Articles and Case Studies

Medical Acronyms – In the Eye of the Beholder

05 Dec 2016

by Yvonne Baldwin

medical_acronyms

Unclear medical correspondence can lead to confusion, particularly when it includes multiple abbreviations with several possible meanings and different clinical implications.

Case study

Dr Con Foozed was a very caring and hardworking General Practitioner (GP). He took pride in the care he took of his patients but, if pressed, would have to concede that he sometimes got confused by medical acronyms. Although Dr Foozed knew that each specialty had its own unique “language”, he prided himself in having a broad knowledge of many areas of medicine.

On a busy Friday morning, Dr Foozed received a fax from the local hospital about one of his patients, referred to as “Mr JB”. A search of the patient database showed that Dr Foozed had five male patients with those initials.

The letter1 stated:

Dear Dr

Your pat, Mr JB, was BIBA to A&E last night c/o SOBOE and SOA. He had a PH of SVT, CHD, CCF, T2DM, TIA, TLE, AAA, CAL, OSA, bilateral THRs, L-TKR, R-#TibFib with ORIF, PMR, TURP and VVs.

OE - RR 30, P 88 AF; SOA +++; JVP 3cm, AB 6ICS AAL, LV++, HS-2, sys murmur +++ c/c AS; ECG - AF, LAD, LAHB and RBBB.

CXR - UL diversion, CTR 22:38. GGT 120; LDH 380, ALT/AST mildly elevated; Hb 8, MCV 65, ESR 88 and eGFR 18

He had dig, Lasix, roids, O2 and TLC.

He was d/ced this morning on his usual meds with cardiac, renal, respiratory, vascular, endocrinology and fracture clinic to be arranged by usual GP.

HTH.

JRMO

Dr Foozed had a habit of continually mumbling, and so he read the letter out loud… to nobody in particular.

Dear doctor (yep... that's me)

Your patient, Mr JB (whoever that is) was brought in by the ambos last night complaining of shortness of breath on exertion and SOA? (what the? can’t be too important!) He had a past history of speedy VT, coronary heart disease, congestive cardiac failure, type-II diabetes, trans-ischaemic attacks (what on earth is TLE?), abdominal aortic aneurysm, chronic airways limitation, sleep apnoea, bilateral hip replacements, a left knee replacement, screws and plates to a fractured right tib and fib (oooh, he’s expensive this guy… PMR – what is that… someone’s getting fancy with all these abbreviations… where was I?), transurenthral resection of prostate and varicose veins.

Ok, so with all that I know the patient is old… that rules out two JBs, but I’m still none the wiser!

On examination – resps 30, heart rate 88 in AF, very short of breath, SOA+++ (that’s the second time they’ve mentioned it… do they mean “shortness of air”, “symptoms of asthma” or “swelling of ankles”; definitely won’t mean “Sons of Anarchy”… mmm – great show! Righto.) JVP (something or other). AB6ICS AAL (really hope that’s not important, no idea what that is… baby doctors and their fancy abbreviations!) systolic murmur; aortic stenosis. They did an ECG… ok. He’s in AF. LAD and LAHB (I’m going to have to Google that). There’s also some right bundle branch block (I just love those little bunny ears!!)

What’s next? Chest x-ray – some upper lobe diversion and his CTR is 22:38 (what’s that? the only CTR I know of is “carpal tunnel release”). GGT is 120. Liver enzymes are mildly elevated. Hb 8. MCV 65, ESR 88. eGFR 18 (that’s not great).

They gave him digoxin, Lasix, steroids (which ones?) and TLC (I hope that means “tender loving care” and not “triple lumen catheter”).

He’s been discharged on his usual meds… ok… and they want me to arrange a ton of clinics – cardiac, renal, respiratory, vascular, endocrinology and fracture (finally, a paragraph that’s clear… except for the fracture clinic part… not sure why that’s there!).

HTH (what??? oh… “hope this helps”… well it didn’t really!)

Now… to work out which patient they’re telling me about. I might have to get the reception staff to phone the three JBs and see who has been in hospital.

Discussion

Although some poetic license has been taking in writing this case study, it exemplifies the confusion of unclear medical correspondence – including discharge letters. This is particularly so when multiple abbreviations are used, some of which have several possible meanings but different clinical implications.

The Medical Journal of Australia (MJA) recently published a research article which reported the results following GPs’ understanding of abbreviations used in hospital discharge letters.2 Not surprisingly, abbreviations that were peculiar to a particular medical specialty were often not understood by GPs. It was interesting to note, however, that even commonly used abbreviations – such as SNT, PMHx and GCS – were not understood by a percentage of GPs.

Depending on the clinical context in which a letter is written, any abbreviations it contains may only make sense to the author because he or she knows what they’re writing about and why. This case study and the MJA article exemplify this. Abundant caution should be exercised when using abbreviations in correspondence or clinical notes, as it is important that those caring for the patient – either on the next shift or following the patient’s discharge from hospital – know precisely what is intended to be conveyed.


Yvonne Baldwin
Claims Manager (Solicitor), MDA National


References

  1. Comment in MacKee, N. Lost in Translation. Available at: https://insightplus.mja.com.au/2015/29/lost-translation/
  2. Chemali M, Hibbert EJ, Sheen A. General Practitioner Understanding of Abbreviations Used in Hospital Discharge Letters. Med J Aust 2015;203(3):147. Available at: mja.com.au/journal/2015/203/3/general-practitioner-understanding-abbreviations-used-hospital-discharge-letters
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