After almost 10 years off the bench, and out of the lab, I found myself in training for a chemistry analyzer.  I was among active chemistry technologists and supervisors. And there I sat, 15 years of microbiology bench experience, 2 years of experience in research and development, and almost 10 years out of the field.  Boy, was I like a fish-out-of-water.  But being a strong-minded person, I buckled into my seat and prepared for the ride of my life.  This was it.  I was about to become…A Chemistry Tech.

This wasn’t the first time I was exposed to Clinical Chemistry.  I took a class in my A.A.S. program for Medical Laboratory Technician… 25 years ago.  I studied Clinical Chemistry for the ASCP Board of Registry – 25 years ago – and passed.  I had Bio-Chemistry and Organic Chemistry in my B.S program – almost 20 years ago.  This would be a breeze.

The first two hours were easy.  It started with a brief review of the analyzer, an introduction to the test menu, and some method review.  It was coming back to me.  I was feeling pretty good.

After a brief break, we dove right into daily operations and quality control. My confidence was up, and I was sitting taller. I had this under control.  What I didn’t “know” was coming back to my recall memory.

As the trainer discussed the morning start-up procedure, the trouble began.  The first thing we had to do was an ABS Check.  Uh oh!  What did that mean?  ABS.  I didn’t remember.  Did I ever know it?  I was starting to panic.  I didn’t want to look like a fool among these seasoned chemistry minds, but I didn’t know.

As the training went by, I looked for context clues.  There had to be something that would trigger a memory or provide the definition.  Nothing was helping.

My husband, an automotive technology instructor, would have the answer right away.  ABS – Antilock Brake System.  Perfect.  On my chemistry analyzer, I perform a daily check of the Antilock Brake System.  Not quite. I was smart enough to know that would never fit.

After most of the day passed, I finally found the courage to raise my hand and ask.  “Excuse me.  I have been trying all day, but I cannot go on without knowing…What does ABS mean?”  The instructor paused, and responded.  “Absorption.  This analyzer contains a spectrophotometer, and you must check the absorption every day.”  And there it was.  The answer so simple, to everyone but me.

I laugh about it now, but this is a real problem in health care, and in other industries, where acronyms and initialisms are part of everyday language.

So what is an acronym?  When first letters from a series of words or a phrase are taken up to make a pronounceable word, it is called as an acronym. Some acronyms, like NASA (National Aeronautics and Space Administration) and RADAR (Radio Detection and Ranging) are used so frequently and universally, they have been added to the dictionary and are now considered words themselves.

Initialism is another way to shorten or abbreviate a long word or a series of words. The Federal Bureau of Investigations, (FBI) is one such abbreviation. Since the shortened phrase is not pronounceable, it is initialism, not an acronym.  We know instantly what is meant by IT (Information Technology) and USA (United States of America), but we wouldn’t try to pronounce them.

Acronyms and initialisms are difficult enough to learn when you are new to the industry.  But when they are reused or are not obvious, it is even worse.

For the early part of my career, I worked in Microbiology.  Here, we all understood that FOB represents the Fecal Occult Blood test. In my transition to Laboratory Manager in an OBGYN group, I became confused when I saw FOB regularly in charts of pregnant patients.  The idea of checking them all for Fecal Occult Blood didn’t make sense.  Once I was educated that FOB (Father of the Baby) has significant meaning, I understood.

Recently, I found myself in a conversation about the BUN.  The nurse couldn’t find it on the laboratory slip.  She asked if it could be added.  After a labored and anxious conversation, I realized that she was looking under “B” and not under “U” for Urea Nitrogen.

The Joint Commission (initialism – TJC), formerly known as JCAHO (acronym pronounced JAY-CO) warns of the dangers of acronyms in medicine. I find this ironic given the nature of their recent name change. But their concern is not without merit. Errors in medicine are the 4th leading cause of death.  The danger is so real that they published a list of “don’t use” acronyms/initialisms that are known to cause confusion which could lead to an error.  Among the list, I found a few that were particularly enlightening.

IU – International Units – can be confused with IV – IntraVenous or with the number 10

D/C – shown to mean both discharge and discontinue depending on the context

But my favorite comes from a different list…

DOA – Date of Admission or Dead on Arrival – these two couldn’t be much further from equal. And I would hate to see what would happen if they were confused.

Acronyms and initialism are part of everyday speech.  Whether at work or in a text message conversation with your child, you cannot escape them.  Many comedians have skits centered on errors and confusion caused by acronyms and initialism.  Facebook is full of quips and cartoons about them.  But the danger is real.

I challenge you to look around your lab, your hospital and your home.  What acronyms and initialisms are you using daily? Does your audience know the meaning? Or are they left to wonder and assume?  Like me, do you live in a world where double meanings and reused acronyms add to the confusion?  I am curious to know. RSVP in the comment section. I will check back ASAP.

And in the words of TIGGER, my favorite Winnie the Pooh Character…

TTFN – Ta Ta For Now!