Clear vocabulary is one of the simplest and most powerful tools for patient safety. Precision in communication is not optional. It is a safety mandate with ethical weight.
Sorry, but if offense is not an issue as well than why even comment that the common vernacular may make the pt feel “she did not try hard enough “ with failed GTT or failed induction or failure to progress?
The mere act of mentioning AMA raises a flag to any provider reading the chart irrespective of the actual age and in and of itself is a precise definition. It automatically informs any competent practitioner what potential disorders to be on the lookout for which you claim only takes 5 more seconds to do. This being so when pt reads her chart she understands it better? But how is she to understand category 2 FHR with repetitive deep variable decelerations when reading same chart . Who exactly are we catering to with our documentation?
Proper protocol in place for years already has eliminated “non-reassuring” nomenclature but as you imply may still not be in use universally with presently accepted physician documentation. I agree with you that there is always room for improvement but reiterate that splitting hairs is not one of them.
Thank you for your thoughtful comments and for engaging with this topic so thoroughly. You raise valid points about clinical precision and the practical realities of medical documentation and I agree that we shouldn't sacrifice clarity for the sake of change alone. My broader point is simply that when equally precise alternatives exist, choosing language that doesn't carry unnecessary negative connotations costs us nothing and may strengthen the patient-provider relationship. I appreciate the dialogue, and it's clear we share the same goal of providing the best possible care.
I agree wholeheartedly with the need to improve our vocabulary in medicine. We should not be using terms like elderly or advanced maternal age. (Since the age of many pregnant women is higher these days maybe we should just refer to women under 35 as younger age pregnancies lol)
But some words like failing a test are not about the person they are speaking of the test which is itself non personal. If it makes people feel better you could say meets criteria or does not meet criteria . I think it’s a bit much to make healthcare providers have to say “ there were less than 2 accelerations in 20 minutes “.
We use the term abnormal cardiac stress test but for NST or BPP we use non reassuring which is more precise as it’s not clearly abnormal
Failed induction is accurate and does not refer to a person
So yes, some terms need to be changed but let’s not forget we use the terms to communicate efficiently with each other
"Non-reassuring" replaced "fetal distress" for good reason—we couldn't diagnose distress from a tracing alone. But we traded false precision for vagueness. The term tells you what the tracing isn't without telling you what it is.
The NICHD categories do better. "Category II with absent variability and recurrent late decelerations" communicates exactly what you're seeing and implies urgency. "Category II with minimal variability and no decelerations" is also Category II—but a different clinical situation entirely.
Precision and efficiency aren't opposites. The right vocabulary achieves both.
So now we need to be concerned with what is written in the charts lest we offend our pts now that they have easy access to them. We should refrain from using “AMA” when doing so may alert another provider reviewing the chart to additional potential complications?
We should tell the pt that her graph represents a category 2 tracing with repetitive variable decelerations rather than telling her it is “non- reassuring “?
A “failed induction “ is exactly that…… it speaks to the procedure , not the patient. Would “unsuccessful” be more appropriate? Most of this jargon is used amongst us providers that each of us understands and while there is room for some modifications, me thinks you are splitting hairs .
Patients reading their charts is reality now, not a problem to work around. But that's not why we should improve our language. We should improve it because vague terms lead to vague thinking.
"AMA" lumps a 35-year-old with a 44-year-old. The risk profiles aren't remotely similar. Writing "age-related increased risk for aneuploidy and hypertensive disorders" takes five extra seconds and tells the next provider—and yes, the patient—exactly what you're watching for.
You're right that "failed induction" describes the procedure. I have no issue with it. Same with "non-reassuring" in conversation with a patient—it's accessible and honest.
But among ourselves? "Category II with recurrent variable decelerations" is more useful than "non-reassuring" precisely because it communicates what you're actually seeing. That's not splitting hairs. That's the difference between a term that informs and one that just fills space.
Precision and efficiency aren't enemies. The goal is vocabulary that serves both.
Sorry, but if offense is not an issue as well than why even comment that the common vernacular may make the pt feel “she did not try hard enough “ with failed GTT or failed induction or failure to progress?
The mere act of mentioning AMA raises a flag to any provider reading the chart irrespective of the actual age and in and of itself is a precise definition. It automatically informs any competent practitioner what potential disorders to be on the lookout for which you claim only takes 5 more seconds to do. This being so when pt reads her chart she understands it better? But how is she to understand category 2 FHR with repetitive deep variable decelerations when reading same chart . Who exactly are we catering to with our documentation?
Proper protocol in place for years already has eliminated “non-reassuring” nomenclature but as you imply may still not be in use universally with presently accepted physician documentation. I agree with you that there is always room for improvement but reiterate that splitting hairs is not one of them.
Thank you for your thoughtful comments and for engaging with this topic so thoroughly. You raise valid points about clinical precision and the practical realities of medical documentation and I agree that we shouldn't sacrifice clarity for the sake of change alone. My broader point is simply that when equally precise alternatives exist, choosing language that doesn't carry unnecessary negative connotations costs us nothing and may strengthen the patient-provider relationship. I appreciate the dialogue, and it's clear we share the same goal of providing the best possible care.
I agree wholeheartedly with the need to improve our vocabulary in medicine. We should not be using terms like elderly or advanced maternal age. (Since the age of many pregnant women is higher these days maybe we should just refer to women under 35 as younger age pregnancies lol)
But some words like failing a test are not about the person they are speaking of the test which is itself non personal. If it makes people feel better you could say meets criteria or does not meet criteria . I think it’s a bit much to make healthcare providers have to say “ there were less than 2 accelerations in 20 minutes “.
We use the term abnormal cardiac stress test but for NST or BPP we use non reassuring which is more precise as it’s not clearly abnormal
Failed induction is accurate and does not refer to a person
So yes, some terms need to be changed but let’s not forget we use the terms to communicate efficiently with each other
The vocabulary should clarify, not obscure.
"Non-reassuring" replaced "fetal distress" for good reason—we couldn't diagnose distress from a tracing alone. But we traded false precision for vagueness. The term tells you what the tracing isn't without telling you what it is.
The NICHD categories do better. "Category II with absent variability and recurrent late decelerations" communicates exactly what you're seeing and implies urgency. "Category II with minimal variability and no decelerations" is also Category II—but a different clinical situation entirely.
Precision and efficiency aren't opposites. The right vocabulary achieves both.
So now we need to be concerned with what is written in the charts lest we offend our pts now that they have easy access to them. We should refrain from using “AMA” when doing so may alert another provider reviewing the chart to additional potential complications?
We should tell the pt that her graph represents a category 2 tracing with repetitive variable decelerations rather than telling her it is “non- reassuring “?
A “failed induction “ is exactly that…… it speaks to the procedure , not the patient. Would “unsuccessful” be more appropriate? Most of this jargon is used amongst us providers that each of us understands and while there is room for some modifications, me thinks you are splitting hairs .
The issue isn't offense—it's precision.
Patients reading their charts is reality now, not a problem to work around. But that's not why we should improve our language. We should improve it because vague terms lead to vague thinking.
"AMA" lumps a 35-year-old with a 44-year-old. The risk profiles aren't remotely similar. Writing "age-related increased risk for aneuploidy and hypertensive disorders" takes five extra seconds and tells the next provider—and yes, the patient—exactly what you're watching for.
You're right that "failed induction" describes the procedure. I have no issue with it. Same with "non-reassuring" in conversation with a patient—it's accessible and honest.
But among ourselves? "Category II with recurrent variable decelerations" is more useful than "non-reassuring" precisely because it communicates what you're actually seeing. That's not splitting hairs. That's the difference between a term that informs and one that just fills space.
Precision and efficiency aren't enemies. The goal is vocabulary that serves both.