One of its integral traits is its
offensiveness, yet medical slang has nevertheless proven
over the years to be part and parcel of being a doctor.
But as malpractice litigation has
increased, the use of medical slang has fallen. No longer
can doctors write "CNS-QNS" (Central Nervous System—Quantity
Not Sufficient) on patients' charts — at least
not on anything their family's likely to ever see.
KEEP
IT TO YOURSELF
Medical slang elicits polar-opposite responses from
doctors and lawyers.
"Years ago, I think medical records
were viewed by physicians as their own documents, to
serve as an aide-mémoire, and never to be reviewed
by the patient," says NRM's Health Lawyer columnist
Lonny Rosen, a partner in the Health Law Group at Gardiner
Roberts LLP in Toronto. "That belief led to physicians
noting a 'diagnosis' of JPN — Just Plain Nuts —
or referring to patients with less than professional
language. That sort of conduct would be inexcusable
today."
Jeffrey Wahl, a medical liability
attorney from Cleveland, Ohio, has seen his share of
slang. "I advise physicians and other healthcare providers
not to use derogatory or pejorative remarks in writing,"
he says. "I believe that the same restriction should
apply in public areas in the hospital."
"After a long night on call, or
following an encounter with a particularly annoying
or comical patient, you may feel the need to use an
INC — or Inappropriate Notation in a Chart," wrote
Mr Wahl in an essay in Endocrine Today in February.
Suppress that desire, he urges.
SLANG
CATHARSIS
Despite the lawyers' sturm und drang act, some physicians
long for the days before the politically correct anti-slang
movement took hold.
Dr Adam Fox, a pediatric allergist
in London, UK, has been a leading proponent of medical
slang since 2003, when he and several colleagues published
an exhaustive dictionary of medical slang in Ethics
& Behaviour. "Unfortunately the whole thing
is dying out and we never hear [residents and students]
using it," he told NRM by email.
"The more acute and mentally-taxing
the condition is, the more we try to defuse that by
using slang or humour," says Dr Russ Kennedy, a Vancouver
family physician and stand-up comedian. Jokey slang
is a way for doctors, like everyone else, to deal with
difficult or upsetting subjects, he says. "People have
this idea we have it made, that we drive big cars, but
doctors are some of the most screwed up people there
are."
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How well do you
know your medical slang?
Select the correct meaning
for each slang term to find out.
1. Brainsucker
a)A neurosurgeon who gleefully brandishes a frightening-looking
suction-equipped endoscope
b) A Google-obsessed patient who challenges your
expertise at every turn
c) A psychiatrist whose patients end up worse
off than when they arrived
2. ATS
a) Acute Thespian Syndrome
b) At the Time, Stoned
c) Ambulance as Taxi Service (for nonurgent emerg
arrivals)
3. Pumpkin Positive
a) Gone beyond jaundiced and turning orange
b) Teenaged patient who arrives in the ER after
some particularly stupid Halloween hijinks
c) Brainless (shining a light into a patient's
ear, nose or mouth lights up their head like a
jack-o'-lantern)
4. PPP
a) Party Person, Piss-drunk
b) Piss Poor Protoplasm (a patient whose body
just ain't gonna make it)
c) Patient Praying and Pleading (either to God
or physician)
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Answers: 1 b, 2 a,
3 c, 4 b
0-1 correct You're
a tad dyssynaptogenic when it comes to medical
slang. Perhaps that's just as well; you
can guiltlessly attest to your ignorance
about the meaning of "TTFO" on a horribly
obnoxious patient's chart. ("Told To F@*%
Off" — not Told to Take Fluids Orally,
as one quick-thinking physician prevaricated
to a judge at a malpractice hearing.)
2-3 correct You're
no expert on medical slang, but you know
a thing or two. Enough, anyway, to know
to think twice when you see NAD marked on
a patient's chart. Is that No Acute Distress
or No Abnormality Discovered? You're sharp
enough to know it just as often indicates
the test was Not Actually Done.
4 correct You're
a true connoisseur of TLAs (Three Letter
Acronyms). Other physicians may get a kick
out of your patois, but make sure you keep
it off the charts and away from patients'
family members' ears, or you'll find yourself
SOL in court.
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Some definitions adapted from
Dr Scott Haig (1), the University of Ottawa (2),
Dr Adam Fox et al (3, 5), Jeffrey Wahl (4)
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