Speaking in tongues

TRAINING to be a doctor may sometimes feel like learning an entirely new language.

Whether it’s talk of dealing with “an indication of needs matrix” or measuring “patient outcomes”, the use of Latin or Greek phrases, complex instructions on how and when to administer medication or the endless abbreviations, the profession seems to have a vocabulary all its own. And while using this medical-speak can act as a useful shorthand for under-pressure doctors, it can also be a source of confusion and present a challenge to both patients and fellow healthcare workers alike.

The biggest problems arise when medical terms or abbreviations introduce ambiguity and are open to being interpreted in different ways.

One example is the doctor who notes ‘CP’ in a patient’s records. While she will likely remember the abbreviation refers to chest pain, consider the next doctor who may think the note indicates cerebral palsy. And abbreviations indicating different routes for administration of treatment can easily be confused, from “im” (intramuscular) to “iv” (intravenous) to “it” (intrathecal). MDDUS is aware of significant cases, some involving patient death, when there has been an error in reading such abbreviations – particularly when a practitioner is not used to working in a certain field. Illegible handwriting can also be a factor in these cases. Doctors must take extra care in checking abbreviations, especially when the consequences of making a mistake are significant. If in doubt – always check.

There are many different types of medical jargon – all of which can impair clear and accurate communication. This includes using medical terms when simple language would do. An assistant professor at a US medical centre said doctors sometimes use jargon because they are trying to be specific.

“The trade-off is most people don't understand what those fancy terms are, and it causes problems,” he said. Instead of saying hypertension, doctors should call it high blood pressure. Rather than referring to blood glucose, they should call it blood sugar. And hyperlipidaemia? That's high cholesterol. A simple check at the end of the consultation to ask the patient if they understood or have any questions can prove useful.

The use of Latin and Greek terms is still common in medicine, but a 2008 report in The Lancet highlighted the patient safety issues surrounding their use. Dr Melinda Lyons of the University of Cambridge called for such terms to be ditched, believing they are only preserved by “linguistic snobbery”. She explained: “The risk for adverse consequences of sound-alike terms is greatest if they are used in time-pressured situations in which there is unfamiliarity with the terms, there is little opportunity to clarify them, and there are high levels of noise and distraction.”

Prefixes like intra and inter, anti and ante, hypo and hyper are examples of terms that look and sound the same but have different or opposite meanings. Dr Lyons believes “confusion could have serious consequences for patients” and has called for clear terminology to avoid mix-ups. She added: “For the sake of clinicians and patients alike, removal of archaic, risk-prone terms to simplify the language of medicine is a necessary step."

Medical slang is another phenomenon that you may become familiar with during your training. While most junior doctors will be well warned about it, there may still be times when a patient record has the abbreviation “FLK” where a doctor is treating what he reckons is a “Funny Looking Kid”. Other examples include “CTD” meaning Circling the Drain (for a patient close to death), NFN meaning Normal for Norfolk and UBI which refers to an Unexplained Beer Injury in a drunken patient.

But while such acronyms might be intended to be humorous, the increasing rate of litigation means there is a far higher chance that doctors will be asked in court to explain such abbreviations in medical notes. The duty of care to all patients extends to the keeping of accurate and clear medical records. Where the record is rendered ambiguous by the use of slang then this could constitute a breach of the required standard of care. It would be down to the doctor in a case like this to prove the slang used was established – used by other doctors – and that it was unambiguous.

MDDUS medico-legal adviser Dr Gail Gilmartin said: “It is good practice to avoid using terms that are not relevant to the patient’s treatment, especially terms that insult or make fun of a patient. Slang, jargon or abbreviations might save you time, but consider the harm that can occur in the management of a patient whose notes are not clear, as well as the offence that could be caused if the patient were to find insulting comments in their records.”

Joanne Curran is associate editor of FYi