January 8th, 2017

7 Medical Terms to Ditch in 2017

Harrison Reed, PA-C, practices critical care medicine in Baltimore, MD.

Harrison Reed, PA-C, practices critical care medicine in Baltimore, MD.

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.”

toothpaste“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.

35 Responses to “7 Medical Terms to Ditch in 2017”

  1. Paul says:

    On #4: “Nauseous” vs. “Nauseated”. The information presented is poorly researched. Merriam-Webster’s has a dedicated discussion on these terms which indicates that a patient can, indeed, become nauseous.

    “DEFINITION of nauseous
    Sense 1: causing nausea or disgust: nauseating
    Sense 2: affected with nausea or disgust

    Usage Discussion of nauseous
    Those who insist that nauseous can properly be used only in sense 1 and that in sense 2 it is an error for nauseated are mistaken. Current evidence shows these facts: nauseous is most frequently used to mean physically affected with nausea, usually after a linking verb such as feel or become; figurative use is quite a bit less frequent. Use of nauseous in sense 1 is much more often figurative than literal, and this use appears to be losing ground to nauseating. Nauseated is used more widely than nauseous in sense 2.”

    #6: The Glasgow Coma Scale (GCS) has well-established utility in predicting outcomes in traumatic brain injury (TBI). Improper use of the GCS in non-TBI patients is, of course, of little value and should be discouraged. However, dismissing the GCS as a “technology… [that] has outlived its utility” is uninformed. Please continue to document a GCS score as part of a thorough neurological exam in patients with TBI.

  2. Brittny says:

    Glasgow coma scale is used in interqual medical necessity criteria

  3. Max Voysey says:

    I guess you’re upset about (incomplete and limited) “complete” blood counts (CBC’s) as well?

  4. Alexandra Godfrey says:

    Can we make cardiac enzymes and arrhythmia 8 and 9?

    Neither rhyme nor are they palindromes.

  5. Hi Harrison – Thanks for the entertaining and thought-provoking blog. I appreciate your humor in trying to discuss some rather boring stuff! I for one am a fan of “nauseated” as well, easier to spell 😉

  6. Tom D says:

    How stupid to bring the gender debate into this. Instead of “40 year old female presents with vaginal bleeding.” I’m supposed to say “40 year old gentlemen presents with vaginal bleeding.” …? You are a biologist when you deal with human life and gonadal descriptions are necessary. This makes me nauseated.

    • W. R. Gailmard says:

      I maintain you are asking “regular” to do the work of “steady” or “non variable.” A rate is a number. A heart rate is by definition the average number of beats over time. As an average it cannot describe variability. The term used for beat to beat variability with origin in the SA node is “sinus arrhythmia,” not “sinus irregularity.” Also, arrhythmia is not the same as dysthymia.

      • Kenneth A. Klein, MD says:

        Nice going, W. R. Gailmard! LOVED your last sentence! This blog is making me a little dysthymic. LFT’s (as I have seen the term used for 40 years) comprise albumin, globulin, total and direct bilirubin, alkaline phosphatase, LDH, etc. in addition to transaminases.

  7. Richard says:

    Rates can be regular or irregular. In musical terms, rhythm can be regular (march like) or varied. Rate (tempo) can accelerate or decelerate, or it can remain steady (regular). Indeed, there are patients with irregular rates, having bursts of tachycardia or bradycardia, but within those bursts having a regular rhythm. (Think tachy-brady syndrome.)

  8. Eeklim yaw says:

    IMHO. Its a matter of perspective. I Totally agree with Paul Richard Brittny and Tom. Here is where you separate the MD’s and the Pa’s.

  9. Belinda Vail says:

    Personally, I think you left out the most offensive–endorse. As in, “the patient endorses nausea and vomiting” Really? The meaning of “endorse” is to “declare one’s public approval or support of” So the patient really thinks nausea is a good thing and would like to publicly support it? Perhaps nausea could be president. It does also mean to sign on the back of a check, but I don’t think that fits either. So please, try to stamp this out.

    • Dan Urbach, MD says:

      What about when the president causes nausea and vomiting? Seems a large part of the country endorses nausea

    • Nick says:

      YES!- and even worse is “admits to”… I’ve seen notes where the patient admits to having a fever. Are you sure? Did you have to waterboard the patient to get that information out of them??? talk about setting up an adversarial tone in a patient- provider relationship.

    • Soyun Kim says:

      This!! The worst offender! Thank you for pointing this out.

  10. Kristina says:

    I appreciate you addressing the use of the term “midlevel” to describe NP/PA providers. It is outdated and sends a poor message to patients that they will receive “midlevel” care if they see an NP/PA, which is not true!

  11. Jasper L, MD says:

    On #5. It is old. In fact i think it was introduced by Samual Shem in ‘the house of god’ (1978). He used is in combination with NAD, a LOL in NAD: A Little Old Lady in No Apperent Distress.
    None the less:it should not show up in medical records.

  12. Daniel says:

    what’s wrong with calling you a mid-level?

    • Beth NP says:

      What’s wrong with the term “Midlevel??” How about everything??? If NP/PAs are “midlevel providers,” does that mean our nurses are “low level providers?” And what should we call our Medical Assistants? Pond Scum? Daniel, I would ask you how you would do your job without your nurses? Take a look at the studies, Daniel, and you will see that your Advanced Practice Providers (yes, there’s an APP for that) provide high quality, compassionate care in a wide variety of fields. Better yet, talk to your physician colleagues who could not provide the high level of care they provide without their APPs. And maybe check with your patients who have been taken care of by an APP and ask them if they feel the quality of care they received was half-assed, which is what the antiquated term MLP implies. Think outside the box, Daniel – your patients (and the LLPs and Pond Scum who support you) will thank you….

  13. Ryan says:

    I am from Glasgow and work with the team who invented this score. It was never meant to be used without all three factors being defined. It is not one number but 3. Even then, it is the trends in GCS that are most useful. Like any score you use it in the correct clinical context. I suggest you have a look at the original papers on it utility before criticising it.

    • E. Kaul says:

      I always look at the 3 components of the GCS, and have found it useful for helping with prognostication in recent TBI patients. I wouldn’t want it to go away! I would like clinicians to be sure to document the subscores. Thanks!

    • John says:

      Nothing bothers me more when a <3 GCS somehow gets documented. If you're dead or darn close, get a 3, otherwise please rescore.

  14. Dan M says:

    I suggest “mini-stroke” for 2017, it is neither a medical term nor an accurate description of what the patient may, or may not have had. Patient either had a “TIA” or a “small stroke”, who knows, maybe a lacune? I don’t know, but what I do know is they did not have a “miniature stroke” for sure and most of the time they had none of the above. Oh, and don’t respond to the question “what is a mini-stroke” with “patient had a right sided stroke”…. Right hemispheric infarct? Right sided hemiparesis, aphasia, hemianopsia? What? Argh!!! -annoyed vascular neurologist.

  15. John Collins says:

    Well, I realize the mid-level controversy will not go away, but somehow it depends on your perspective. I find it disingenuous to call someone who has many years less training than a physician, especially with some/most of the training on-line, as an advanced level practitioner. What does that make physicians? Super advance level practitioners. Also, physicians are physicians, NPs and PAs are providers.

  16. Pat M says:

    Yes, Dan! Absolutely correct about min-stroke.

    “Blood thinners”. Arrgh! Patients tell me they get cold all the time because they are on an anti-platelet drug or an anticoagulant.

  17. Mikhail Nabatoff says:

    What about “simptoms and signs”? Difference between this entities is not obvious, especially for non-native English speakers.

  18. Jeffery B says:

    Here are 2 that annoy me to no end: appropriate and inappropriate. Try to go a day without riding these old sawhorses and you will be forced to use descriptive language, and even some value-laden words like “wrong” and “false.”

    After that, we can gather the courage to banish the passive voice: “The patient was placed on penicillin.” Just think about that one for a minute.

  19. Robert says:

    How about “drug eluting stent”? It should be called a “drug releasing stent” since the stent doesn’t elute anything, it releases a drug. How could people who took basic chemistry continue to mischaracterize this

  20. Eric U MD says:

    I’d nominate “therapy” when applied to the use of medicines, with the exception of chemotherapy. As in, “yes, Mr. S, despite the fact that your cholesterol profile has improved, I recommend you continue your statin therapy.” For some reason this smells like a usage propagated by Pharma. “Treatment” or just “medication” seems more natural.

    Also, “health” as applied to organs or systems, as opposed to referencing a patient’s overall well being; e.g. “kidney health,” “prostate health,” “heart health,” etc. Again, probably a personal peeve rooted in my training, but there it is.

    Thanks for the thought-provoking blog entry.

  21. Haley says:

    To piggyback on “LFTs” I would motion for the phrase “transaminitis” to go the way of the LOL in NAD. To the best of my knowledge, this condition is not caused by an inflammation of your transaminases.

  22. Maja says:

    Utterly useless.

  23. john mosby says:

    Very enjoyable, mostly polite exchanges, and I thank Mr. Reed for this contribution. My confusion centers around the term “palpitations without symptoms.” Aren’t palpitations a symptom? Of course, so much of our language is applied without a strict scrutiny of implications, e.g. I doubt that anyone anywhere misunderstands someone being “on” a medication.
    Finally, I very, very much appreciate the contribution (guess I should say “work of,” before someone objects to “contribution”) of non-physician health care providers. As you see, we don’t think of these co-professionals as DONATING their services, do we? This is a perpetual discussion in a living, changing, evolving language, democratically advanced by its global users, IMHO.

  24. Jonathan says:

    How about the use of “replete” as a verb? E.g., “We need to replete her potassium.” “Replete” is an adjective.

  25. Matt Garofalo says:

    The words we use both inform and reflect our world views and actions, so I applaud the goal of this post. The word ‘confused’ as used in your section on the GCS also warrants discussion. This word is used to the dismay of many psychiatric consultants to determine delirium versus dementia versus psychosis. In a medical context confusion is a nonspecific term which can mean disorientation, memory deficit, and/or perceptual/thought disturbance. Specifying the type of confusion (and having the awareness and interest to do so) helps the consultant to narrow the differential before even walking through the door and promotes better serial clinical assessments.

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