Time to spell it out ASAP

When he was left alone in an office with his medical record open on the doctor’s desk, a longtime friend of mine admitted curiosity got the best of him and he went over to see his file.

Twice on one page he noted “SOB” was underlined.

“I had complained several times to his office staff about how long I had to wait for my scheduled appointments and I figured he was so aggravated with me that he called me a son of a (expletive),” my friend said.

After the doctor returned, my friend, who admitted being “damned angry” at being called an SOB, demanded to know what kind of a doctor would write down in a medical chart that his patient was an SOB.

Well, the physician, irritated by my friend’s accusatory tone, loudly said he was the kind of doctor who spoke with his patient’s cardiologist — a specialist who told him that during a treadmill stress test his patient repeatedly suffered from shortness of breath, or SOB.

“I made an ass of myself,” my sheepish friend said. “I apologized.”

And so a misunderstanding over a medical abbreviation made for a humorous anecdote.

That’s not always the case, however.

“If there are misunderstandings among medical personnel, people can suffer,” said Dr. Mitchell Forman, dean of the Touro University College of Osteopathic Medicine in Henderson.

They can also die.

According to the Institute for Safe Medication Practices, more than 7,000 deaths per year can be at least partially attributed to errors caused by abbreviations.

The United States Pharmacopeia MEDMARX program, a national medication error-reporting program that tracks medication errors, found that of the 643,151 errors reported to them from 2004-06, 4.7 percent was attributable to abbreviation use.

Dr. Len Kreisler, former UMC chief of staff, remembers how a misunderstanding caused a patient to become seriously ill from taking far too much of a powerful blood thinner medication for a heart condition.

Kreisler said he wrote the Latin abbreviation “q.d.” for daily use and he said a pharmacist took the period after the “q” for an “i,” or “q.i.d,” meaning four times daily. “We were fortunate the situation turned out OK,” he said.

Now that physicians are turning to electronic medical records, Las Vegas oncologist Dr. Heather Allen pointed out recently that fewer abbreviations will be misunderstood because of “handwriting problems.”

That’s true. But abbreviations still cause problems. Why? Because medical abbreviations can mean different things to different medical professionals.

CP, for instance, can stand for cleft palate, cerebral palsy, chest pain, cardiac pacing, chicken pox, child psychiatry, creatinine phosphate, current practice, cyrstalline penicillin. An online medical dictionary yielded 79 medical phrases for CP.

MediLexicon’s abbreviations dictionary contains more than 200,000 medical, biotech, pharmaceutical and health acronyms and abbreviations.

In an article recently published in the New York University Langone Online Journal of Medicine, “Why You Should Think Twice About Using Medical Abbreviations,” Benjamin Rodwin wrote that abbreviations are “frequently a source of confusion and can be a major risk in clinical practice. Medical students and doctors struggle with ambiguous abbreviations daily in trying to figure out a patient’s history from the chart. Although they can often be deciphered in context, these abbreviations can lead to serious morbidity and mortality.”

Rodwin went on to note that in a 2008 study done at an urban hospital with a large number of children as patients, pediatricians were able to understand 56 to 94 percent of the abbreviations used, while physicians from other fields “understood only 31 to 63 percent, highlighting the ambiguous nature of many abbreviations.”

Effective communication, Rodwin wrote, “between patient care members is essential, and abbreviations can obfuscate what should be simple recommendations.”

To further illustrate how dangerous abbreviations can be, Rodwin also noted a 2011 study that showed that members of a multidisciplinary patient care team at one hospital could only decipher abbreviations correctly 43 percent of the time.

The Food and Drug Administration and the Institute for Safe Medication Practices have an educational campaign under way to convince medical professionals that abbreviations are problematic. In 2004, the Joint Commission on Accreditation of Healthcare Organizations introduced a “Do Not Use” list of abbreviations, including “q.d.,” which caused Kreisler and his patient real trouble.

Kreisler said it’s time for doctors and other medical professionals to do the right thing on their own, without the regulation being pushed for by some patient safety advocates.

“The best thing for doctors to do is to write out the whole thing they’re talking about,” he said. “Abbreviations can save a few minutes, but prohibiting them can save lives. That’s what we should be concerned about.”

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.