BIGGEST PET PEEVE EVER

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.

NO! AARRRGH!! STOP IT!!!

Ok, Dino; calm down.
Breathe.
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.