sBMJ | Medical slang

Medical slang

Adam Fox, Pauline Cahill, and Michael Fertleman discuss why doctors use slang and give a few choice examples

All professions speak a secret language, indecipherable to outsiders. This is especially true of medicine. Scientific jargon and three letter acronyms (TLAs) are increasingly a part of a doctor's everyday language.¹ There is, however, yet another vocabulary that does not appear in any medical texts, journals, or dictionaries but is almost universally understood by junior doctors. This is medical slang.

Slang is defined as "the special vocabulary used by any set of persons of a low or disreputable character."² Perhaps staff in emergency medicine departments, the epicentre of medical slang, would prefer the kinder definition of "language of a highly colloquial type." Either way, medical slang has a growing vocabulary, and over several years we have collected over 200 slang terms in use in British hospitals.

Who uses it?

Medical slang seems to be an international phenomenon. Work from the United States and Brazil suggests that slang terminology often evolves locally.³ ⁴ This may be expected, given that acronyms and puns seldom retain their humour after translation. But the source of the slang itself may cross language barriers. A common British diagnosis such as PFO (pissed, fell over) has a Brazilian correlate in PIMBA (literally translated as "swollen footed drunk run over beggar").⁴ Even within Britain, use varies. The TTR (tea time review) is used in northern hospitals yet seems to be unheard of in southern England.

What influences it?

Books such as The House of God brought us "turfing" and "bouncing," and Patrick Keating's Bluffer's Guide taught us the "rule of fives."⁵ ⁶ Television is also responsible for proliferating terms such as that used in medical drama ER, where a "code brown" means an episode of faecal incontinence.

Legal issues

The duty of care to all patients extends to the keeping of accurate and clear medical records. Where the record is rendered ambiguous by the use of slang then this could constitute a breach of the required standard of care. GOK written in the notes as a diagnosis would imply "God only knows." It is not a huge leap to confuse this with GOR, a conventional abbreviation for gastro-oesophageal reflux.

A patient will only be able to sue successfully when he or she can show that there has been a breach in the standard of care owed to them. Facing an allegation of breach of duty for writing slang, the doctor must find colleagues that can also claim to use such terms in the notes and that therefore the writing of slang is reasonable. Providing the practitioner is using established and unambiguous terms, then the claim would fall at this point.

The claim could, however, proceed in circumstances where the terms were not established or ambiguous. It is good practice to avoid the use of terms that are not helpful in the management of the patient, and especially those terms that very occasionally creep in as attempts at amusement at the patient's expense. Representatives of medical insurers advise doctors to avoid slang at all costs.

Ethically, healthcare professionals should balance the time saving that slang allows with an understanding of the potential harm that can occur both in the management of a patient with ambiguous notes and to the patient's feelings should he or she ever read their notes.

Where does it originate?

Slang evolves in various ways. The most straightforward is by acronym such as an ERCP (emergency retrograde clerking of patient, as any house officer will tell you). Abbreviation provides words such as "stat," shortened from the Latin for immediately (statinum).

Sometimes, the origin may be a play on more conventional terminology, such as the "flower sign" (also known as the "grape sign"), where the patient is considered "positive" if there are flowers by the bedside. Although anecdotal, this is considered to
be of prognostic significance with regard
to speedy discharge to a supportive
family without the need for involving social services.

The largest group is simple obscenity and derogatory name calling. Any interested parties should spend five to 10 minutes in their hospital's emergency department.

A final, important source for slang terms is a genuine need for words that describe situations where a single, succinct medical word doesn't exist. "Acopia" is a perfect example of this.

Psychology of slang

Humour is a way of coping with some of the unpleasantness of dealing with human bodily functions, suffering, and death on a daily basis. Many medical trainees may not know how to stay open to their humanity and vulnerability and so associate human responsiveness, warmth, and compassion with not being professional. As a result of this it has become acceptable openly to demonstrate, even revel in, the lack of empathy encompassed in some medical slang.

Themes

Coping mechanisms

The use of medical slang helps to depersonalise the distress encountered in doctors' everyday working lives. It is a way of detaching and distancing oneself from patients' distress through loss, grief, disease, dying, and death. Often someone else's pain is too much for us, so we cut off. An example of this would be dealing with the morbid practice of receiving payment from filling out cremation forms. "Ash cash" (collected from the ash point) is a universally recognised term. This should not be confused with "bash cash" following claim forms from assault victims.

Scapegoating and body fascism

Doctors are there to try to heal, cure, and repair, so the pressure to do this is massive. Many doctors feel they have failed if they haven't stopped a disease progressing. Of course we find it hard to be surrounded by disease, ageing, and dying in our culture. Referring to elderly people as "crumble" is a classic example.

Avoiding responsibility

The "getting away with it" mentality is strongly evident in slang. After graduating from the "September club" (students who have to return after summer holidays for retakes) the new doctor may look for a quiet job in "dermaholiday." The use of terms such as the "Woolworth's test" (an anaesthetist may claim that if you can imagine bumping into the patient in Woolworth's then the patient is fit for an anaesthetic) express a pride in managing to get by with minimal effort, often implying a superior clinical instinct to compensate for a compromised knowledge base.

Slang in paediatrics

The collection of terms used by paediatricians is remarkable in its tameness and thus far more amenable to publication. Perhaps the greater perceived vulnerability of our young patients makes them a less acceptable object of ridicule. Or perhaps the macho culture of other specialties is far less prevalent among paediatricians. The truth may just be that paediatricians don't have a particularly good sense of humour.

Glossary of slang used in paediatrics

Babygram--You try just x raying the abdomen of a 400g neonate
Cephosplat-- Kills all known germs
Champagne tap-- Reference to the bottle of bubbly a junior should receive from his consultant after achieving a bloodless lumbar puncture. Now known in the new NHS as a shandy tap
Crackerjack referral-- It's Friday, it's five to five, it's...
Double bind trial-- Two orthopods looking at an electrocardiogram
Fascinoma-- Interesting pathology, but not as interesting as the ensuing politics over who gets first authorship when the case is written up
FLK--Funny Looking Kid. Would be less useful if "possible dysmorphology" wasn't such a mouthful
Friday construction--Anatomical correlate of the cars made on Fridays, when the workers mind was more on the weekend than the job in hand.
JLD--Just Like Dad. Found under FLK once the father appears on the postnatal ward.
Journal of Anecdotal Paediatrics--Favourite source for ward round pearls of wisdom
NAD--Not actually done
NFN: Normal for Norfolk--Used as an explanation for the FLK with no other problems
Ohno-second--The moment you realise you've dropped that blood sample it took six stabs to get, into the sharps bin
Paninvestigram--When you haven't got a clue what's going on...
Parentectomy--Panacea of many paediatric concerns
Percussive maintenance--Last resort when the ventilator won't work
Retrospectoscope--Look through it, and you can see you should have given steroids
Rocking horse stool--Rarer even than hen's teeth
Rule of five--If more than five orifices are obscured by tubing the patient is considered critical
Scepticaemia--Chronic condition suffered by anyone involved in the albumin versus saline debate
Serum rhubarb--What they test for at tertiary centres
Turf--To get rid of, usually by referring to another team. This may require "buffing" the patient's story to make it sound more appropriate for the patient to be admitted by somebody else. This may result in the patient being "bounced" back if deemed inappropriate. Try getting a 17 year old confused, diabetic school leaver with abdominal pain out of the casualty department and you will understand

A T Fox, paediatric specialist registrar, Luton and Dunstable Hospital, Luton LU4 0DZ
Email: adam.fox2@virgin.net

Pauline Cahill, psychologist, Department of Psychology, University of West of England, Bristol BS16 2JP

Michael Fertleman, specialist registrar in geriatrics, University College Hospital, London WC1E 6BT

The authors are keen to hear of any other medical slang terms not mentioned in this paper.

studentBMJ 2002;10:215-258 July ISSN 0966-6494

Isaacs D, Fitzgerald D. Acronymophilia: an update. Arch Dis Child 2000;83:517-8.
The Shorter Oxford English Dictionary. 3rd ed. Oxford: Guild Publishing, 1985.
Coombs RH, Chopra S, Schenk DR, Yutan E. Medical slang and its functions. Soc Sci Med 1993;36:987-98.
Peterson C. Medical slang in Rio de Janeiro, Brasil. Cad Saude Publica 1998;14:671-82.
Shem S. The House of God. London: Bodley Head, 1978.
Keating P. Bluff your way in doctoring. London: Ravette, 1993.

Responses published this month

Articles	Responses
EDITORIALS Who should own medical knowledge? Adam Fox, Pauline Cahill, Michael Fertleman (July 2002)	Robin Dibblee (September 20, 2004) Read this response

	EDITORIALS Who should own medical knowledge? Adam Fox, Pauline Cahill, Michael Fertleman (July 2002)
	Robin Dibblee (September 20, 2004) CPN, Haverhill robin.dibblee@lhp.nhs.uk
	Fritz Speigel's written a dictionary on the subject. "Sick Notes" Parthenon Publishing 1996. Recommended loo-time reading