Tomorrow is Thanksgiving and there are so many things to be thankful for. One of those things is the honor that I have enjoyed, for the past thirty years, of being an Obstetrician-Gynecologist; the most sophisticated of all specialties.
I am sure that almost every medical specialty (obviously excluding dermatology and anesthesia) could make a reasonably strong argument why they may be the best. But, sadly, they would be wrong. What other specialty other than Ob-Gyn could present a case report as amazing as the following:
DN (MRN 005231955)
HX: 25 yo WF G2P0A1 @ 39 3/7 wks gest
LMP 3/19/15 EDC 12/25/15 c/o HA, N&V
PROM–0200; Reg Utx Contx q3 min–0600
PMHx: HBP x 5 yr; Cigs 1&1/2 ppd x 5 yrs; neg ETOH
PSurgHx: Appy 2005
POBHx: D&C 2011
PHX: BP 178/98 mmHg; p88, R 22, T 99.2, Wt 84.2 kg, BMI 32
PULM: A&P – WNL
COR: NSR; II/VI SEM
ABDO: NT, Neg HSM; FH 38 cm, Vtx, FHTs 152 bpm
CX: 5 cm/100%/- 2 ; pos MEC
NEURO: DTRs 4+
TOCO: RUC q 3 min / 60-70 mmHg
FHR: Rx NST; neg decells; FHR 150-160 bpm
EVAL: CBC- WBC 12.0; Hgb 14.0/Hct 40.8%; PLTS 92,000
BMP- Na 138/K 4.2/Cl 110/HCO3 22/BUN 12/Glu 120
Cr 1.2; UA 7.8; ANA neg
SGOT 128; SGPT 215; TB 1.2; PT 11.2; PTT 32.2; Fib 418
UA- 1.030; 3+ Pro/1+ Ket
U/S- VTX; Ant Plac; AFI 3.8 cm; EGA 36 wks; EFW 2440 g (5th %tile)
DX: IUP 39 3/7 wks
PE / HEELP
IUGR (5th %tile)
Oligo w/ MEC
IP/PP TX: Pit AOL / MgSO4 Sz prophy
NSVD- OA; 11:05 a.m.; 2516 g; XY
8/9; pH 7.28; pO2 16; pCO2 52; HCO3 19
3 cv PLAC; 11:20 a.m. Spont
MLE w/ 3rd; Neg Cx/Vag lacs
EBL 450 cc
pp Sz x 4 min; Tx IV MgSO4 3 gm/hr x 24 hr
Okay, Okay. I can hear you. What is so amazing about a straight up case of severe pre-clampsia at term? Sure, delivery was complicated by the discovery of a growth restricted fetus and maternal HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) Syndrome. We deal with these type of complications frequently. A post-partum eclamptic seizure is fairly rare, but that too was appropriately managed and there were not any untoward results. An interesting case, but amazing??
Maybe re-read the case study once more. Do you see it? It’s right there in front of you. In the entire History, Physical, Evaluation, Diagnosis, Intrapartum and Postpartum Treatment summary, there is not a single complete English word.
If you are an Obstetrician-Gynecologist,which I assume most of you are, I’m sure you zipped through the case looking for anything special. If you are in another specialty, but have had the honor of doing an Ob-Gyn core rotation or have had the pleasure of spending time with an Ob-Gyn, you probably scanned through this case report pretty quickly as well.
But, if you are a lay person and have never had a child, you might be scratching your head trying to interpret the gibberish.
Many animal species utilize tools, almost all mammals nurse their young, chimps have opposable thumbs, and several animals including fish and birds,are capable of vocalizing and communicating. However, the ability to develop a written language is unique to man and a hallmark of intellect and culture. Only Obstetrics and Gynecology, among all medical specialties, has developed its complete own written and spoken language.
Hospitals and transcription services have periodically tried to suppress the highly evolved Ob-Gyn language. Few references exist in the Urban dictionary. They claim the use of such “unapproved” abbreviations creates safety issues where orders and instructions are misunderstood. Quite the contrary, no one with even a single day of Ob-Gyn experience would have any difficulty interpreting the above case summary.
On a busy service, where panic can ensue in an instance, forcing care providers to sit quietly at a desk, using long hand calligraphy to record delivery notes, would endanger all around him or her. If the above case summary had been written out in complete sentences, the average Obstetrician-Gynecologist would have lost interest halfway through and would’ve never known how the case turned out.
Despite the truth of the above, the University Office of EMR (Electronic Medical Records) Correctness continues their efforts to ethnically cleanse the Ob-Gyn language. That’ll never happen. They may drive us underground, but culture cannot be lost. In our middle of the night 3 a.m. board checkouts you will still hear it spoken and see it written, just as you might hear Gullah spoken on the Wadmalaw Island shrimp boat docks.
We understand that we will get no help from our colleagues in other specialties. They are jealous of our advanced language skills. Sure, they will occasionally come up with cool abbreviations for procedures with long names like a CABG or a Perc Neph or maybe LASIC eye surgery. But those are weak efforts at best.
Even the famed lowland gorilla Koko was said to have a vocabulary of almost 1000 words in GSL (Gorilla Sign Language) which she was known to use whenever throwing her poop did not get her what she wanted. Koko reportedly had the ability to recognize displacement and a sense of humor. Koko even asked for a pet cat one Christmas and then was “sad, frown, sad” when it ran away and was hit by a car and killed. Right there, Koko moves beyond specialties like orthopedics and urology. However, Koko has no ability to use syntax or grammar and can only learn words she has been taught. The ability to create a new language separates Ob-Gyns even from Koko the Gorilla.
No other specialty can come close to the fully formed and complete language of the Ob-Gyn. A nuanced, efficient and evocative language that elevates the Obstetrics-Gynecology to the most advanced and sophisticated of all the medical careers.
I will admit to being challenged to find a Springsteen song appropriate to this topic. I finally settled on his classic “Blinded by the Light” the first song from his first album Greetings From Asbury Park, N.J. . In Blinded, Springsteen uses language as a musical instrument. “Madman drummer, bummers, and Indians in the summer,” “in the dumps with the mumps as the adolescent pumps,” all those mmmms functioning as a bass line. Young and naive, but still a beautiful impressionistic painting of the Jersey Shore life and its characters. But, if you aren’t hip to the language you’re going to have trouble figuring out what he’s talking about.
As you might guess, I am an Obstetrician-Gynecologist and have been one for 30 plus years at the Medical University of South Carolina. MUSC has a very brief approved list of acceptable abbreviations and has had that for years. It is a very nice list. The opinions expressed in this blog are mine alone and not those of my employer.