Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, January 17, 2007


I got my January 2007 issue of Family Practice Management today. I enjoy this little throwaway journal, and I generally read it cover to cover before throwing it away. But today, right in the middle of a perfectly fine little article about the finer points of documenting a level 2 vs. level 3 visit, I nearly threw it across the room!

There it sat, right in the middle of a table of documentation examples, staring out at me:
Exam: tonsils enlarged with exudative material, shoddy [emphasis mine] cervical nodes.


Ok, Dino; calm down.
Move along, folks; nothing to look at here.
You ok now, Dino?

"Shoddy." Much as I wish it were, that was not a typo. So what am I talking about and what's the big deal?

A frequent finding in pediatrics is a row of small, firm, slightly enlarged lymph nodes along the front edge of the sternocleidomastoid muscle in the neck -- the "anterior chain." They aren't usually tender and tend to occur frequently with viral upper respiratory infections in kids. They are different in size and location from the tonsillar nodes, which are often enlarged in cases of strep throat.

This row of hard little nodes can feel kind of like buckshot under the skin; buckshot, of course, being small metal balls used as ammunition for a shotgun. A descriptive shortcut is to call them "shotty" nodes. Although when spoken aloud this word sounds the same as the adjective referring to poor quality or slipshod, "shoddy", THEY ARE NOT THE SAME!!!

Whoa, Dino; settle down.
Did you forget your meds this morning?
Alright then.

So pediatricians, FPs, residents, nurses, med students, all of you: please, I beg you. Don't call them "shoddy nodes." They're SHOTTY. "T." Two of them. Like buckshot. Got it?

Good. Thank you. Because if I ever see another reference to "shoddy" nodes, I am going to get angry. And you wouldn't like me when I'm angry.


At Wed Jan 17, 05:28:00 PM, Blogger Dr. A said...

Thanks for warning me. I know I have that issue around here somewhere. I wouldn't want to see you angry either...

At Wed Jan 17, 09:43:00 PM, Blogger Bo... said...

You are too funny! Speaking of misspellings or mispronunciations, here in Podunk quite a few things are mispronounced by patients and staff alike---so much so, that I now say things like "phenergrin", "bronical tubes", "harked" for coughed up, "risin'" for abscess, "fell out" for syncope, "urped" for threw up, and the ever-pleasant "pooted" for farted...

At Wed Jan 17, 10:05:00 PM, Anonymous Anonymous said...

For me it's rein/reign/rain. I hate to see people reign in their horses just as much as i hate to see them rain over people. Both sound rather messy.

And i can't count the number of times i've heard nurses and nursing professors say "dilitation." *headdesk*


At Thu Jan 18, 06:17:00 AM, Blogger #1 Dinosaur said...

Apologies to the Independent Urologist. I inadvertently double posted this, and then accidentally deleted the one with his comment, which was this:

"You're brutal."

At Sat Jan 20, 06:36:00 AM, Blogger Shodan25 said...

As an engineer, I go ape when the news folk refer to "cement" sidewalks....

And Bohemian Lou, it's 'cause yer in Texas, where the speak a language different from the rest of the country...

Ursa, when we were taking our Lamaze classes many moons ago, the RN that taught said "dilitation". Drove me batty because I was trying to figure out if it was something different than dilation.

At Mon Aug 11, 10:23:00 AM, Anonymous Anonymous said...

Found this a little late, but mine is using "that" instead of "who" when referring to a person.


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