OSH, or “outside hospital,” is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny.
What are the implications of calling another health care facility “outside”; does that make your hospital the “inside” hospital? I suspect that it is, as many patient-related conditions are described, multifactorial. Or, if you like the band Fort Minor, “Remember the Name” (apologies to the band):
This is ten percent luck
Twenty percent skill
Fifteen percent concentrated power of will
Five percent pleasure
Fifty percent pain
And a hundred percent reason to remember the name.
Is there a built in snarky factor that you would not even bother to name the OSH? How many admissions were you into the night on call when that transfer came in from St. Aloysius by the Swamp Regional Medical Center (this is how my division chief used to lovingly refer to outside facilities before the days of OSH)? You will never remember the reason for the transfer, only the way it made you feel, to paraphrase Maya Angelou. God rest her soul, and I hope that she was never transferred between hospitals in the middle of the night.
So one of the few things you had left in your power was to delete the facility from existence by converting it to the essential non-entity. Its true name does not even exist in the medical records of your esteemed mecca. Perhaps this is the Harry Potter equivalent of “He Who Shall Not Be Named”; by not naming the Lord Voldemort of all hospitals, you have taken away its power to inflict upon you the grievous harm of a transfer. This is the eternal battle between good medical care and the poor medical care of the OSH.
How many stories are there told in the barrooms of the post call universe that begin with, “This guy came in last night, a transfer from …”? I imagine the Rime of the Ancient Mariner with a grizzled resident in scrubs, splashing his or her third or fourth drink and he or she catches the eyes of the assemblage, recounting with us, a blaze in his or her bloodshot eyes, the use of the football helmet with the Blakemore tube to treat an acute GI bleed or decompressing a tension pneumothorax with an angiocath. This is the stuff of legends!
Perhaps we should be more grateful to the OSH for giving us glory rather than admitting another nursing home patient with a UTI. Hard to capture an audience with a story that involves a demented, elderly patient with antibiotic resistant bacteria in the urine dropped off on the night before Thanksgiving.
In the era of the new millennium, with electronic medical records, the “Interwebs” with all of its glorious search capability and handheld smartphones, there really is no excuse for the abbreviation “OSH.” It implies condescension, laziness, passive aggressiveness and disregard for the fine people who have to staff the OSHs. And there are some fine people there, mark my words.
Take a few minutes: Talk to the patient, engage the family (who if you are lucky will know that Nana is now at your fine institution), and peruse the records, paper or electronic and, when all else fails, find the bastard that signed the transfer order and roast them slowly over the coals of your wonderful night on call.
And most of all remember, to every other hospital in the world, you are the OSH.
Jaan Peter Naktin is an infectious disease physician.
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