I startled. I had never before heard the term “sniff.” Although my hospital has discouraged abbreviations and acronyms, they nevertheless persist and, if anything, proliferate at a furious rate. Everyone is too pressed for time to spell out diabetes mellitus rather than popping in DM with two quick keystrokes. Who has the luxury of time to say “an ST elevation myocardial infarction” rather than the more familiar and benign sounding “STEMI”? STEMI sounds like a cute name for a girl rather than a catastrophic life-threatening event.
When you round with a new team, it is always good to start off with a winner, a case where—as the attending—you can show your stuff. The best circumstance is to have a case within your clinical bailiwick. With lupus, I could shine, lecturing on recent articles and asking the house staff questions for which I know the answer.
But I did not know what a sniff was and being flummoxed is no way to start as the attending.
I wracked my brain to see if I had ever heard of a sniff. Was it a class of drugs like an ARB (angiotensin receptor blocker)? Or was it type of diagnostic test like a cath or a therapeutic intervention like TIPS (transjugular intrahepatic portosystemic shunt)?
My silence was uneasy as I conjured possibilities for sniff. Maybe it was a sinus node fragmentator or frumtanator or something like. Alas, I could not come up with anything that corresponded to sniff.
Ten minutes into my attending work, I was ready to go down in defeat, stumped by an acronym the preciousness of time had forced into use.
My face desolate, shaking my head, I asked, “What is a ‘sniff’?”
“Oh,” the resident said, smiling in a kind but indulgent way, “a ‘sniff’ is a skilled nursing facility.”
A light went off in my head as I put two and two together. It was clear that sniff was for a pronunciation of SNF.
I was tempted to expatiate on the importance of clear communication in medicine and the hazards of using abbreviations. I decided to accept a small setback, however, and not act like an old curmudgeon.
“The sniff is a good idea,” I said, sitting upright, and then added with just a little swagger in my voice, “Make sure the BUN and hematocrit are stable so that we can transfer him quickly. His length of stay is already too long.”
Alphabet Soup
I did well for about another 10 minutes when I had to ask what “HOCUM” was. That was an entity that I used to call IHSS (idiopathic hypertrophic subaortic stenosis); its new moniker is hypertrophic obstructive cardiomyopathy.
