Let's have some fun this month. Maybe you've seen the tweet a few months ago from @AllisonRBond, an infectious-disease fellow at the University of California, San Francisco, asking the Twitter universe for thoughts on “medical terms to retire or rename.” Hundreds of responses came in from all over the world and they hit home for me, mostly from an ethical perspective. Let's see if you feel the same.
Here's one to retire: withdraw care. The respondent said, “We don't do that. Ever.” How true, especially for nurses. We always care. ALWAYS. No matter what futile medicines or tubes have been removed from the care plan. A related term was do not resuscitate; someone suggested it be replaced with allow natural death. Both changes reframe end-of-life and help us talk with families in a more positive and therapeutic way at a most vulnerable time in their lives.
Another hot button for me was noncompliance. I haven't liked that term for years, going back to its inclusion in the NANDA taxonomy of nursing diagnoses. Such a judgmental and negative label! We use it for both patients and staff. There are so many reasons for noncompliance; maybe we should go a little deeper and use the root cause. For patients, it could be barriers due to cultural lifestyle, misunderstanding, or even poverty. For staff, it could be prioritization, short-staffing, or even irrelevance to actual practice (Why should I check that inane box?). We could go a lot deeper here, but you get the point.
How about against medical advice (AMA)? When patients leave, it could be because they waited over 4 hours for a provider to give discharge orders or more than 24 hours in the ED for an inpatient bed. Maybe their spouse needs them, or they have no child-care arrangements. AMA seems to be a term for the lawyers; it's just another unfair and negative label we give to patients.
One respondent wrote, “Patients don't fail therapy; the therapy fails them.” Hmm, true. Have you used the term morbid obesity? It's defined as being 100 lb (45.4 kg) overweight with adverse effects on the person's health; morbid alone is defined as diseased and pathologic when used medically. Patients who are overweight shouldn't be shackled with this label. We don't say morbid cancer or morbid congestive heart failure.
Speaking of definitions, should elderly be retired from medical language? Besides being the opposite of young, we have no idea how that's defined for purposes of medical documentation. There was a potpourri of responses to the original question—for example, thinking of people who use wheelchairs as wheelchair users instead of being wheelchair-bound. Does poor historian really mean you gave up trying? Why do we have doctor's orders–doesn't everyone contribute to the care plan? Last, I'll mention chief complaint. This term implies being a nuisance, so it should be chief concern.
Maybe you've made these changes already; kudos to you if you have! Maybe you have other terms to retire or rename. At the very least, let's think about what we're saying and its effect on our patients.