No, said Aziraphale, it's ineffable.

Anonymous asked:

Hi. Can I ask what you think to the term IVDU or ex-IVDU being printed on surgery lists for staff? We often have notations made for us, about weight (need other equipment) or history (need post op breathing treatments) and I often wonder how patient centred that is. No one really judges. We use this info to assess a situation. But from an outside perspective is is rude, unfeeling? Uncaring? Thanks.

Great question!

So I made an transition away from the term IVDU in documentation of all forms. And I think it makes a lot of sense for practical and professional reasons.

1. IVDU= Intravenous Drug User; as discussed, ‘user’ is not great terminology. “Drug user” is a judgment-ladened term that really only serves to diminish the care we provide and stigmatizes patients. We should all work on phasing this out.

2. IVDU is outdated. We also have, as espoused by the CDC and multiple other specialty societies, a newer term: PWID (person who injects drugs) which is similar to the term PLWH (person living with HIV). It is not a value judgement and gets the point across in a short acronym as well.

3. From an operational standpoint: IVDU provides very little information. Heroin and meth can both be injected. Either one is managed differently from a medical and anesthesia standpoint. OUD (opioid use disorder) is more specific, “PWID (insert name of drug)” is another more medically useful and helpful way to impart information on the list. And as those of us in training or have trained all know, the one-liner is where only the most important information shows up. So let’s make every character, every word provide helpful information.

4. What information is the phrase ‘ex-IVDU’ actually providing in a situation assessment? One of my favorite attendings once challenged me when I said ex-IVDU at the start of my fellowship, asking: “When you say that, what does it tell me or the team consulting you?” And I thought about it. And thought about it. My conclusion? It provided…really nothing.

It does not address what we actually wanted to know: did the injection of drugs lead to medical or surgical complications that inform the current hospitalization or clinical presentation. It says nothing about when the injecting stopped. Ex-, what does it mean? Stopped two days ago? Two weeks ago? Two years ago? Twenty years ago? The temporality is perhaps more important than the exposure itself. Many people have injected drugs in the past but have not required medical attention, hospitalization, or have lead to addiction. If there have been no complications with lasting mortality or morbidity outcomes pertinent to the patient’s current hospitalization or active medical/surgical issues, what is the value of putting that in the one liner, where only the most important information needs to be present?

One-liners on a sign-out sheet or rounding sheet take up valuable real estate. Let’s be mindful about putting only the truly relevant into them for the sake of ourselves, our colleagues, and our patients.

5. ‘No one really judges.’ I would just add to that statement, to paraphrase from the episode on Queer Eye when the Fab 5 makeover their first trans male client ‘No one really judges…that you know of.’ And of course I do not mean a pointed ‘you’, anon. I mean the general you. Us. I think that’s something we as young physicians and healthcare professionals need to remember. That we know of. Our colleagues do not all hold the same values as we do, and many (sometimes even ourselves) refrain from speaking up because of the rigid hierarchy that exists in medicine and surgery.

6. The outside and inside perspective is that IVDU is a term we should all transition away from. Physicians are humans. There are practicing physicians who have struggled with addiction, are struggling currently with addiction, have injected drugs before, etc. What do they hear when they hear their own colleagues, supposedly people on their side, say these terms or type these terms so casually? It hurts. The presence of the words unto themselves tells them that the human struggles they have faced are not acknowledged or respected and that they are seen as deficient, broken, not worthy. That’s how our patients feel, too, when they hear or see that verbage. So don’t just do it for the patients who will never see your sheet. Change the language for those around you who you’ll never know are impacted by those words.

Thank you for the excellent ask!

md-a

See, that’s what the app is perfect for.

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