He has written: "Plumbum oscillans."
What disease can this be? It sounds contagious... maybe even fatal... Is it time to phone friends and family and say farewell? Is your will up to date?
Relax.
Plumbum oscillans is no threat to health. It is Latin for "swinging the lead," and it is the doctor's discreet way of concluding that you are a malingerer, someone seeking a sick note to take time off work.
These and other terms are part of a secret language, indecipherable to outsiders, that doctors use with each other to convey a truth that is otherwise unsayable, especially to the patient.
The slang can be cruel, insulting and highly inventive, says Adam Fox, a specialist registrar at the Child Allergy Unit at St. Mary's Hospital in London, who has put together a dictionary of the terms.
Medical acronyms
CTD - Circling the Drain (A patient expected to die soon)
GLM - Good looking Mum
GPO - Good for Parts Only
TEETH - Tried Everything Else, Try Homeopathy
UBI - Unexplained Beer Injury
ATFO - Asked To Fuck Off
GOK - God Only Knows
FLK - Funny Looking Kid
Digging for Worms - varicose vein surgery
Departure lounge - geriatric ward
O-sign - is very sick, lying with his mouth open
Q-sign - when the tongue hangs out of the mouth, when the patient becomes terminal
Pumpkin positive - the person's brain is so tiny that a penlight shone into his mouth will make his empty head gleam like a Halloween pumpkin
They include British emergency-room acronyms such as UBI (for "Unexplained Beer Injury"), PAFO ("Pissed And Fell Over") and ATFO ("Asked To F... Off"), not to mention Code Brown, referring to a faecal incontinence emergency.
Then there is DBI, for "Dirtbag Index." This is a formula which multiplies the number of tattoos on the patient's body by the number of missing teeth to estimate the total of days he has gone without a bath.
Relatives of patients on the critical list may blanche if they knew what CTD, GPO or Rule of Five mean on their loved-one's records.
The first means "Circling The Drain", the second signifies "Good for Parts Only" and "Rule of Five" means that if more than five of the patient's orifices are obscured by tubing, he has no chance.
A patient who is "giving the O-sign" is very sick, lying with his mouth open. This is followed by the "Q-sign" -- when the tongue hangs out of the mouth -- when the patient becomes terminal.
General practitioners may use LOBNH ("Lights On But Nobody Home") or the impressively bogus Oligoneuronal to mean someone who is thick.
But they also have a somewhat poetic option: "Pumpkin positive", referring to the idea that the person's brain is so tiny that a penlight shone into his mouth will make his empty head gleam like a Halloween pumpkin.
If a doctor is stumped for what is wrong with his or her patient, they may record GOK, for "God Only Knows."
As for genetic quirks or inbreeding, FLK means "Funny Looking Kid" and NFN signifies "Normal For Norfolk," a rural English county.
Fox says he has a list of more than 200 terms used by medical practitioners in Britain but his collection shows that doctors around the world make up their own versions.
In Brazil, for instance, physicians use the acronym PIMBA for what can be translated as "swollen-footed, drunk, run-over beggar."
Fox agrees that some terms are offensive and even cause confusion to other doctors who are not in the know.
But he asks at least for critics to understand the stress that doctors face every day. And in any case, the colourful language is under threat of dying out because of fears of lawsuits.
"The use of medical slang helps to depersonalise the distress encountered in doctors' everyway working lives," Fox told the British Medical Journal (BMJ) last year.
"It is a way of detaching and distancing oneself from patients' distress through loss, grief, disease, dying and death. Often someone else's pain is too much for us, so we cut off."
Doctor slang is a dying art
The inventive language created by doctors the world over to insult their patients - or each other - is in danger of becoming extinct.
So says a doctor who has spent four years charting more than 200 colourful examples.
Medicine is a profession already overflowing with acronyms and technical terms, and doctors over the years have invented plenty of their own.
However, Dr Adam Fox, who works at St Mary's Hospital in London as a specialist registrar in its child allergy unit, says that far fewer doctors now annotate notes with acronyms designed to spell out the unsayable truth about their patients.
The increasing rate of litigation means that there is a far higher chance that doctors will be asked in court to explain the exact meaning of NFN (Normal for Norfolk), FLK (Funny looking kid) or GROLIES (Guardian Reader Of Low Intelligence in Ethnic Skirt).
Dr Fox recounts the tale of one doctor who had scribbled TTFO - an expletive expression roughly translated as "Told To Go Away" - on a patient's notes.
He told BBC News Online: "This guy was asked by the judge what the acronym meant, and luckily for him he had the presence of mind to say: 'To take fluids orally'."
Quaint up North
Regional dialects abound, even in the world of the medical acronym.
In the north of England, the TTR (Tea Time Review) of a patient is commonplace, but not in the south.
And the number of terms for patients believed to be somewhat intellectually challenged is enormous.
From LOBNH (Lights On But Nobody Home), CNS-QNS (Central Nervous System - Quantity Not Sufficient), to the delightful term "pumpkin positive", which refers to the implication that a penlight shone into the patient's mouth would encounter a brain so small that the whole head would light up.
Regular visitors to A/E on a Friday or Saturday night are also classified.
DBI refers to "Dirt Bag Index", and multiplies the number of tattoos with the number of missing teeth to give an estimate of the number of days since the patient last bathed.
A PFO refers to a drunken patient who sustained injury falling over, while a PGT "Got Thumped" instead.
This is an international language - Dr Fox's research reveals that a PIMBA in Brazil can be translated as a "swollen-footed, drunk, run-over beggar".
Doctor insult
And much of the slang is directed at colleagues rather than patients.
Thus rheumatology, considered by hard-pressed juniors one of the less busy specialties, becomes "rheumaholiday", the "Freud Squad" are psychiatrists, and "Gassers" and "Slashers" are anaesthetists and general surgeons respectively.
Dr Fox is keen to point out that neither he, nor the other authors of the paper, published in the journal Ethics and Behavior, actually advocate using any of the terms.
He said: "It's a form of communication, and it needs to be recorded.
"It may not be around forever."
He said: "I do think that doctors are genuinely more respectful of their patients these days."
If that is the case, perhaps the delights of a "Whopper with Cheese", "Handbag positive" or "Coffin dodger" could be lost forever.
Top medical acronyms
CTD - Circling the Drain (A patient expected to die soon)
GLM - Good looking Mum
GPO - Good for Parts Only
TEETH - Tried Everything Else, Try Homeopathy
UBI - Unexplained Beer Injury
Medical terms - A glossary
Digging for Worms - varicose vein surgery
Departure lounge - geriatric ward
Handbag positive - confused patient (usually elderly lady) lying on hospital bed clutching handbag
Woolworth's Test - Anaesthetic term (if you can imagine patient shopping in Woolies, it's safe to give a general anaesthetic)
http://www.thelinksociety.com/LinkDirectory/index.htm
A's and B's - apnea and bradycardia...sometimes, particularly when referring to a neonate. A note to the dictator might be in order here, especially if dictated in the diagnosis or if the meaning is unclear
appy - spell out appendectomy
art line - arterial line; spell it out
amp and gent - ampicillin and gentamicin; spell them out
banana bag - acceptable term; an IV potassium drip
bili - bilirubin; spell it out
bili lights - an acceptable and long-used term, dictated usually by neonatologists in reference to lights used in treatment of neonatal jaundice (hyperbilirubinemia)
bovied - you can substitute "Bovie coagulated"; however "bovied" has become an acceptable corruption of the proper noun. Do not capitalize a term whose part of speech has been changed, even if it has been derived from a proper noun. Such terms are referred to as "back-formations." A back-formation is a coined verb which was formed from an already existing noun, and the result is technically not a dictionary term. Medical dictators love to make verbs out of nouns which are about as acceptable as the bastardization of the noun modem into "modemed" a term many of us use in our everyday conversation. Follow the guidelines of your employer with regard to usage of these back-formations. As long as the meaning is clear, it may be an exercise in futility to attempt to convert such commonly dictated terms into the deathless prose we would like our transcription to be. Aside from that, many dictators do not take kindly to our changing their dictation style. As author/teacher, Vera Pyle was fond of saying, "Doctors dictate, transcriptionists transcribe."
bruisability - not a word in the true sense, but used a great deal by dictators to indicate that the patient bruises easily. Okay to type as dictated.
cap gas - capillary blood gas; spell it out
cathed - catheterized; spell it out
coag - coagulation (time)
consented - Statement is often made "The patient was consented for surgery." What is actually meant, of course, is that the patient signed an Informed Consent form. However, the misused form of "consent" is becoming quite popular, and the meaning is not distorted by this phrase. See "bovied" and "double-doc'ed" for further discussion on such terms.
crit - hematocrit; spell it out
DC - discontinue (or) discharge; when the meaning is obvious, as it usually is, spell it out.
decels - decelerations; expand to full word in reports
dehisced - actually, a wound does not dehisce; it is in a state of dehiscence, but here again the word has become acceptable through usage. See "bovied."
DeLee'd - a better way would be to substitute "DeLee suctioned"
dex - spell out dexamethasone
di-di twins - spell out dichorionic-diamniotic
diff - as in "CBC with diff." It's best to spell out the word differential; however, the short form is acceptable in most facilities.
dig ("dij") - spell out digitalis. Even if the doctor is indicating digoxin, both are digitalis-derived drugs, and "dig" by itself is confusing and interrupts flow of thought.
digitalized - not a proper term, but widely used. See "bovied"
digitation - Aside from the dictionary definition(s), ED doctors sometimes use this to mean amputation of a digit. When the meaning is clear, it should be transcribed as "amputation of digit" to avoid confusion with the legitimate definition.
double-doc'ed - Meaning that two procedures are planned to be performed on the patient involving two surgeons such as an orthopedist and a plastic surgeon requiring two consents to be signed. You could possibly change the statement to say that the patient was consented (or signed consents) for both procedures. This one is a dilemma, and quite often we resort to putting this spurious term in quotes.
echo - echo what? echocardiogram? ECHO virus infection? echoencephalogram? Be certain of the meaning if you are going to expand the term. Otherwise, leave the prefix as dictated.
epi - epinephrine; spell it out
exam - an acceptable short form of the word examination.
ex lap - spell out exploratory laparotomy
fluctuance - used to indication the presence of a fluctuant mass. (not "fluctuants") This particular non-word has been hotly discussed on MT chat pages on the internet. It has become acceptable through usage.
glyco - hemoglobin
H. flu - okay to leave the H. as an abbreviation, but spell out influenzae
heparinized - same principle as "bovied"
histo - histo what? histoplasmosis? histiocyte? A note may be in order here unless the meaning is absolutely clear.
impossible meningioma - okay to transcribe as dictated; refers to meningioma near the optic foramen
incentaloma - okay to type; means a mass discovered on sonogram that was not previously palpable
jake - can refer to one of the Jako instruments or any instrument the surgeon wants it to. See joker.
joker - may refer to any instrument a surgeon or ED doctor is used to being handed at this point in a surgery or repair procedure.
junky lungs - nonspecific lung disease/noise; worthy of a note to the dictator.
lab - laboratory/laboratory data; an acceptable short form
laboring - in OB/GYN usage, labor should be a noun; the patient is in labor, not laboring (although many women would disagree). If dictated as "The patient was laboring satisfactorily" this should be recast to read "The patient was having satisfactory labor."
lytes - electrolytes; spell it out
mec, mec-staining - referring to meconium, which spell out
mets, metz - can mean at least two things; metastases and/or Metzenbaum scissors, and should be typed out in the proper context of the report.
mikes - micrograms; spell out in a sentence; use standard abbreviation when dictated with a quantity
nitro - used for many types of nitroglycerin; an acceptable term in most medical facilities. Aside from that we cannot assume WHICH form of nitroglycerin is being referred to.
olive - not really slang; a term meaning a hard knot found in the right upper quadrant in pyloric stenosis
osteo - osteoporosis? osteomyelitis? osteopenia? Here again we cannot second-guess the dictator, so we must leave the prefix stand alone
oxy hood and oxy tent - oxygen hood, oxygen tent
peds - spell out pediatrics
pee - Unless the doctor is quoting the patient, please substitute the word urinate for pee.
peristalsing - Peristalsis is a noun and should not be back formatted to become a verb, even though often dictated that way. Recast the sentence to use correct format; e.g. instead of "Bowel sounds are peristalsing normally," it should read "Peristalsis is normal."
pulse ox - acceptable, as there is only one meaning, but "pulse oximetry" is better spelled out.
pneumo - pneumo what? pneumonia? pneumothorax? pneumocentesis? pneumocystis? Do not spell out the entire word unless you are absolutely certain of what is meant by this dictated prefix. In this case I would attach a note for the dictator.
preemie - premature infant; best spelled out in medical reports
primip - type out primipara
ROMI, romied - meaning "rule out myocardial infarction," which may be spelled out or the acronym used. For the dictated "The patient was romied," it is usually safe to type "The patient was placed on a rule out myocardial infarction protocol." or "...placed on a ROMI protocol."
sat, satting - In the proper context, "sat" or "sats" refers to saturation of oxygen. The term "satting at..." is certainly unacceptable. Substitute "having saturations at..."
saucerized - corruption of the word saucerization, and an acceptable term.
skeletonized - an acceptable back-formation used in surgery dictation which means that an anatomical part (usually an artery) was stripped of surrounding tissue.
segs - segmented cells; acceptable abbreviation
Smurf sign - slang for Chadwick sign and/or Jacquemier sign ("Smurf" because it refers to a blue discoloration of vaginal tissue in pregnancy). Okay to type as dictated.
swiss cheese - a colorful descriptive term sometimes used in radiology to describe severe osteoporosis. All we can do is type as dictated.
temp - better to spell out temperature
tet syndrome - tetralogy of Fallot syndrome; spell out
theo level - theophylline level; spell out
trach - spell out when the meaning is known, which should be obvious; tracheostomy or tracheotomy
twisted gut - volvulus; decision to be made on an individual basis as to the advisability of using this rather unprofessional description
UA - an abbreviation which can be used in laboratory data for urinalysis or for uric acid; better to spell out for clarity
vanc - vancomycin; spell out in reports
V tach - spell out ventricular tachycardia
white coat syndrome - This is a perfectly acceptable term. The patient is anxious/nervous about being in the doctor's office which results in benign temporary hypertension.
yuppie flu - okay to transcribe as dictated
