No abstract

Objectives: Keywords, also known as "buzzwords" or "trigger words," serve as memorable descriptors to associate physical findings with specific diagnoses. These terms, such as "target lesion" and "steeple sign," liken a physical or radiographic finding to a nonmedical comparator as a means to elicit an associated diagnosis. Keywords permeate medical literature and clinical conversations. However, the potential for miscommunicating critical information exists and the impact of keywords on communication-related medical error is unknown. We explored the use of keywords and how physicians perceive their use in their clinical communication as part of patient care. Methods: With a grounded theory approach, semistructured interviews were completed in 2016 to 2017 with a purposive sample of 15 resident and attending physicians working in one pediatric emergency department, where clinical conversations occur frequently between providers of different specialties and levels of training. Constant comparative analysis for emergent themes was conducted. We identified key themes and examined their relationships to theorize how keywords affect clinical communication. Results: We identified three major aspects: 1) keywords belong to the culture of medicine, by which providers connect with each other using specialized terms that imply a shared experience and knowledge base. This culture encourages keyword use. 2) By encapsulating a pattern of clinical findings into one word or short phrases, keywords allow for convenient, efficient communication of both diagnoses and of thought processes between providers. 3) Keywords, however, may mislead; if incorrectly applied to a given clinical situation, they may be misinterpreted by the receiver, or they may introduce bias to diagnostic decision making. Conclusions: More than simple descriptors, keywords can communicate entire diagnoses and activate illness scripts between providers. Also, keywords are integral to the culture and language of medicine. However, providers should be aware of the potential negative effects of keywords in clinical conversations and must balance the demands of efficient and accurate communication with the potential for miscommunication and error. K eywords, also known as "buzzwords" or "trigger words," are terms used as memorable descriptors to associate physical findings with specific diagnoses. These descriptors, such as "butterfly rash," "honey-colored crust," and "hot-potato voice," liken a physical or radiographic finding to a nonmedical comparator and are closely associated with a single diagnosis (Table 1). While keywords permeate medical literature and daily clinical conversations, these terms may lead to medical errors due to their associative properties, contributing to cognitive bias or misdiagnoses based on false assumptions. 1-3 In addition, keywords may contribute

CW CHOW, LR LEE-PACK, N SENATHI RA GAH, M RAWJI, M CHAN, CK CHAN. Com mu nity ac quired, nurs ing home acquired and hos pi tal ac quired pneu mo nia:A five-year re view of the clini cal, bac te rio logi cal and ra dio logi cal char ac ter is tics. Can J In fect Dis 1995;6(6):317-325. PUR POSE:To as sess the con tem po rary clini cal, bac te rio logi cal and ra dio graphic fea tures of hos pi tal ized pa tients with com mu nity ac quired (CA), nurs ing home ac quired (NA) and hos pi tal ac quired pneu mo nia (HA) and to ex am ine pa tient out come. PATIENTS AND METH ODS: All hos pi tal rec ords of pa tients with pneu mo nia over a five-year pe riod from April 1987 to March 1992 were re viewed ret ro spec tively. Pa tients in cluded in the study were all those with a di ag no sis of pneu mo nia as iden ti fied by com puter rec ords of di ag nos tic codes at dis charge; pa tients with a spe cific di ag no sis of Pneu mo cys tis carinii pneu mo nia were ex cluded. Of 74,435 dis charges over the five-year pe riod, 1782 pa tients met the in clu sion cri te ria. RESULTS: Charts of 1622 of the to tal 1782 cases were re viewed. Mean age was 64.4 years with 59.4% men and 40.6% women. Sixty-three per cent were CA, 28.5% were HA and 8.5% were NA. A to tal of 1542 pa tients (95%) had at least one con comi tant medi cal con di tion. Chest roent ge no gram was ab nor mal in 97%. Com mon or gan isms iso lated over all were Hae mo phi lus in flu en zae (from 204 pa tients), Staphy lo coc cus aureas (from 152 pa tients), Strep to coc cus pneu mo niae (from 143 pa tients ), Escheri chia coli (from 113 pa tients) and Pseu do mo nas ae rugi nosa (from 111 pa tients). H in flu enzae and S pneu mo niae were most com mon in CA pneu mo nia, whereas S au reus and Gram-negative or gan isms were more com mon in the HA group and Gram-negative agents in the NA group. One hun dred and four pa tients de vel oped com pli ca tions. Fif teen per cent re quired in ten sive care unit ad mis sion. The av er age length of hos pi tali za tion in the CA and NA groups was 17 days and in the HA group, 43 days. At time of dis charge 1261 pa tients (78%) were cured or improved, and 361 pa tients (22%) died dur ing the ad mis sion. CON CLU SIONS: These re sults sug gest that hos pi tali za tion for pneu mo nia in the 1990s is pri mar ily for eld erly pa tients with sig nifi cant co-morbidity. Al though mi cro bi ol ogy ap pears un changed com pared with ear lier re ports, the con tem po rary popu la tion is sig nifi cantly sicker than pre vi ous co horts. This may ac count for the per sis tently high mor bid ity and mor tality de spite bet ter or newer an ti bi ot ics. was by August Hirsch in 1881 (1), in which he de scribed pneu mo nia to oc cur in epi dem ics and to be more preva lent in the eld erly, the sick and those of low so cio eco nomic status. This re port had fol lowed the first suc cess ful cul ture of a bac terial or gan ism from a pa tient with pneu mo nia by Louis Pas teur, who aptly named the or gan ism Strep to coc cus pneu mo niae. Hirsch'...

Multimedia in assessing clinical decision-making skills (CDMS) has been poorly studied, particularly in comparison to traditional text-based assessments. The literature suggests multimedia is more difficult for trainees. We hypothesize that pediatric residents score lower in diagnostic skill when clinical vignettes use multimedia rather than text for patient findings. A standardized method was developed to write text-based questions from 60 high-resolution, quality multimedia; a series of expert panels selected 40 questions with both a multimedia and text-based counterpart, and two online tests were developed. Each test featured 40 identical questions with reciprocal and alternating modality (multimedia vs. text). Pediatric residents and rising 4th year medical students (MS-IV) at a single residency were randomized to complete either test stratified by postgraduate training year (PGY). A mixed between-within subjects ANOVA analyzed differences in score due to modality and PGY. Secondary analyses ascertained modality effect in dermatology and respiratory questions using Mann-Whitney U tests, and correlations on test performance to In-service Training Exam (ITE) scores using Spearman rank. Eighty-eight residents and rising interns completed the study. Overall multimedia scores were lower than text-based scores (p = 0.047, η = 0.04), with highest disparity in rising interns (MS-IV); however, PGY had a greater effect on scores (p = 0.001, η = 0.16). Respiratory questions were not significantly lower with multimedia (n = 9, median 0.71 vs. 0.86, p = 0.09) nor dermatology questions (n = 13, p = 0.41). ITEs correlated significantly with text-based scores (ρ = 0.23-0.25, p = 0.04-0.06) but not with multimedia scores. In physician trainees with less clinical experience, multimedia-based case vignettes are associated with significantly lower scores. These results help shed light on the role of multimedia versus text-based information in CDMS, particularly in less experienced clinicians.