Medical Jargon: A Hospital's Unseen Danger

Medical errors are a common cause of injury or death, with an estimated 44,000 to 98,000 preventable deaths occurring in US hospitals each year. One factor contributing to these mistakes is the use of confusing medical terminology. Medical terminology can be complex and difficult to grasp, and errors in its use, such as incorrect terms, misspelling, and ambiguous abbreviations, can have serious consequences for patients. For example, the abbreviation q.d. meaning once daily can be mistaken for q.i.d., meaning four times daily, potentially leading to an overdose. Similarly, mishearing or confusing terms like epigastric and hypogastric can result in surgery being performed on the wrong part of the body. These issues are exacerbated by factors such as language barriers, limited health literacy, and a lack of clear communication between healthcare providers and patients. Addressing these challenges through improved training, standardised communication systems, and the use of cognitive aids can help reduce the incidence of medical errors and improve patient safety.

Misinterpretation of medical abbreviations

Medical terminology errors are a significant contributor to hospital mistakes, and the misinterpretation of medical abbreviations is a key factor in this issue. While the use of abbreviations in medicine is not new, with a history spanning nearly 200 years, their misuse or misunderstanding can lead to serious consequences for patients.

Medical abbreviations are prevalent across all departments within hospitals, including medical and surgical departments, the emergency room, and at discharge. They are routinely used in medical charts, drug prescriptions, and patient medical records. Abbreviations are favoured by healthcare professionals as they save time, fit into small spaces, and reduce the risk of misspelling. However, their ambiguous nature can lead to misinterpretation and errors in communication. For example, the abbreviation "AD" means the right ear, while "AU" means both ears. Misinterpreting these abbreviations could lead to an operation being performed on the wrong side of the body.

Another example is the abbreviation "q.d.", which means "once daily". This can be misinterpreted as "q.i.d.", meaning "four times daily", potentially causing a patient to take four times the recommended dose and risking serious harm. Similar issues arise with the abbreviations "Q.O.D." (every other day), "I.U." (international unit), and "I.V." (intravenous). The placement or omission of a decimal point can also lead to incorrect dosages, with "5.0" often misread as "50", resulting in a tenfold overdose.

The use of non-standard abbreviations further exacerbates the problem. Healthcare workers have been known to create their own abbreviations, leading to a growing number of ambiguous terms. A survey found that only 20% of the abbreviations had more than 50% of volunteers providing the intended definition, with an overall mean score of just 32%. This highlights the potential for misinterpretation, especially among junior staff who may be unfamiliar with certain abbreviations.

To mitigate these issues, healthcare leaders have advocated for reduced use or elimination of medical abbreviations. Standardisation and regulation of abbreviations are necessary to minimise misinterpretation and improve patient safety.

Confusion over similar-sounding terms

For example, the prefixes "endo-", "epi-", and "hypo-" all refer to different parts of the stomach: endogastric means inside the stomach, epigastric means above the stomach, and hypogastric means below the stomach. If a medical assistant mishears or forgets the correct term, they might record the wrong information, leading to a patient receiving surgery on the wrong part of their body. Similar-sounding terms like "dysphagia" (difficulty swallowing) and "dysphasia" (impairment of speech) can also be confused, resulting in incorrect diagnoses or treatments.

Abbreviations are commonly used in medical settings to save time and increase efficiency. However, they can also lead to mistakes when misinterpreted or used incorrectly. For instance, "AD" means the right ear, while "AU" means both ears. Confusing these abbreviations could lead to a procedure being performed on the wrong side of the body. Additionally, the abbreviation "q.d." ("quaque die") means once daily, but it can be mistaken for "q.i.d." ("quarter in die"), meaning four times daily. This confusion could result in a patient receiving four times the recommended dosage, potentially causing serious harm.

Language barriers and low health literacy among patients can also contribute to confusion and mistakes. Patients may struggle to understand complex medical terminology, especially if English is not their first language. This can lead to misunderstandings about their condition, treatment plan, or medication instructions, increasing the risk of adverse events.

To mitigate these issues, healthcare professionals should prioritize clear and concise communication with patients and each other. Standardizing medical terminology and implementing rigorous training and education can help reduce errors caused by similar-sounding terms and abbreviations. Additionally, encouraging a culture of error reporting without fear of punishment can help identify problem areas and implement corrective measures to improve patient safety.

Lack of health literacy

Health literacy is defined as the "degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions" (Nielsen-Bohlman et al., 2004). Limited health literacy can have severe negative implications, causing worsened health outcomes, straining the healthcare system, and increasing costs.

A study conducted in two urban tertiary care hospitals found that only half of the patients admitted to the general internal medicine unit had adequate health literacy. Patients with inadequate health literacy were more likely to revisit the emergency department compared to those with adequate health literacy. This trend was particularly notable among patients with high education levels but low health literacy, indicating that educational attainment is not a sufficient indicator of health literacy.

Low health literacy is associated with more hospitalizations, greater use of emergency care, decreased use of preventive services, poorer interpretation of health messages, and higher mortality rates. It can impair patients' understanding of their disease, treatment, and healthcare decision-making, leading to delayed diagnoses and poorer outcomes. For example, women with low health literacy are less likely to undergo mammography screening and are more prone to making suboptimal decisions regarding their breast cancer treatment.

Despite the significance of health literacy, it is often not evaluated or recorded in patients' medical records, and physicians may be unaware of their patients' health literacy levels. This lack of assessment can hinder patient-physician communication and contribute to adverse outcomes.

To address these challenges, healthcare providers, hospital systems, and health plans can play a pivotal role in promoting health literacy. They can equip patients with clear, relevant, and useful health information, utilizing plain language principles and improving both written and verbal communication. Strengthening health literacy at the organizational level is vital for advancing health equity and fostering deeper engagement with patients and communities.

Language barriers

Medical terminology errors can lead to incorrect prescriptions, misdiagnoses, and even surgeries performed on the wrong body parts or locations. For example, the prefixes "hypo" and "epigastric" refer to different parts of the stomach, and mixing them up could result in surgery being performed on the wrong area. Similarly, abbreviations like "AD" for the right ear and "AU" for both ears can easily be confused, leading to procedures being carried out on the incorrect side of the body.

In addition to the inherent complexity of medical terminology, language barriers can also arise from differences in cultural backgrounds, levels of education, and health literacy among patients and healthcare providers. For instance, providing medication instructions in English to a patient who has limited English proficiency could lead to misunderstandings and non-adherence.

To address these issues, healthcare providers should prioritize clear and concise communication with patients, ensuring they understand their medical conditions, treatments, and instructions. Simplifying medical terminology, when possible, and providing explanations in a patient's native language or using visual aids can help improve understanding and reduce errors.

Furthermore, standardizing communication systems and implementing rigorous training programs for healthcare professionals can help ensure consistent and accurate usage across the industry. By addressing language barriers and improving health literacy, hospitals can significantly reduce the risk of mistakes and improve patient safety.

Inadequate training

In other cases, inadequate training can lead to a lack of understanding of medical abbreviations, which are commonly used in healthcare settings to save time and increase efficiency. However, when abbreviations are misused or misunderstood, they can lead to dangerous misinterpretations and wrong prescriptions. For instance, the abbreviation "q.d." meaning "once daily" can be mistaken for "q.i.d.," which means "four times daily," potentially causing a patient to take four times the recommended dose.

Furthermore, inadequate training can result in a lack of critical thinking skills and overconfidence among healthcare professionals. This can lead to a failure to identify and correct errors, especially in cases with obscure clinical findings or unexpected trajectories. For example, a medical assistant who is unfamiliar with the terms "epigastric" and "hypogastric" may mishear or confuse them, resulting in surgery being performed on the wrong part of the stomach.

Additionally, inadequate training can contribute to diagnostic errors, which are the leading cause of medical errors in outpatient facilities. Insufficient training in recognizing and interpreting symptoms, as well as a lack of familiarity with rare or complex conditions, can lead to delayed or mistaken diagnoses, which can have traumatic consequences for patients and their families.

To address these issues, healthcare institutions should focus on providing comprehensive training programs that cover medical terminology, abbreviations, and their practical applications. Encouraging critical thinking, fostering a culture of continuous learning, and implementing regular skill assessments can help ensure that healthcare professionals are well-equipped to avoid mistakes arising from inadequate training.

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