A Response to the “How a SHPOS is Born” article in The National Post

You may have read the article “How a SHPOS is born: What doctors call their very worst patients”, which was written by Anne Skomorowsky and published in The National Post (originally appearing on the Slate Magazine website) on November 10, 2014. Many people in the social media universe had very strong emotional responses to the article. If you haven’t read it, I encourage you to do so. I collaborated with several other individuals (Eve Purdy @eve_purdy, Teresa Chan @tchanMD, Swapnil Hiremath @hswapnil, Heather Murray @heatherm211, Ross Morton @signindoc) to produce a letter to the editor, which was submitted but was not published by The National Post. Thus, we decided to publish our letter on three FOAM websites (TheChartReview.org, manuetcorde.org, BoringEM.org) to share our response with the medical community online. Read below. Feel free to share your thoughts on the comments or on Twitter.

Dear Editor,

We read with horror the recent article “How a SHPOS is born: What doctors call their very worst patients” by Anne Skomorowsky dated November 10, 2014.

We were appalled that the author conveyed the impression that this offensive term, SHPOS, is common and used by the general medical community. The opening line “A medical acronym, SHPOS, helps a doctor summarize a patient’s history in just five letters” implies that the term “a doctor” would include a large number of practicing physicians.

This is false.

This article has sparked discussions over several social media platforms and in the hallways of our hospitals. The consensus from our investigation is that the majority have never used, nor heard of this disgraceful and offensive term. Physicians and learners spanning many generations (medical students to experienced physicians of greater than 20 years) and specialties (emergency medicine, internist, surgeons) agree that that the SHPOS term is completely foreign. The term is as uncomfortable to us as it is the intended readership. On digging a bit deeper (as a result of this article), it seems this term may have been used in the past, in the early 80s or before but given the unfamiliarity of currently practicing physicians, it is unlikely that it is used with any frequency today (1,2). Thus, to taint all current doctors with this archaic and unused term is a reckless overreach at best and slanderous at worst. In fact, the journalistic ethics of reintroducing such a horrible term back into the current lexicon is both irresponsible and dangerous. Language evolves over time, and most of the time with good cause, because terms like SHPOS are eliminated because of their inherent problems.

As a community we do recognize that the language physicians choose is important and appreciate that in many instances we might do better. We have explored issues around language in medicine through an international and open-access case study that can be accessed at one of the world’s pre-eminent medical education blogs (3). We would encourage readers interested in the use of slang by medical professionals to read this much more up to date, balanced and thoughtful exploration of the important topic. This document incorporated patient, allied health, and physician voices all together to generate a very robust discussion and handout for young physicians to read and better understand the importance of words in clinical practice.

Sadly, the information in this article was likely not verified among the health care professionals to whom it refers. Unfortunately, the message conveyed to the readership of the National Post and general public is that terms like “SHPOS” are commonplace and accepted among the medical community, and this supposition is largely unverified in Canada too – especially since it is merely a repurposing of a previously featured article from an American magazine. Acknowledging that slang and language are contextual, and cultural, the National Post might have been better served to do their own, contextually relevant, investigation into this issue, rather than simply feature the article of an American author.

We do not use the term SHPOS. The thesis of the article is simply untrue. This article potentially biases and inflicts pre-arrival damage to future doctor-patient encounters, creating barriers and potentially interferes with the relationship developed by current health care staff and the people they wish to help.

We urge your newspaper to consider the ramifications of posting such inaccurate and potentially damaging materials in the future.

Elisha Targonsky, MD CCFP-EM
Eve Purdy BHSc MD Candidate
Teresa Chan MD FRCPC
Swapnil Hiremath, MD MPH
Heather Murray MD MSc FRCPC