To the Editor:
The Electronic Health Record has become our standard method of communication between physicians and for our own use to memorialize a patient's findings over time. The clear statement of observations, assessments, and plans form the work output of a patient encounter, and increasingly patients view the encounter note as their property, to be immediately provided at the conclusion of an encounter.1–3 The Open Notes movement argues for this transparency, urging all notes be made available to patients through the patient portal as soon as the physician signs them.
Rule #16 of Strunk and White's “The Elements of Style” (use definite, specific, concrete language) becomes more important when it is clear that we are now writing our notes not only for ourselves and our peers but also for our patients as well.4
Given the changing nature of the patient record, it is time to re-evaluate the use of several time honored and (for some) cherished abbreviations: OD (Right Eye), OS (Left Eye), and OU (Each Eye). For patients, often without medical training, this terminology we use to delineate eyes can serve as a barrier to understanding their own health status with respect to their vision. More importantly, the use of OD, OS, and OU have been repeatedly cited as “error-prone abbreviations” by multiple entities including the Institute of Safe Medicine Practice (ISMP).5 The Institute of Safe Medicine Practice goes as far as to recommend the use of “right eye, left eye, and each eye” over the use of OD, OS, and OU as a means to eliminate medical error.5 The Joint Commission Journal on Quality and Patient Safety also cite multiple cases of medical errors stemming from the use of OD, OS, and OU in a study they conducted in 2007, indicating that this has been an issue that has been examined for more than a decade.6
Those hesitant to adopt simpler terminology to document left, right, and each eye may argue upholding existing terminology is important because it maintains universality in communication between researchers. Lysanets and Bieliaieva7 argue for the continued use of Latin terminology in the medical literature because it “promotes conciseness.” However, “concise” language is not necessarily straightforward and understandable. Increasingly, machine translation (e.g., Google Translate) is used when patients receive instructions in other than their preferred language. Using simple declarative sentences free of abbreviation is more safely machine translated.8 For example, the Google Translate Spanish translation of “OD” is “De.”
It does not matter whether we as ophthalmologists know what OD, OS, and OU mean. It does matter if others who read our notes do not know what the terms mean. It has become more important than ever to use simple terminology. Electronic Health Records should promote safe communication by eschewing the use of these Latin terms.9
Retrolental fibroplasia provides us with a case example that establishes precedence for changing terminology and gives insight as to how the change plays out in the academic world (Fig. 1). The first use of the term “retrolental fibroplasia” was in 1942, by T.L. Terry, in the American Journal of Ophthalmology.10 Language evolves over time. Just as “retrolental fibroplasia” is now a historical term, replaced by the more informative “retinopathy of prematurity”, it is time to replace the use of the abbreviations OD, OS, and OU with the “definite, specific, concrete language” of Right eye, left eye, and each eye.
Joseph M. Miller, MD, MPH
University of Arizona
College of Medicine
Harris Ahmed, MPH
Burrell College of Osteopathic Medicine
Las Cruces, New Mexico
1. Delbanco T, Walker J, Bell S, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med
2. Nazi KM, Turvey CL, Klein DM, et al. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc
3. Weinert C. Giving doctors' daily progress notes to hospitalized patients and families to improve patient experience. Am J Med Qual
4. Strunk W, White E. The Elements of Style
. 4th ed. Tucson, Arizona: Turtleback; 1999:30–32.
6. Brunetti L, Santell JP, Hicks RW. The impact of abbreviations on patient safety. Jt Comm J Qual Patient Saf
7. Lysanets YV, Bieliaieva OM. The use of Latin terminology in medical case reports: quantitative, structural, and thematic analysis. J Med Case Reports
10. Terry T. Fibroblastic overgrowth of persistent tunica vasculosa lentis in infants born prematurely*. Am J Ophthalmol