January 8th, 2017
7 Medical Terms to Ditch in 2017
Your new diet plan might fail. That daily planner might collect dust on the corner of your desk. The gym membership gifted by a well-intentioned (but not-so-subtle) cousin might go unused. But fear not. You can still resolve to make 2017 just a little bit better than last year. And it starts by cleaning out the clutter of some terminology that must retire.
The following list includes terms that in some way hamper, impede, degrade, misinform, or otherwise gunk-up communication in the healthcare setting. If you’re rolling your eyes and thinking to yourself, “oh great, a grammar snob is going to spend an entire blog picking over the semantics of my charts,” you’re right. But you already clicked on the link so you might as well keep reading.
Besides, you might like it.
“Liver Function Tests” or “LFTs”- People often use the phrase “liver function tests” (or “LFTs”) to refer collectively to aspartate transaminase (AST) and alanine transaminases (ALT). Although this shortcut is ubiquitous in healthcare, we have inexplicably agreed to accept a complete misnomer. Generally speaking, the AST/ALT values do not describe liver function as much as they represent enzymes released in the setting of hepatocellular destruction or death. It’s like calling your favorite cocktail “liver function sauce.”
In fact, there is a longer list of labs that better represent the metabolic and synthetic function of the liver that often seem to escape the traditional umbrella of “LFTs.” While I’m sure most clinicians understand this concept, many still enjoy the convenience of the erroneous term. The fix is simple: use “transaminases.”
“Regular Rate and Rhythm” or “RRR”- Another common shortcut that places convenience over accuracy, you’ll find this abbreviation in the physical exam section of many progress notes. Even some large, commercial electronic medical record services place the “triple Rs” as a one-click option. You’ve probably already guessed my beef: while a rhythm can be regular, a rate cannot. Use “regular” to describe your rhythms and your toothpaste. Call your rate “normal.”
“Nauseous” vs. “Nauseated”– I’m the first one to admit my own guilt here, but it’s important to know this distinction when you’re confronted by a real grammar geek. The primary definition of “nauseous” is actually “causing nausea.” So during morning sign-out when you say your patient “became nauseous overnight,” someone might think he made his nurse puke. But I bet you really meant the patient experienced nausea or was nauseated.
By now, you might think this blog is pretty nauseous, too.
“AAM”/ “AAF”- When I read this abbreviation in the first line of a note, I assume it means “African-American male” or “African-American female.” The truth is, I don’t really know. There should be a separate debate about whether or not race/ethnicity/skin tone should be included in the first line of a note. But this term has plenty of other reasons to get the boot. There’s the confusion factor: it could just as easily mean Asian-American male, Armenian-American female, or any other combination of words based on your geographic perspective. And then there’s the respect factor: my patients are “ladies” and “gentlemen” (or something else, if they prefer). Leave the gonadal descriptors to the biologists.
“Little Old Lady” or “LOL”- I assume this is a relic of the pre-texting era. But since I have read this in a real present-day chart, I feel obligated to include it. There’s an image this phrase conjures: your own grandmother set down her knitting needles and her tea and drove herself to the hospital. It attaches the kind of bias that makes even the best clinicians miss the diagnosis of alcohol withdrawal or a sexually transmitted infection. Plus, in the abbreviated form, it sounds like you had a good laugh in the middle of writing your note. This vernacular belongs in its own retirement home.
The entire Glasgow Coma Scale (“GCS”) – Like the VCR, the floppy disc, and most technology from the 1970s, the Glasgow Coma Scale (GCS) has outlived its utility. The GCS was designed to communicate neurologic status in trauma patients and has since crept into the lives of nearly every other specialty.
And what’s not to love? In a single number you can communicate a wealth of information about your patient’s mental status.
Except it doesn’t work. A GCS of 10, for instance, tells you that something is wrong but nothing more. It could be a confused patient with quadriplegia. Or it could be a patient who followed your every motor command but refused to open his eyes or speak until you knuckled his sternum. Besides, were those “motor responses” bilateral and equal or was there something focal to report? And did his eyes open spontaneously because he was seizing?
The fact is, any score other than a perfect 15 or a rock bottom 3 requires a longer explanation. And that’s a conversation you could have without attaching a silly, confusing number.
“Midlevel”- The letters behind my name mean I am contractually obligated to mention this once per year. The collective term for PAs and NPs (and CRNAs and nurse-midwives) is not “midlevel.” Pick your favorite reason as discussed by every blog on the Internet: an outdated hierarchy of medicine, the false idea that PAs somehow bridge the nursing and medical worlds, the implication of substandard care.
But I offer an appeal to your pragmatic side. “PA/NP” is only five characters when typed. “Midlevel” is eight. So if you won’t ditch the term for your colleagues, do it to save space on Twitter.
Scour these terms from your vocabulary and leave a comment with your own medical term to ditch in 2017.