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Critical but stable

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Ildhund - 16 Apr 2009 18:53 GMT
Just to keep this group alive...
Yet again I hear on the wireless that a victim of violence is - and
has been for several days - in a 'critical but stable condition'. To
my ear, these are almost antonyms, a view borne out I think by
dictionaries. How do you understand it?
Signature

Noel

Peter Duncanson - 16 Apr 2009 19:43 GMT
>Just to keep this group alive...
>Yet again I hear on the wireless that a victim of violence is - and
>has been for several days - in a 'critical but stable condition'. To
>my ear, these are almost antonyms, a view borne out I think by
>dictionaries. How do you understand it?

I have had similar thoughts about that description.

This seems to be a relevant definition:
http://medical-dictionary.thefreedictionary.com/critical

   2. pertaining to a disease or other morbid condition in which there
      is danger of death.

Stable has its usual meaning: unchanging.

An analogy might be of someone standing at the top of a cliff very close
to the edge. They are in a critical condition. Standing still, being in
a stable condition, is better than wobbling about, being in an unstable
condition.

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Peter Duncanson, UK
(in uk.culture.language.english)

Theo Markettos - 16 Apr 2009 20:03 GMT
> Just to keep this group alive...
> Yet again I hear on the wireless that a victim of violence is - and
> has been for several days - in a 'critical but stable condition'. To
> my ear, these are almost antonyms, a view borne out I think by
> dictionaries. How do you understand it?

Critical = "life-threatening"
stable = "getting neither worse nor better"

Someone whose life is threatened can have their condition worsening or
improving, while at the same time still remaining life-threatening.
Consider someone whose heart is beating irregularly... it can either stop
completely (getting worse) or beat more regularly but still be dangerous
(getting better).  Stable implies there's no change in the condition, even
though that condition remains serious.

Theo
Ildhund - 17 Apr 2009 00:02 GMT
Theo Markettos wrote...
> Critical = "life-threatening"
> stable = "getting neither worse nor better"

My understanding is presumably coloured by descriptions of the
course of a feverish illness. As it progresses, the patient
eventually reaches the crisis - the point of decision from which it
could go either way. A crisis is to my mind a momentary situation,
so a stable crisis doesn't make sense. Peter's analogy of the
cliff-edge is perhaps a bit closer to what the hospital spokesman
meant, but I can't help thinking that (a) the usage is a devaluation
of an otherwise useful term, and (b) there must be other ways of
describing the situation that don't make old pedants like me do a
double-take.
Signature

Noel

Peter Duncanson - 17 Apr 2009 12:33 GMT
>Theo Markettos wrote...
>> Critical = "life-threatening"
[quoted text clipped - 10 lines]
>describing the situation that don't make old pedants like me do a
>double-take.

Wikipedia has an article on this subject:
http://en.wikipedia.org/wiki/Medical_state

   Medical states or medical conditions are used to describe a
   patient's condition in a hospital. These terms are most commonly
   used by the news media and are rarely used by doctors in their daily
   business, preferring to deal with medical problems in greater
   detail.

There are separate sections for USA practice and UK practice.

   UK practice
   
   The release of patient information to the press is strictly
   controlled in the National Health Service (NHS). The Department of
   Health (DH) publishes a Code of Practice for guidance to NHS
   Trusts.[3]
   ....    
   Each NHS Trust has its own guidance for statements to the press. The
   DH Code of Practice has no official definitions of the standard
   phrases in use. However, most NHS Trusts will specify some[4] or
   all[5] of the following phrases in their guidance;
   
   * Deceased
   * Critical
   * Critical but stable
   * Stable
   * Satisfactory
   * Comfortable
   * Progressing well
   * Discharged

   USA practice

   A frequently cited condition is "stable". Typically, stable is not a
   condition on its own; it is usually qualified with a true condition.
   It is commonly used to denote conditions where a patient has a
   favorable prognosis or stable vital signs. The American Hospital
   Association has advised doctors to not use the word "stable" either
   as a condition or in conjunction with another condition, especially
   one that is critical, because a critical condition inherently
   implies unpredictability and the instability of vital signs.[1]
   Despite this, "critical but stable" conditions are frequently
   reported, ...
   
   The use of such conditions in the U.S. media has increased since the
   passing of the HIPAA in 1996. Patient privacy has become more of a
   concern to doctors and hospitals, and they are less likely to
   release specific medical conditions, fearing litigious patient

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Peter Duncanson, UK
(in uk.culture.language.english)

Ildhund - 18 Apr 2009 18:44 GMT
Peter Duncanson wrote...
> Wikipedia has an article on this subject:
> http://en.wikipedia.org/wiki/Medical_state
...
> most NHS Trusts will specify some[4] or all[5] of the following
> phrases in their guidance;
...
> * Critical
> * Critical but stable
...
Thank you, Peter. I think it's very sad that established authorities
perpetuate the bad language they never learnt to recognize.
Signature

Noel

Peter Duncanson - 18 Apr 2009 19:53 GMT
>Peter Duncanson wrote...
>> Wikipedia has an article on this subject:
[quoted text clipped - 8 lines]
>Thank you, Peter. I think it's very sad that established authorities
>perpetuate the bad language they never learnt to recognize.

I sympathise with your point but I also sympathise with the authorities.
They need to have words and phrases that communicate the desired general
concepts to the general public. These words and phrases need not be
pedant-proof.

At least they aren't using a colour code for the conditions.

Let's see what I can invent:

   Black: Deceased
   Double Red: Critical
   Red: Critical but stable
   Double Amber: Stable
   Amber: Satisfactory
   Green-Amber: Comfortable
   Green: Progressing well
   White: Discharged

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

Molly Mockford - 18 Apr 2009 19:59 GMT
At 19:53:59 on Sat, 18 Apr 2009, Peter Duncanson
<mail@peterduncanson.net> wrote in
<9q7ku4put8vh649k2v8b4a59naiej8qcvp@4ax.com>:

>    Black: Deceased
>    Double Red: Critical
[quoted text clipped - 4 lines]
>    Green: Progressing well
>    White: Discharged

Only a man could combine the concepts of "white" and "discharge" to mean
"everything is OK"...
Signature

Molly Mockford
They that can give up essential liberty to obtain a little temporary safety
deserve neither liberty nor safety - Benjamin Franklin
(My Reply-To address *is* valid, though may not remain so for ever.)

Peter Duncanson - 18 Apr 2009 23:25 GMT
>At 19:53:59 on Sat, 18 Apr 2009, Peter Duncanson
><mail@peterduncanson.net> wrote in
[quoted text clipped - 11 lines]
>Only a man could combine the concepts of "white" and "discharge" to mean
>"everything is OK"...

"Discharged" is an administrative or organisational status rather than a
state of health. It doesn't describe a patient's health so doesn't
really fit into any colour coding that is based on a patient's
condition.

I chose "white" having in mind a blank sheet of paper symbolic of the
hospital having nothing to say on the patient's state of health.

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

Molly Mockford - 19 Apr 2009 03:20 GMT
At 23:25:39 on Sat, 18 Apr 2009, Peter Duncanson
<mail@peterduncanson.net> wrote in
<o4kku45cgi7ss0en7o22b7ija70ol8tpeo@4ax.com>:

>>At 19:53:59 on Sat, 18 Apr 2009, Peter Duncanson
>><mail@peterduncanson.net> wrote in
>><9q7ku4put8vh649k2v8b4a59naiej8qcvp@4ax.com>:

>>>    White: Discharged
>>
[quoted text clipped - 8 lines]
>I chose "white" having in mind a blank sheet of paper symbolic of the
>hospital having nothing to say on the patient's state of health.

I rest my case, m'lady.

(And I am, I suppose, rather pleased that Mr Duncanson has never
encountered a white discharge.)
Signature

Molly Mockford
They that can give up essential liberty to obtain a little temporary safety
deserve neither liberty nor safety - Benjamin Franklin
(My Reply-To address *is* valid, though may not remain so for ever.)

Peter Duncanson - 19 Apr 2009 10:31 GMT
>At 23:25:39 on Sat, 18 Apr 2009, Peter Duncanson
><mail@peterduncanson.net> wrote in
[quoted text clipped - 21 lines]
>(And I am, I suppose, rather pleased that Mr Duncanson has never
>encountered a white discharge.)

Only pus from an infected pore on my right arm.

As for Code Green, that should not be interpreted as a description of
the patient's colour either. Greenness of a patient is not a sign that
all is well.

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

Peter Duncanson - 19 Apr 2009 12:47 GMT
>Only pus from an infected pore on my right arm.

Make that "left". It was decades ago.

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

Mike Barnes - 18 Apr 2009 20:21 GMT
In uk.culture.language.english, Peter Duncanson wrote:

>>Peter Duncanson wrote...
>>> Wikipedia has an article on this subject:
[quoted text clipped - 13 lines]
>concepts to the general public. These words and phrases need not be
>pedant-proof.

In a slightly different context, I cringe every time I hear schools
inspectors and the like, going on to the effect that for a school to be
"satisfactory" isn't good enough. Do they ever stop to think what the
word actually means?

Signature

Mike Barnes

Ildhund - 18 Apr 2009 21:40 GMT
Peter Duncanson wrote...
> They need to have words and phrases that communicate the desired
> general concepts to the general public.

http://news.bbc.co.uk/onthisday/hi/dates/stories/march/24/newsid_2785000/2785265.stm
describes Queen Mary's last day:

A bulletin released at Marlborough House at 1140 GMT was the first
warning that her condition was causing some anxiety. A second
bulletin, framed like the first and hung on a screen of corrugated
iron protecting stonework repairs to the front of the gateway, was
issued at 1340 GMT. It said: "During the past hours Queen Mary's
condition has become more grave. There has been a serious weakening
of the heart action which gives rise to increasing anxiety." The
third bulletin, at 1900 GMT, was brief: "Queen Mary's strength is
ebbing, but Her Majesty is sleeping peacefully." The fourth and
final bulletin was to announce her death.

This seems to me to communicate the general concepts perfectly
adequately, using terms which anyone should be able to understand,
even pedants.
Signature

Noel

Peter Duncanson - 18 Apr 2009 23:59 GMT
>Peter Duncanson wrote...
>> They need to have words and phrases that communicate the desired
[quoted text clipped - 13 lines]
>ebbing, but Her Majesty is sleeping peacefully." The fourth and
>final bulletin was to announce her death.

That is true, but that gives too much information for an NHS hospital
statement about a patient. Those cryptic descriptions of a patient's
condition are given in response to enquiries from the press. A patient's
relative or other representative can give more detailed information if
they so wish.

I imagine that it is relatively easy for a hospital spokesperson to
discover a patient's condition in terms of the seven or eight standard
categories. To get more detail it might be necessary to take up the time
of a appropriately senior doctor to get an assessment of a patient's
condition and to agree suitable wording.

There is also the point that a patient or relatives might be happy to
have a cryptic condition statement issued but would not want more
details to be published.

>This seems to me to communicate the general concepts perfectly
>adequately, using terms which anyone should be able to understand,
>even pedants.

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

Molly Mockford - 19 Apr 2009 03:38 GMT
At 21:40:09 on Sat, 18 Apr 2009, Ildhund <jnllb@removemsn.com> wrote in
<gsddra$mqs$1@news.motzarella.org>:

>A bulletin released at Marlborough House at 1140 GMT was the first
>warning that her condition was causing some anxiety. A second bulletin,
>framed like the first and hung on a screen of corrugated iron
>protecting stonework repairs to the front of the gateway, was issued at
>1340 GMT.

Since we were not informed as to the style of framing of the first
bulletin (was it gold, or gilt, or plain black wood?) this more detailed
description of the second bulletin is somewhat lost on us.

However, I am pleased to hear of the corrugated iron protecting
stonework repairs to the front of the gateway, even though these were
apparently screened from view;  these days, the opportunities for honest
British working men to exercise the skills of their craft are fewer, and
farther between.

(Because no bugger will pay them.)

>The third bulletin, at 1900 GMT, was brief: "Queen Mary's strength is
>ebbing, but Her Majesty is sleeping peacefully." The fourth and final
>bulletin was to announce her death.

What I, me and I remember is not the death of (HMS) Queen Mary, but that
of King George VI (pronounced "vee-eye" by those who are accustomed to
refer to "One Clavdivs").

I remember the occasion vividly.

It occurred, with no prior consultation (to be fair, they didn't consult
his elder daughter either, although she was rather embarrassingly up a
tree in Kenya at the time), when I was a couple of months short of four
years old - *and they cancelled "Listen With Mother" because of it*.
Now, c'mon!  Even I, a pre-school bairn, knew that the King would not
have been paying attention to "Listen With Mother" even if he hadn't
died.

For decades, I wanted to raise the matter with his widow.  Or with his
daughter.  I never had the opportunity for the former;  I was, once, in
company with the latter, but (I am ashamed to say) bottled out.  Let's
face it - when you turn around, all unsuspecting, and find yourself
confronting a wee wummin, five foot tall, with inch-thick make-up, a
large hat, and an expression well-schooled in trying not to look bored -
well, you just kind of fling yourself underneath the nearest trestle
table, don't you?

(Those who have, somehow, never found themselves in this specific
situation are not required to answer.  Those who actually are eligible
to reply should confine themselves to one side of foolscap.)
Signature

Molly Mockford
They that can give up essential liberty to obtain a little temporary safety
deserve neither liberty nor safety - Benjamin Franklin
(My Reply-To address *is* valid, though may not remain so for ever.)

Peter Duncanson - 19 Apr 2009 10:27 GMT
>At 21:40:09 on Sat, 18 Apr 2009, Ildhund <jnllb@removemsn.com> wrote in
><gsddra$mqs$1@news.motzarella.org>:
[quoted text clipped - 26 lines]
>
>I remember the occasion vividly.

The similar occasion I remember most vividly (at least aspects of it)
was the last few days of Winston Churchill's life. His personal
physician Lord Moran would appear in public to deliver the latest health
bulletin. He was dressed smartly like a character from an Edwardian
drama, most notably wearing a wing collar. He pronounced "bulletin" with
the final syllable as "teen".

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

John Hall - 19 Apr 2009 11:10 GMT
>What I, me and I remember is not the death of (HMS) Queen Mary, but
>that of King George VI (pronounced "vee-eye" by those who are
>accustomed to refer to "One Clavdivs").

I don't recall the death of George VI, but I do remember a tremendous
fuss about something called a "coronation" when I was four years old. I
never discovered what a coronation was until much later.
Signature

John Hall        "Hard work often pays off after time, but laziness always
                 pays off now."  Anon

David - 19 Apr 2009 12:44 GMT
> >What I, me and I remember is not the death of (HMS) Queen Mary, but
> >that of King George VI (pronounced "vee-eye" by those who are
> >accustomed to refer to "One Clavdivs").

> I don't recall the death of George VI, but I do remember a tremendous
> fuss about something called a "coronation" when I was four years old.
> I never discovered what a coronation was until much later.

It's when someone gets coronated - as I once heard on that charming US
TV proggy about three witch sisters.

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New Marmite(TM): Not as thick! Not as dark! Not as te!

David - toro-danyo atcost uku fullstop co fullstop uk
http://www.toro-danyo.uku.co.uk/

Peter Duncanson - 19 Apr 2009 13:14 GMT
>> >What I, me and I remember is not the death of (HMS) Queen Mary, but
>> >that of King George VI (pronounced "vee-eye" by those who are
[quoted text clipped - 6 lines]
>It's when someone gets coronated - as I once heard on that charming US
>TV proggy about three witch sisters.

The lucky person is connected to a very high voltage source of
electricity. Their hair will stand on end and they will be surrounded by
a glow - a corona discharge.

Signature

Peter Duncanson, UK
(in uk.culture.language.english)

David - 19 Apr 2009 12:47 GMT
[Snip]

>Let's face it - when you turn around, all unsuspecting, and
> find yourself confronting a wee wummin, five foot tall, with
> inch-thick make-up, a large hat, and an expression well-schooled in
> trying not to look bored - well, you just kind of fling yourself
> underneath the nearest trestle table, don't you?

Doesn't that count as lese-majesty?

Signature

New Marmite(TM): Not as thick! Not as dark! Not as te!

David - toro-danyo atcost uku fullstop co fullstop uk
http://www.toro-danyo.uku.co.uk/

 
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