About Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

A Lexicon for the Workplace

We have many Research Associate volunteers who staff the SF General Emergency Department collecting research data. They are often ask “what did you mean when you said…” or “what does that mean on the patient census whiteboard”. When I answer their questions, they often chuckle. This then made me realize that we routinely use terms and phrases that aren’t part of the usual medical vocabulary and are unique to the SF General ED.

  • HACito: For acutely agitated patients (often under the influence of one or more intoxicants), we commonly use Haldol, Ativan, and Cogentin in a single syringe to inject intramuscularly. This is commonly referred to as HAC. For smaller patients or those who just need only slight chemical restraint, we use a smaller dose of HAC, or a “mini-HAC” or “HACito” .
  • Syncopize: Many medical nouns are converted into new verbs when we speak to each other. “Syncopize” describes one who has had an episode of syncope. “Hematemesize” describes one who has vomited blood.
  • MTF: Many of our patients present because they are under the influence of alcohol, heroin, methadone, cocaine, amphetamines, or a combination of them all. After several hours, these patients wake up and are discharged assuming nothing else is wrong with them. For these patients, we write “MTF” on the whiteboard next to their name, meaning that we are waiting for them to “metabolize to freedom”.
  • The eagle has landed: Some mornings, often a nurse or institutional police officer buys several dozen donuts for the ED staff. Instead of sending out an overhead annoucement that donuts are in the break room, the code words are “the eagle has landed”.
  • Trauma Alpha: All of our severely-injured trauma patients fall under code names, chronologically arranged in alphabetical order. These pre-printed medical charts have pre-registered medical record numbers to allow us to immediately start ordering labs and other diagnostic tests. There’s Trauma Alpha, Trauma Beta, Trauma Charlie, etc. You know it was a bad trauma day when the ED cycles the entire alphabet in a 12-hour shift.
  • Med Pack Whale: Similarly for our acutely ill non-trauma patients who need tests started immediately, we have pre-registered, pre-printed medical chart packets for them. These are also arranged in alphabetical order, except we use animal names. I always feel bad that we have a Medical Packet Whale, especially if the patient happens to be a little overweight. Some of my favorite are Med Pack Giraffe and Med Pack Yak, FYI, I have really bad luck with Med Pack Kangaroo. For me, it is an independent predictor for intubation. My intubation rate is about 80% on them!
  • Platinum CT scan: Are you getting pan-scans for more and more of your trauma patients, despite the recent irradiation risk literature? I’ve started calling the head, cervical spine, chest, and abdomen/pelvis CT set as the Platinum scan. If we don’t need the chest CT, I call it the Gold scan.
  • IP: The Institutional Police are a omnipresent staple in our ED. Stationed only the ED, they are extremely protective of our ED staff whenever patients become unruly, potentially dangerous to the staff, or refuse to be discharged from the ED. Until recently, we had an IP officer named Frank who was amazingly adept at convincing patients to calm down and be respectful. I suppose having a gun on your belt helps at being convincing. You would often hear an overhead page calling for “Uncle Frank”. I describe our IP officers as “motivational speakers”.

Question: What unique phrases/terms do you have at your ED?


By |2019-09-10T14:06:45-07:00Jul 31, 2009|Life|

Tricks of the Trade sneak peak: Teaching procedures

Teaching procedural skills in medical school is increasing falling on the shoulders of emergency physicians. Two common problems that arise are the equipment expenses and simulation of realism. Working with my colleague Dr. Jeff Tabas, we came up some creative ideas around the teaching of (1) the Seldinger technique for central line placement and (2) saphenous vein cutdown.


By |2016-10-26T17:05:43-07:00Jul 29, 2009|Medical Education, Tricks of the Trade|

Article review: The ABCs of manuscript writing

I came across a practical and insightful review article written by Dr. Mark Langdorf (editor-in-chief of West JEM) and Dr. Steve Hayden (editor-in-chief of Journal of EM) outlining how to write a manuscript for publication. This is a crucial skill because paper publications are the standard unit of currency in academics, which then translates into promotions and academic credibility. Although this article primarily targets novice manuscript writers, it’s always nice to get the perspectives from Mark and Steve, editors-in chief of two major EM journals.


By |2016-11-11T19:01:58-08:00Jul 27, 2009|Education Articles, Medical Education|

Three phases of educational technology in the classroom

I recently encountered a thought-provoking video about how technology is transforming education in the classroom setting. We are slowly experiencing a culture shift in how learners are learning. It follows that this should affect how teachers should be teaching. Briefly, the author lays out the progression of educational technology in 3 phases.


By |2016-10-26T17:05:43-07:00Jul 24, 2009|Medical Education, Social Media & Tech|

Trick of the Trade: The Digi-Speculum

Frequently patients present to the Emergency Department for lacerations, partial amputations, and abscesses of the fingers. After repairing the wound or injury, however, a bandage can be a bit unwieldy to apply and difficult to secure. To me, an ugly bandage just seems to detract from all of the diligent work that you just put into a plastic surgeon-quality wound repair.


By |2019-01-28T23:56:19-08:00Jul 22, 2009|Tricks of the Trade|

Work in Progress: Visual Aid Project

Practicing at an academic ED, such as in San Francisco General, I find that I am constantly surrounded by medical students, interns, and residents. Most are working on shift with me, but occasionally I have medical students shadowing me to learn more about the Emergency Medicine specialty.

Have you ever had a person shadow you (excluding your annoying little brother when you were a kid)? It’s actually a little stressful for me, because I want the shift to be a positive learning experience for them. Inevitably, it doesn’t take long before I get immersed in mundane troubleshooting activities (eg. calling to transfer a patient to another facility, coordinating the CT scan priority list, paging the inpatient team for admitting orders).


By |2016-10-26T17:05:44-07:00Jul 21, 2009|Medical Education|
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