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What They Didn’t Tell You in Medic School

I hope MADD (Mothers Against Drunk Drivers) doesn’t get offended that I’ve modified their abbreviation, but it really drives home my point regarding the rampant abuse of alphanumeric shrinkage.

Don’t get me wrong. Acronyms (aka, Abbreviated Coded Rendition Of Name Yielding Meaning) allow us to quickly package complex ideas into a small space. They save us from having to repeat complete words and phrases. And, I use them all the time in this column to save my publisher ink—even though I’m SOL when it comes to getting a raise for this cost-saving effort.

Acronyms work well if everyone knows what they stand for, but there are so many now that it’s hard to keep up. For example, I once thought “TMS” on a patient chart meant “The Muppet Show” instead of “Transcranial Magnetic Simulation.”

Some medically related acronyms cleverly use the same letter repeatedly, such as AAAAA (American Association Against Acronym Abuse). This makes it almost impossible to remember what the acronym stands for. It’s easiest to remember acronyms that sound like words, such as CHAOS (Chief Has Arrived On Scene) or KISS (Keep It Simple Stupid).

That brings me to my next point. I think acronyms are getting too long and convoluted. Do you remember when an MI was just an MI? Now it’s a STEMI (ST-Elevation Myocardial Infarction). Not only that, but that acronym now also goes within another one—SRCs are STEMI Receiving Centers.

We no longer say, “I got pulses,” after successfully defibrillating a patient. Now you have a ROSC ACAPP (Return of Spontaneous Circulation with Adequate Coronary Artery Perfusion Pressure). In defense of the CACs (Cardiac Acronym Creators), we’ve come a long way from CPR (Can’t Possibly Recover) to actual CPR (Cardiopulmonary Resuscitation).

Medical acronyms should be limited to two or three letters. Otherwise they should be labeled as SFLAs (Stupid Four-Letter Acronyms). A special note here: An “F” in any acronym is up for interpretation. This may not be a very professional attitude, but WTF are you going to do about it?

Other medical forms of calligraphic contracture can be confused with everyday abbreviations, such as TIA (Transient Ischemic Attack) versus Joe Q. Public’s version of TIA (Thanks In Advance), LMA (Laryngeal Mask Airway) versus (Leave Me Alone) or SOB (Shortness Of Breath) versus … well, you know.

Sometimes we create mnemonic acronyms to help us treat patients, but what GMH (Gripes My Hide) is when they expect you to know them by the exact wording as you’re being tested. During one airway management practical, I forgot what the mnemonics LEMON, MOANS and SHORT stood for. It didn’t matter that I knew all the contra-indications and appropriate maneuvers for airway management, so I had to take a WAG (Wild A** Guess).

Of course, there’s a multitude of colorful abbreviations to describe patients and health-care professionals in a less-than-positive light. Often, such medical slang is perceived as unethical and insulting. Yet some of us argue that it can serve as a protective function. Restricted to oral use only, it can create a unique sense of identity and bonding.
 
Instead of using the well-known “DOA,” a medic may use DIC (Death Is Coming), AGMI (Ain’t Gonna Make It), FTD (Fixing To Die), ART (Assuming Room Temperature), ADD (All Done Dancing) or WUD (Woke Up Dead).

Some may wonder why we have so many death-related acronyms. I believe it’s because laughing at what hurts us can give a sense of control in an often hopeless situation. I’ve seen it break the tension that came with therapeutic failure.

Uncooperative or inebriated patients are also common targets. A problem develops, however, when one actually believe the meaning behind the acronyms. I find no humor in acronyms that poke fun of the elderly. Maybe that’s because I’ve heard them being said by too many who believe the acronym.

So, if you’re gonna take a jab at someone with one of these merciless acronyms, you’d better be willing to have it come right back at you. I can laugh at myself when I hear the acronym IJADAD (I’m Just a Dumb Ambulance Driver). I’m secure enough in what I do, and how I do it, to not have an AHF (Acute Hissy Fit)—either that or I’m just TOTC (Too Old To Care).

Until next time, SSMFs (Stay Safe My Friends). JEMS

This article originally appeared in May 2010 JEMS as MAAD:Medics Against Acronym Desecration.



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