The mysterious land of OSH

Those of you who have looked at medical records, especially before the era of electronic "cut and paste" may be befuddled by the alphabet soup of acronyms that doctors use to communicate with one another -- that is, if you are not absolutely stupefied by the illegible handwriting first. A typical admission to a cardiology team might look like:

63 yo M c PMHx of DM, HTN, HL, +tob p/w CP x 20 mins c exertion, relieved c NTG.

In English, that's: A 63 year-old man with a past medical history of diabetes, high blood pressure, high cholesterol, and a smoking history presents with chest pain for twenty minutes with exertion, relieved by nitroglycerin tablets.

My favorite of these acronyms is OSH. This stands for "OutSide Hospital." No, not as in referring to something that happened oustide of the hospital, as one might logically infer, but as in another hospital that is outside the one you (the listener or reader) is currently in. Isn't that odd? A patient might have a cardiologist at OSH, as if the most important thing about the cardiologist is that he is not from "our hospital." A patient might have mitral regurgitation, but, we are quick to add, that is from an echo from an OSH.

This is not peculiar to Northwestern, I know. All my doctor friends at OSH use OSH too. What if you worked at Ohio State Hospital? OSH would get confusing for sure. I can just imagine rounds: "so wait, the echo was at our OSH or their OSH? gosh..."

What if in the news, we were to read "OS prime minister assassinated?" or "OS baseball team wins the World Series!!!" What if fourth graders' geography lessons in Chicago consisted of a map that had a dot labeled Chicago, surrounded by a big, fuzzy label that said OUTSIDE? (Well, with the way gradeschoolers test on things these days, maybe this is how it's actually done...)

If we didn't enrich our lives with actually knowing something about somewhere else beside where we are, wouldn't we be poorer for it?

You might think the OSH phenomenon means doctors are snobs, and devalue the work of other doctors. I don't think that's exactly right. What I think it reflects is what experienced doctors know, and what I am beginning to learn: in medical tests and diagnoses, to paraphrase Churchill, there are nuances on top of subtleties inside variations. A written report from OSH, though OSH be the Mayo Clinic, can ony carry so much weight with it. The report can't tell you the worried look on the face of the radiologist when he writes "must consider volvulus." The report can't tell you the severity of mitral regurgitation the way looking at it with your own eyes will. The report can't convey any of our colleagues' intuitions that we rely on to navigate our patients through illness to health.

So when we say OSH, I think we mean to say OSMCZ: outside my comfort zone. I think we are really saying that a piece of data is out of the context we are used to, and therefore we aren't really as sure what to do with it. But since OSMCZ is all but impossible to pronounce, outside (there it is again!) perhaps Eastern Europe, I will CPM & cont c OSH (continue present management, and continue with 'outside hospital').