MEDICAL MATTERS:Medical folk love a good acronym - but they may need some new ones, writes Pat Harrold
READERS OF The Irish Timeshealth supplement are a well-informed, cosmopolitan lot, but I bet not too many of you know what GROLIES are.
Doctors have always loved acronyms and abbreviations. Maybe it is because they spent so many hard years in college trying to obtain those two little letters to put in front of their names. From Dr to ER, from Marcus Welby with his MD to Brendan Drumm and the HSE, acronyms have been shorthand, slang and, often, disguises.
Dr Adam Fox, a paediatrician with an interest in TLAs (three-letter acronyms), is worried that they will soon disappear. People are becoming suspicious about them. While the doctor might innocently protest the SOB stands for "short of breath" and has nothing to do with having a mother in Crufts, and BS means "bowel sounds" and does not suggest something that a matador might step on, the punter is not so sure.
Fox recounts the story of a court case in which a doctor was grilled by the judge on the appearance of TTFO (told to go away emphatically) in a patient's chart. "To take fluids orally," said the quick-witted doctor, but it was a close call.
Historically, doctors probably used abbreviations for the same reason that they used Latin - namely, to ensure that nobody knew what they were talking about. In many cases this was probably no harm.
Anyway it is far easier to write about an ECG than to laboriously write out "echocardiogram". From written to verbal shorthand was an easy leap and in many cases the acronym was remembered when the original meaning had been all but forgotten - as in the cases of MRSA and HIV. (The term VHI positive was once quite popular in Irish hospitals, as I recall.)
Acronyms were also a way of distancing yourself from emotion. "Ash cash" was a term used to describe the money a junior doctor got for filling out a cremation form, and "bash cash" meant an accident report.
In time some acronyms became pejorative. These were the expressions that dared not speak their name, for the doctor's personal safety. The anaesthetist, predictably, was a gasser, a blower or gasbag.
The psychiatric team became "the Freud squad". A disbelieving doctor could suffer from "scepticaemia". If he got over it he might write TEETH in the notes, which stands for "tried everything else, try homeopathy".
And in a moment of bitterness he could refer to the geriatric ward as the "departure lounge".
Down in the casualty department a UBI was an "unexplained beer injury". PFO meant "drunk (sort of ) - fell over", and may have been followed by a PGT, who "got thumped" instead.
In fact, the people who might impress the doctor with a lack of intelligence give rise to some of the best acronyms. LOBNH meant "lights on but nobody home''.
CNS-QNS (central nervous system - quantity not sufficient).Somebody had Halloween in mind when they described a patient as "pumpkin positive". This suggests that the patient was so brainless that if you shone a torch in their mouth their whole head would light up.
I think a particularly heartfelt expression is NFN (normal for Norfolk), and one which can be transferred to just about anywhere. FLK means "funny-looking kid", which is not really in the best medical textbooks, and not one that you would come out with on the ward round. If you did you might cause a "404 moment".
This is an expression culled from the internet. It sums up perfectly the moment when the whole ward round becomes unhinged as the test, investigation, or even explanation has become lost. That is when the scarlet-faced junior confesses to the test being NAD, which in mainstream medicine stands for "no abnormality detected" but in this case means "not actually done".
This is the cue for the wise ward sister to announce that "Mrs Brown" needs to be seen. "Mrs Brown" is, of course a cup of tea. Feel a bit guilty outing this one, as it has been a great standby to the harassed doctor for many a long year, and a gentle deception at worst.
You see, charts still have "not to be seen by the patient on the cover" but nowadays this is nonsense, and everyone knows that whatever you write can be extricated, in most cases, without too much difficulty.
The medical lawyers advise us not to write anything in a chart that we would not be happy to see quoted on the front page of a tabloid newspaper. So I suppose that referring to the "dirt bag index" will soon be a thing of the past. To estimate the DBI you multiply the number of tattoos by the number of missing teeth to estimate the number of days since the patient had a bath.
GROLIES, by the way , means "guardian reader of low intelligence in ethnic skirt" - a class of person I got on quite well with. But what else can you expect from a BITHOC (bearded Irish Times Healthplus occasional correspondent).