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/Communication

There are some phrases/terms that are best avoided in the emergency department, especially when communicating with colleagues and other health professionals. They can cause not only misunderstandings / ambiguity, but in the worse cases can have legal implications – imagine being questioned by a lawyer that you have thought about something but not acted on it, or labelling a patient with a wrong diagnosis and having no evidence to back it up (closing the door to further investigations)

Conscious Collapse – I still have no idea what this phrase means. Googling yields not results. Heck, Chat GPT doesnt seem to know either. It appears in no textbooks. Always clarify: [1] if there was a fall (on to hip/knees/etc – specify), and [2] if there was loss of consciousness (syncope). This phrase appears every single shift on triage notes and even some medical notes. It is almost meaningless. Was it syncope? Syncope is true loss of consciousness – people often remember waking up on the floor without recalling that they fell down, and may remember feeling a bit lightheaded prior. Or was it legs giving way from proximal myopathy or a spinal canal stenosis? Was it someone with a partial seizure causing a fall with full consciousness? Instead of saying ‘conscious collapse’, say ‘brought self to floor after feeling lightheaded’, or ‘felt legs become weak after standing for awhile’, or ‘felt like room was spinning and lowered self to ground’.

Dizziness – This is a layman’s term. In english, it can refer to either lightheadedness or vertigo. The workup pathways for these two conditions are very, very different. When speaking to another doctor, only use the term ‘dizziness’ (in air quotes) if absolutely unable to clarify it after taking a history and examining the patient. Even if a patient has dementia, obvious pathological nystagmus triggered on head movement is likely to be vertigo. So use the term vertigo.

Medically Cleared – This is a common request from the mental health clinicians (CLIPS / MHCL) prior to psych admissions. As a rule of thumb, very few patients would be legitimately ‘medically cleared’ and most would have some chronic medical condition or another. They may also have an acute injury (eg superficial cuts in from self harm). Instead, document that “there are no acute medical issues requiring inpatient admission or further medical treatment in ED. Urgent medical care (eg wound dressings) has been provided and the patient has been handed over to the psychiatry team (or MHCL / CLIPS).”

Migraine – This term has a different meaning in colloquial English and clinical medicine. A migraine is not just a severe headache, but one that meets the International Headache Society (IHS) definition whereby secondary causes of headache have been excluded. It is relatively simple to diagnose a migraine with aura, but migraines without aura have a much stricter criteria – with the provision that secondary causes of headache have been excluded. If a patient presents with a bad (interrupts ADLs) headache **without aura**, do not label them as having a migraine. I would go so far as to make a clear note stating “A diagnosis of migraine is not being made”. If a patient presents with a unilateral headache with a clear typical aura, the term migraine may be appropriate, but only once secondary causes of a headache have been excluded.

Poor Historian – This is a medicolegally-loaded term. You are effectively declaring that the patient has an altered level of cognition. A lawyer can seek clarification as to why this possible symptom of delirium was not further investigated in the event of a SAPSE/ISR1-2 event. Just because a patient does not volunteer information does not make them a poor historian, it is your job as a clinician to ask open ended questions followed by specific questions to clarify what the patient is telling you. Very often when I am told a patient is a poor historian, it is evident that the patient is compos mentis, and simply hasnt been asked specific questions regarding their presenting complaint. Only if a patient cannot answer specific questions regarding their presenting complaint (eg “Is the chest pain worse on breathing?”) would I label someone as being a ‘poor historian’. The term ‘poor historian’ must be qualified/evidenced. For example “Poor historian due to a poor memory from moderate dementia / ongoing delirium / acute ETOH/DU/toxidrome”