March 2026 correspondence

Abbreviations still spell confusion

Almost four decades ago, we published an article in this journal titled ‘Abbreviations can spell confusion’.¹ Generally communication within general practice is good, and if necessary, it is easy to clarify meanings by chatting to the colleague in the office next door. However, communications between the tertiary health sector and primary care are still a problem, despite the availability of rapid messaging systems. A study of inadequate hospital clinical handover from hospital to primary care documented many difficulties.² All communications should be timely, accurate and understandable and advise any actions needed for continuing care. While there has been some improvement since the descriptions of Kripalani et al,³ problems still occur. The use of abbreviations in medicine continues to be a problem in achieving quality patient care.⁴

As an example, here is a summary I recently received describing the continuing care needs for a woman aged 80 years with a scaphoid fracture:

‘Plan:

change to BEFGC

opc 5w for cc and rop

Safety netted

No contact sport or high risk activities for 3 months from injury’

I circulated the ‘Plan’ to the 14 doctors in the practice. One colleague suggested that the first line meant ‘Big Enthusiastic Friendly Giant Cast’. Only one doctor, who had been an orthopaedics registrar, correctly deciphered the abbreviations (‘change to BEFGC’: change to below-elbow fibreglass cast; ‘opc 5w for cc and rop’: outpatient clinic in five weeks for clinical check and removal of plaster). The first two lines confused me; the last was a source of amusement, unless of course the reference to a safety net meant that the hospital considered that she might take up tight-rope walking as a sport.

I have had the privilege of supervising many PhD students, and my advice to them has always been not to use abbreviations. A grumpy examiner faced with unfamiliar abbreviations may just simply fail the candidate.

A recent review suggested that artificial intelligence would improve physician-to-physician communication.⁵ However, the introduction to the article gave a list of 24 abbreviations that would appear in the text. Constantly having to refer back to the first page did not speed up communications.

Hospital-to-primary-care communications should be timely and, for accuracy, should not include any abbreviations.

Author

Colin Binns MBBS, MPH, PhD, FRACGP, FAFOEM, FAFPHM, General Practitioner, Quinns Mindarie Super Clinic, Perth, WA; Emeritus Distinguished Professor, Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA

Competing interests: None.

AI declaration: The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript.

References

1. Logan J, Binns CW. Abbreviations can spell confusion. Aust Fam Physician 1988;17(5):394–97.
2. Johnston K, Cassimatis J, Hattingh L. Effects of inadequate hospital clinical handover on metropolitan general practitioners in Queensland: A qualitative study. Aust J Gen Pract 2024;53(8):583–88. doi: 10.31128/AJGP-03-23-6783.
3. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA 2007;297(8):831–41. doi: 10.1001/jama.297.8.831.
4. Berger S, Grzonka P, Hunziker S, Frei AI, Sutter R. When shortcuts fall short: The hidden danger of abbreviations in critical care. J Crit Care 2025;91:155236. doi: 10.1016/j.jcrc.2025.155236.
5. Rubinstein B, Matos S. Value creation for healthcare ecosystems through artificial intelligence applied to physician-to-physician communication: A systematic review. Neural Process Lett 2025;57(1):6. doi: 10.1007/s11063-025-11725-1.

Research letter

Delphi consensus: General practitioner role in follow‑up of patients with a positive National Bowel Cancer Screening Program result

In this letter, we report on the subsequent findings from our previously published study on Delphi¹ round one key informant interviews with Western Australian (WA) general practitioners (GPs).² This study investigated experiences of GPs regarding follow-up of patients who returned positive immunochemical faecal occult blood tests (iFOBTs) through the Australian National Bowel Cancer Screening Program (NBCSP). Full study methodology is available in a detailed report.³ This letter pertains to round two of the Delphi study, which was an online questionnaire aimed at establishing priorities and consensus of opinions from the Delphi round one interviews.

The 14 study participants who responded to the Delphi second round were WA-based GPs. Half (50%) were male, the majority were practising in metropolitan Perth and one was in the South-West region of WA. The questionnaire was open from December 2023 until January 2024. Results consolidated the findings of the first-round interviews in highlighting key issues in terms of involvement and inclusion in the bowel cancer screening process. Primarily, study results highlighted consistency across GP management of patients who return a positive screen. Agreement was reached on: patient contact attempted immediately or within one week, follow-up appointment with patient requested within 1–2 weeks, and referral of patient for colonoscopy. However, there was a perceived need for improving the National Cancer Screening Register (NCSR) and clinical software integration, as well as enabling GPs to promote alternative access to bowel screening kits, thereby improving the effectiveness of the NBCSP and reducing the burden on GPs. In fact, only one GP had used the alternative access option to order NBCSP kits. Half of the GPs noted that simpler kit diagrams and clearer test instructions would improve uptake. GPs were found to have a number of competing demands on their time and, thus, had limited opportunity to discuss the NBCSP during consultations. Ultimately, if GPs are to become more included and involved in encouraging patient participation and adherence to the NBCSP, it is essential to recognise the competing demands on GPs’ time. Measures that acknowledge and address these time pressures will help facilitate more consistent GP engagement in the program.

Human Research Ethics Committee approval: The University of Notre Dame (ID 2023-005F).

Authors

Diane Arnold-Reed PhD, BSc (Hons), Associate Professor, School of Medicine, University of Notre Dame Australia, Fremantle, WA

Caroline Bulsara PhD, Grad Dip Educ Studies, BA (Hons), Research academic, Institute for Health Research, University of Notre Dame Australia, Fremantle, WA; Professor, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, WA

Jane Gaspar BSc (Hons), Research Associate, Institute for Health Research, University of Notre Dame Australia, Fremantle, WA; Research Associate, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, WA

Karen Taylor PhD, RN, BN, PGDipOnc, MNurs, GAICD, Cert IVTAA, Cert IVCouns, MACN, Adjunct Associate Professor, School of Nursing and Midwifery, University of Notre Dame Australia, Fremantle, WA

Anne Williams PhD, MSc, PGDipHS, BSc (Hons), Emerita Professor, College of Health and Education, School of Nursing, Murdoch University, Perth, WA

Competing interests: CB, JG and DAR received a grant from North Metropolitan Health Service. North Metropolitan Health Service had no input in the design and conduct of the study or interpretation of results. KT and AW were members of the Project Steering Committee established for the study. JG and DAR received financial support, and CB, DAR and JG received conference support through the grant.

Funding: This study was funded by the State of Western Australia acting through the North Metropolitan Health Service.

Provenance and peer review: Not commissioned, externally peer reviewed.

AI declaration: The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript.

Correspondence to:
caroline.bulsara@nd.edu.au

Acknowledgements

We would like to acknowledge the GP participants who gave their time to discuss their insights into the follow-up of positive result from the National Bowel Cancer Screening Program.

References

1. Linstone H, Turoff M. Introduction. In: The Delphi method: Techniques and applications. Addison- Wesley, 1975.
2. Bulsara C, Arnold-Reed D, Gaspar J, Taylor K, Williams A. The role of general practitioners in managing patient participation in the National Bowel Cancer Screening program: A qualitative study. Aust J Gen Pract 2026;55(1–2):59–65. doi: 10.31128/AJGP-03-25-7604.
3. Bulsara CE, Arnold-Reed D, Gaspar J, Taylor K, Williams A. National Bowel Cancer Screening Program: Western Australian general practice follow-up processes of positive immunochemical faecal occult blood test results. Nursing Research Reports 2024;2. doi: 10.57981/wsaq-s632.