What Hospital Descriptions of Ebola Patient Conditions Really Mean

With all the attention being given to those who are, or might become, infected with the Ebola virus, it might be instructive if we try to get a better understanding of the terms being used by hospitals and others in describing the severity of the inflictions.

Right now, the condition of one of the two nurses from the Texas Presbyterian Health Hospital Dallas is described as being “fair,” while the other is diagnosed as “stable.” What’s the difference? One is being hospitalized at Emery University in Atlanta, while the other is at the National Institute of Health facility in Bethesda, MD. Which is farther along on the road to recovery? Does “fair” at one hospital mean the same as “fair” at the other. Finding an answer to these and other questions wasn’t quite as simple as one might have expected.

Generally speaking, the one-word descriptions we hear are not medical terms, but are opinions based on a doctor’s best judgment of the patient’s condition. Once charted, the doctor’s remarks are then relayed to hospital PR spokespersons whose job, of course, is to make the hospital look as good as possible. Most hospitals try to adhere to American Hospital Association (AHA) guidelines when describing a patient’s condition. These guidelines instruct hospital personnel to give out only one-word descriptions so as to not violate the patient’s
Health Insurance Portability and Accountability Act
(HIPPA) right to privacy.

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Listing in order from better to worse, the recommended descriptions, as excerpted from the AHA’s General Guide for the Release of Information on the Condition of Patients, are:

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Good: Vital signs are stable and within normal limits. Patient is conscious and comfortable. Indicators are excellent.

Fair: Vital signs are stable and within normal limits. Patient is conscious, but may be uncomfortable. Indicators are favorable.

Serious: Vital signs may be unstable and not within normal limits. Patient is acutely ill. Indicators are questionable.

Critical: Vital signs are unstable and not within normal limits. Patient may be unconscious. Indicators are unfavorable.

Stable: The AHA’s “General Guide” says “stable” should not be used as a condition. It means just what it says — not changing at the moment. As one hospital spokesman put it, “You can be dead and still be considered stable.”

Undetermined: Patient is awaiting physician and assessment. (A term that seems applicable to much of what we have been hearing lately.)

Other terms:
Other terms used include grave, extremely critical, critical but stable, serious but stable, guarded, satisfactory, and others. Most patient descriptions have less to do with the reality of the situation and more to do with using simple terms to describe complex situations.

As I write this, NBC reports
Nurse #1 Nina Pham, currently in the National Institutes of Health isolation unit in Bethesda. MD had gone from being described in “good” condition when she left Dallas to be now in “fair” condition.

Nurse #2, Amber Vinson, who has been flown from Dallas to Emery University in Atlanta, is being described as “stable,” but MSN reports that her condition is not as favorable as that of nurse Pham.

Is “good” better than “fair,” or vice-versa? Just depends. And “stable”? Totally meaningless.

So, there you have it. And since nurse Nina Pham’s boyfriend, as well as her little dog “Bentley,” are still undergoing tests, I guess we should just describe their conditions as “undetermined.”

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