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Paraglyphics and EMS Pidgin

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I happened to see something frightening last night: the written run report of a colleague, one of my fellow Borg drones.

Now, we have a computerized reporting system at The Borg. We also have the option to dictate our run reports, phoning them in to a 24-hour medical transcriptionist, using a standardized reporting template. Sadly, the dictation option is being phased out because 75% of the medics who use it are too damned stupid to follow the standardized reporting template provided by the company.

Our computerized reporting system has an integral spell-checker. Like most spell-checkers, it catches some things and not others, and it isn’t particularly good with technical language.

Now, this colleague has been a paramedic for over a year now. He should be well into the groove, past his new-paramedic jitters. He’s still not the sharpest scalpel in the drawer, but hey, he obtained a high school diploma, passed an EMT-B course and its subsequent national certification exam, and a full paramedic course and its subsequent certification exam.

Yet his run report, the one he hands to ER doctors and nurses, was so full of paraglyphics* as to be incomprehensible and the words he did spell out were some real doozies:

Like aspration namona in the block for Chief Complaint.

Or sepis, psycho and ostoarthritius in the section for Past Medical History.

And the sad thing is, he’s not a rarity. I’ve seen others almost as bad. His run narrative was a personal injury lawyer’s wet dream. It just screamed “down payment on a new Mercedes!”

What’s worse is that, when he turns in semi-literate gibberish like this, it doesn’t just reflect poorly on him. It reflects poorly on me as well.

The doctors that don’t know me assume that I’m just as incompetent as he is, because that is their reference point for EMS. The doctors that do know me tell me I’m wasting my time and talents as a paramedic. Even a mediocre medic shines like a diamond compared to the unpolished turds like my colleague. Next to Mongo Medic with the dubba digit vocabalerry, I look like friggin’ Gregory House, MD.

If we’re ever going to make this EMS 2.0 dream a reality, turds like my colleague are going to have to be flushed. Problem is, there are so many of them that we may well back up the plumbing doing it.



Paraglyphics (noun): the use of abbreviations, symbols and EMS jargon in such volume as to render the report indecipherable to anyone but the paramedic who wrote the report.

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Posted by Ambulance Driver on October 29, 2009 • Filed under: Uncategorized • Tagged: ,
  • topv7051
    I worked with a Lt on an ALS engine (he wasn't the medic) who used to ask me every time he did a report "How do you spell seizure/diabetic/intubate, etc". Great hands on fireman, couldn't write a coherent sentence to save his life.
  • Ambulance_Driver
    Hey, at least he asked you how to spell them! I see too often that many people don;t even know or care that they misspell words.

    I worked with a medic once who couldn't spell worth a damn, but you never found a misspelled word in one of his reports. That is because he carried a laminated sheet of paper in the back of his clipboard with all the words that he had trouble with, and their correct spellings. He at least cared enough to make it look right.
  • rsullivan133
    Since when did spellin' and gramr' save anyone's life?
  • Love it AD. I can't tell you how many times I see that. Luckily, in my small service I have the opportunity to correct these things most of the time. Argh... it's just this kind of stuff that makes us look like idgets to the rest of the medical profession.

    "The degradation of the English language is the ruination of our culture" - Unknown
  • I love some of the notes I get from my daughters teacher. "After October 15th, I will not be able to except money for the field trip".

    Teacher. Teaching. In public school.

    And it's a common occurrence. God Bless Mississippi.
    (LOVE the new look)
  • ack
    Totally agreed A.D. Unfortunately, most of America is going this way with even simple words. Most high school students, and many, many of the college students I worked with, can barely spell at all, which does not help the situation to start with, but then when our peers, and bosses as I have experienced too many times, can't even spell the even that basic medical terms that we see and document daily (ditto: seen "azthma" and "seezure, and one more than one of my preceptors in medic school have written "post-dictal" (I mea, what is that? after speaking???).. well, we all look like idiots. Very, very upsetting... as you said, how can we move forward if we can't even do the basic things?
  • ack
    of course, you must proofread too, as I just proved.. typos and runon sentences.. so embarassed especially given the context here ;) yeah I see the irony
  • Brian
    Wehl i cen spelz reel gud . . . But my electronic PCR includes coding for things such as "MAIJOR MULTPLE TRAMA", "DYSPENEA", and "SNF PT REQ CONTENTIOUS O2". Makes me look like an ignoramus, through no fault of my own. My long-winded and eloquent narrative (with no abbreviations) generally makes up for it -- one big advantage to electronic is no more tendonitis from trying to make the pen do what I want at 60 mph.
  • Ambulance_Driver
    "Contentious O2?"

    Is that when the patient is so claustrophobic that he fights the mask?
  • El_Dano
    'ell I fight the mask... but only because I can't breathe with it on.
  • BryanP
    I see this sort of thing everywhere. Add in the internet / texting shorthand that I see showing up more and more. If you call them on it you usually get a variation of the "You know what I mean, and that's all that matters" speech.
  • El_Dano
    AD - my only bitch is that the computer system isn't programmed correctly. I ended up having to call for an ambulance recently.. then got the bill.. and on the bill the cause for transport was listed as severe dehydration, when I was actually yarfing up a lot of blood (in the ER I filled two of those 'kidney shaped' barf bowls and put a good inch in a large tub not to mention what I did in the GI surgery waiting room later [hearing a doc say shit was priceless tho']). I know I'm not your (or anyones) normal patient... I had a printout of my current meds, and my insurance card and dl in my hand when they showed up at the door (while I was on the floor, I saw the shoes and just stuck my arm up)... and I somehow managed to walk to the ambulance.

    But from what I've seen and heard y'all need some better code to deal with billing, records, et al. But given what I've seen of the current crop of code slingers... good luck (and yes, I am/was a professional geek... I know good code when I don't have to fix it). And it's not something that can be regulated... but it does make good sense to have flexible, rock solid code backing y'all up. Better billing, records, and a lower overall cost to the borg. And as to boneheads who can't file a report is EMS the only place they can survive? No company I've worked for tolerates that crap.

    Think I wondered off-topic... but hopefully you get my drift.
  • totwtytr
    A couple other thoughts. My compatriots complain about the electronic PCR system. The first complaint is that it was easier to do narrative based reports on paper than it is electronically. Mostly that's true at the beginning, but once people learn how to use the system, it's actually faster. They elaborate by saying that hospital staff likes the paper reports better. Then in the next breath they say that it doesn't matter what the report looks like, because no one reads them anyway.

    As I've said many times before, if the IRS knew how much we like complaining about stuff, they'd find a way to tax it as a benefit.

    I had one trainee that complained that the spell check was not medically oriented enough. I suggested to her that if she couldn't spell a medical term properly, maybe she shouldn't use it. She didn't seem to like that.
  • totwtytr
    It's as I said in an email to you. Part of improving BLS care (and ultimately ALS) the EMT-B course has to include Anatomy and Physiology, a writing course, and a course on medical terminology. The latter has to include appropriate use thereof. You can't build a house from the roof down, first you must lay a good foundation.
  • Name
    Things that make you go hmmmm. "The doctors that do know me tell me I’m wasting my time and talents as a paramedic." Are you ever going to quit wasting your time and talents, AD?
  • I sympathize with you; my boss is almost as bad with his spelling, and he's got a bachelor's degree. I asked him how he got through college with such bad spelling, thinking of all the papers he probably had to write. He told me he didn't have to write any. I think he paid someone to do them for him, because in two years of college, I wrote lots of papers. And not only is his spelling atrocious, his handwriting is, too.
  • Way back in the day, one of my fellow Military Policepersons brought a GI in. His report stated that 'the subject was apprehended and incinerated."
    Not incarcerated. Incinerated. At least he spelled it right...
  • theflyingmonkey
    I'm responsible for the chart review in my borg cube and the charting issues don't improve with education. One of our nurses charting just screams "sue me". We have pretty high-tech monitoring equipment. Everything is "set and forget". Set the machines up and they'll do dynamic gas readings, q 10 minute BP's (per our policy), etc. This guy's charting, for a 40 minute flight has two sets of vitals, a primary, and no narrative. When asked if he set the machine, he says YES!!! Well, if it's set, then why the heck wasn't it charted? Response: Nothing had changed.
    The good news is, the foam rubber wallpaper is going up in my office next week so when I bash my head against the wall in frustration, I'll quit knocking myself out.
  • help dey breevin. geez....
  • emtgnome
    reminds me of when, as an EMT-B, I gave what I thought to be a good hand-over report to the nurse, who then asked me if I was a paramedic, and was surprised when I said I was an EMT-B. What is so hard about giving a good, comprehensive hand-over report to the receiving facility? I don't care if you're a basic or a medic, you should be able to give the nurse a good report.
  • PJ
    I had a partner who spelled "asthma" using four letters, including a 'z'.
  • Ambulance_Driver
    Down here, they use medical ebonics: "A booty roll is dat stuff owsma patients take to help dey breevin'."
  • stormgren
    I am now going to have to ask my wife to get my booty roll prescription filled next time she's at the pharmacy.
  • roanokecop
    Sounds like a police report. Why do all the terrible writers end up in our professions?

    Roanoke Cop
    http://roavapd.blogspot.com/
  • Ambulance_Driver
    At least cops don't use abbreviations that only give a defense lawyer openings to question his credibility, or at least that's been my impression.

    None of the cops I know use abbreviations at all. But you're right - poor writing is becoming more and more common, and our primary and secondary school systems are a major culprit. What garners an A now wouldn't have gotten me a C back when I was in school.
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