Where X Stands for Everything

Medical students and doctors have this nasty habit of using the letter “x” to stand for anything and everything. To illustrate:

An intern sees a Px in the ER, elicits pertinent SSx, and writes his clinical Hx in the chart. The resident-in-charge examines the Px and subsequently orders Dx and Tx, which include getting a CXR to check for a possible rib Fx. Seeing that the Px might be suffering from an acute appendicitis, the receiving physician then refers the Px to a Sx resident for further Mx.

We see these in clinical abstracts, chart entries, case reports, and even in Powerpoint presentations during department conferences. This widespread, indiscriminate use of the 24th letter of the alphabet has — to the dismay of grammar Nazis — gained some degree of acceptance nobody seems to mind them anymore, even on legal documents.

This is jejemon culture in the medical field.

What is wrong with saving a few strokes of your handwriting or a few taps on your laptop or iPad?

Medicine is an exact science. Or at least, it aims to be. We try to look for the diagnosis that explains all of the patient’s signs and symptoms. We are taught to study a disease’s pathophysiology so that we can institute the treatment that will be most beneficial to a specific individual. Nothing should be left to guesswork. There is no room for trial and error because somebody’s life will always be at stake.

If it would only take a few more strokes of your barely legible handwriting, or a few more taps on your high-tech device, why would you want to use abbreviations and risk being misinterpreted by the next health care worker who handles your patient?

You could argue that these abbreviations are well known anyway, and the probability of these being misinterpreted in any health care facility is probably close to nil. I would agree, but I would also say that is a lousy excuse for a habit that risks patient safety for a physician’s convenience.

It reflects character unbecoming of heath care professionals. Are we always in such a hurry that we cannot even write our p(atients’) h(istories) documenting their s(igns) and s(ymptoms) properly anymore?

As medical students, it took us hours to interview and examine a single patient. We made sure that our histories contained the exact date, time, and sequence of events, that our review of systems covered every symptom, and that our physical examination documented every macule, papule, patch, and plaque. It took an entire night to come up with a decent case discussion.

As we move up the health care ladder and begin to see more and more patients, the common trend is to spend less and less time with each of them. Of course no doctor would admit that. The communal excuse is that we already know the pertinent questions to ask and the pertinent physical examination maneuvers to perform, hence, the substantial reduction in patient-physician interaction.

But do we really?

How much time is enough time with each patient?

In the last three months, I have had to do rounds on twenty to thirty patients each day. The daily goal has been to start at 4:30 am, so that I can go to the operating room at 6:30 am. That’s an average of 5 to 8 minutes for each patient (double that for patients in the intensive care unit).

Despite my growing sleep deficit, I feel that the time spent at each bedside is not enough. In between each “Good morning, Dr. Baticulon po ako” and “Sige po, sabihan ninyo na lang ang mga nurses kapag may problema po kayo” I sometimes wonder how many pertinent symptoms I have failed to elicit or how many misdiagnoses I have made, only because I have not had enough time to sit down and listen more carefully to each of them. To be quite honest, I would rather not count.

Instead, I make a conscientious effort to spell out my chart orders and discard the unnecessary X’s. Many frown upon the widespread use of abbreviations in mobile devices. How much more in a patient’s health record?