SOB

We’ve recently changed our terminology in the ED. Medical terminology is it’s own topic (and has been previously on this blog), but I don’t think I’ve really touched on the acronym. Acronyms are those abbreviations we use to simplify communication, and are certainly not unique to medicine ( LMFAO). But we do have our own special ones for ED use. There’s TMCTC (Too Many Complaints to Count), VND (Veak und Dizzy…accent intentional), OTDHTB (Out The Door, Hit The Bricks), III (Insurance-Induced Injury), and AMFYOYO (Adios My Friend, You’re on Your Own.)

But one of our most beloved and useful acronyms has fallen on the junk heap of political correctness. SOB (Shortness of Breath) has been replaced by SOA (Shortness of Air). Apparently some folks objected to seeing the term “SOB” featured prominently on the front of their charts. In truth, I’m not sure how you can be short of air. There’s a lot of it around, and as far as we know it’s not running out any time soon. You can actually run out of breaths, so SOB seems to be more clinically accurate.

With SOB in mind, it is true that the terms we in the healing professions use to describe a small minority of suboptimal patients are not always as polite as they might be. In the ED, we try to be as culturally sophisticated as we can while still conveying the essential message, preferring to use terms such as “oxygen thief” (one who steals perfectly good oxygen from the atmosphere at the cost of CO2 production and global warming). And as far as SOB goes, well, sometimes the patients just are.

Strangely enough, it’s not our habit to note when someone is a decent citizen, simply because most people are. I don’t know why that is. Perhaps it’s for the same reason that Man Bites Dog is a headline while Dog Bites Man is not. So we tend to reserve the terms “good” and “nice” only for people for people who are genuinely sick or in a bad situation. For example, the patient with end stage lung cancer whose wife has been trying to take care of him at home and brings him to the hospital because she literally can no longer care for him are “nice people.” They’ve done all they could and then some, and failed. And they qualify as nice because of the immutable ED law that Nice People Get Bad Disease and Dirtbags Live Forever.

The one exception seems to be our frequent use of the word “pleasant,” often as part of the phrase “pleasantly demented.” Of course, not all patients with dementia act particularly pleased about it. Many are angry or agitated, but for whatever reason I can’t ever recall saying that someone was “really teed-off demented.” I wonder if this is because I have this belief…unsupported by fact, of course, but it seems to work…that when your higher mental functions and processes are stripped away, you really present as the person you always were. And because dementia is a rotten thing to have, we try to somehow make it more palatable by rewarding a cheerful demeanor. It’s another manifestation of the immutable Law of the ED. If you’re pleasant now, you were probably pleasant before; and dementia is a bad disease. Consistency matters.