Once upon a time physicians used Latin to communicate with each other and with pharmacists. It was a handy way of having a secret language that patients could not penetrate.

Vestiges of this code persist to this day. For example, doctors frequently write q.d. to mean take once a day. This is derived from the Latin quaque die, which means every day. Similar abbreviations include b.i.d. (bis in die or twice a day), h.s. (hora somni for a medicine to be taken at bedtime) or NPO (nil per os, meaning nothing by mouth).

Such archaic abbreviations lead to nothing but trouble. They may seem like familiar shortcuts to prescribers, but they can often lead to confusion and mistakes. For example, h.s. is sometimes used to mean half strength instead of take at bedtime.

Even when abbreviations are not in Latin, they can sometimes cause complications. One example was described by pharmacist and patient safety expert Michael Cohen: “The patient was suffering an ache in his right ear and the doctor prescribed Lidosporin, a combination antibiotic-local anesthetic.

“It was a simple remedy, except that in the doctor’s prescription there was no period after ‘R’ (for right) and the person administering the drug read it as ‘Rear.’

“The patient received three drops of the drug Lidosporin in his rectum three times before the error was discovered. Perhaps he immediately should have questioned why he was receiving rectal medication for an earache, but then, in case after case, patients–and nurses, pharmacists, and other physicians–do not question prescriptions.”

Getting health care professionals to give up their beloved abbreviations could be a challenge. They pepper their conversations with terms like HIPAA (the law requiring that patient privacy be protected, the Health Insurance Portability and Accountability Act), MI (standing for myocardial infarction) or URI (for upper respiratory infection).

One could argue–and no doubt some doctors do–that MI is in fact much shorter and easier to say than the multisyllabic Myocardial Infarction. But is it really that much quicker and clearer than “heart attack,” which is what it means?

We suspect that some of the attachment to such acronyms is a way of marking the boundaries of the group. People who look puzzled when someone spouts off about BPPV (benign paroxysmal positional vertigo, a dizziness that can be extremely disorienting) are probably not members of the in crowd.

One doctor decided that all the notes he takes during clinic should be shared with the patient. He realized immediately that the abbreviations would have to go, because instead of improving communication they got in the way. Others have pointed out that doctors who think the patients may read their clinic notes will do well to avoid the abbreviation SOB (for short of breath, though of course it has another meaning as well).

What should you do when you see or hear an abbreviation you don’t recognize? The best thing to do is request an explanation right away. Safe health care requires clear communication. For questions to ask and tips to help avoid mistakes, we recommend our book, Top Screwups Doctors Make and How to Avoid Them (online at www.PeoplesPharmacy.com).

 

 

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  1. Dr. Judi
    Reply

    Many years ago, an article in the NEJM about a British orthopedic surgeon visiting an orthopedic ward at the MGH (Massachusetts General Hospital). One of the young doctors presented a case, and the visitor said, “that is a typical case of PID.” The MGH staff gasped. PID in the US means pelvic inflammatory disease, but in Britain it means prolapsed intervertebral disc!

  2. Cindy M. B.
    Reply

    I agree with Deb more than not. As a healthcare worker for many years, I can tell you that if you had to write everything out, you’d be there all day charting… a tragedy, as you have so little time to be with the patients as it is — especially now that most facilities have tightened down on staffing ratios to save money. YES, “qd” vs “qid” is a tricky one, but there are very few like that.
    Ever mindful of $$ liability (sadly, much more important than patient care at most facilities though they’d never admit it), dosages are one thing that caregivers are really careful to get down correctly. Really, medical shorthand is SUCH A HUGE TIMESAVER! As it is, most people’s charting is very hurried, slapdash and incomplete (as far as giving a thorough and balanced report of the patient’s day, his clinical situation and general progress) — and without medical shorthand I think this sorry situation would be even worse.

  3. Mark
    Reply

    I disagree with Deb.
    Deb says that abbreviations allow health care workers to “communicate among ourselves precisely enough to be safe.” She says “there are books of officially accepted abbreviations.”
    Here’s a real world example where accepted abbreviations cause mistakes.
    q.d. is the officially accepted abbrevation for “once a day.”
    qid is the officially accepted abbreviation for “four times a day.”
    More often than you would believe, the prescriber’s period after the “q” is large enough that it looks like like the letter “i”
    This causes the pharmacist to misread the prescription as “four times a day” rather than “once a day.”
    Every pharmacist has seen this. If the doctor had taken the time to write “once a day” rather than use the abbreviation q.d., this error would not happen.
    This is not a rare example.

  4. Deb
    Reply

    I so disagree with this argument. The abbreviations, like so much of medical terminology, are very precise. The examples you’ve given have in common that the reader chose obscure possibilities without thinking about what’s written, and without asking necessary questions when unsure. Too self-confident.
    There are books of officially accepted abbreviations for this. How many times have you read a newspaper article about a medical topic in which only colloquial terms are used, so it reads as if it’s a simple topic but you have NO IDEA what they’re actually talking about? Dumbing down can happen; what looks more friendly can be so simple that it’s actually simplistic and meaningless. I’m absolutely committed to demystifying medical topics, but not to the extent that we cannot communicate among ourselves precisely enough to be safe.

  5. NJ Foster
    Reply

    Maybe the most accurate statement in this article was it might be difficult for health care professionals to give up their “beloved abbreviations”. As a health care professional, I know I would not want to give up those abbreviations so embedded in my brain.

  6. cara
    Reply

    Doctors like to keep people in the dark. They think their clients are intelligent. The dark ages are over, and many of us are just as well educated as any doctor. Every client has the right to understand exactly what is being prescribed, what the side effects are, and what exactly their health problems are. Clients can no longer allow the medical world to bully them.

  7. jnm
    Reply

    One of my favorites is “PND”: it can stand for “paroxysmal nocturnal dyspnea” or “post-nasal drip.”

  8. Ignitor4
    Reply

    If so many high school and college administrators had not made the foolish decision to de-emphasize or even eliminate the study of Latin from the curriculum, then maybe we wouldn’t be having this problem!
    (Spoken like the displaced Latin teacher that I am…)

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