The Patient Becomes Acronymous

 

Whenever I read a patient history written by a relatively young physician, particularly the residents I teach, I am struck by the abundance of acronyms employed to describe the person:

This is a 44 yo aaf with T2 dm, hld,  htn, cad, hfpef, osa, copd who presents with acute sob and cough.  

For those of you who are not medical, the translation reads:

This is a forty-four year old African-American female with type two diabetes, hyperlipidemia, hypertension, coronary artery disease and heart failure with a preserved ejection fraction, obstructive sleep apnea, chronic  obstructive pulmonary disease who presents with acute shortness of breath and cough. 

If you try to type out all the words and not use acronyms, it takes you a lot more time.  Resident physicians and hospitalists are slaves to the electronic health record (aka EHR) so one cannot blame them for their extensive use of acronyms.  In addition, they are taught to include in their charts all the diagnoses they can come up with for every patient to facilitate accurate coding and billing.

When I entered medicine the medical academics generally were frowning on the frequent use of eponyms—the use of a surname, usually a dead, white, male physician, to describe a medical condition.  For example, Addison’s disease was replaced with adrenal insufficiency, Cushing’s Disease with adrenal hyperplasia and so forth.  Henceforth, acronyms began to reign. Coronary thrombosis was replaced with myocardial infarction which was replaced with MI.

In American English acronyms were seldom employed until they poured into the language from their spawning ground in the allied military of World War II.  They could be spoken words derived from a group of words, such as fubar  (f——d up beyond all recognition) or radar(radio detection and ranging) or they could be pronounced letters like GI (government issue).

Acronyms  are here to stay, both in the military and in medicine.  Yet when I hear a patient described in the manner of the patient above I always get the feeling that the pasta has just been thrown on the wall.   Yet when a medical resident tells me about a relatively young patient with all those specific problems I often ask the resident to cut to the chase and tell me how bad is the obesity of the patient.  And when we get to the bedside, as we did in this case, and find some poor person who is so obese that they can barely walk and breathe, I reflect on how depersonalizing this list of acronyms for disease states are and, in a sense, how inaccurate.  In the case of the above patient she is really an unfortunate lady suffering from hyper obesity and its attendant syndromes of crippling arthritis and…..(acronyms).  She does not have a series of medical problems that struck her from the blue, but a syndromic problem with predictable mechanical and metabolic sequelae. How she copes with all these problems usually does not appear in the record.

In a rush to acronymous description we seem to have abandoned the notion of personhood.  Histories in the past often began with a description of the person within a social context:
This is a forty-two year old hypertensive, moderately obese white man, a warehouse supervisor, married and the father of two children, who developed chest pain while lifting heavy pallets at work this morning. 

Such a description gives us a picture.  He is employed, he has children to worry about, he appears to have a life partner. Considering those issues and embedding them in the record, our literary depiction of the patient is how we embark on knowing the patient.  Acronyms can help us slog through the ravenous demands of an EHR but they can also, singularly pursued, become like bar codes in a check-out line, creating objects out of living and breathing souls.

– Peter S. Kibbe, MD, FHM