At my clinic there are no shortage of abbreviations. I thought that I was learning a whole new language when I started nursing school (I mean really, does this sentence make any sense to you: “Pt denies LOF, VB, +FM. Cx 1-2/50%/Floating”?)
Once I had learned the language of nursing and midwifery, I learned that in my particular clinic, there are abbreviations for everything. I mean everything. Every type of office visit has its own 3 letter abbreviation after the patient’s name to tell me why that patient is coming in that day.
Now what’s the difference between an STI and an STX? Or what about a BCS versus a BCM? PWW? PWW–FPW? Or an IUC versus an IUD? Why, for the love of all that is holy, all of the categorizing every type of visit into some sort of subset category?
I wrote a while ago about taking histories and asking open ended questions. Asking patients to explain their own level of knowledge prior to discussing a subject is something that is laid out like Nursing 101. If there is ever a first step question on the NCLEX, we are all told, choose the one that says “Assess readiness to learn and knowledge about the subject”
With all these abbreviations, and even most of the time a report from the medical assistant about what the patient’s main issue is that day, I always find it helpful to open with, “What brings you in today?”
It is literally the broadest thing that one could ask. Sometimes patients are frustrated by this question. They have already told the medical assistant why they are there. Many have already filled out paperwork and been asked why they are there already, and even have described their symptoms. But I want to hear it again. What a pain, right?
Well, it makes a big difference, especially in sexual health, an area so shamed and so stigmatized. Sometimes it takes many open ended questions to really get to the bottom of why the patient is there, or make them feel comfortable enough to tell you, that, you know what, it actually has been burning when I pee for the past month and I’m really scared.
Sometimes I make assumptions about why a patient is there, what symptoms they are having, and, I admit, when I see, “pt complains of discharge and itching x 1 wk” I practically have a script for an anti-yeast infection pill written.
And sometimes, I’m right. Sometimes having all these categories pre-determined for me, and having someone else ask about symptoms and other problems before me helps me do my job faster. And that’s a great and necessary thing when you see 25 patients in a day.
But sometimes, you have to take a step back.
Your patient is not a PWW. They’re a 22 year old woman shivering on your table because its her first periodic well woman exam and she has lots of questions about what it will be like.
Your patient is not just a BCM, she’s a woman who has been on birth control pills for a long time, but doesn’t know that she’s a really excellent candidate for an IUD.
I secretly love and hate all the abbreviations, they make my life easier but sometimes harder in a lot of ways. But alas, my daily exercise of finding contradictions in the working midwifery world never seems to be done.