Wednesday, May 07, 2008

The "Hidden Curriculum"

From the Chicago Tribune today:
Indoctrination into the finer points of slang is part of what many professors call the hidden curriculum of medical school and residency training. The official course work requires reading textbooks and paying attention during medical rounds, but the rest comes from watching how older doctors and nurses actually deal with the sometimes overwhelming experience of caring for patients.

A common slip happens when doctors refer to a patient as his or her disease—as in, "the gall bladder in Room 602" or "the P.E. [short for pulmonary embolism] who was admitted last night."

Gregory Makoul, director of Northwestern's center for communication and medicine, said such references can make doctors forget the human dimension of their decisions.

"When you start labeling someone as a disease you can't help but see them as a problem and not as a person," Makoul said. "We try to get people to recognize that, the power and detriment of that sort of label."

Some residents note that medical privacy regulations have made doctors and nurses careful about when they use a patient's name, which can encourage shorthand such as referring to patients by their disease.

Many medical slang terms revolve around the struggle to get patients in and out of the hospital as fast as possible. Schumann said such concerns reached new heights in the 1980s, when Medicare and many insurance plans began paying hospitals fixed rates according to a patient's illness, putting a premium on wrapping up care quickly.
Things haven't changed in the 2000's either. Personally, I really don't like when staff call a patient by their room number, but I can certainly see, with the quick turn-arounds due to business pressures, "right side, right surgery, right patient initiatives" and privacy implications of our work, why this happens.

Of course, there's the issue of new-onset "CRS:" also known as "can't remember (uh) stuff." In those cases, I occasionally ask my staff how good ol' Ms. Fatchamatacheesedip is doing. They usually can figure it out and it seems so much more personal that way...


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