Sex-dependent central amygdala physiology after supradural CGRP exposure is associated with migraine-like behaviors.

A colleague on Labor and Delivery recently sought my advice about one of her pregnant patients whom I was co‐managing. In giving me the update, she mentioned that the patient “failed her non‐stress test.” I was not surprised as I often hear this term on rounds, but it was the first time I'd heard someone refer to antepartum testing this way. The most common clinical scenario where I encounter this term is in relation to the diagnosis of gestational diabetes. Patients with gestational diabetes are frequently described as having failed the glucose tolerance test. Should they have tried harder? What does this term even mean in the broader medical context? Can one fail a medical evaluation as one does a school examination? How does this term make patients feel? Other areas of Obstetrics and Gynecology where the word failure is used include trial of labor after cesarean (TOLAC), induction of labor (IOL), and even labor itself, as well as cerclage, noninvasive prenatal testing, in vitro fertilization (IVF) cycles, pessary, vaginal slings, and chemotherapy. A friend with ovarian cancer had been told she was failing chemotherapy. She felt defeated as though she was failing at her own healing. Unfortunately, she did not survive, but not because she failed. The use of this term in medicine is not limited to Obstetrics and Gynecology. Physicians from a myriad of other fields have shared examples of how failure/failed is used when describing their patients. Babies are said to have failed the car seat test or the hearing screen. Even children with cancer can be described as failing induction or chemotherapy. In the emergency department patients are described as failing noninvasive ventilation and requiring intubation or failing outpatient treatment requiring admission. In the ICU patients can fail a swallow evaluation or have a failed breathing trial requiring prolonged intubation. Patients with treatment‐resistant depression might be described as having failed two or more antidepressants. To get approval from insurance companies for specialized medications or higher levels of care, we may have to document that our patients have failed initial therapies. The examples are endless.