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.”
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’.”
If you have any favorite medical verbs, I’d love to hear them. Until then, I’m done-
Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog “Wachter’s World.”