We are being robbed: Robbed of the tools of language our profession has used and shared with the world at large. Popular culture has embraced our language and incorporated it in other areas: Who hasn’t seen a bill hit the senate floor DOA or STAT communications in non-medical contexts, for example? But now, we – the first users of our language – are restricted from using it.
For over a hundred years, prescriptions have used abbreviations, like PRN, PO and QID. Those are now slated to disappear. Even the Joint Commission says so.
Every area of life has a rapidly evolving vernacular, full of newly minted abbreviations for concepts that didn’t exist until yesterday. NFTs, non-fungible tokens, for the first rendition of a ubiquitous internet image, is the latest one that comes to mind.
First, the argument was that we needed to issue prescriptions via computer because our handwriting was sloppy. Now, even neat, digital prescriptions and office notes are unwelcome because lay people or lazy or inattentive readers might misread our electronic communications.
Why does this apply only to us? Why are there USB connectors, when the real term is Universal Serial Bus? How come online chats are allowed to use terms like LOL and ROFL? What if a newcomer doesn’t understand those abbreviations? And what about finance? Why can they use terms that even their customers don’t understand.
Should we level the playing field and simply outlaw all abbreviations in this country? Or, should we allow rapid communication between technical experts in their own language? Lower the bar or maintain and protect it?
A Country Doctor Writes: 
I take your meaning. And some of those abbreviations and terms are no longer common. I have seen handwritten scripts with the sig “nocte”. Younger pharmacists have no clue what it means, if they can even read the handwritten word. Some things seem obvious, like OD…but is that once a day or is it right eye? D/C: discharge or discontinue? And ask a patient what the prn means, or ud. They can’t remember what you told them in the office last week when you wrote the rx. Then there are 5.0 and .5 to confuse things. I have seen volumes or weight written in ounces, drams and minims. And I have seen computerized rx-generators print out meaningless quantities like i tab bid f7d, m:12482 tabs, quantities with no units, “one tub” (does that really mean a tube, or a tub? Is there a standard-sized tub?). Been a pharmacist for 30 years, seen all sorts of changes. Things will keep changing, I guess, and somehow together we’ll figure things out.
I’m a physician. All of these examples given are clear to me. I was trained what they meant and how to use them. Pharmacists back then knew them too and translated them on prescription instructions. There is no OD for once daily. No physician would use that abbreviation. Once daily is QD. So it looks like the problem is pharmacists stopped learning what these meant so all physicians have to change?
Agree Shenary… came here to say… OD never meant once daily… I do resent having to write out things that have clear abbreviation in a TYPED rx or note… which are 100% legible. Not using abbreviations doesn’t mean never making a mistake, which Laura above seems to think. OD is right eye. D/C can be either, that is true, but look at the context. If you write d/c to home, that means pt is going home. We don’t use it to describe a draining abscess alone… we just say there is serosanguinous d/c or drainage (more often the later) It isn’t confusing.
The drug companies feel free to invent abbreviations. Now apparently PSA means psoriatic arthritis… And one local clinic in Orlando advertises that they “treat ED and PE”. I thought that was a pretty strange combination of problems to treat for an outpatient clinic until I realized that their “PE” meant premature ejaculation. Maybe there are good reasons not to abbreviate!
Consider PT. Physical therapy, protime, patient, part time, pulmonary toilet, or my nice little PT Cruiser. LOC is usually laxative of choice, but it can also be level of consciousness. Pity the poor patient who is being monitored for a head injury who ends up getting a laxative every two hours!
Context is everything
LOL *pun intended*
The article is referring to when doctors were medical professionals. From the caveman witch doctor until about 40 years ago We were all practicing INDEPENDENT professionals. Now the majority of doctors are employees. Real medicine was run by medical personnel. Modern medicine is run by businesses and the insurance companies. We have witnessed The death of a time honored profession. If our medical societies had spent as much time preserving the integrity of the Professional titles instead of creating ways to maintain their income, we might still be a noble brotherhood of practitioners providing medical care to society.
The painful truth, short and to the point.
You had me right up until the “noble brotherhood” bit. There are women in medicine. However, I agree, the insurance companies run everything now.
I understand there can be confusion with abbreviations, and there is even confusion in using terms. Remember Lasix, Losec and even Latex? It is obviously much easier to just prohibit all abbreviations rather than decide on a list/dictionary and rules for acceptable ones.
I also understand the frustration for practitioners as we experience 1 more demand upon our already difficult existence, imposed by outside powers who are losing or have lost at least some understanding and appreciation for all we are asked to do.
The problem here really lies in the clarity of communication vs time management. Accuracy AND Speed are both important. I can understand the benefit for a pharmacist (or nurse or even others) to have everything written in clear, complete script. It gives them speed and accuracy. But they also have a luxury of some extended time to fill scripts/orders. That is true even for some providers, but for many, with a waiting room full of patients waiting and then facing the provider, each requiring managment of multiple problems and medicines, and shrunken time to spend on their issues, on top of a mountain of other tasks, speed is very precious.
On the other hand, time spent clarifying prescriptions and orders can certainly be the greater of 2 evils.
So, I don’t see this a dumbing -down. I reserve that for 3-year medical schools and other more obvious examples.
Although our abbreviations were developed as a means to communicate professionally in an exclusive fashion (if what I have been told is correct), their value has evolved into something else.
Furthermore, there will always be abbreviations. Read any cardiology/technology report and see the insanity of requiring EVERYTHING to be written out completely. I hate to see their value summarily ignored and universally prohibited. What we need more is agreeable abbreviations and limitations for special interest groups, professional or lay, to develop and use their duplicated abbreviations publicly which is another cause for the problem. OMG! Like that will ever happen. LOL!
Certainly agree with Rx since I teach my students this is secret language between doctors & pharmacists. Also agree in letters to each other. As a family physician, I am asked to ” translate ” these letters for patients. We should be bilingual. Must ask questions of patients in English ( or native language) using plain words, but record in “doctorese”. Only abbreviation I am not fond of is qd for daily since writing or typing can become qid. .
Before electronic records, notes were frequently unreadable because of simple bad penmanship and idiosyncratic terminology, including abbreviations. Medical jargon frightened and confused patients. Dot phrases in the EMR have replaced my abbreviations without creating extra scribing, and mindfully avoiding jargon strengthens patient engagement and compliance . I’m OK with giving up abbreviations in the service of clear communications.
I like the enthusiasm of concern. I would like to see what our organizations (academies, colleges and associations) think about it and also what are they going to do about it. This is the time when I would like to see them shine.
I also question, what is the purpose of changing everything. Are they trying to invent NEW medicine or what ???
Smartening Up Doctors: A Profession Whose Language Has Changed
The abbreviations cited are all Latin phrases, and the problem is that few people know the meaning of the original phrases anymore (really, how many of us know what PRN stands for?). Physicians and pharmacists happily abandoned training in Latin and Greek as irrelevant in today’s world, and the idea of medicine as a secretive paternalistic guild has been abandoned as well. So how can we be “robbed” of things we willingly gave up decades ago?
American physicians are an increasingly diverse group and medicine has become a team sport – our instructions are read not just by pharmacists but by nurses, aides and family caretakers for whom medical jargon is dizzying and mistakes occur all too frequently – both in the writing and in the reading.
And we ourselves are guilty of using abbreviations inaccurately: LFTs, for instance, and even the Greek word diabetes.
So, changing our language to reflect our communication needs and the reality of our work is not a matter of dumbing down – it is a matter of smartening up.
We have too many people breathing down the necks of our profession. How about work on getting rid of prior authorizations and precertifications instead of nit picking us to death. Abbreviations actually do save us time, something that we have very little of, and this will only take more away from the patient.
Look at it this way…………..life changes every day, that includes what happens to doctors. So let’s be realistic and be aware of our lack of power nowadays. Unless you come up with a better idea.
I sent a prescription to a Walmart pharmacist that required compounding.
He informed me that it was “corporate policy” that they didn’t do compounding (which is is an integral part of the art), and secondly, he couldn’t read the latin…. ie: M et Ft ung……Yes, we’ve lost the art of medicine and pharmacy. The unlicensed, unschooled now run the practice.
Ever since I read about a LOL in NAD with COPD and UGIB with recent development of DOE and PND, I have love abbreviations as our own personal efficient language. Don’t let the SOB’s take them away……;
Perfect!
Perfect (IMHO) – LOL!
How about 5 gtts OD Q3H?
Any one remember how to covert drahms to grains?
Terpin Hydrate 5 drahms PO qid prn cough.
I have deceased relatives that sold leeches to cure all kinds of things.
Let’s realize that the only constant in our professions is change.
We are evolving!
And must be on our toes to keep up with it.
So cheers to us all! We are not getting dumber, just better!
We just need to adjust to the new medical world, have to accept the way it is becoming, we longer are in “total” control. It’s ok, we will survive. But forget about the big bucks.