Vogue (Rogue) Terms: An ACGME Core Competency Gone Amuck

“Mistakes Were Made”
–A Politician Somewhere

I wish I knew who labeled the above phrase as the “past exonerative.”  Absolutely brilliant!  Most commonly, we associate that expression with the politician who is fearful of the mea culpa, i.e., “I made a mistake.”  The poor bast**rd just cannot admit it.

I cite the above, because language matters.  When hospital staff attends a non-clinical conference involving c-suite personnel, most know nuance from nonsense, and there are few doubts concerning wooly terms when an executive on the first floor utilizes any of the following (feel free to add to list below, as by no means is it exclusive):

1.     Actualize
2.     Bandwith
3.     Best Practice
4.     Dashboard
5.     Deliverables
6.     Heavy Lifting
7.     Matrix
8.     Mission Critical
9.     Moving Parts
10.   Operationalize
11.   Optimization
12.   Robust
13.   Scalable
14.   Synergy**
15.   Value-added
16.   Vertical Integration (or ACO)

**particularly hateful

Additionally, what really goads me is the horrible conflagration between patient and consumer:

“Every time I hear the word consumer instead of patient, an angel dies.”
–Unknown

Let’s get this clear: a consumer expires, a patient passes away.  Stop.  Must I continue?

Okay, why the rant.  While I have no literature to support my claim, more often than not, these expressions —so ubiquitous on airport terminal placards—are substitutes for non- explanations.

A.      Need a Fix    >>>>>    B.  “Robust” Solution    >>>>>     C. Problem Solved

The quickest way for me to adopt a cynical exterior and abandon my core competency, card-carrying ACGME bearing (the multidisciplinary team, play nice pose) is to hear these vague, silly terms.  Providers can quickly finger the consultant in the room when the buzzword dictionary comes out of the briefcase.

This is an example of a cultural miscue for sure, and as a physician, I want to understand your world, as you want to understand mine.  However, I really struggle with these idioms, as they are empty and vacuous.

The docs want to climb aboard–honest, but to convince us, the evidence-based horde that we are—meet us halfway and say what you mean.

Mistakes were made?  Perhaps.

Brad Flansbaum

Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.

Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.

Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.

He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

6 Comments

  1. Mike on February 14, 2011 at 10:58 am

    Brad,
    Love it.

    Alas, I have no MBA. Yet I was always pretty good at picking up the local dialect.

    My take on the Doc to C-suite relationship is simple: WE blew it. Instead of focussing on the stewardship of the Healthcare system, we abused the system like Wall Street hedge fund managers riding the wave last decade. We physicians missed that opportunity to truly lead at the local and national levels. In particular, the salad days of the 1980’s were a prime example of hubris on the part of the entrepreneurial physician. Now, with busisiness people and non-clinical finaciers controlling the checkbooks, physicians must earn their place at the board room table.

    Those of us (present company included) who earned our chops in the post-salad days knew that a career in medicine meant wearing moderately priced shoe wear and Khakis from the GAP. Much like the state of our society, the next generation of docs will be less prosperous than their predecessors.

    To me, this is what makes the Hospitalist movement and SHM so exciting. We hospitalists have the opportunity to regain our place at the table- to shape the future of healthcare delivery on our terms and consistent with our values.

    However, “make no mistake,” this requires swallowing a couple bitter pills and “taking one or two for the team.”

    This is a huge “opportunity” for us. A “challenge” unlike others we have faced.

    And Brad, I know that “under your leadership we will overcome those challenges and achieve our mutually aligned goals!”

  2. Bill Rifkin on February 14, 2011 at 10:56 pm

    I fully agree that \we blew it\. Docs (in general) have fought against every change. Even today, have you ever tried to find someone willing to tell an attending he made a mistake or didn’t wash his hands?

    I don’t buy into the \blame free\ culture. Somethings require blame.

    The only sector in healthcare that says \no\ to any test, intervention or spending is the payor. That is sad.

    \Aligning the incentives\ is another way of saying, get the docs to stop profiting from more care.

    re: AGME Core Competenices, we gave away the farm long ago. We have confused resident satisfaction with resident education. Anyone thing less hours per day, but same number of days (3 years) to be an internist is making better docs?

    My C-Suite problem was either lack of well grounded reality testing, or like Brad says, not laying out the stark choices clearly.

  3. […] Flansbaum of The Hospitalist Leader explains that language matters, and gives us a list of words that are tossed around to sound impressive but don’t really […]

  4. […] Brad Flansbaum writes the following: “What really goads me is the horrible conflagration between patient and consumer. ‘Every time I hear the word consumer instead of patient, an angel dies.’” I would counter that it is precisely because patients aren’t the consumers in the American system that things are as dire as they are. We need more conflation and less conflagration. If you want to hear about how real people—not angels—die because we don’t let patients act as consumers, read this tremendous piece by David Goldhill in The Atlantic Monthly, entitled “How American Health Care Killed My Father.” Several of our commenters have, and they can vouch for its profundity […]

  5. […] despite generous coverage. Yet another example of how coverage and access are not the same thing.Brad Flansbaum writes the following: “What really goads me is the horrible conflagration between patient and […]

  6. […] Brad Flansbaum writes the following: “What really goads me is the horrible conflagration between patient and consumer. ‘Every time I hear the word consumer instead of patient, an angel dies.’” I would counter that it is precisely because patients aren’t the consumers in the American system that things are as dire as they are. We need more conflation and less conflagration. If you want to hear about how real people—not angels—die because we don’t let patients act as consumers, read this tremendous piece by David Goldhill in The Atlantic Monthly, entitled “How American Health Care Killed My Father.” Several of our commenters have, and they can vouch for its profundity […]

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