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Saturday October 16, 2004: Personal: Medical Abbreviations

         I'm tired of being so serious.  At the very least, I need a break. Yesterday I had to run errands between the hospital lab and the North Ingall's lab.  As I walked through the parking structure, I noticed the license plates looked a lot like medical abbreviations and was surprised to find myself trying to reason out each medical condition.  It's an occupation hazard.

         As with many fields, the medical community loves to abbreviate conditions, tests, and diagnoses. It reduces writer's cramp and saves time and space when filling out stacks of requisitions. It reduces tongue-tying when communicating with colleagues. The entire community is familiar with some abbreviations and acronyms. If we see a requisition and the doctor has written "SOB" under patient history, we all know it means 'shortness of breath' and is not a reflection of the patient's character.

          In cytopathology, where we are clinically screening for cancer cells, history can become an important part of how we interpret atypical or abnormal cells.  An IUD (intra-uterine device, though I'm sure you knew that) occasionally produces a reactive change that resembles endometrial adenocarcinoma. There's a big difference between a benign reaction and a malignant lesion. If a forty- or fifty-year-old woman's pap smear arrives with no history and we see a specific pattern of cellular change, then a monkey wrench has been thrown into the work flow while we stop to track down the doctor or the patient's chart for more history.

            Even unrelated illnesses sometimes affect how we interpret the cells or cell pattern.  If we see it written that patient is forty, obese, and hypertensive, we know she will be at higher risk for endometrial cancer. A smoker will be at higher risk for cervical cancer. Anorexia may alter hormonal levels, creating an uncharacteristic atrophic pattern in a young woman. If the doctor notes the patient has arthritis or is obese, we understand that the doctor may not be able to obtain an optimal smear. A history that the patient is undergoing chemotherapy for lymphoma will explain large dark nuclei (therapy changes) found in scattered cells and we won't worry about it. Bottom line -- we like all the history we can get.

         After a while, you get pretty good at coming up with possible interpretations of abbreviated medical histories; you know most abbreviations are related to the body sites being sampled. We still run across unfamiliar codes that can stop us in our tracks.  Time out for a group huddle: the requisition is passed between cytotechs while we try to reason out if this is significant history.  One woman's requisition stated only APE. That confused everyone before we determined it was simply an annual pelvic exam.

           None of us could figure out GSW.  Let me see, G could stand for gonococcus or genital or gynecological, W usually meant wide (as in wide excision) or warts. What to do with the S in the middle -- symptom, syndrome, Simplex? We had two residents in training with us.  The first was equally at a loss. The mystery was only solved when the second resident came back.  He had been moonlighting on weekends and had noticed the abbreviation was one used in the Emergency Room. GSW = gun shot wound.

           Wow.  Who would have guessed?  It left us wondering if the doctor really thought this was relevant history. Was the doctor trying to tell us that the patient lived a rough life and we should look for STD (sexually transmitted diseases)? Or should we simply imagine the patient came in to be treated for a gun shoot wound, and somewhere in the course of conversation the very conscientious doctor had decided to ask, "When was the last time you had a pap smear, my dear?" 

           While some decoding may be challenging, it's down-right fun to decipher the misspellings of office personnel, untrained in medical terminology. These mistakes come from a generation that was 'Hooked-on-Phonics.'  You'd think by now most people understand that the C in C-section is shorthand for cesarean. If instead, the requisition says Sea-Section -- how can we avoid the image of Moses parting the waters?  If (instead of hysterectomy) they put down historyectomy, are we not left to conclude the doctor has removed the patient's history?  Wait a minute -- on second thought, that might come in handy for some individuals.

        One of the most common abbreviations in anatomical pathology is CIN (cervical intraepithelial neoplasm). It's become an acronym and we rarely think about how it must sound to an outsider. Since most CIN lesions are related to a sexually transmitted virus, we prefer to think the following was a Freudian slip, rather than a phonetic misspelling: "Patient has a history of SIN in her past."  My, my.  So much for being objective and not judgmental.

Posted on Saturday, October 16, 2004 at 08:30AM by Registered CommenterThe Skeptical Mystic | CommentsPost a Comment

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