FAO FY2- Are we doing enough to make ourselves understood?

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I was inspired to write a piece about medical acronyms and jargon. On an elderly care ward round, an experienced geriatric consultant asked me what “TLA” stood for… I got that sickly feeling that you get when you are being quizzed about some niche, long-forgotten piece of information that you have not thought about since medical school. The patient looked amused. I tried to use some logical reasoning to quickly work out what diagnosis or test he could have been referring to– he interrupted my panicked train of thought – “Three Letter Acronym”. He was referencing the abbreviations that had been used in the patients previous notes; ‘PD’ (Parkinson’s Disease) and the one that had taken us some investigative work, ‘BWO’ (bowels well opened- FYI!). 

I have thought a lot about the point he was trying to make; everyday in clinical noting we read (and write!) lots of medical jargon, including shortened phrases and acronyms. Even though some are widely accepted, universal abbreviations across medicine, do we really know that the next person reading them will interpret in the same way as ourselves? 

Personally, I occasionally find myself getting mixed up with reading and expressing acronyms, especially in the early hours of the morning during a long and busy night shift. We perceive that they save time and, having been the foundation doctor hurrying about with the COW (computer on wheels) for many a ward round, I am guilty of using them frequently. But I am also passionate about communication, and making sure that my written and spoken communication is well understood. Where do we draw the line? 

Are we over-utilising the ‘TLA’ and other abbreviations in medical written (and even spoken) communication? Have you seen abbreviations and shorthand being used in patient letters such as discharge paperwork? Do you take the time to explain what each letter stands for when speaking to patients and relatives? Does everyone in the MDT (multi-disciplinary team) know what you are talking about when you use abbreviations? 

Poem: FAO FY2 

PPI OD for TTO,  

OTC NSAID PRN,  

eGFR low, please amend.  

UGIB in A&E,  

Low Hb on VBG-  

Urgent XM RBCs,  

NBM pending OGD.  

Headache for 7/7,  

GCS 15, ØLOV,  

CT Head, consider LP.  

CP on a BG of IHD  

ECG shows STEMI  

ASA then PCI.  

GUM appt;  

When was LMP?  

STIs? IMB? COCP? BBV?  

WR on SAU:  

BNO with N&V,  

CTAP, insert NGT.  

ABG for IECOPD-  

Raised pCO2: T2RF,  

CXR: RLL changes,  

STAT IV Abx.  

BPH with LUTS  

AKI on U&Es,  

IP/OP chart,  

IVF + US KUB.  

UMN LSW,  

CVA on MRI- commence DAPT,  

PT/OT before D/C.  

ATSP with high NEWs,  

A-E, bleep SpR-  

Handover: SBAR.  

TLAs and abbreviations of an FY2,  

TLDR; do they understand you? 

As an exercise, re-read the poem but do not allow yourself to interpret the acronyms and abbreviations; instead read or speak the letters as written (eg. Line 11: See Pea on a Bee Gee of Eye Aitch Dee). These are the combination of letters and shorthand phrases that patients, families, non-clinical and also medical colleagues hear or see us using constantly. Have another look… can you read through the prose with all the abbreviations expanded, do you know what every letter stands for? Reflect on whether your colleagues and patients would understand; is there any content which could be interpreted differently, or maybe you know another shorthand or abbreviated version which could be used in place. Is this the way you would present information to patients? I am sure that you do not need me to remind you, but communication is a key aspect of Good Medical Practice. Are we doing enough to make ourselves understood? 

Dr Elizabeth Martin

F2, West Midlands Central Foundation School

All previous HOFP articles can be found on on our HOFP webpage