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The long and short of it

Friday, 7 March 2014

The long and short of it

Let’s talk about acronyms and abbreviations. These are wonderfully useful devices in the right hands. A good one, like radar or laser can become a word of independent means, a neatly packed holdall of sense that never needs to be opened again.

We no longer need to know, for instance, that “scuba” stands for “self-contained underwater breathing apparatus”. The former helps us survive underwater, the latter is so heavy that we would never make it back to the surface.

Used well, acronyms and abbreviations make life easier. They save precious syllables and they can be fun.

But there are rules. Above all, an acronym or abbreviation needs to be memorable and readily understood. There is no other excuse for making one.

Neither of these rules is followed in the public sector and, sadly, the NHS is among the worst offenders, a world scale producer of pointless and forgettable shortenings, and the source of more painful contractions than a busy maternity ward.

Consult any NHS style guide and it will tell you that any abbreviation should be spelled out in full at first use. It is sensible advice but does not go far enough. The style guide should urge writers simply to stop.

In many NHS documents the author chooses to ignore the “first use” principle and plays it safe by tucking the abbreviation behind every use of a term. Apart from the waste of capital letters and brackets, this practice has the opposite of its intended effect.

If an abbreviation is unmemorable, repetition will not make it stick. Give it up.

You need to recognise when the thing in question doesn’t deserve to be remembered, either because it’s a silly made-up concept (SMUC), a solution in search of a problem (SISOP) or an attempt to make something sound more important than it really is (SMITIRI).

Need to make your half-baked project, programme or "initiative" appear as if you’ve actually given it some thought?  Stick a few initials after it, or better still an acronym. If it’s good enough, people will be so impressed by your ingenuity that they will assume that the millions of pounds you are about to waste are in safe hands.

It is possible to be memorable for the wrong reasons. QIPP is among the most successful acronyms to roll off the NHS production line in recent years, but also one of the silliest. This is partly because it fails to declare its real purpose (saving money), but mainly because it sounds like something you might say to raise a cheap laugh.

Which brings us to the last cardinal rule of acronyms and abbreviations: they are allowed to be humorous, but not unintentionally so – and only if the joke is on someone else.

The leading exponents of the art are IT people who mix technical jargon with coded insults aimed at their customers.

For instance, the technical sounding BDU has nothing to do with silicon but the carbon-based middleware attempting unsuccessfully to interact with it: the Brain Dead User. Similarly, the acronym PICNIC denotes Problem In Chair, Not In Computer.  The error code ID 10T needs no further explanation.

There is hope for the NHS, too. While managers and policy wonks continue think that liberal use of abbreviations gives their dull reports gravitas, those at the business end of health appreciate their comedy value.

If you wake up with a hangover, a surgical dressing and a vague memory of A&E, you may have sustained a UBI (Unexplained Beer Injury), possibly as the result of an alcohol induced AGA (Acute Gravity Attack), otherwise known as a fall. If you keep doing it, you may be diagnosed with a PISA (Permanent and Irrecoverable State of Alcoholism).

A nurse who scribbles CTD on your chart is sharing the news that you are Circling The Drain or, less euphemistically, Close To Death. If a consultant cheerfully declares you to be GPO, don’t be surprised if she leaves an organ donor form and a pen next to your bed. It means Good for Parts Only.

A diagnosis of BUNDY (But Unfortunately Not Dead Yet) means that not only are you on the way out, but that you haven’t made any friends among the staff.

Don’t be fooled by the positive sound of GOK. The doctor is confessing that God Only Knows what’s wrong with you.

On the other hand, OP is not an emphatic warning of major surgery, but good news. It stands for Oscillating Plumbism, the condition colloquially known as swinging the lead. Expect an imminent discharge.

Finally, CARE is not just a healthcare term, but useful career advice for any member of staff worried about management’s capacity for forgiveness: Cover Arse, Remain Employed.

Ed: JP

NB In the interests of good CARE, we have been asked to point out that the practice of making facetious, disrespectful notes about patients is banned in the NHS. We can’t speak for other health services.

Have we missed any? Leave a comment...

Anonymous says:
Mar 07, 2014 11:41 AM
A couple of mental health acronyms: NFB = Normal For Bermondsey; MIU = Making It Up (very similar to 'OP' cited in main text)
Anonymous says:
Mar 07, 2014 12:14 PM
About time too, most of the people who use them have forgotten what the words mean. Particularly as someone who represents patients I find it appalling that the Health Service still insists on producing documents for the public written in gobbledegook. NHS acronyms are a silly waste of time. Health Service people already have a language in common with most of their patients and they should use it.
Hugo Limachi
Hugo Limachi says:
Mar 07, 2014 12:15 PM
Hi, I'm curious about

1. Purpose and value of this news?
2. Who is the receiver?
3. How many reads it?
4. Who is writing this?

You've missed the most important acronyms PGP and TPS, which stands for Productive General Practice and Toyota Production System. You could also have mentioned VMI - Virginia Mason Mason Institute.
Julian Patterson
Julian Patterson says:
Mar 07, 2014 12:21 PM
1. Light relief (see BBC for news)
2/3. You and about 50,000 others
4. Me

Thanks for your interest.
David Foord
David Foord says:
Mar 07, 2014 12:16 PM
I fully agree that the use of acronyms, abbreviation and jargon that is not known to be commonly understood should cease. Please read my last blog which is on this exact subject and contains access to a directory of over 18,800 examples http://directors-diary.blog[…]-for-nhs-change-day-up.html
Mark Aitken
Mark Aitken says:
Mar 07, 2014 12:20 PM
Remember OBE? Not the accolade! When I was a medical student it was the way in which labour could be started and stood for Oil Bath and Enema. The oil being Castor Oil and the Bath being HOT.
Sandre Jones
Sandre Jones says:
Mar 07, 2014 12:57 PM
More than an ample sufficiency here:


Just to reinforce the penultimate para of the article - remember that patients have the right to request sight/copies of their records. Acronyms which may cause embarrassment to the professional who entered them are not specified as a valid reason to exempt disclosure of records to a patient!
Julian Patterson
Julian Patterson says:
Mar 12, 2014 03:18 PM
Sandre, what a fine list (and a sensible caveat to anyone tempted to try any of these out in the wild).
Nick Sargeant
Nick Sargeant says:
Mar 07, 2014 01:11 PM
One particular favourite of mine from an ISTC was 'HTTR' .. High Tattoo to Teeth Ratio
Anonymous says:
Mar 07, 2014 01:13 PM
I love this blog!
So apt that it arrives in my inbox on POETS day!
Anonymous says:
Mar 07, 2014 01:37 PM
A prescription recieed, signed by a GP requesting:
I'll leave you to fill in the words.....
Anonymous says:
Mar 07, 2014 03:10 PM
In the IT world I had not actually heard of PICNIC - I usually say that there is a loose nut on the keyboard. We also get a lot of RTFM problems - Read the flipping (or similar) manual!
Julian Patterson
Julian Patterson says:
Mar 07, 2014 03:16 PM
There's always a loose nut on this one...
Anonymous says:
Mar 07, 2014 03:22 PM
Probably the best one that is current is: The Wessex Area Team!
Anonymous says:
Mar 10, 2014 09:18 AM
I particularly like DTS ..used for the (much)larger patient (Danger to Shipping)
Anant Patel
Anant Patel says:
Mar 10, 2014 12:29 PM
This Is Not A Show Stopper, utlised just before a project goes live, e.g. the 2004 EPR go live
Anonymous says:
Mar 10, 2014 12:30 PM
BOHICA should be familiar to the change-weary....
Bend Over, Here It Comes Again
Tawfique Daneshmend
Tawfique Daneshmend says:
Mar 11, 2014 07:13 AM
JPFROG was not infrequently used by the late Professor Mitchell at Nottingham and stood for Just Plain Flipping Run Out of Gas. Often more apt that the ubiquitous TATT, Tired All The Time.
Anonymous says:
Mar 14, 2014 12:55 PM
GPO-'good for parts only'
Anonymous says:
Mar 28, 2014 09:22 AM
There's something to be said for the Sexual Health Advisory Group which a colleague, dare I say, sits on. That was either a decision by Committee or someone with a wicked sense of humour