Give it to me straight, Doc: Am I a ‘rock’?
If you’re a hospital patient and a doctor refers to you as a “rock,” it’s probably not a compliment. But try not to take offense if a nurse mutters “SOB” in describing your condition.
Those are just two examples of the common slang and shorthand that reveal one of medicine’s little secrets: Doctors and nurses gossip just like anyone else, and they’re not above gossiping about the patients they serve.
Some of the jargon is harmless or even useful; for instance, “SOB” usually is an acronym for shortness of breath.
But medical educators are trying to curtail the use of more callous language that can lead doctors to think of their patients as obstacles to overcome rather than as human beings deserving of empathy.
Medical residents tend to pick up such terms quickly during training, and many said the lingo ranges from humorous to downright nasty. A patient not in obvious need of surgery may get the tag “LGFD” -- short for “Looks Good From the Door.” But a “rock” describes someone whose condition never seems to get better or worse, creating a hassle for doctors who often see their job as moving patients smoothly through the system.
“It’s implying that these human lives, these suffering people, are no more than mere insults to you,” said Dr. John H. Schumann, a professor of internal medicine at the University of Chicago Medical Center who tries to prevent medical students from adopting crude habits of speech.
Medical slang is always changing, but doctors say many of the terms in use appeared a generation ago, when residents routinely endured seemingly endless shifts and a crushing workload that was supposed to prepare them for the rigors of medical practice.
Some residents say they still pick up slang terms from the influential 1978 novel “The House of God,” one doctor’s fictionalized account of the absurdity and emotional churn of medical training. One of the most infamous words that book introduced was “GOMER,” short for “Get Out of My Emergency Room” -- an epithet usually reserved for elderly patients with difficult, chronic illnesses.
“Oh, we never use that word anymore,” said Dr. Alexis Dunne, a third-year internal medicine resident at Northwestern University School of Medicine. “That’s old school.”
But other trainees said the word still made an appearance now and then. Dr. Mark Obermeyer of Loyola University Medical Center said his colleagues tried not to use offensive language around patients, but some amount of venting was only natural.
“A lot of this work is pretty morbid,” said Obermeyer, a resident in internal medicine. “If you’re working in an ICU with people who may die any day, you use different ways to keep your mood up.”
Indoctrination into the finer points of slang is part of what many professors call the hidden curriculum of medical school and residency training. The official course work requires reading textbooks and paying attention during medical rounds, but the rest comes from watching how older doctors and nurses actually deal with the sometimes overwhelming experience of caring for patients.
A common slip happens when doctors refer to a patient as his or her disease -- as in, “the gall bladder in Room 602" or “the PE [short for pulmonary embolism] who was admitted last night.” Gregory Makoul, director of Northwestern’s center for communication and medicine, said such references could make doctors forget the human dimension of their decisions.
“When you start labeling someone as a disease, you can’t help but see them as a problem and not as a person,” Makoul said. “We try to get people to recognize . . . the power and detriment of that sort of label.”
Some residents note that medical privacy regulations have made doctors and nurses careful about when they use a patient’s name, which can encourage shorthand such as referring to patients by their disease.
Many medical slang terms revolve around the struggle to get patients in and out of the hospital in as short a time as possible. Schumann said such concerns reached new heights in the 1980s, when Medicare and many insurance plans began paying hospitals fixed rates according to a patient’s illness, putting a premium on wrapping up care quickly.
Hence the resentment some doctors feel toward “rocks” or their glee in “turfing” a patient, which refers to discharging the person or transferring him to another department. Residents often refer to newly admitted patients as “hits,” sometimes lamenting, “I got 10 hits last night.”
Some of the most emotionally laden terms revolve around the struggle either to keep patients alive or to explain to families when a loved one is heading for death.
Several doctors said they had heard the expression “circling the drain” used for a patient who seemed certain to die soon. In “The House of God,” author Samuel Shem described “GOMERS” as patients headed toward a death that aggressive medical care may only make more painful.
“They want to die, and we will not let them,” wrote Shem, who used a pen name for the book but whose legal name is Stephen Bergman.
The best solution to the language issue, doctors said, is to drop the medical jargon. “Sometimes you have to de-translate yourself,” said Dunne of Northwestern. “Some people will just tell the family, ‘He needs to go to God.’ ”