is reproduced here with permission. I will put some additional comments as an Addendum at the end of the copy. ..Maurice.
Maurice Bernstein, M.D.
Medical slang is a form of slang used by doctors, nurses, paramedics and other hospital or medical staff. It is expressed either in informal vocabulary as words, abbreviated terms or also as acronyms (words made up of initial letters of the words the acronym represents) related to medical terms or conditions, persons or events. Presumably the basis for the use of medical slang is to communicate one’s concept or clinical finding or evaluation or diagnosis to other caregivers in a rapid and concise way. Unfortunately, the use of medical slang may lapse into derogatory expression or become ambiguous. Derogatory means that findings or persons are expressed in a disrespectful or degrading manner. Ambiguity can be related to the fact that an acronym or abbreviated word may not be sufficiently distinctive and can be used or interpreted for more than one medical term.
Examples of medical slang can be as benign as but also potentially ambiguous as the following medical transcription terms: “lytes”=electrolytes, “nitro”=nitroglycerine,”sats”=saturations, “crit”=hematocrit, “mets”=metastases, “osteo”=osteoporosis. On the other hand, medical slang can be derogatory even though amusing when applied to medical specialties. For example: “baby catcher” for obstetrician or “butchers” or “knife happy” for surgeons. Examples of medical slang as applied to patients include “dirt ball” for a patient who enters the emergency room filthy and smelling badly or “druggie” for patients known or suspected for illicit drug use or “goldbrick” for a patient who demands more attention than their (minor) condition warrants or the acronyms LOBNH for “lights on but nobody home” for a patient with suspected dementia and, of course, GOMER for “get out of my emergency room!”.
My argument is that medical slang generally can not only be or become disrespectful or ambiguous but also in the case relating to patients themselves, the derogatory descriptions may actually represent an action by the professional to create a logical fallacy. What is a logical fallacy? It is an error in reasoning that renders an argument invalid. Why attribute a medical slang expression as promoting a logical fallacy? First, a basic premise within the profession of medicine is the responsibility to obtain history and facts, if possible directly from the patient, and then to attempt to draw and present a conclusion from the facts. Drawing that conclusion is a logical exercise. Because, unlike the application of medical slang to “conditions” when this slang is applied to a person (an ad hominem), it may allow a fallacious conclusion by the healthcare provider originating the slang which rejects any argument or facts given by the patient since these arguments or facts are trumped by the provider’s own conclusion about the character or reliability of the patient. This is a logical fallacy since such a conclusion may be unwarranted. The explanation and facts provided by the patient must be logically evaluated separately for their validity and value and not invalidated by simply the provider’s personal decision regarding the patient as a person. The doctor can’t fairly make a judgment that the patient’s descriptions of pain should not be considered and reconsidered because the patient is known or suspected and described as a “druggie.” Some person on the street may say “that guy over there looks like a druggie” but that person is not required professionally to go beyond that assumption and so the statement may only be considered “unfair” or “uncouth.” My argument is that in a doctor-patient relationship such a slang expression by the doctor would represent a professional ad hominemimproperly affecting the doctor’s judgment regarding the history and facts presented by the patient.
For a number of reasons, including medico-legal, there is said to be a diminution in the general use of medical slang. Hopefully this is true and will continue to diminish. Certainly, expressions by physicians, nurses and other healthcare providers which are non-humanistic, are demeaning to the patient and indirectly to the profession itself and finally, as a consequence, allows a logical fallacy to be exercised, which distracting from and preventing proper clinical evaluation of the patient, cannot be considered of value to be continued to be used in medical communication.
Addendum: Beyond the issue of how derogatory medical slang may affect a physician's fair decision making responsibilities, what do you think about medical slang in general, particularly if it was applied to you as a patient? ..Maurice.
7 Comments:
Within the context of their use, words have meaning -- and those meanings have consequences. And those consequences can influence attitudes and behavior. Consider race and gender issues today, and consider what words we don't use anymore, words that were used and taken for granted not long ago. Just as minorities can be considered the "other," so too can patients, within the medical system, be considered the "other." They are "patient" -- a category that can easily be, and often is, stereotyped. The words you give as example are some of the more tame ones. I've heard worse, such as CTD in the ER for a patient for whom there is no hope -- Circling the Drain. These terms may relieve stress for the caregivers, but they may also lead to a hardness and cynicism that produces an attitude that affects patient care.
Maybe a bit of skepticism of the slang rather than cynicism of the patient would be a healthier attitude to take by the doctors. ..Maurice.
Maurice, you raise an issue that has been at my professional core since entering medical school in 1987. I have written about this (alone and with colleagues), largely in the context of "turfing," but my arguments extrapolate to other terms. See: Caldicott CV. "Sweeping Up After the Parade": Professional, Ethical, and Patient Care Implications of 'Turfing." Perspectives in Biology and Medicine. 2007; 50(1):136-49. The reference list may be of interest to you as well.
Catherine, I have read your perspectives of "turfing" in Virtual Mentor , May 2012
My question is whether patient derogatory slang and patient turfing satisfies some general need within the psyche of the members of the medical profession. If so, what is the need?
There may be a need to defeat the professional notion and the requirement that each patient is an independent entity and treated as such by physicians demonstrating, through slang, that physicians can establish and put patients into categories of behavior or conditions and treat them as such.
In the case of turfing, the physicians are demonstrating that in some situations, the professional requirement that any "good" for the physician must first always be trumped by the need for the "good" of the patient and this requirement can be rejected.
Before these "professional habits (?)" of derogatory slang and turfing can be treated, understanding of their etiology is first necessary. ..Maurice.
Maurice, the need, I believe, is physician solidarity, identity, and positioning. I believe that derogatory terms (and, in the case of turfing, terms and actions) persist because they are about the docs, not about the patients. In the case of turfing, the language and action allow an intra-professional (or inter-specialty) power relationship to play out. I suspect that House of God did not create turfing; it only codified it.
I suspect that physicians use derogatory terms for patients when patients present difficulties. Not intellectual puzzles, but social, behavioral, or other hurdles that the doc does not have the time or inclination to deal with. I think that terms such as "noncompliant" and "the patient failed XYZ" can be seen in the same way. By using those terms (that appear to be widely acceptable to others in the same professional group), docs can distance themselves from the expectation that they should treat the gomer, shpos, dirtball, turf, or noncompliant patient with their full measure of respect and patience. It seems to be an extreme of the "how can I help you if you won't help yourself" perspective, one that allows docs to absolve themselves of responsibility beyond a certain point.
These are just my personal opinions. But if a doc were to tell a colleague, "I didn't do a careful social history or a full physical exam on Mr. X," the colleague may very well think the doc was negligent. But if the doc were to preface the exact same statement with "Mr. X came into the ER again. Congestive heart failure from, big surprise, noncompliance with diet and meds. No wonder he's a frequent flyer. The gomer!", the colleague might offer a knowing look, a sympathetic comment, or a wink and a sigh. Now the professional distance from things the doctor COULD address but chooses not to obscures the negligence and allows the colleague to lapse into inattentiveness to the negligence.
And Catherine, one may wonder where in the years of medical education, derogatory slang and turfing get instilled. I suspect, of course, that it will appear as part of the "hidden curriculum" in the latter years of medical school and in internship and residency. Unfortunately as a teacher of my group of first and second year medical students in the "Introduction to Clinical Medicine" course, though many ethical issues are discussed with them, I have not been talking to our students about these behaviors which hardly meet professional goals. Though such slang and turfing are not practiced at that part of their career. I think they deserve open discussion with the students and I intend to bring the topic up to our faculty meeting and see what other instructors are doing in this area
It could be that all the teaching in the world on this matter may be readily trumped by the exposure of the students later on in the "business of medicine". ..Maurice.
Yes, I sadly agree that the business language in medicine will trump other terms. (See one of my favorite articles:; Rashi Fein, What's Wrong with the Language of Medicine? N Engl J Med 1982; 306:863-864April 8, 1982DOI: 10.1056/NEJM198204083061409. He noticed this 30 years ago.)
As for when trainees hear and learn this language, I believe it occurs on day one. As a 30-something first year med student with a background in language and humanities, the way my instructors talked struck me as very peculiar from the moment I set foot on campus. And I went to a relatively humanistic, enlightened medical school. It is very much a "hidden curriculum" kind of thing--subtle, unexamined, unchallenged. Kudos to you for bringing it up.
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