If you poke around old medical records you’ll find WNL written in parts of the physical exam. Neurological: WNL.

It means within normal limits. It’s the pen and ink dotphrase used through most of paper record history by physicians to indicate that the organ or system under exam was unremarkable. One of medicine’s most versatile and open-ended acronyms, within normal limits was like an old friend when your hand was cramping at 2 AM after your 11th admission. A shortcut that predated the EHR.

Unfortunately it was sometimes translated as we never looked. Rather than write down what you found when your hands were on the patient you’d phone it in with WNL.

So as a supervising resident or attending reading the chart it served as a clue that maybe the system hadn’t been thoroughly examined. And as a kind of bedside parlor game it was fun to showcase how the organ in question wasn’t exactly WNL. This typically only had to be done once. (As one who had medicine all figured out toward the end of his intern year, I speak from experience.)

With electronic health records WNL is fading as a less-than-quaint bit of medical history. With that we lose our litmus for loose physical exams and patient evaluations happening faster than they should.

Now trainees are moving faster than I ever could with a pen. With the press of a button we have smartphrases, the processed meat of medical documentation. It’s like WNL on crack.

So maybe WNL never really went away. There’s just no way to see it.

Photo by mari lezhava