TBA for OT HHC vs OPC f/u

If 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 hospital. Although I have seen some real doozies in my medical career, this one takes the cake.

Figure.

Abbreviations appearing in a medical chart.

Which brings me to my first important point.

We tend to forget that the only person who invariably knows what an abbreviation stands for is the person who uses it. In that regard, the doctor of the patient mentioned above took the best option he had—to track down the perpetrator of the recommendation and have her decode it for him. She readily complied, adding, “I assumed you knew what I meant. Everyone in my group is familiar with those abbreviations. In fact, we use them all the time.”

Which brings me to my second important point.

Abbreviations that are obvious to members of one specialty can be, and often are, foreign to members of another specialty. Even within the same specialty, an abbreviation can have a specific meaning in one hospital and no meaning in another. Years ago, I attended medical grand rounds at a hospital in San Francisco. In her oral presentation of a case, the chief resident kept repeating what sounded like “alkep.” Mystified, I interrupted her for an explanation. “Oh, that's alcoholic hepatitis,” she said. “I thought everyone knew that.”

Point #3: Interpreting an abbreviation correctly depends to a large extent on one's frame of reference. Consider CHF. To most general internists, CHF stands for congestive heart failure. To infectious disease specialists, it might suggest Crimean hemorrhagic fever. To gastroenterologists, it could signal congenital hepatic fibrosis. And to researchers, it can trigger chick heart fibroblast.

Point #4: Because of their ambiguity, abbreviations can 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 or receive the wrong medication, with devastating results. I know of two patients—one in Houston and one in Iowa—who were killed when a nurse erroneously thought that the order for “IVP” meant intravenous potassium instead of intravenous pyelogram and proceeded accordingly.

Why are abbreviations so prevalent in the health care community? For physicians, this custom begins in medical school, where students are bombarded with abbreviations in their lectures, in their patients' medical records, and on their teaching rounds. Consequently, they assume that abbreviations are acceptable, quickly adopt the habit of using them, and perpetuate the habit thereafter. And, of course, abbreviations “save time”—except for the host of individuals who struggle to decipher them.

Final point: All of us are guilty of using abbreviations in the care of our patients. Regrettably, however, many abbreviations are simply covert expressions of self-importance. Most of us, I believe, would prefer clarity and precision over these self-serving shortcuts. And we would concede, I hope, that abbreviations do nothing for our patients other than place them at increased risk—financial, emotional, and physical.

So, like the consultant who prompted this editorial, I offer my own recommendation—DNA. (Warning: that abbreviation does not stand for deoxyribonucleic acid, did not attend, did not answer, or does not apply) (1).

P.S. If you have read this entire piece searching for a translation of its title, your search is over: “To be assessed for occupational therapy home health care versus outpatient clinic follow-up.”