UBI in the Knife and Gun Club
The secret language of doctors and nurses
- By Richard Conniff
- Smithsonian magazine, October 2009, Subscribe
Young doctors these days get trained to talk nice, think pretty thoughts and steer clear of malpractice lawyers. So the colorful subculture of medical slang is probably CTD ("circling the drain"), if not DOA ("dead on arrival"), and that may be a good thing. It was probably a little insensitive when doctors sticking a pulmonary artery catheter into a plus-sized person referred to it as "harpooning." And it was never great bedside manner to remark that a newly arrived motorcycle crash victim was GPO ("good for parts only").
But in the bad old days, when medical life was more freewheeling, "MASH"-style humor was commonplace. Patient reports were safely stashed away in the back office, so doctors felt free to scribble cryptic little notes to themselves, like FLK ("funny-looking kid") or even FLK with GLM ("good-looking mom"). The LOL in NAD ("little old lady in no acute distress") was the bread-and-butter of many medical practices, at least until she got transferred to the ECU ("eternal care unit"). Or sometimes her family dumped her at the Knife and Gun Club ("emergency room") without cause, generally as they were racing off on vacation. When that happened, the language used by harried ER staffers tended to become unprintable.
If patients had trouble understanding instructions, doctors sometimes labeled them CNS-QNS ("central nervous system—quotient not sufficient") or just plain NTB ("not too bright"). In England, where getting "pissed," or drunk, at the local pub was a popular route to CNS-QNS, doctors often categorized patients as PFO, PGT or PDE ("pissed, fell over," "pissed, got thumped," "pissed, denies everything"). Less diagnostically precise, though still useful, was the bruised and battered catchall category UBI ("unexplained beer injury").
To be fair, doctors often directed their callous argot not just at patients but also at one another. Depending on specialty, a doctor could be a "gas passer," "nose picker," "crotch doc" or "rear admiral." Surgeons were "knife happy" or "slashers," while "fossil docs" learned everything they knew back when mustard plaster was cutting edge.
Especially for interns and residents, "developing our own private lingo made us part of a club (or a gang) who looked out for each other," one middle-aged doctor recalls. They shared the experience of getting PIMPED ("put in my place") by a hostile elder firing questions drill-sergeant style. For the real horrors of their work, referring to blood as "the house red" or to burn victims as "crispy critters" put the pain at a bearable distance.
The slang was no doubt also a way to vent unwholesome attitudes. Categorizing a patient as FOS (which does not mean "full of sense") or suffering from TMB ("too many birthdays") probably would not meet the standards of modern compassionate care. So good riddance, to be sure.
And yet a part of me also regrets the idea that doctors now get discouraged from even thinking, much less expressing, what any human being in their position might naturally feel. The other day, for instance, I showed up at my eye doctor to get new glasses. The nurse led me through the usual tests, and I wound up sheepishly admitting what had happened to my old glasses. We need not get into all the messy details here. Let’s just say that it involved storing my glasses in my shoes and, later, walking around for a while before I noticed that something underfoot felt oddly crunchy.
The nurse looked at me for a moment, possibly searching for a UBI, or trying to decide if I was a pumpkin ("you shine a light in the ear and the whole skull lights up").
Then she murmured to herself, "NTB," and I could hardly disagree with her diagnosis.
Richard Conniff's newest book is Swimming With Piranhas at Feeding Time: My Life Doing Dumb Stuff With Animals.
Subscribe now for more of Smithsonian's coverage on history, science and nature.
Comments (8)
I haven't laughed so hard in ages, from the article and comments both! I needed that!
I've lived around health care professionals enough to know and enjoy the value of laughing at ourselves and each other, so I'm sending this out to a number of friends.
God Bless you all!
Posted by Shir-El on November 24,2009 | 02:19 PM
Writer Conniff found an interesting and slightly macabre subject in his investigation of the various forms of medical acronyms in use over the years. There can be no doubt that the terms in use were, and still are, just the least bit politically incorrect, along with often being darkly amusing. There can also be no doubt, however, that these succinct terminologies have their roots in a real and very much needed pressure-relief mechanism. It is quite easy to point accusatory digits at medical staff, police, EMT cadre and other public service workers without remembering that these are the front line troops who are awash in the very worst results of human actions and technology gone awry, often for incredibly long hours, in unbelievably poor conditions, and for less pay than would be acceptable for most of the rest of us. The users of often tongue-firmly-in-cheek labels referring to patients/victims as "gomers" or "crispy critters" were also aimed at themselves. When I was an OR/ER tech years ago, urologists were "peter palmers" and phlebotomists were "blood suckers" or "vampires". I'll refrain from supplying some of the more "salty" terms for proctologists and ob/gyn docs. The point is that this was all a way of putting the ugliness and pain, as Mr. Conniff puts it, "at a bearable distance".
I seem to remember a study done years ago where items and cartoons of so-called "dark" or "gallows" humor were shown to various different segments of society, and resposes carefully monitored. Most of the public was somewhat amused, albeit with a bit of what is called schadenfreude (sp?) in German. The really interesting result was that medical and police openly found the items amusing, but convicted violent criminal offenders did not. I can't even hazard a guess as to what that difference meant. I guess we need to understand that everyone deals with the world in his or her own way.My salute goes to anyone who does a tough job that I can't.
Stephen R. Colantuno
Posted by S.R.Colantuno on October 18,2009 | 08:30 AM
Two of the very first 'useful expressions' I learned in EMT training was "intensive O2 therapy"--subduing a dangerously out-of-control patient in the back of an ambulance with an oxygen cylinder lightly applied to their temple (I've never actually anyone who claims to have done it) and FGDB--Fall Down, Go Boom, useful for all manner of conditions, generally involving drunkenness and/or willful stupidity. I still can't look at a hospital status board without breaking out in a grin...
Posted by Bob T. on September 29,2009 | 05:05 PM
I think this version of your article is superior:
http://news.bbc.co.uk/2/hi/3159813.stm
Posted by Hippolito Pichardo on September 29,2009 | 09:49 AM
You forgot PIN (Pain In Neck).
Thanks for a good laugh.
-Morgan (a TMB)
Posted by Morgan Henderson on September 28,2009 | 09:05 PM
This was hilarious. I have lost count of the UBI's I have taken care of in my career as an ER nurse.
Posted by Nancy on September 28,2009 | 12:13 PM
I'd had a bad day until I read this and wound up laughing so hard my attitude changed completely. What a hoot. I retired after 30 years working with the Social Security Administration and wound up seeing a lot of the patients described in the article after they'd left the doctor's office.
Posted by Otis R. Parker on September 25,2009 | 07:04 PM
There's quite a bit of medical humor out there that doesn't poke fun at patients or even doctors. Just funny terms like malapropisms and chart bloopers... sites like GiggleMed.com, PlaceboJournal.com, The Journal of Nursing Jocularity, and ChartFarts.com.
These are examples of clean (usually) fun that could rarely be deemed offensive, but certainly helps people like me cope with the multitude of stresses of my profession.
Posted by Joseph on September 24,2009 | 04:50 PM