You’re in the on-call lounge one night and overhear the following report on the IM:
“I've already admitted three bounce-backs to the floor. Two are frequent flyers and one is a swallower. The last one is full code, by the way.”
What could it possibly mean?
Starting your clerkships can be an exciting turning point in your medical education. It’s your chance to finally take your newly-learned knowledge and put it into action. But, as you get acquainted with the wards, you might be surprised to find there’s something you hadn’t at all prepared for: the overwhelming use of medical argot.
An argot is a “language used by a particular type or group of people: an often more or less secret vocabulary and idiom peculiar to a particular group,” and it’s an apt description. On the wards, physicians and nurses use it as both efficient shorthand and as a “secret” way of holding conversations about symptoms, diagnoses and patients .
Why does medical argot exist?
Medical argot has been around for at least a century now, but it only spiked in popularity in 1978 with the publication of Dr. Stephen Bergman’s satirical The House of God. In it, a young intern is introduced to the ins and outs of a clinic by a fast-talking, argot-wielding attending.
Whatever its beginnings, medical argot has become a reliable feature of the wards. Its advantages are pretty obvious: as mentioned previously, it’s an efficient way to communicate, as these short, pithy phrases convey tons of information. It’s also a convenient way to chat without the fear of exposing private information to other patients.
Beyond that, it offers the ability to forge bonds between colleagues, giving physicians and nurses a way to commiserate over challenging situations and vent frustrations (usually about the lack of resources and tools available in the healthcare system). More complexly, argot allows for emotional distance during the more trying cases that come up day-to-day thanks to its irreverent nature.
The darker side of argot
However, many healthcare professionals find the widespread use of medical argot problematic. That same irreverence often carries negative connotations, with some of its more popular phrases featuring charged and derogatory language referring to race, gender and socioeconomic status. It could certainly be interpreted as contempt for patients and get in the way of more empathetic and compassionate care-taking.
It doesn’t help that the actual meanings behind the myriad terms used aren’t always clear. Acronyms, for instance, can refer to two or more things. In fact, in a recent study conducted by doctors at Karachi’s Aga Khan University, only 68% of the residents and medical students surveyed could correctly identify at least 70% of acronyms.
Medical students who use argot
Students will often eagerly start using medical argot once they start their rotations. There’s a pressure to quickly adapt to their new professional environment and to be “in” on the conversation (in fact, its use tends to peak during their first postgraduate year and declines during residency). Ugo Udogwu, a fourth-year student applying into Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai, often hears argot on the wards:
“I think there is an underlying sense of belonging when you are able to communicate effectively and efficiently with attendings and other staff around. I don’t perceive there to be external pressure—I have not witnessed anyone calling me or my classmates out for not using certain terms. However, when asked, residents/nurses/PAs/NPs will explain the lingo and that will make you want to use it once the opportunity presents itself.”
At the same time, many find it alienating, believing it targets disadvantaged groups and promotes stereotypes. Often, it can be hard to dismiss as simple shoptalk. Ugo notes, “There are some terms that carry certain connotations and this is what I try to combat when I hear them used and when choosing to include certain terms in my medical jargon...[I]t should be used more thoughtfully, especially considering language that is based on stereotypes.”
With that said, the nature of medical argot seems to be changing, especially as patient management becomes an ever more important topic. With the rise of new, rigorous school curricula focusing on empathy for patients, many of its more caustic terms and acronyms have fallen out of use (and favor). Yet, it’s still very prevalent on the wards, and quick and simple terms like DBN (discharge before none) and SNF (skilled nursing facility) still seem to do the trick much better when efficiency is of utmost importance.
What do you say?
Get to the real meaning behind the slang.
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