your accusations, because none of them are remotely supported by anything I've posted here.
What I will say is that my position has nothing to do with the validity, or lack thereof, of iatrogenic injury as a problem. It has to do with the fact that you either can't or won't back your assertions up with credible evidence.
That's still the issue. And you still haven't addressed it.
posted by scrump at 9:17 AM on August 29, 2006 [1 favorite]
Maybe if the doctors took it a little more seriously, iatrogenic deaths wouldn't be such a huge problem. Just the fact that this little list exists points to the problem.
Snakey, how is it that the medical community's internal dark humor is connected with iatrogenic deaths? Are you claiming that our pet names for injuries, illnesses, certain types of patients, etc. has some effect our competence as care providers? That without such humor, the competence level would be higher and iatrogenic mortality and morbidity would be lower? I understand that iatrogenic M&M is a problem. And I understand that many outside the medical community will not understand and/or not see the humor in many of the list entries. But how are you tying the two together?
posted by CodeBaloo at 1:13 PM on August 29, 2006
Snakey, how is it that the medical community's internal dark humor is connected with iatrogenic deaths? Are you claiming that our pet names for injuries, illnesses, certain types of patients, etc. has some effect our competence as care providers? That without such humor, the competence level would be higher and iatrogenic mortality and morbidity would be lower? I understand that iatrogenic M&M is a problem. And I understand that many outside the medical community will not understand and/or not see the humor in many of the list entries. But how are you tying the two together?
posted by CodeBaloo at 1:13 PM on August 29, 2006
Hey CodeBaloo. Thanks for your respectful, well reasoned discourse.
The list is just a symptom of the underlying problem. I don't think this is really the time or place to get into a lengthy scientific discussion on iatrogenic death. But the 'dark humor' in this list does point to the trap of medical arrogance that so many doctors end up in. Hell, by the time you've got that MD, you've already been through decades of conditioning to see yourself as part of an elite class.
Now I know it's easy to see things that way, especially when you're in debt up to your eyeballs from med school and you watch your life go by at a smelly hospital all day. But I doubt that you'd find any doctor who would say this stuff directly to a patient's face. So instead they hide behind the TLAs. Its all just a passive-aggressive mechanism that lets doctors poke fun right in front of the people they're treating.
It's too bad that allopathic medicine is so dependent on big pharma. I think that the corporate approach contributes as much to bad health care (iatrogenesis) as anything else. You could even argue that the HMO culture dehumanizes the doctor as well, leading to a major rift between the doctor and the patient.
I'll admit that I've enjoyed just riffing off the list myself. But it wouldn't be nearly so much fun if there weren't already a system in place that dehumanizes the patient. The language here just exemplifies the problem beautifully. After all, what kind of a system is it, when if you crank through your patients fast enough, you'll "Win the Game"?
posted by snakey at 7:51 PM on August 30, 2006
The list is just a symptom of the underlying problem. I don't think this is really the time or place to get into a lengthy scientific discussion on iatrogenic death. But the 'dark humor' in this list does point to the trap of medical arrogance that so many doctors end up in. Hell, by the time you've got that MD, you've already been through decades of conditioning to see yourself as part of an elite class.
Now I know it's easy to see things that way, especially when you're in debt up to your eyeballs from med school and you watch your life go by at a smelly hospital all day. But I doubt that you'd find any doctor who would say this stuff directly to a patient's face. So instead they hide behind the TLAs. Its all just a passive-aggressive mechanism that lets doctors poke fun right in front of the people they're treating.
It's too bad that allopathic medicine is so dependent on big pharma. I think that the corporate approach contributes as much to bad health care (iatrogenesis) as anything else. You could even argue that the HMO culture dehumanizes the doctor as well, leading to a major rift between the doctor and the patient.
I'll admit that I've enjoyed just riffing off the list myself. But it wouldn't be nearly so much fun if there weren't already a system in place that dehumanizes the patient. The language here just exemplifies the problem beautifully. After all, what kind of a system is it, when if you crank through your patients fast enough, you'll "Win the Game"?
posted by snakey at 7:51 PM on August 30, 2006
« Older http://www.h-pep.com/icepaw.html | The scandalous tale of Kate Mosque Newer »
This thread has been archived and is closed to new comments
posted by blucevalo at 9:36 AM on August 23, 2006