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Joel Diamond 6/2/09

June 2, 2009 News 12 Comments

Controlled Medical Vocabularies

In my last post, I discussed how our current coding systems just don’t suit the needs of everyday working physicians. For some reason, it got me all nostalgic for the good old days of paper records. Nothing like curling up in front of the fireplace with an old novel. Ahh … the texture, the smell …

OK, the reality of paper charts: falling apart, disorganized, and an odor best characterized by the last body orifice examined.

My EMR records are so much more complete and accurate, yet I will admit that there are subtleties that are often lost. For instance, my long-since retired, older partner was fond of writing F.I on the front of certain patients’ charts. This was to boldly remind him that a patient was a “(expletive deleted) idiot”. I remember when I first went into practice, one of his patients was staring at the outside of her chart while I was talking. “Dr. Diamond”, she asked, “what does F.I. mean on my chart?” Thinking quickly, I blurted out that my aging partner liked to label only the charts of his favorite patients, designating them as “fine individuals”.

Then there are the long-lost abbreviations written in the margins of countless charts — meant to convey a certain nuance that is sadly missed in today’s templated notes. Most of us fondly remember the sign-off on complicated VA patients: AMF YOYO– an encouraging “adios, mother (expletive), you’re on your own”. The essence of a patient’s condition could often be wrapped in the gallows humor of a cryptic abbreviation: ART (assuming room temperature), FTD (fixing to die), or an order for PBAB (pine box at bedside).

The term SWAG written next to a differential diagnosis conveyed to the reader that this was just a “scientific, wild-ass guess”. The conclusion to a discharge summary, TTGA (told to go away) somehow told the real story. An opening description such as LOLINAD (little old lady in no acute distress) will be missed as much as the politically incorrect description of the pediatric patient’s parent, GLM (good-looking mom).

Don’t get me wrong, I strongly advocate the use of CMT (controlled medical vocabularies). Codifying information in reproducible terminology is necessary for a true longitudinal record, which can be used for analytics and research and effectively allows communication amongst the health care team.

It’s just that some days, I miss chuckling as I enter the exam room — wondering how I’d explain my old partner’s unabashed label of his opinionated and misinformed patient as ABITHAD (another blithering idiot, thinks he’s a doctor).

Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh, and a practicing physician at UPMC and of the Handelsman Family Practice in Pittsburgh, PA. He also blogs on interoperability.

Currently there are "12 comments" on this Article:

  1. PMR GUY says:

    This is great, Joel. I have
    some nurse friends that work
    In E/R that would write DND (damn near dead) or FPS (poor fashion sense) as a way
    to lighten the day. Until there was a chart audit…..

  2. anon says:

    My favorite is the ED acronym SOCMOB.

    SOCMOB is what patients who show up in the ER were doing just before they were shot.

    Standing On The Corner Minding My Own Business.

  3. anon says:

    Joel’s is skirting an important point.

    Notes that are developed based on templates can hide the nugget of critical thinking that is the real value that the physician is providing.

    Our new EHR’s must offer an easy way for physicians to highlight their unique critical thought that has led to their conclusions and the resulting care plans.

    Templates don’t do that, and the result is a standardized, but less useful note.

  4. Former Med Rec Mgr says:

    I once worked in a cardiology clinic medical records department and we had some physicians and nurses who were masters at this craft as well. My favorite, but not so subtle one, was a red lightening bolt stamp on the front of the chart to indicate “difficult” patients…their version of F.I.

    Good read, Dr. Diamond. Thanks.

  5. Pookie says:

    Joel, that is SFAS! (Some funny azzed sh!t!)

  6. Frank Marino says:

    Our first client (~25 years ago!) had an acronym similar to FI – PITA, for Pain In The Neck.

  7. SouthSider says:

    Here’s an abbreviation that was used by some alpha/beta clients whenever a new “patch” was applied to their application…BOHICA: “Bend Over Here It Comes Again!”

  8. Dr F Howard Fine says:

    Thanks for another good piece. Others to add GOMER(get out of my emergency room), FLK (funny looking kid) and for patients not respinding to medical intervention: CTD (circling the drain)

  9. emrguru says:

    As you and the commenters seem to agree, among all the requirements for the ‘perfect emr” one must add chart cover notes. My emr clients have places to put patient characteristics and habits (lets be kind) so they are not in any chart “document” but rather associated with the patient record for use by those in the practice. This is an critical need in the pain mgt specialty. These and other little useability features are what will eventually help make emr productive for more practices.

  10. canoehead says:

    Is that like our drugseeker recipe card system in the ER? Only there unofficially, and never spoken of.

  11. Cassis says:

    What does it mean when there is an underlined “R” on the front of your chart? I went to the doctor today, noticed it on my chart, and thought IMMEDIATELY of this article. Please fill me in if you know!

  12. Wendy says:

    You just have to be careful that after you establised your patient is GON (going on nuts) they don’t start questioning their STD status

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