A celebrity is sick in the hospital or a shooting victim is rushed to the emergency room. Their condition is reported as “serious” but later upgraded to “fair” or “good.” Did you ever wonder what those terms mean? If they are “good,” why are they still in the hospital? And what’s the difference between “serious” and “critical?” Neither sounds very good.
As a physician, I often discuss my patients' medical conditions with them. I try to use terms that are free of technical language, describing their progress and offering realistic expectations about where things are going. But I never understood how the news reports established a person's condition – it is not a routine part of my medical practice to use terms such as “fair” or “guarded” to describe the condition of patients in the hospital.
It turns out that these are terms specifically developed as a way to respond to media requests for information about a patient. It allows the hospital to answer without providing detailed information that might invade the privacy of the hospitalized person.
According to the American Hospital Association, these are the recommended single-word terms used to describe a person's medical status (along with definitions to guide staff in choosing the most accurate option for a particular patient):
- Undetermined — The patient is awaiting assessment by a physician.
- Good — Vital signs (such as heart rate and blood pressure) are stable and normal, the person is conscious and comfortable, and indicators are excellent.
- Fair — Vital signs are stable and normal, the person is conscious, indicators are favorable, but the person may be uncomfortable.
- Serious — Vital signs may be unstable and abnormal, the person is acutely ill, and indicators are questionable.
- Critical — Vital signs are abnormal and unstable, the person may be unconscious, and indicators are unfavorable
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What About “Stable Condition?”
Although I often hear it used to report a patient's condition, the term “stable” is not particularly helpful and, its use is specifically discouraged by the American Hospital Association. The problem with “stable” is that it simply means that a person’s condition is not changing: One person could be terribly ill and another ready to go home, and both are “stable.” Another term that ought to be retired is “critical but stable.” Presumably, such a person is very ill, but not getting worse — clearly a better situation than the critically ill person whose situation is declining. However, since abnormal and unstable vitals signs are part of the designation “critical,” the notion of “critical but stable” is confusing and best avoided.
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Predicting the Outcome
Doctors aren't as good at predicting the future as many movies or television series may have you believe. Many people hear stories about someone's sick relative given six months to live who recovers and outlives his or her doctors. The conditions reported in the news media won't predict the outcome well (although, on average, patients in good condition will do better than the others); they're simply a way of expressing the current situation in a standard and objective way. For these terms to have any useful meaning they must be updated regularly and they should be applied consistently with attention to their definitions. On the receiving end, the media should take into consideration the limited amount of information contained in these terms and that the sicker the patient, the more likely it is that the condition could quickly change.
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The Bottom Line
If you're the one in the hospital, you'll receive more and better information than the one-word conditions hospitals provide to the media. Your doctors will talk to you (or, when appropriate, with your family or loved ones) about the illness that led to your stay in the hospital, the various treatment options and, what you should expect. If there's uncertainty, that should be discussed as well. If you're a family member calling for an update, you will likely be referred to the patient's nurse who knows the minute-to-minute progress.
The conditions you hear on the news — good, fair, serious or critical — are an interesting example of how even nontechnical terms may provide relatively little information. And that's exactly what they're intended to do.
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Robert H. Shmerling, M.D., is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.