Acronymics Anonymous (AA)

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Jack Barrette of Yahoo! wrote in a letter to the editor (MM&M, May 2006): "We live in a world of consumers deeply engaged in their health."

That may be true, but there are stumbling blocks.

The other day a family friend called to say that she'd been told she needed open-heart surgery. Not wanting to practice medicine, but knowing the mindset of cardiac surgeons, I asked a neutral question: Had she asked about alternative treatments?

“Oh no, I was confused enough. He kept talking about cabbage.”

CABG meant bypass procedure to the doctor; to his patient it was vegetable gibberish. But to save a few seconds, we all fall into the trap of using abbreviations or acronyms even though they often interfere with clear communication. Just look at the package inserts in PDR (there I go), and see how many of them are salted with capitalized initials, which all too often creep into patient information pamphlets and PPIs (that's patient package inserts).

Or take these examples from a recent article in JAMA (OK, some abbreviations take the place of the original name): BMT, RID, SCID, MMRD, HLA, MUD—a clear case of abbreviationitis, and that was just from the abstract.

But, I wondered: Wouldn't doctors know what all this means? Then, thanks to the gods of serendipity, I got the answer, for the same day I was writing this the FDA announced that it was launching a nationwide educational campaign aimed at reducing medication mix-ups caused by the use of  abbreviations. (And later that day, just to confirm that indeed there is a problem, the agency sent out a second release “to clarify” a mix-up in the original. )

True, most abbreviations are spelled out when first used, but am I the only one who tends to scan articles and often skips the throat-clearing beginnings? That means having to go back to find the explanation…or giving up and saying the hell with it. That's when the inclusion of a  glossary would help.

In the interest of full disclosure, let's admit that marketing publications such as ours are not without blame. Selective Serotonin Uptake Inhibitors is undoubtedly a mouthful. But in a table of drug categories, does every reader recognize SSRI? Or PPI (in this context, adding to the confusion, it means Proton Pump Inhibitors).

The new Medicare drug benefit legislation has brought with it a whole slew of abbreviations that are not always defined. There's the law itself. Who would have guessed that MMA stands for Medicare Prescription Drug, Improvement and Modernization Act? CMS we've come to recognize (and fear). But how about PDPs—those Prescription Drug Plans that threaten to undermine the industry's pricing policies and which, CMS has charged, don't even always abide by the regulations regarding their members' rights.  

My point is not merely that capitalized shortcuts are often annoying. It's that—as the FDA has come to realize—they often interfere with clear communication. In the words of commissioner Andrew von Eschenbach, they may lead to “mistakes that result in patient harm.”

If we're serious about inviting patients to become partners in making decisions about their  health, and making sure doctors don't make mistakes, we'd better make sure they understand what we're saying. Step one is not to become players in NCAA (Needless Confusion due to Abbreviation Abuse).  

Warren Ross is MM&M's editor at large

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