Baylor University Medical Center Proceedings April 2017 - 245

TBA for OT HHC vs OPC f/u
Herbert L. Fred, MD

f the title of this editorial confuses
you, it should. And if it also intrigues you and compels you to
seek its meaning, read on.
As shown in the Figure, the title
is an exact replica of a rehabilitation
recommendation recently posted
in the electronic health record of
a patient in a local teaching hospi- Figure. Abbreviations appearing in a medical chart.
tal. Although I have seen some real
doozies in my medical career, this one takes the cake.
for "IVP" meant intravenous potassium instead of intravenous
Which brings me to my ﬁrst important point.
pyelogram and proceeded accordingly.
We tend to forget that the only person who invariably knows
Why are abbreviations so prevalent in the health care comwhat an abbreviation stands for is the person who uses it. In that
munity? For physicians, this custom begins in medical school,
regard, the doctor of the patient mentioned above took the best
where students are bombarded with abbreviations in their lecoption he had-to track down the perpetrator of the recommendatures, in their patients' medical records, and on their teaching
tion and have her decode it for him. She readily complied, adding,
rounds. Consequently, they assume that abbreviations are ac"I assumed you knew what I meant. Everyone in my group is
ceptable, quickly adopt the habit of using them, and perpetuate
familiar with those abbreviations. In fact, we use them all the time."
the habit thereafter. And, of course, abbreviations "save time"-
Which brings me to my second important point.
except for the host of individuals who struggle to decipher them.
Abbreviations that are obvious to members of one specialty
Final point: All of us are guilty of using abbreviations in the
can be, and often are, foreign to members of another specialty.
care of our patients. Regrettably, however, many abbreviations
Even within the same specialty, an abbreviation can have a
are simply covert expressions of self-importance. Most of us, I
speciﬁc meaning in one hospital and no meaning in another.
believe, would prefer clarity and precision over these self-serving
Years ago, I attended medical grand rounds at a hospital in San
shortcuts. And we would concede, I hope, that abbreviations
Francisco. In her oral presentation of a case, the chief resident
do nothing for our patients other than place them at increased
kept repeating what sounded like "alkep." Mystiﬁed, I interrisk-ﬁnancial, emotional, and physical.
rupted her for an explanation. "Oh, that's alcoholic hepatitis,"
So, like the consultant who prompted this editorial, I oﬀer
she said. "I thought everyone knew that."
my own recommendation-DNA. (Warning: that abbreviation
Point #3: Interpreting an abbreviation correctly depends to a
does not stand for deoxyribonucleic acid, did not attend, did
large extent on one's frame of reference. Consider CHF. To most
not answer, or does not apply) (1).
general internists, CHF stands for congestive heart failure. To
P.S. If you have read this entire piece searching for a translation
infectious disease specialists, it might suggest Crimean hemorrhagof its title, your search is over: "To be assessed for occupational
ic fever. To gastroenterologists, it could signal congenital hepatic
therapy home health care versus outpatient clinic follow-up."
ﬁbrosis. And to researchers, it can trigger chick heart ﬁbroblast.
1. Logan CM, Rice MK. Logan's Medical and Scientific Abbreviations.
Point #4: Because of their ambiguity, abbreviations can
Philadelphia: J.B. Lippincott Company, 1987.
be dangerous, especially in medical settings. If they are not
routinely questioned, particularly in doctors' orders or in doctors' prescriptions, the patient might undergo the wrong test
From the Department of Medicine (Emeritus), McGovern Medical School,
or receive the wrong medication, with devastating results. I
Houston, Texas.
know of two patients-one in Houston and one in Iowa-who
Corresponding author: Herbert L. Fred, MD, MACP, Emeritus Professor of Medicine,
McGovern Medical School, Houston, Texas (e-mail: hlf1929@yahoo.com).
were killed when a nurse erroneously thought that the order
Proc (Bayl Univ Med Cent) 2017;30(2):245

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