One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.”
Say whaa?
I’m pretty sure that the most valuable thing I’ve done in my 15 years running UCSF’s inpatient service has been to convince the hospital to hire a discharge scheduler, Yolanda Jones, a delightful woman with a big smile and the world’s most thankless job. When a patient is ready for discharge, the interns send Yolanda a note with a list of follow-up appointments, radiology studies, and other outpatient tests that need to be scheduled. She makes all the appointments, then calls the patient and intern with the info. Our hospital would cease to function if not for Yolanda; she is the unsung hero of the medical service.
And now, the process of asking Yolanda Jones to schedule discharge appointments had become a verb.
The next day, I was at a patient safety meeting. Somebody mentioned a bad error. “That case needs to be RCA’ed,” he said. Another new term – root cause analysis – had morphed from noun to verb.
I’m guessing every specialized field develops its own language, and that condensing common activities into verbs is universal. Yet I somehow suspect we use this type of shorthand more in medicine than in other walks of life.
We learn to verb-alize early in our career – the English majors among us undoubtedly recoil when they first hear these linguistic bastards, but everyone eventually gets on board. “She was surgerized,” “we digitalized him” (that’s the cardiac medicine derived from the foxglove plant, not the rectal exam; that goes by “rectalized”), “I heparinized him,” “we Swanned her” (or “lined her up”). The list goes on.
I asked my colleagues for some of their favorites, and heard a few goodies. Sumant Ranji recalled his days as a resident at the University of Chicago, where the housestaff used the term “housed and spoused” to refer to a patient who had somewhere to live, someone to take care of him/her, and was ready for discharge. As in, “she doesn’t need a SNF, she’s housed and spoused.”
And the new world of healthcare IT is exposing us to terabytes of jargon, and thus many new words to verb-alize. Our informatics guru Russ Cucina turned me on to the unique jargon of Epic, my hospital’s soon-to-be implemented IT system. Epic uses several words in interesting ways, Russ told me, including “Pended” and “Done-ed” as verbs. “Actions in Epic (orders, notes, etc.) are usually accompanied by a button labeled ‘Pend’ where you can put them in a holding state,” he explained. “Physician users of Epic universally start saying ‘I pended it.’ After something has been ‘pended’, you can reopen it and finish what you are doing, and there is a button labeled ‘Done’. Physician users of Epic start saying ‘I done-ed it’.”
Wow.
If you have any favorite medical verbs, I’d love to hear them. Until then, I’m done-
-ed.
My team of residents in January used many entertaining descriptors mentioned above. My favorite new word was the verb “to antibiose” referring to their treatment plans for pneumonias, UTIs, sepsis etc. The word used in a sentence sounds as follows:
— Mr. Smith is a 64yo man admitted with a fever and cough, found to have an infiltrate on CXR. He was admitted to the step down and antibiosed. —
The English language is amazingly specific and sensitive in the descriptions of common and scientific topics. The new subset of highly specialized verbs removes any ambivalence of the exact procedure undertaken. I’m definitely enjoying observing the budding of a new language.
More are probably going to occur to me, but here are a few from my UCSF Internal Medicine residency days, some more whimsical than others:
“scoped” – endoscoped or colonscoped, questionably a verb
“cathed” – had a cardiac catheterization
“treat and street” – deliver a treatment to a patient, typically in the ER, and put him back on the street; implies a rapid turnaround
“coumadinized” – placed on the blood thinner coumadin
“d/c’d” – discharged from the hospital, or a medication that was discontinued
“TURP’d” – undergo a transurethral resection of the prostate
“boxed” – died, as in now in a box
And while technically contaning a regular verb already, the expression “hurt me” was very prevalent when I was intern, usually used as an interjection of angst or disgust by housestaff who felt they were overworked, underappreciated, or faced with the hopelessness of the human condition. “I just got 3 admissions to County wards, and the last one is going to the unit with a GI bleed – hurt me!” The verb could be turned BACK into a noun, e.g., “That last case was a big hurt.” Sometimes the suffix “-ada” was added to intensify the effect, completely unclear why, e.g., “the big hurt-ada.”
Robert S. Miller, MD
Yes, I remember that well, Robert. During my training in the 80s, there was even a patient – a “frequent flier” at San Francisco General Hospital – whose last name was “Hurtado”. When he was admitted, the ED resident would call up the admitting resident, saying I’m admitting “The Big Hurtado.”
Sometime in the 90s, “big hurt” was replaced by “eye poke”. I’m not sure what it is today but I’m sure it’s something. Even in a world with better rested and more humanistic housestaff (House of God came out during my internship, if that gives you any insight into the Zeitgeist), I’m pretty sure that this sort of gallows humor is an inevitable part of the residency experience.
Mine is one that is unique to my institution – and names have been changed to protect the guilty.
There are two particular ER attendings who are well known for calling with admission ‘requests’ that invariably end with “I’m just not comfortable sending the patient home” – thereby forcing you to admit the patient regardless of the clinical facts of the case or followup plan. Let’s just call one Dr. Stackhouse.
The verb is properly used as follows:
“Alright Dr. Intern, you’d better head down to the ER for an admission – we just got ‘Stackhoused'”
Very interesting, these are great and some are a little humorous. We work in recruitment, so we don’t always get to stay on the cutting edge of hospital dialect. Thanks for sharing.
Not exactly the same kind of thing, and I know nuclear medicine scanning is much better these days than the mid 1970s, but referring to it “unclear medicine” was a natural. Or, after squinting at the films for a while (remember when they were on actual films?), it was just abbreviated as “dots.”
My friend Vinny Arora of the University of Chicago writes:
“That is so funny! I haven’t heard the term “housing & spousing” in a while; it brings back memories of training with Sumant. Back in those days, we did not have Epic…
So instead we ‘Oacisized’ the patient – meaning do a review of data & create skeleton notes of any the labs, test results, diagnoses, or anything else that we could pull out of the Oacis clinical data repository before seeing the patient. Even though we’re implementing Epic now, “epicize” doesn’t work as well, so some die-hards (like me) still say ‘oacisize.’
We also ‘resi-terned’ – meaning resident doing intern work when intern was off, which was the toughest day as a resident by far.
More recently and possibly a byproduct of reduced resident hours, the attendings started to say they are ‘resi-tending’ when their resident is off or in clinic and they are rounding with their interns alone.
I’ll keep on the lookout for more here…”
It’s me again (Bob): BTW, Vinny just launched a terrific new blog focused on trainee and career issues called “FutureDocs”. You can find it at http://futuredocsblog.com
Nice info you got there mate…
I think all of those practices are unprofessional even if intended to be funny. In a subtle way they marginalize the patient.
I spend a large part of my day trying to convince my residents not to “Zosyn-ate” our patients.
how do you like SNF’d [sniffed] , tubed( intubated).
How about one of high maintenanced anesthesiologist with the last name of Stone? When he introduces an issue, the hospital staff may introduce the issue to other staff as “I’ve been Stoned and this is what he wants this time….”
One of our ER Docs likes to say “I buzzed his gourd” meaning “I did a head CT.”
In our ED, to perform a CT scan has become “to spin,” and then there is the bane of the cardiology fellow’s existence, the “rule out” for ischemia with serial biomarkers and stress test in cases of atypical chest pain. Put it all together: “He had some epigastric pain, so we’re going to spin his belly; if there’s nothing there, he’ll need to come in for a rule out.”
A general plea to physician authors from a journal manuscript editor: Please don’t forget to translate back into regular English when you write journal articles. It’s amazing how confusing things can get — especially for readers from other countries/cultures. The basic policy at our edtorial offices is “If it isn’t in Stedman’s or Merriam-Webster’s latest, try to get the author to explain what he/she meant.” But sometimes it’s tough.
Writing a talk on practice management…
Objective #3:
DMAIC your system.
We have a fun one that we use sometimes for empiric broad spectrum antibiotics when a sick patient comes in: vanc-zosyfloxacin. There are others but the tongue-twister in it makes it especially entertaining. Try saying three times fast.