Every program has slang. For example, I cannot seem to stop calling a certain test "LENIS" (pronounced: Lenny's. As in, belonging to that greasy guy on "Laverne and Shirley"), which is what we called this test at my residency training site. The clumsy acronym stands for "Lower Extremity Non-Invasive Series" or something like that, but the rest of the world calls them lower extremity doppler ultrasounds and will persist in not understanding you if you keep calling them LENIS.
Oh, and we used to call pre-eclampsia "P-E-T" (you would say every letter, you would never say "pet"); I think it once stood for "Pre-Eclampsia-Toxemia" [toxemia is a very, very old word for pre-eclampsia], and it's redundant, and not any shorter than just saying pre-eclampsia, but there you are. We said it, it's how I learned to talk OB, and it's awfully hard to get rid of that mother tongue. Multiple times every day, I look up to see a befuddled colleague looking at me, and then I have to translate the language of my residency-country into that of my new fellowship-land.
But here's one term that I have been introduced to at my fellowship program, and I really like it: GI rounds. GI as in gastroenterology. Rounds as in... you know, meeting to talk about patients and weighty clinical issues.
But at Large Urban Hospital, GI rounds means: Let's go eat! Or: the delivery guy from the Thai place is here! Or: the cafeteria closes in 10 minutes - go catch the elevator! *
It's a little bit of a euphemism, but it sounds clinical, so it is very helpful when trying to maintain a professional veneer.
Thus it came to be that in the midst of my triage chaos tongiht, I walked into the room where my intern was performing an ultrasound after running around non-stop since coming on the labor floor 5 hours earlier. I stood by him, and very sternly said: Dr. F, you are late to GI rounds, and that is not acceptable. I will finish up here.
He got all the way to the hallway on autopilot; I think he was really convinced he was in some sort of serious trouble with me. Then I heard him cracking up as he walked to the break room.
*Unless you are actually a gastroenterologist. Maybe they go on OB rounds?
Wednesday, April 14, 2010
Sunday, April 11, 2010
Mind your Gs and Ps
We talk about patient reproductive histories in short-hand - "She's a G2P1", meaning: she's had two pregnancies (this one counts) and is thus a gravida two, and one delivery; thus a para 1. That's an abbreviation for the longer format, which would be a G2P1001 - again, the G is the pregnancies, and the four digits of the P are various types of pregnancies she's experienced. Many med students use the mnemonic TPAL - the digits stand for, in turn, term pregnancies, premature deliveries, abortions, and live children.
But of course this becomes more complicated. First of all, "abortions" in this and most other medical language refers to any pregnancy loss prior to 20 weeks, regardless of whether is was spontaneous (or what we would call a miscarriage) or a termination. And twins always complicated matters- one pregnancy, two deliveries.
And finally, when you break it down to the short-hand - G2P1 - that one digit after the P refers to the "L" number, the living children this patient has. I was always taught that the "L" digit did not really mean "currently alive" but rather was a reference to children that had survived the neonatal period. That is, it was no longer part of the obstetric history if their 4 year old died in a car accident; that patient, with no living children, would still be a P1. It's tragic, yes, but unlikely to be related to the pregnancy, labor, or delivery we were thinking about now.
I'm seeing my residents, however, use it differently: as a notation for how many live children this patient actually has. The above patient would be presented by them as a P0; she has no children at home.. Arguably, that's a way of melding social history with obstetric history. And arguably, more appropriate.
---------------
None of this terminology ends up being short-hand, in the end, as the terminology has so many possible meanings that an explanation must inevitably accompany it. That is, is the G3P1011 someone who had a term delivery after a six-week miscarriage? This is medically low-risk, and not a red flag for her pregnancy. Or is she someone who had a term delivery, followed by an 17-week intrauterine loss? Or a second trimester termination? Both of those people would have very different concerns and follow-ups, as their bodies would have been subjected to extremely different physiologic and pathologic processes.
-----------------------
In any case, though, I recently took care of a G9 P0. And you don't need much explanation to know how terrible that is. Nine pregnancies; no living children.
Most of these were in other countries, with minimal medical care so far as I can tell. And yet, it is amazing to me that she has the strength to even try again. This time, things seem to be progressing uneventfully, which is really the best you can hope for in any pregnancy.
But of course this becomes more complicated. First of all, "abortions" in this and most other medical language refers to any pregnancy loss prior to 20 weeks, regardless of whether is was spontaneous (or what we would call a miscarriage) or a termination. And twins always complicated matters- one pregnancy, two deliveries.
And finally, when you break it down to the short-hand - G2P1 - that one digit after the P refers to the "L" number, the living children this patient has. I was always taught that the "L" digit did not really mean "currently alive" but rather was a reference to children that had survived the neonatal period. That is, it was no longer part of the obstetric history if their 4 year old died in a car accident; that patient, with no living children, would still be a P1. It's tragic, yes, but unlikely to be related to the pregnancy, labor, or delivery we were thinking about now.
I'm seeing my residents, however, use it differently: as a notation for how many live children this patient actually has. The above patient would be presented by them as a P0; she has no children at home.. Arguably, that's a way of melding social history with obstetric history. And arguably, more appropriate.
---------------
None of this terminology ends up being short-hand, in the end, as the terminology has so many possible meanings that an explanation must inevitably accompany it. That is, is the G3P1011 someone who had a term delivery after a six-week miscarriage? This is medically low-risk, and not a red flag for her pregnancy. Or is she someone who had a term delivery, followed by an 17-week intrauterine loss? Or a second trimester termination? Both of those people would have very different concerns and follow-ups, as their bodies would have been subjected to extremely different physiologic and pathologic processes.
-----------------------
In any case, though, I recently took care of a G9 P0. And you don't need much explanation to know how terrible that is. Nine pregnancies; no living children.
Most of these were in other countries, with minimal medical care so far as I can tell. And yet, it is amazing to me that she has the strength to even try again. This time, things seem to be progressing uneventfully, which is really the best you can hope for in any pregnancy.
Wednesday, March 10, 2010
This joke is requiring a lot of explanation
Much of life on labor and delivery revolves around The Board. This is a big white board with all the patient rooms on it, and rows for their name, their gestational age, and other important info, like how dilated they are. The last row is for "Comments", which means it gets filled up with everything: epidural, magnesium, history of chronic hypertension, etc. The Board serves as a communal brain for the L&D team - attendings, residents, nurses, everyone.
It's rather universal (or it has been at the hospitals I've worked at) that when you put a "to do" on The Board, you put a little empty box, like this:
[] start penicillin.
Then, once you've done it, you put an X in the box, like this:
[x] start penicillin.
That way, everyone knows that this patient a) needed something and b) it was taken care of. The x'd boxes are, of course, the best, because they're done.
So that being said, much time on L&D is spent adding little boxes to The Board, or staring at little boxes on The Board, or just kind of loitering near The Board while thinking about the little boxes .
And when I was doing those things last night, I saw this:
And it made my night.*
*Partly because it was funny, and partly because it was DONE. We are efficient even in our humor!
It's rather universal (or it has been at the hospitals I've worked at) that when you put a "to do" on The Board, you put a little empty box, like this:
[] start penicillin.
Then, once you've done it, you put an X in the box, like this:
[x] start penicillin.
That way, everyone knows that this patient a) needed something and b) it was taken care of. The x'd boxes are, of course, the best, because they're done.
So that being said, much time on L&D is spent adding little boxes to The Board, or staring at little boxes on The Board, or just kind of loitering near The Board while thinking about the little boxes .
And when I was doing those things last night, I saw this:
And it made my night.*
*Partly because it was funny, and partly because it was DONE. We are efficient even in our humor!
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