The strange land of Emergistan is full of even stranger ideas.  It seems that the people in charge of medicine (by which I mean everyone but physicians, nurses and mid-levels) are simply losing their ability to focus on reality.  Thus, they focus on anything and everything else.

Case in point.  I work in one facility which no longer uses the term Short of Breath in its charting templates.  The new, updated, customer friendly phrase is ‘Shortness of Air.’  Nobody comes in with SOB; they present with SOA.  Pourquois, you ask?  Good question.

I envision it like this.  Somebody looking over a chart in this small town was shocked (shocked I say) to learn that their dear old grandfather is described as SOB.  (Probably by some damyankee locums doctor from the North.) Of course, we all know it had nothing to do with either the character (or species) of his mother.  It simply meant he is short of breath.

Offended person complains to hospital administration;  thus, a committee is born.  Now, with all due respect, hospitals are generally run by nurses these days.  So I envision a room of former clinical nurses, turned administrators (and dressed quite sharply, by the way) sitting around a conference table and fanning themselves over the vapors they develop when they consider the fact that for years they, too, described old ladies and small children, young men and veterans and all the rest as SOB.  Scandalous!

Granted, it may not be the case. This committee might have been populated with practicing clinicians (but they usually don’t have time for meetings like that), or former lab technicians, xray technicians, security officers, or even current CEO’s, CFO’s, nurse managers, IT employees, etc.  Without the slightest doubt, there was also someone from risk management who realized the enormous legal peril of slander, should anyone else be described with the ages old moniker, SOB.

Other options were likely bounced around over coffee and pastries.  Dyspnea?  Too many letters.   Trouble Breathing?  TB?  (Nobody wants their chart to say TB).  Breathing Problem? (Too much like Blood Pressure).  Ultimately, someone came up with Shortness of Air.

Not to be a stickler, but Short of Air suggest a problem with the atmosphere rather than the body.  The sort of thing that happens when an alien species decides to take the oxygen off of our planet for their own.  Or when an airplane depressurizes.  It suggests a rather collective problem, not the intimate individual trouble of Shortness of Breath.

Long and sort, when I chart at this little garden spot of Emergistan, I have to use Shortness of Air on the template.  Sometimes I use dyspnea, just to show off.  And often, I still free text Shortness of Breath or SOB.  Because that’s the kind of guy I am.

But I have to ask, of all the issues in medicine today, this was the one that had to be addressed?  I guess when it comes down to it, customer satisfaction (or the fear of dissatisfaction) trumps all common sense and nearly all other concerns.

Tragic.  Why, it makes me feel all SOA just thinking about it all!

Edwin Leap

President of Emergistan (self-appointed)

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