April 15th, 2016

Mystifying Abbreviations on Daily Medical Rounds

acronym cartoonI am currently attending on the inpatient medical service — always a treat, and a great learning experience for me each year. Aside from the refresher on inpatient general medicine — hey, no amount of repetition is too much when it comes to working up hyponatremia — I’m also fascinated by the steady proliferation of abbreviations and acronyms, bits of absurd sounding non-words or letters that sprout like weeds in the conversations and notes of these fine young doctors.

Below a select list of some of the commonly used terms bandied about by our skillful interns and residents. Some are nationally used, others are just local-isms that are highly relevant for our hospital’s patient population.

  • MOLST
  • BMP — not to be confused with BNP, which also wasn’t in circulation when I was a resident (because it wasn’t available), but is now pretty established
  • CIWA
  • G and G — originally I thought it was GNG, but it’s not.
  • CTPE
  • TTP — not the hematologic disorder
  • WOB
  • DOAC
  • HDS
  • PNA
  • TROPE
  • RUCKUS — at least that’s how it’s spoken, as in making a lot of noise (a ruckus), but (hint) not spelled that way.
  • APLAS

Note that none of these abbreviations or acronyms was in circulation when I was a house officer, but of course that was some time ago (ahem), so that’s not surprising. What’s remarkable is that many of them weren’t even used much last year, showing the remarkable fluidity of medical language, and ensuring an unending supply of confused medical students and gray-haired doctors.

So how many of them do you know? Please offer some guesses in the comments section. Upfront warning — the degree of difficulty is highly variable, and using the google machine (or even UpToDate) may not help.

DAILY CARTOONclick to enlarge

ANDERTOONS.COM DOCTOR_AND_MEDICAL CARTOONS

(Installed the cartoon widget so I can highlight that brilliant cartoon at the top of the post.)

46 Responses to “Mystifying Abbreviations on Daily Medical Rounds”

  1. SJ says:

    I got a kick as an ID fellow every time I had the opportunity to use the acronym for Progressive Outer Retinal Necrosis (somehow I didn’t get fired either). Not as fun for the patient however.

  2. Max Voysey says:

    A Hospital note arrived at my (community provider) office- “pat was OP” .
    Firstly – Patients name is not Pat, and what does OP stand for? Was it a reversal of PO (per os), or short for Operated/Operated on? Off program? I call medical records – who clarifies “Patient has osteoporosis”. Great – except patient actually has “osteopenia” (Op?) – only a slight difference – right (one you observe – one you treat with highly toxic drugs)? Since there were 29 other abbreviations in the 3 page note I asked for them to be translated for me – in the best interest of patient care. Three days later Medical records faxed me the note with hand written pencil (difficult to read on a fax) expansions – as to what they though each one meant. I call back – this is exactly the same problem – except, Noctors get more wrong than Doctors.
    Could I have a copy of your standardized abbreviations list – something I’m sure all those thousands of person hours in Medical Records have created in the 125 year old hospital. . . .?
    Dead silence.

  3. Tilahun G. says:

    MOLST- Medical Order for Life Sustaining Treatment
    BMP- Basic Metabolic Panel
    CIWA- Clinical Institute Withdrawal Assessment
    CTPE- CT scan for pulmonary emboli
    TTP- Tender to Palpation
    DOAC- Direct Acting Oral Anticoagulant
    HDS- Hemodynamically Stable
    PNA- Pneumonia
    RUCKUS- ?? RUQUS- Right Upper Quadrant Ultrasound
    APLAS- AntiPhosphoLipid Antibody Syndrome
    G and G- ??
    WOB- ??
    TROPE-??

  4. Loretta S says:

    I’ll admit to being completely mystified. PNA in my world is pneumonia, but I have my doubts that what it means after looking at that list.

  5. marvin rabinowitz says:

    bmp basic metabolic profile aka sma-6
    molst something to the effect of medical order for life sustaining treatment. sort of a medical will.. the rest are htfsik=will not translate as not pc
    marvin

    • Paul Sax says:

      htfsik

      Love it! While we don’t see that one in medical charts, it’s quite common in the “thought bubble” of medical students and residents during pimping on rounds.

      Paul

  6. Alex Viehman says:

    G and G: gown and gloves aka contact precautions?

    WOB: work of breathing

    TROPE: ? To rule out pulmonary embolism?

  7. Christina says:

    WOB is work of breathing.
    TROPE is to rule out pulmonary embolism?
    G and G… How the eff should I know what that is? 😉

  8. Pratik Vishnu Patel says:

    In my training WOB meant “Work of Breathing”

    Your article reminds me of my first day in a family practice clinic in medical school. The attending was dictating a note about his patient (who was recovering from heart surgery) and said what sounded like “cabbage” to me. When I asked him what he meant, he couldn’t suppress his smile. It still warms my heart when I see CABG in a note.

    I’ll add two that I learned since moving to the University of Washington from our neurosurgery residents:
    SPORT ?
    SILT ?

    • Loretta S says:

      When I was a student, I, too, thought they were saying “cabbage”. I had absolutely no idea what they were talking about until I asked a fellow student.

      A fellow student was mystified by “SCD” in one patient’s post-op progress notes. She thought it meant “sickle cell disease”, but could make no sense of the note. That one I knew — it was “sequential compression device”. Now that I write that, all those darn abbreviations seem dangerous. Maybe the Joint Commission should expand its list of “Do Not Use” abbreviations. 🙂

      • Max Voysey says:

        Yes, there are “standard” approved abbreviations – but if we are having this discussion, then it is not clear what there they are agreed upon by each place of work. To have a list of “prohibited abbreviations” does not make any coherent sense: there are only a finite number of abbreviations – new ones can be added, but an infinite number of prohibited ones. In aviation a test in “standard phraseology” is REQUIRED before you take someone’s life in your hands. Why not in medicine?
        In the good old days a physician (verbally) ordered a “milk drip” for the patient with the bleeding peptic ulcer . .. you know the outcome. . . . . (it went in via intravenous line – not nasogastric line). Roger, Wilco Over and Out!

      • Iqbal S says:

        You mean the list of DNUAs?

        • max voysey says:

          No. I would put the PAP onto you . . . (Prohibited Acronym Police. . . what were you thinking?)

  9. zk says:

    G&G: glucan and galactomannan. too much time on BMT as a resident.

  10. zk says:

    I would add that I learned about G&Gs on BMT while caring for patients like those with AML (FLT3-neg/NPM1-pos) s/p MMURD RIC allo HSCT c/b GVHD.

  11. Alyssa says:

    G and G = Beta D glucan and Galactomannan.

    I only got a few of the others. WOB is definitely used in the pediatric world much more often as it is difficult to ask an 8 month old if they are short of breath, but you can tell that they have increased work of breathing.

    My new favorite is “Patient deserves BS antibiotics. Will continue linezolid and meropenem for now.” Frequently the patient doesn’t need antibiotics so it remains true in either definition.

    I’m also surprised at how folks now state problems such as nonneutrocytic bacteriascites. Not sure I would have ever written this in a note.

  12. Silvia De Rossi says:

    I think that these abbreviations are used mostly to exclude the ones that don´t work at the same place, keeping the regular staff in a “bubble”…

  13. Miriam says:

    Reminded me of the student who started telling us about a patient’s echo after hearing us talk about HAART

  14. Adam Lake says:

    I agree that there has been an explosion in TLA’s (three letter acronyms)
    SILT: sensation intact to light touch.
    SPORT I don’t know, but I find HL to be the worst – “He has Hodgkin’s lymphoma?” “No, hyperlipidemia.” “Oh.”

  15. Sanford Kimmel says:

    Not to be a spoil sport but which abbreviations are approved by the Joint Commission? Some abbreviations have two meanings e.g. PT could mean Protime or Physical Therapy. Using an abbreviation incorrectly gets a “ding” from the “JC”, which is not quite as high an arbiter as the other JC.

  16. Steven Sable says:

    I believe that GOMER and all of the abbreviations in the HOG should remain on your list. It is a classic medical book and should be required reading for all interns and residents!

      • Roberta G. says:

        Except that medical transcriptionists already have that list in book form, with many handwritten additions.

        In days past, before EMR (read that as the stone age), we had to figure this stuff out by researching, calling the dictators personally, or giving our best WOG based on patient’s presentation and subsequent treatment.

        Every day a new one… or more.

  17. BunyipBill says:

    American Nursing/Medical acronyms are very different to the ones we use in Australia

  18. BunyipBill says:

    Try a few of these:
    FBE
    U&E’s
    LFT’s
    COPD
    PEEP
    ECG
    LVEDP
    GOMER
    PRN
    COAD
    PERLA
    ………

    • r k shenoy says:

      Fbc full blood counts
      U&e. Urea and electrolytes
      Lft. Liver function tests
      Copd. Chronic obstructive pulmonary disease
      Gomer. Is it not from a novel?

    • Max Voysey says:

      Full Blood Examination
      Urea & Electrolytes
      Liver Function Tests
      Chronic Obstructive Pulmonary Disease
      Peak End Expiratory Presssure
      ElectroCardiogram
      Left Ventricular End Diastolic Pressure
      Get out of My Medical Emergency Room
      Pro Rae Nata (as helpful requested or required)
      Chronic Obstructive Arterial Disease
      Pupils Equal and Reacting to Light
      (Haven’t practiced in Australia for 32 years).
      Hope you guys use SOAP there now. . . .

  19. Adrienne Drake says:

    TTP: Totally Terrified Patient
    PNA: Pallid ‘N Apneic but Pay No Attention (replaces DNR)
    WOB: Wobbly Outta’ Bed
    DOAC: The patient is now Dead but was Comatose On Arrival
    CIWA: Came In Without Authorization
    G and G: Gatekeeper with hand Grenade

  20. r k shenoy says:

    Ackup. Adenocarcinoma of unknown primary

  21. My favorite: “Heart – P and P”. Translation from the intern who wrote it : Heart – present and poundin’ “

  22. AGeriatrician says:

    Personal favorite:
    CAM AIDA neg w MOYTB intact

  23. Amanda says:

    Dermatology is rife with acronyms. One of my favorites is BADAS. We pronounce it bada$$.

  24. Roger says:

    G&G = (B-D) Glucan and Galactomanan

  25. Mike K says:

    Some abbreviations may change over time as well as be specialty dependent. For example my wife was totally confused that I as a cardiologist was talking about our pts who were awaiting a TAH (total artificial heart)

  26. Ori says:

    G & G = gurnish and gurnish? (in Idish?)

  27. Jeremy says:

    LENI is another local classic!

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Paul E. Sax, MD

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