12 Words To Never Say In The Hospital
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- čas přidán 9. 07. 2024
- The words we use during patient care has an impact on our attitudes and empathy. Some innocuous (and some not so innocuous) words commonly used by doctors can have a negative impact on how we view our patients.
If you look around disability communities you will see that not everyone prefers person first language (person with a disability vs disabled person). To me personally "person with a disability" suggests that you must remind yourself that I am a person in order to consider me as such. People's individual preferences and opinions on this differ.
Thank you for pointing this out. Our doctoring course holds a dedicated afternoon each year to disability medicine, and we have some advocates from the community who help to organize and run it, and they voice a strong preference for "person with a disability".
However, you are 100% right that every healthcare professional should mirror the language used and preferred by the individual they are caring for/working with, and that person may not agree with what we've heard and been taught elsewhere.
EDIT: Here is a relevant blog post that I saw today about person-first vs. identity-first language: healthjournalism.org/blog/2019/07/identity-first-vs-person-first-language-is-an-important-distinction/
The distinction made regarding "deaf person" vs. "person with deafness" vs. "person with hearing impairment" was particularly interesting to me. (Post asserts that most deaf individuals prefer identity-first language: "deaf person", and dislike "hearing impaired".)
@@StrongMed a lot of people prefer autistic person instead of person with autism
The most important is the “Q” word. Never, ever say, wow it is really quiet today. 😂
Lol! Very true!
Why? Is that like saying Beetlejuice, Beetlejuice, Beetlejuice?
Hmmmm tiktok
I dont get it... Why Quiet? Does it mean something?
@@vincelheyperez8390 afther saying its quiet here in hospital everything goes the other way hospital is full and it is loud! Y got to be kiding me!
Excellent. A much needed advice for not just interns but all doctors who forget these simple things, in hospital or in their clinics.
Hi Dr. Strong, I just wanted to say that I really respect and appreciate that you are using your platform to emphasize the importance of our language in medicine.
Medical terminology already evolves to better describe certain diseases, so I would hope that professionals are receptive to adopting more humanizing and empathetic language to communicate with and about their patients.
I've learned to not say "It's quiet tonight!"...
"I just scoped out the ER and it looked totally empty..."
[followed by 2 back to back codes, and an outside transfer]
.........probably hard way :)
whats about the Q word?
aka : The "Q" Word (Q=Quiet) is a word known in the Emergency Services as a punishable offensive word. Whenever the word is muttered, the night (or day) becomes flooded with emergency calls.
Some terms I've heard during medical school are Oligophrenic, polycomplainer and many other jargonized insults. Often used in the context of shift changes and warning your colleague that a patient is more difficult than others, due to low intelect (oligophrenic literally meaning little head) or being full of anxious complaints. Where I live, "Tiger" is a derogatory expression for (usually) men of low socioeconomic status that don't usually follow medical recommendations or are generally careless, often with a criminal record and a certain way of speech. From that, comes "tigrin" as in "This patient has high levels of Tigrin".
As for "deny" being used, I always learnt from attendings and read that it was to establish that it is a patient statement, not our analysis. It has happened to me that a patient denies abdominal pain, on examination, they experience pain on light touch of the abdomen.
Lots of great pointers. There's been a clear move away from most of these. Some of these seem quite unusual to my English ears. We don't really use endorse or deny here and 'SOB' wouldn't mean much to a member of the public. Are GOMER and FLK really used?! One field where they really need to modernise is OBGYN - they have some horrendous terms. My wife was classed a "geriatric mother" for being over 35 for our second kid. "Failure to progress" is such an awful thing for a woman in labour to hear, like it's her fault. "Incompetent cervix" ffs. I'm undecided about attempts to rename 'heart failure' though...
Rohin, thanks for stopping by! Yes, there's definitely been a move away from some of these. I last heard FLK used seriously on rounds about 5 years ago, though as an internist, I'd come across its use less than a pediatrician (one of whom told me recently she still hears it not uncommonly). It's been a while since I heard "gomer", but I hear "gomed out" a few times a year (i.e. "Man, we just got this transfer from the ICU - pegged, trached, and totally gomed out."). Agree 100% on the o&g terms, though hadn't heard "geriatric mother" before (I'd better hold that one back from my wife).
"Heart failure" is kind of interesting. The first time I talk to a patient about their new diagnosis of heart failure, I sometimes find myself trying to explain that it's not as imminently bad as it sounds, but then I'm not sure if that's doing the patient a disservice by swinging too much towards minimizing a diagnosis that potentially very serious in the long run.
The medical term is Advanced Maternal Age as it demarcated the increase in prenatal care mother/baby & management, delivery, and possibly post-partum care of the mother. Language carries meaning and intension.
As a patient with severe chronic illness who's been to the ER (particularly when still undiagnosed), I'd also suggest doctors refrain from dismissing our needs/complaints by comparing us to your "sicker" patients who are admitted. We can be just as sick as they are or even sicker (and ongoingly, not just temporarily!), the only difference being that their illnesses may be better understood and better funded/researched/have better treatments than ours, whereas we've been largely abandoned to suffer at home indefinitely, only risking coming to the ER when our symptoms get really intolerable. So please do not insinuate or think that we are "less sick" or think that a little help won't go a long way. It's incredibly invalidating and makes us feel like you/medicine do not care about us at all. We don't expect you to work miracles. Just be kind, listen to what we need, and do what you *can.* And please don't mistake the fact that we've developed a high tolerance for severe symptoms (since we live with them constantly) for being fine because we "look fine" to you. Please refrain from telling us that we look fine when we’re telling you that we’re not fine. Even if the tests you’ve run also look fine. Just because certain tests or available tests don’t show it doesn’t mean it’s not real or doesn’t have a devastating impact.
Thanks for your comment. I agree that the problem you've described is real, and I'm sorry that you've had that experience.
Strong Medicine Thanks so much for validating that. It’s such a common problem. I know very few people with severe chronic illness who haven’t experienced this sort of thing multiple times, in the ER and/or in doctors’ offices. A huge number of patients develop actual (C)PTSD from these experiences with the healthcare system, being so ill and being completely brushed off. (So then we not only have debilitating illness, but devastated mental health as well.) And we have no choice but to keep returning into potentially re-traumatizing situations because that’s also where the medical help is. It’s awful.
I must thank you for your comment as well. I am still a medical student and it helps me work on my doctor-patient relationship perception.
Med Stuff Thank you so much for caring. This is a big shift that needs to take place in medicine. It harms far too many people far too much.
@@silverbroom02 agreed
I can never forget what happened when, during rotations, I reported a patient as suffering from alcoholism ...
And I died of laughter with SOB :'D
great video! Those things are much important
Great , helpful and truely ethical ! Thank you ,Dr Eric ✨
Ugh I realize how often I use many of these terms, and also how I really should not be. Got to work on being better. Thank you so much for this Dr. Strong.
I just found out about this channel. I really like this guy! Very often I find myself thinking about ethics in medicine as well.
Lately, I am asking myself how good is it really when calling someone a "patient". At least in my language, in greek, a "patient" is called "a-sthe-nis" (ασθενής) meaning someone who is sick / someone who has no power. This term assumes that the other isn't well and I find it negative. Especially when the patient hears it. So what I prefer doing is referring to someone as a "case of ..." or in general as "a case" - greek "pe-ri-sta-ti-ko" (περιστατικό). This states that only a certain thing is wrong with the patient or there is just reason for concern but doesn't imply that everything is wrong with the patient. Now writing this I saw that the word patient means something different in English based on the dictionary definition - "someone receiving medical treatment" which doesn't sound negative. But I now wonder how people really perceive the English word "patient". Since I expected a definition like "someone who suffers from something", I find it in English a bit negative as well, and again I would prefer using the term "case". I'm not really sure why I am writing all this but maybe someone is interested in it and might share their point of view!
Could not be said better . Thank you .
Agree with all points and appreciate you choosing this topic for the intern series. Well done as usual.
Such a great video - thanks for this. Keep up the awesome work!
"Uses a wheelchair" results in lost information about if a person can move without a wheelchair. Wheelchair bound suggests it is not optional. The phase "uses a wheelchair" has be used in instances of broken leg using wheelchair as convience or preference.
I agree information is lost - at least up front. But that can easily be filled in during the PMH or social history. Many terms best avoided came about as shorthand (not b/c anyone was deliberately trying to be inconsiderate), so using the preferred phrasing often requires a few extra words.
“Full time wheelchair user” vs “part time” or “temporary” wheelchair user, perhaps?
@@silverbroom02 Wheel chair dependent?
@@StrongMedThere's a slippery slope here. Rounds can be long at the best of times without changing "wheelchair-bound alcoholic" to "an individual who uses a wheelchair who meets criteria for alcohol use disorder".
That all being said, I'm supportive of the idea that the language we use has a sort-of retrograde effect on how we view our patients. There's a balance to be struck, but that shouldn't be at the expense of quintupling the number of words required or losing any meaning (at all). I think it's probably fair to say that accuracy ought to trump all else and brevity ought to be preferable where possible.
Very good video on the subtle nuances of our language when speaking with patients. Keep up the good work.
You know, I always did think it was funny that we use the terms, "endorse," and "deny." Even, "refuses." Sounded like some kind of creepy legal document. But I though that we had to do it because I would see it on pretty much any note I see. I initially said that my patient said he had x, y, z, but then eventually my notes evolved to use those terms.
To see someone state that it's not necessary and, well, a bad idea, really makes me realize how much I have to take literally anything I do and learn with a grain of salt.
Excellent!!!
Brilliant!
I have endorsed your channel many times to my colleagues.
Wow, thank you 🙋
thank you so much
Awesome videos. One of my fav channel.
Thank you Doctor , anyhow i saw those endorse and deny a commons words . For example, patient endorse manic symptoms or Patient denied Sucidal and homicidal idea. These are a must note in psychiatry and carry legal connotations.
Very good points! 😊
Thank you a lot , as all videos on the channel i love cardiac physical exam playlist. I wish there were more videos about physical examination
Another physical exam video is scheduled to be posted in the middle of next week.
One I always tried to watch myself on was "Crazy". Not just to refer to patients (that's easy to avoid if you're not a dick), but even saying, "Wow, that's crazy," something I say all the time. I let it slip once when I had an hour long transport and was in the back of the ambulance with a woman experiencing a psychotic break. She noticed, but was lucid enough that we were okay. I had a lot of mental health runs, and as a person with mental health issues, I was very careful to treat them respectfully.
Unrelated: A nurse was giving me a report one time and said the patient was admitted with SOB, and the eavesdropping wife yelled from the other room, "What did you just call him??" They had apparently been bullying the nurses for the last three days. It was hard not to laugh.
A clear and concise ten point consideration. These realizations of best practice communications skills are of the most important in medicine as well as in our larger socio-political relations.
Wow this is great. You hit the nail right on the head. Not sure why we are in the habit of using this language but it promotes a culture of cynicism whether conscious or not.
Dr. Strong, this video has your best CZcams thumbnail! It's awesome haha...
Thank you. I hate the word "withdrawal" it is so negative and scary and sounds as if we don't care any more.
SOB is commonly used in British textbooks lol
I hear even experienced attendings slip up sometimes, so this was a great reminder to be mindful!
I don’t know abound wheelchair-bound. I would like to know quickly whether they can stand up or not
I think wheelchair-bound and "an individual who uses a wheelchair" are not mutually interchangeable.
Very useful in regard to many of the terms and words that you present. This video is great to hear. I shared this with my class and they greatly appreciated it. Medicine is politically correct x3. However, I think that you increased your list to gain more likes. Regardless, good video
what about Frequent Fliers
Totally agree that should be avoided too!
"Train wreck" is another similar term.
i work in lab and RN refer to room numbers so i have to ask their name..some actually seem irritated that I ask
Use the bigger needle if they act like a dick
I didn't know any of these until now, it appears you have introduced me to medical swear words.
I once used 'alcoholic woman' for an assignment, this was critiqued and I ended up changing it to 'alcohol dependence'.
I love SOB.
I can’t believe you said “Bitch!” 😱
👁👄👁
Hahaha....nice video!
I am somewhat surprised that even in the US hospital admission could sometimes be "demeaning". I am writing from India with experience of a government hospital. Demeaning is just too mild a term. In the Indian context of governmental health care system.
6:01 what you should change SOB for
J B
He said “dyspnoea” which means ‘laboured or difficult breathing’ that is, shortness of breath. Dyspnoea can be due to obstruction to the flow or air into or out of the lungs; various diseases affecting the tissue of the lung (including emphysema, tuberculosis, or cancer); and heart disease.
Nice. I am a grouch: I can't stand it when house staff, or even junior faculty, use the word "issue," as in" he has a kidney issue." It's a word which doesn't say anything. Be specific.
Also, isn't it time to replace "male" and "female" with "man" and "woman" (and "boy" and "girl" ) for children. In some languages, the equivalent of "male" and "female" are NOT used for human beings. Thanks for reading this.
“This patient is a case of”
the title is so clickbaity, but the video is very helpful and full of insight. thank you for sharing!
You remind of Tinsley Harrison
Kool
Endorsed or denied means "they said yes/no WHEN I ASKED THEM"
Reported X, offered X or complained of X means "they said X without me prompting them"
This is how I have always interpreted their usage anyways
We Endorse [support] a political candidate! Why would anyone ever support Diarrhea? I agree with almost all of the them.
@@mariezurie7828I think it's important to have a word to distinguish between what the patient volunteered prompted vs unprompted.
For example if i presented that a patient had chest pain radiating to the back, whether or not the patient freely volunteered that info versus saying "yes" when I asked is very different
@@mariezurie7828for what it's worth, i prefer "admitted" to "endorsed"
Well meaning video, but most of these are rather extreme and overly sensitive.
Who else is just watching this randomly at 2 am 🌝💅✨
Along the lines of alcoholic, I wouldn't much like being called a diabetic either. Suffering from diabetes sounds more considerate.
I personally would not be triggered by ANY of the words used... just fix me please!
Son of a bitch? No, shortness of breathe. ;)
I endorse this video
i couldnt hear it, it was pretty quiet
I Disagree. Several of these are fine. Endorse and deny might be a bit formal sounding nowadays but are reasonable and correct. Regarding deny suggesting that that the patient is untruthful I don't really follow - it is objective to say deny as the truth is not known with certainty. Refused is correct and I would encourage using it liberally - clear documentation of refusals is needed for medicolegal purposes. GOMER and FLK are long dead as far as I know - never heard either used except in talks like this video. I don't really think alcoholic is a problem either - diabetic, epileptic, schizophrenic - there are a bunch of these and they save time. Similarly wheelchair bound or bedbound are quick ways of describing someones functional status. Failed a treatment vs treatment failed the patient - I don't really see the difference. I have never heard the "withdrawl care" used in front of a patient or family member - it is typically used between medical professionals. Overall these seem like overly PC nitpicking - would not be helpful to incoming interns who already have way to much to learn and stress about let alone how someone might over interpret some of these common and well understood terms.
You appear to be suffering from thickheadedness
apparently, in new york, doctors are using the term "high five" to communicate that they were assigned an HIV pt. eg, "I cant believe Bob gave me 3 high fives last night!"
Ugh. I haven't heard that one before.
This guy needs to lighten up
I know the q word is the only one I was told not to say when I visited my mom as a kid
I wouldn't change SOB hornestly, I dont think patients should be looking through their file and if they do then they shouldn't expect that the language is the same as what they are used to. They should just ask what it means.
What about bed -bound?
Code black
Do you have an issue with calling a patient a diabetic instead of "a patient with diabetes"? I mean, yes we are sort of defining the patient by their illness, but when you have something that will take your sight, your sense of touch, your limbs and even shrink your brain then yes I think it should define them in someway Dr. Strong.
Similarly with alcoholism, the patient IS an alcoholic. Sure it may have a negative connotation to it but thats because its a negative thing. We can call it alcoholic dependence and in a few years time, that will develop a negative connotation and we may start calling it Ethyl Alcohol Use Disorder.
At one point, idiot and retard were medical terms. Why are we running away from our lexicon?
Maybe if instead of post-traumatic stress disorder we still be calling it Shell Shock veterans would be more likely to get the help they need (Something I'm sure you understand working in a Veteran's hospital). Political correctness can often take away from the seriousness and urgency of medical conditions. Our patients may not like me as much as they like someone that tip toes around their words, but I will never hesitate to tell a patient that they are digging their grave with a fork as thats the truth.
I would not recommend using "diabetic" as a noun when talking to or about patients. While it lacks the negative connotation of "alcoholic", it just doesn't sound polite.
"Mr. Smith is a 50 year old man with a past medical history of diabetes who came to the ED because..." is preferable over "Mr. Smith is a 50 year old diabetic man who came to the ED because..." which is preferable over "Mr. Smith is a 50 year old diabetic who came to the ED because..."
Referring to a person as an "alcoholic" to their face as a deliberate therapeutic decision *may* be appropriate if one is acting as a therapist, addiction counselor, psychiatrist, or AA sponsor. But if one is the internal medicine intern seeing the patient primarily for a medical condition (which may or may not be related to their substance use), the use of disrespectful language is far more likely to drive the person away from seeking medical care at all than it is to becoming part of that one magical come-to-Jesus moment that leads the patient to sustained sobriety.
Speaking respectfully to patients =/= "political correctness".
The reason for vets with PTSD not receiving adequate care are complex, but would likely be even worse if we used a more stigmatizing term like "shell shock".
Strong Medicine You are correct Dr. Strong. My husband had type 1 diabetes, but he was much more than a diabetic-his disease did not define him, even though it had a tremendous impact on his life and eventually lead to his death. We observed that physicians and other health care providers who referred to him as a diabetic (as opposed to a person with diabetes) did not provide the same level of care, they just were not as good. I noticed that my husband tried harder when a physician saw him as a person and not a disease.
First
q word
Never ever say the Q word it will be a fulled with people
No one endorses diarrhea.
Lol. Agreed!
@@StrongMed Btw....I've been a Gomer before, and it's really frustrating. I frequented the doc and ER for one year with excruciating pain in my knees, TI lig, sacrum and neck followed by a fever of unknown origin for 6 months. I've been accused of everything from "somatic illness," and drug seeking to anxiety attacks. Because of my age at the time (39) & the fact that my markers of inflammation were never high and Rheumatoid Factor neg, it never dawned on anyone to simply image my pelvis. Lots of knee pics....no pelvis . Turns out, I am HLAB27 + and my right hip looked like a coral reef, left hip not far behind, SI joint arthritis, c5-6 impingement, loss of spine curvature and really obtuse angles in my hip morphology. I've got a new hip now and spine is stable. But, the experience of being a Gomer has been PTSD-inducing. Thanks for bringing it up here. 😊
I disagree with SOB