Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Normal Sinus Rhythm is Not a Good Description

What is the rhythm 1a
 

Is Normal Sinus Rhythm a good description of this rhythm?

Is it sinus?

Is it normal?

Dr. Steven Novella writes about normal and some of the meanings of normal.
 

This findings, if confirmed, has several implications. First, it is just good to know how our brains typically work. “Normal” is a combined judgment about what is actually happening and what “should” be happening. This confirms what was observed in health care, especially psychiatry, that there is a moral judgment in deciding what is normal.[1]

 

Too often, we seem to try to apply what we think something should be to our mistaken description of what something is.

As an example, an ECG (ElectroCardioGram) showing a regular, or slightly irregular, sinus rhythm is often described using the misleading term normal sinus rhythm.

Normal suggests that there is nothing wrong with the rhythm, or with the heart, when it is not unusual for a patient to have a heart attack with a normal sinus rhythm being accurately displayed on the ECG.

We are subconsciously telling ourselves, Nothing to see here. Move along.

We are fooling ourselves and discouraging investigation of what may be causing problems by unnecessarily adding the term normal.

In this setting, normal does not add any information, but suggests that we know more than we actually know.

Why lie to ourselves?

Because we trust ourselves and don’t bother to check our assumptions to see if they are valid.
 

What is the rhythm 1
 

It is clearly sinus, but what information do we add by calling it normal?

Footnotes:

[1] What Is Normal?
Steven Novella
Feb 02, 2017
Neurologica
Article

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Comments

  1. Just had a instructor preparation session this morning with the month’s CE focusing on Documentation. The training itself was scattershot but some big points during the round-robin was communication. How to improve it, how to approach importance placed upon it, how to engineer out built-in mistakes. As you have illustrated here. NSR is ground into baby medics from day one. Even before conception (consider mass media presentations).

    This is a fundamental problem of the species, methinks. Got to work on me.

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