‘Rx’, ‘Po’ and ‘alt die’: the doctor’s indecipherable prescription
Doctors are being asked to ditch Latin terms and use language patients understand
It has been argued that the continued use of Latin in healthcare encourages medical paternalism and challenges equality in the doctor-patient relationship. Photograph: iStock
Next time you get a prescription from a doctor, have a good look at it. As well as the drug name, you will likely see some hieroglyphics such as Rx, mitte, tds, and po. Is this some secret language used between medics and pharmacists, you may ask?
Well, it’s not deliberately secret, although it has been argued that the continued use of Latin in healthcare encourages medical paternalism and challenges equality in the doctor-patient relationship.
Latin was once the universal language of academia across Europe. It was a requirement for medical school entry until the 1960s. And while students now get by without a prior knowledge of the language, Latin is the basis of much medical terminology, especially in anatomy and pathology. Understanding Latin undoubtedly makes learning easier.
In Britain, the Academy of Medical Royal Colleges has just launched a campaign to encourage doctors to use clear language to describe medical conditions instead of Latin words, acronyms and complex jargon. A central element of the campaign is to get hospital consultants to write letters directly to patients, with a copy going to the GP.
The reverse is relatively common practice: hospital doctors frequently send a copy of the GP letter to the patient. However, because this communication is primarily ‘doctor to doctor’, it tends to include a lot of jargon and acronyms which most patients don’t readily understand.
The ‘Please Write to Me’ initiative is aimed primarily at doctors working in outpatient clinics, but is also relevant when doctors are penning discharge letters after a hospital admission.
The initiative is being led by Dr Hugh Rayner, a kidney specialist, who first started writing directly to patients in 2005. He said: “The change may seem small, but it has a big effect. Writing to patients rather than about them changes the relationship between doctor and patient. It involves them more in their care and leads to all sorts of benefits.”
Patients get offended
Among these are avoiding the person feeling they are being spoken about over their heads. This can sometimes feel stigmatising or in some cases can seem like someone is talking behind their back. We shouldn’t be surprised if sometimes patients get offended by reading what is being said about them in the third person. Simple changes avoid this: for example, “You have diabetes”, is better than “You are diabetic”.
A pilot study found concerns that sending letters to patients would cause problems with consent, confidentiality and anxiety have been shown to be largely unfounded. And the guidance is explicit when it comes communicating test results that are potentially upsetting: hospital doctors should telephone patients rather than break bad news in a letter.
Apart from avoiding Latin and acronyms, here are some of the other suggestions contained in the guidelines:
– Use short sentences, plain English, and cover only one subject in each paragraph.
– Use “I” and “you” rather than “he” or “she”, and use active rather than passive verbs.
– Do not use words that can cause confusion, such as “chronic”. Although in medical circles it means a longstanding condition, many patients think it means “really bad”.
Meanwhile, back to deciphering your next prescription, here is a brief guide:
Rx, usually found on the top left of script, comes from the Latin verb recipe and translates as the order “take”. TID is “ter in die” meaning three times a day. Po is the Latin abbreviation for “per os” which translates as by mouth or orally. And Mitte followed by a numerical amount translates as “send”, meaning “give the patient the following amount”.
Here are a few more abbreviations commonly used: ac is short for ante cebum, meaning before meals; alt die (alternus diebus) means every second day; and prn stands for pro re nata, meaning “as required”.
And let’s hope the UK ‘Please Write to Me’ guideline is adopted by specialist medical colleges here in Ireland.