Pitfalls in Medical Terminology

Back in 2008, I posted a list of medical terms that are easily confused, such as ileum (part of small intestine), and ilium (a pelvic bone). Medical transcriptionists and healthcare workers who input chart data (i.e., just about everybody), should be aware of medical term-pairs that have nearly the same orthography, are often pronounced identically, and have completely different meanings. These words are not picked up by spell checkers (because they are not misspelled). You can avoid such errors if you know what to look for.

Since 2008, there have been many updates to the list:

acinic, actinic
anisakiasis, anisokaryosis
aptotic, apoptotic
arboreal, aboriginal
arteritis, arthritis
auxilliary, axillary
brachial, brachium, branchial
callous, callus
causality, casualty
chlorpropamide, chlorpromazine
chondroid, chordoid
chondroma, chordoma
chorionic, chronic
cingula, singular
coitus, colitis
colic, colonic
colitis, coitus
costal, coastal
cryptogam, cryptogram
cygnet, signet
decease, disease
deceased, desist
digitate, digitize
dioecious, deciduous
diploic, diploid
disc, disk
disease, decease
diseased, deceased
dyskaryosis, dyskeratosis
dysphasia, dysphagia
ectatic, ecstatic
endochondral, enchondral (these are synonyms)
engram, n-gram, ngram
epistasis, epistaxis, epitaxis (the last is a misspelling of the second)
exxon, exon
facial, fascial
facies, faeces
fetal, fatal
firearm, forearm
foreword, forward
hallux, helicis
helicis, hallux
herpetic, herpangina
hydatid, hydatidiform
ileitis, iliitis
ileum, ilium
insular, insulin
intercostal, intercoastal
intubation, incubation
isotope, isotrope
kerasin, kerosene, keratin
keratotic, keratinic, actinic
keratinocytic, keratinolytic
keratosis, ketosis
lipoma, lymphoma
lumbar, lumber
malleolus, malleus
metachronous, metacrinus
milia, milium
miotic, mitotic, meiotic
mitosis, meiosis, myosis, myiasis
monogenic, monogenetic, and Monogenetic (last, related to class Monogenea)
mucous, mucus
myelofibrosis, myofibrosis
myofibroma, myelofibroma
neuroplastic, neoplastic
nucleus, nucleolus
oncocyte, onychocyte
oncology, ontology, ontogeny
organic, organoid
palatal, palatial
paleodontology, paleontology
palette, palate
palpation, palpitation
parasite, pericyte
parental, parenteral
pathogen, parthenogen
pathogenesis, parthenogenesis
pathogenic, pathogenetic (these two are synonyms)
penal, penile, pineal, panel
penicillamine, penicillin
perineal, peroneal, perianal
pleiotropic, pleiotrophic, pleiotypic (the first two are synonyms)
plural, pleural
porphyria, porphyruria
proptosis, ptosis
prostrate, prostate
protuberant, protruberant (the second term is simply a common misspelling)
quinine, quinidine
rachischisis, rachitis, rachischitic, rachitic
radial, radical
relics, relicts
reticle, reticule, radical
rett, ret
rosacea, rosea
semantic, somatic
serous, serious
silicon, silicone
singleton, singultus
sinusitis, synositis
somatic, semantic
sonography, stenography
taenia, tinea
takoma, trachoma
thecoma, thekeoma
torsion, distortion
trachoma, trachea
trichina, trachoma, trichura
trichinosis, trichosis, trichuriasis
trichrome, trichome
trochlear, tracheal
troglobite, troglodyte, trilobite
tuberous sclerosis, tuberculosis
tunicate, tourniquet
urethral, ureteral
vagitis, vaginitis
venous, venus

If you know the meaning of half of the terms in this list, you have a good grasp of medical terminology; but please don't settle for half measures. Physicians, nurses, chart reviewers, and medical transcriptionists should be aware of the correct meaning of each alternate word in these listed pairs.

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In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

- Jules J. Berman, Ph.D., M.D. tags: common disease, orphan disease, orphan drugs, rare disease, medical terminology, medical errors, malaprop, malapropism, definition, confusing terms, confused medical terms, medical definitions, medical transcription, nomenclature, terminology, transcription errors, transcription mistakes, EMR, EHR, electronic medical record, electronic chart, electronic health record, avoidable errors, avoidable mistakes, sources of confusion, sources of error, common mistakes, common sources of confusion

Diagnostic errors in medicine: excellent paper

On January 10, I wrote a blog on medical errors.

This month, an excellent paper came out on the subject of diagnostic errors.

This citation

Volume 121, Issue 5, Supplement, Pages S2-S23 (May 2008)
Overconfidence as a Cause of Diagnostic Error in Medicine
Eta S. Berner, Mark L. Graber


The authors concentrate on doctor overconfidence. The paper indicates that doctors seldom follow published medical guidelines, seldom refer to books, seldom refer to general omputer-based diagnostic aids, and have a more-or-less reflexive approach to diagnosis. Not surprisingly, the authors' review of the literature also indicates that diagnostic accuracy has not improved much over the decades.

None of this is surprising. A prior publication indicates that many doctors and nurses (less so nurses than doctors) do not wash their hands when they should (See: Lipsett PA, Swoboda SM. Handwashing compliance depends on professional status. Surg Infect (Larchmt). 2(3):241-245, 2001). Some of the most vicious hospital outbreaks of antibiotic-resistant organisms are exacerbated by inadequate handwashing among hospital staff. If doctors can't be bothered to wash their hands, how can you expect them to be responsible in the more demanding areas of patient care?

A prior blog was focused on "failure to rescue". "Failure to rescue" - the failure of hospital staff to recognized and act upon developed symptoms and signs that require immediate action to stem a cascade of events that can lead to death - is a bigger problem than misdiagnosis. Most misdiagnoses resolve in one way or another without leading to a patient's death (the patient gets better despite the misdiagnosis, the patient goes to another doctor who makes the correct diagnosis, the patient's disease is not amenable to treatment whether diagnosed correctly or incorrectly, and so on).

I encourage physicians and other patient-care professionals to read these articles. Understanding the source of medical errors is a good start towards improving care.

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In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

- Jules J. Berman, Ph.D., M.D. tags: common disease, orphan disease, orphan drugs, rare disease, subsets of disease, disease genetics, errors, handwashing, physicians, standard of care, cad, hand-washing

JCAHO policy on abbreviations

Effective January 1, 2004, hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) were required to exclude certain types of abbreviations from hand-written medical records.

As yet (to the best of my knowledge), there is no equivalent ruling for the realm of electronic medical records. Electronic records provide enormous opportunity for the creation and propagation of miscommunications that can lead to medical errors.

Trailing and leading zeros, micrograms (mcg, not µg) and units (units, not U) are issues that can be easily solved in an electronic record. Abbreviations with alternate expansions (discussed in a prior blog , are due for a remedy.

Despite advances in text processing software, no computational algorithms now exist that can accurately expand polysemous abbreviations from their sentence context. Polysemous abbreviations (abbreviations with alternate expansions) must be accompanied by their correct expansions in order to be understood correctly. Text markup languages (HTML, XML RDF) all support this kind of annotation. In HTML, there is evan a designated tag just for abbreviations:

http://www.w3schools.com/tags/tag_abbr.asp

Reports can be viewed to "show tags" or "hide tags" for the convenience of readers.

These kinds of solutions should be easy to implement in EMRs (Electronic Medical Records).

-Jules Berman

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Science is not a collection of facts. Science is what facts teach us; what we can learn about our universe, and ourselves, by deductive thinking. From observations of the night sky, made without the aid of telescopes, we can deduce that the universe is expanding, that the universe is not infinitely old, and why black holes exist. Without resorting to experimentation or mathematical analysis, we can deduce that gravity is a curvature in space-time, that the particles that compose light have no mass, that there is a theoretical limit to the number of different elements in the universe, and that the earth is billions of years old. Likewise, simple observations on animals tell us much about the migration of continents, the evolutionary relationships among classes of animals, why the nuclei of cells contain our genetic material, why certain animals are long-lived, why the gestation period of humans is 9 months, and why some diseases are rare and other diseases are common. In “Armchair Science”, the reader is confronted with 129 scientific mysteries, in cosmology, particle physics, chemistry, biology, and medicine. Beginning with simple observations, step-by-step analyses guide the reader toward solutions that are sometimes startling, and always entertaining. “Armchair Science” is written for general readers who are curious about science, and who want to sharpen their deductive skills.

Failure to rescue

In a fascinating white paper published in 2004, Health Grades, Inc. reached the following conclusions from a large review of MedPar data (medicare records):

"Approximately 1.14 million total patient safety incidents [PSIs] occurred among the 37 million hospitalizations in the Medicare population from 2000 through 2002."

"The PSIs with the highest incident rates per 1,000 hospitalizations at risk were Failure to Rescue, Decubitus Ulcer, and Post-operative Sepsis. These three patient safety incidents accounted for almost 60% of all patient safety incidents among Medicare patients hospitalized from 2000 through 2002."

"The 16 PSIs studied accounted for $8.54 billion in excess inpatient cost to the Medicare system over 3 years, or roughly $2.85 billion annually. Decubitus Ulcer ($2.57 billion), Post-operative Pulmonary Embolism or Deep Vein Thrombosis ($1.40 billion), and Selected Infections due to Medical Care ($1.71 billion) were the most costly and accounted for 66% of all excess attributable costs from 2000 through 2002."

Failure to rescue usually occurs in a setting where a patient starts to develop signs and symptoms that are unevaluated clinically by the medical staff. Maybe the patient has a small rise in temperature, or maybe the patient has a sudden chest pain that is unaccompanied by ECG changes, or unusual leg pain, or maybe the patient has a little GI upset, or seems a bit agitated. It takes a great deal of judgment to react wisely when patients develop unexpected changes in physical or mental status.

Still, small problems can easily lead to big problems in a medical setting, and big problems can lead to death. Often, especially after the small problems have gotten out of hand, the response time by the clinical staff is crucial.

There was an excellent report on automatic defibrillators in the New York Times, Jan 3, 2008, by Denise Grady, entitled, "Hospitals Slow in Heart Cases, Research Finds." The author described a Failure to Rescue scenario that occurs commonly in hospitals. A patient suffers a heart attack and a consequent arrhythmia that could be reversed with defibrillation if received in under two minutes. Many hospitals cannot respond with defibrillation within the two minute window. The reasons are systemic and may include policies that forbid floor nurses to defibrillate.

In contrast to hospitals, automatic debribrillators that are kept at ball parks, health clubs, and department stores, permit laypersons to defibrillate because they come with automatic sensors that determine if the patient has a heart rhythm that can be rescued with the defibrillator. The upshot of the NY Times article was that your chance of receiving life-saving defibrillation may be higher at a ballgame (where people witness your event and a defibrillator is quickly available) than in a hospital setting.

- Jules Berman

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In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases.

I urge you to read more about my book. There's a generous preview of the book at the Google Books site. If you like the book, please request your librarian to purchase a copy of this book for your library or reading room.

- Jules J. Berman, Ph.D., M.D. tags: common disease, orphan disease, orphan drugs, genetics of disease, disease genetics, rules of disease biology, rare disease, pathology, critical period, failure to save, medical errors