PUBLICAT N: INTERTEXT, 1-2 - Chiinu, ed. Foxtrot, 2007 p.

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INFORMAL MEDICAL DISCOURSE: NOTES ON SPECIALIZED SLANG, JARGON AND PROVERBS PhD Inga Stoyanova Free International University of Moldova All professions speak a secret language indecipherable to others. This is especially true of medicine. Scientific jargon and three letters acronyms are increasingly part of a doctors everyday language. There is, however, another vocabulary that does not appear in any medical texts, journals, or dictionaries, but it is almost universally used and understood by junior doctors. This is medical slang and jargon. The aim of this article is to analyze the main peculiarities of slang and jargon functioning in informal medical discourse. The first problem to be discussed here is medical slang. The adjective that most often comes to mind when we attempt to define slang is unconventional [Dirckx, 17]. Slang can be thought of as a sort of eccentric or irregular dialect that exists in parallel with the more formal vocabulary that we find codified in dictionaries. We all use dozens of slang expressions and understand hundreds more when we hear them. Some slang expressions are objectionable because most people dont understand them; others because they are too flippant or frivolous for formal discourse, or even they are offensively vulgar. According to The Shorter Oxford English Dictionary slang is defined as a special vocabulary used by any set of persons of low or disreputable character [Oxford, 459]. Dealing with this Adam Fox in his article Medical slang mentions: Perhaps the staff in emergency medicine departments, the epicenter of medical slang, would prefer the kinder definition of language of a highly colloquial type [Fox, 225]. Thus, medical slang is the slang of doctors, nurses, paramedics, and other hospital and medical staff. It tends to be restricted to verbal use and to informal notes and e-mails which do not form part of a patients formal record. It is not found on patients charts and, due to growing awareness of medical slang, often not used in front of patients: slang should be avoided in medical notes and only those terms used that are properly defined and unambiguous in nature [5]. Just imagine the patient hearing or reading such a remark: You are FUBIL, having a rather offensive and vulgar meaning F**k you Buddy, Im leaving, that is the act of a physician at a small hospital dumping critically ill patient on larger hospital on Friday afternoon before he (the doctor) leaves for the weekend. Or, just hearing GOMER! (Go out of my emergency room!)?! It is not pleasant either, is it? All these influence clear and effective communication between patients and their doctors. Speaking about the origin of slang in medical informal discourse, one should note its various ways of appearance. The first source is based on play on more conventional terminology [Fox, 225], such as flower sign/grape sign, where the patient is considered positive if there are flowers by his/her bedside. This is considered to be prognostic significance with regard to speedy discharge to a supportive family. The second source for medical slang terms is a genuine need for words that describe situations where a single, succinct medical word does not exist. For example, to bounce back means to re-admit to the hospital shortly after discharge for the same or related condition. Another important source of medical slang terms is humour. Here we might mention comical expression such as chandeliers sign, which implies a so painful diagnostic procedure that the patient leaps into the air and hangs from the chandelier. Some medical slang terms are pejorative, uncomplimentary or even abusive, obscene and derogatory. They appear, as A.Fox states, as a way of coping with some of the unpleasantness of 1

dealing with human bodily functions, and death on a daily basis [Fox, 226]: loose change a dangling limb in need of amputation. Medical slang can also be euphemistic, replacing an awkward or offensive word with one that seems more acceptable: confused demented; inappropriate often denotes behaviour that is grossly objectionable; a poor historian refers to a patient whose memory is virtually blank. What kind of specialized notions in medicine become slang terms? As a result of the analysis of specialized electronic sites we have made a collection of 141 slang-terms used in informal medical discourse. Lets see what kind of notions and medical phenomena are mistold by the medical practitioners. All slang terms were divided into the following thematic groups according to the concepts expressed: 1. Disorders, injuries and their symptoms: An Aunt Minnie lesion is a very rarely met lesion, much like certain aunts, whom you see just at the family weddings; a face plant - the patient fell forward injuring face against the floor or other objects; a sidewalk souffl a patient who has fallen from a building (by analogy with culinary term souffl, based on the consistence similarity of souffl and of an injured body with multiple trauma). Crispy critters/ critters are severely burnt patients. Mentioning a head bonk the doctors describe an otherwise uninjured patient who was struck in the head, but has no serious lesions. A number of words deal with injuries, which are a result of road accidents. So, here one of the components of the slang term describes the etiology of the patients injury: Road Chili or Road Pizza - unrestrained driver, ejected and spattered; Road Map injury occurred by going through a car windshield face first, while smashola is a patient with multiple blunt trauma injuries, usually a motor-vehicle accident (by analogy with the verb to smash to break into pieces). Some terms expressively render the notion of tumor: Roasted Goober is a tumor after intensive cobalt treatment; a fascinoma is a strange, unusual tumour or malignancy ( here is the case of interesting combination of English verb to smash and Greek termination -oma, denoting tumour). 2. Instruments and means of treatment: Meat hooks are surgical instruments; white mice are tampons (similarity in form and colour with small rodents). A champagne tap represents a reference to the bottle of bubbly a junior should receive from his consultant after achieving a bloodless lumbar puncture, while guessing tube is a well-known stethoscope. 3. Medical notes: Eating in is an intravenous feeding; treatnstreet means to treat the patient in the emergency room without admitting him to the hospital. Code yellow represents an urination emergency, code brown - fecal incontinence emergency, code pink is used when test results take a while to come back. 4. Tests: A tattoo titter is a way to measure the likelihood of a patient being insane; the more tattoos the patient has, the higher is the probability of mental illness. A pumpkin positive does not deal with the vegetable or Halloween, in informal medical discourse it is a test, implying that the patients brain is so small that shining a torch into his/her mouth would cause the head to light up like a pumpkin. A Meth Mouth is a finding among patients severely addicted to methamphetamine. 5. Divisions of medical institutions: Gun and Rifle Club is a trauma ward full of gunshot and stabbing victims; while victims of local street gangs or criminal organizations that keep doctors in business are patients of Knife and Gun Club. A ward /unit where there are many deaths is called a rocket room. In hospital one can hear about torture room, i.e. Intensive care unit (due to invasive tubes, monitors and experimental treatment). All comatose patients are kept in a cabbage and tomato ward. 6. Anatomic sites:

A red pipe is an artery; a blue pipe is vein; a bean is kidney (by analogy with the shape of the vegetable); house red blood; a squash means brain. A virgin abdomen has a patient that has never undergone abdominal surgery before. 7. Terms of occupations: Captain Kangaroo is the head of pediatrics department; Freud Squad - a psychiatrist (by analogy with Sigmund Freud - the founder of modern psychology and psychiatry). Slashers, sturgeons and axes are surgeons (in the case of sturgeon surgeon weve got a humorous paronymy of two words having an almost similar pronunciation, but quite different meanings). Humpty- dumpty doctor represents a physiatrist or rehabilitation physician and refers to verse from the popular nursery rhyme that all the kings horses and all the kings men could not put Humpty together again. A baby catcher is an obstetrician, while Cath Jockey a cardiologist that catheterizes every patient he sees. An orthopedist is called overpriced carpenter, orthopod and knuckledargger. Vampires and blood suckers are not supposed ghost or reanimated corpse sucking the blood of sleeping persons, but those who take blood samples (lab technicians). 8. Medicines: A hammer is a local anesthetic (by analogy with the feeling the hit of a hammer and an anesthetics effect on a certain part of body). Treatment with antibiotics is metaphorically called bug juice, while a very powerful antibiotic is a gorillacillin (by analogy with the strength of the largest anthropoid ape, native to Africa). 9. Doctors actions: Cut and paste/ peek and shriek means to open a patient, discover that there is no hope, and immediately sew him up. If you hear a doctor speaking about dancing (Shall we dance?), it does not tell you about his intention to go to the disco-club, he means the process of tying of a surgical gown behind the surgeons back as it involves a 180-degree spin by the surgeon. Winning the game has no reference to cards, black jack or so on; it means to discharge all of the patients from the service. 10. Methods of examination and treatment: A brain fry is an electroconvulsive therapy, used in the treatment of depression, while digging for worms (no relation to fishing!) is a varicose vein removal surgery. A babygram implies X-raying the abdomen of a 400 g neonate. A god-awful surgery with a probable poor outcome is called horrendoplasty (a combination of English word horror and Greek word element plastos to excise). 11. Characterization of patients and doctors: A tough stick is a patient that is difficult to draw blood from (by analogy with hardness and shape of stick and vein). A squirrel in medical slang is not a bushy-tailed usually tree-living lovely rodent but a strange patient, particularly one whose eccentricities make your life difficult. A knifehappy is an overly enthusiastic surgeon. 12. Different concepts: A donorcycle is a motorcycle, celestial discharge death (by analogy with souls which as it is supposed, go to the Heavens); two beers - the number of beers every patient involved in an alcohol-related automobile accident claims to have drunk before the accident. Our quantitative analysis of the above mentioned slang terms showed that the following medical concepts, i.e. names of disorders, injuries, terms of occupations, doctors actions as well as different tests and notes used by health specialists predominate in informal medical discourse and constitute 72% of our collection (see Table 1) Table 1 Thematic groups name Disorders, injuries and their symptoms Terms of occupations Doctors actions Found words 39 26 13 3

Medical notes Tests Divisions of medical institutions Anatomic sites Different concepts Characterization of patients and doctors Methods of examination and treatment Instruments and means of treatment Medicines Total

12 12 7 5 5 5 9 4 4 141

Medical jargon can also contribute to poor communication between patients and doctors. Generally speaking, jargon, in its most positive light, can be seen as professional, efficient shorthand. The word jargon can be traced to 14 century Old French, but the actual origin is unknown. Jargon is derived from the word with the meaning for twittering or warbling of birds, which in turn has the root garg from which also stem such words as gargle and gurgle. One modern definition of jargon is an outlandish, technical language of a particular profession, group or trade. Another meaning is unintelligible writing or talk since the reoccurring problem with jargon is that only a few people may understand the actual terminology used by different groups, this may explain its origin from twittering which would be misunderstood by most people. However, a jargonaut (one who studies jargon) may claim that jargon was invented simply as a professional shorthand, developed out of convenience rather that intentional trickiness [Caudle]. Thus, the term jargon refers to special vocabularies used by practitioners of certain trades or professions to discuss their activities or their equipment and its use. According to Peter Ives, for those who use it, it is a language which describes the world in which they live [Ives]. Jargon is instilled during the years of medical training in highly intellectual and scientific environments. After such an intense, professional training, it is easy to forget that the physicians vocabulary is extremely technical. The clinical/medical language ability of the physician may be many grade levels above that of an average patient. Physicians typically have had more than 20 years of education by the time they reach practice, whereas the patient reads and speaks at an 8th or 9th grade level, pointing to a huge disparity in learning and comprehension. The jargon of medicine can be divided into two broad categories: specially coined terms and ordinary words to which special meaning have been assigned. As John Dirckx states, the first of these categories encompasses the whole vast lexicon of the healing professions like osteochondropathy or spondylolisthesis [ Dirckx, 17]. A large part of medical jargon consists of ordinary English words to which a special meaning have been assigned. Many of these expressions are on the borderline between jargon and formal phrases. For example: The chest is clear. He spiked a temperature. Acute abdomen, documented lymphoma, generous biopsy, etc. Most of these words have become so familiar to the doctors that they (words) seem like strictly formal technical language. Another aspect to be discussed in this context is the use of acronyms. Medicine is a profession already overflowing with acronyms and technical terms, and doctors over years have invented plenty of their own. We would like to pay our attention to those ones, which are designed to spell out the unsayable truth about their patients (acronyms-jargon-slang). Our research showed that the full form of the majority of such types of acronyms deal with characterization of the patients: LOL little old lady; TAT tired all the time; LGFD looks good from door (used to describe a patient that the doctor does not want to enter the room and interact with); DTS danger to shipping (an obese patient); CTD circling the drain (a patient expected to die soon), PFO - patient fell over (a drunken patient), TFTB too fat to breath.

Different diseases and their symptoms, injuries are also miscalled by a special group of acronyms: FOSH fell on the stretched arm, UBI unexplained beer injury, GSW gun shot wound. The full forms of another group of acronyms express special notes and actions performed by the doctors: TUBE totally unnecessary breast exam; TEETH - tried everything else, try homeopathy; NLPR no longer playing records (dead patient). Thus, the acronyms given above just render the medical environment with all its positive and negative aspects. Why do medical professionals use slang-terms and jargon-terms? They do it, because it helps to depersonalize the distress encountered in doctors everyday working lives. It is a way of detachment and distancing from patients distress through loss, grief, disease and dying. Often someones pain is too much for us, so we cut off [Fox, 226]. A medical resident, having heard about the toad service mentioned: They told me someone had named it because the patients are just old people in contractures [bent weak limbs], and they looked like toads, which was pretty revolting. It was appalling to me. I was shocked at the way doctors talked about people. But having just finished a month of being tired and sleep deprived, and being up all night for really stupid things, I can see where the frustration comes from. I still dont think its right, but I can understand it a little [Parsons, 545]. Therefore, we have two parts of the same problem. On the one hand, slang and jargon is something that happens when people are under stress [5]. On the other hand, a patient could start a legal action over the use of slang/jargon as patients get their rights to view their medical records [5]. Just imagine what may happen if the patient sees such notes in his/her medical record: 1. I saw your patient today, who is still under our car for physical treatment. (Probably, care.) 2. She is numb from her toes down. (Is anything down the toes?) 3. Discharge status: alive but without permission. (Does a patient need a permission to live?!) 4. On the second day the knee was better and on the third day it had completely disappeared. (Perhaps, the ache or swelling disappeared, as the knee itself can disappear just by patellectomy, i.e. a surgical operation, dealing with the excision of the patella/ knee-cap/.) However, many patients state that doctors are more respectful these days. In this case rocking horse stool or whopper with cheese can be vanished. Communicative specifics of medical informal discourse are also reflected in non-official proverbs, which are frequently met in doctors speech. The problem of defining a proverb appears to be as old as mans interest in them. People who consciously used them or began to collect them in antiquity obviously needed to differentiate proverbs from other gnomic devices such as apothegms, maxims, aphorisms, quotations, etc. Not only did such great minds as Aristotle and Plato occupied themselves with the question of what a proverb constituted, but early Greek paremiographers in particular wrestled with this task as well. Jan Fredrik Kindstrand reviewed some of these early definition attempts in his fascinating paper on The Greek Concept of Proverbs, and Bartlett Jere Whiting had already in 1932 assembled dozens of definitions from ancient times to the modern age in his remarkable essay on The Nature of the Proverb [8] A proverb is usually defined as a traditional, fixed-phrase saying, usually one sentence that expresses an opinion, often considered wisdom, on a subject or recommends a course of action [10]. Applying this concept to our field of science, we shall take the definition, given by Miguel de Cervantes: A proverb is a short sentence based on long experience [13]. Our collection of medical proverbs includes 26 units, which in a rather expressive, but laconic, as well as in imperative-rough form reflect the system of scientific values, morality and 5

ethics, that, first of all, deals with doctor - doctor and doctor patient relationships. Some proverbs are humorous, others are full of edifications, but all of them touch upon different aspects of medical environment. For example, proverbs of general medical point: - Nothing heals like cold, hard steel. - What you can do for a patient is infinitely more important that what you do to a patient. The art of medicine is to discover the difference. - The lesser the indication, the greater the complication. Here are proverbs dealing with surgery and surgical treatment of patients: - A chance to cut is a chance to cure. - When the only tool you have is hammer, the whole world looks like a nail. - All post-operative complications begin in the operating room. - If you dont know what you are cutting, dont cut. - Not everyone needs an operation before he/she dies. Thus, modern English medical terminology has its twins, which function in informal medical discourse. These slang and jargon terms as well as a number of paremic constructions form an intermediate zone between proper medical terms and medical sociolect, in the framework of which there is a combination of expression plan and of a scientific notion specialized plan. They also represent a means of emotional and psychological distress the health service professionals are so often in need of.

BIBLIOGRAPHY: 1. BARTLETT J.W. The Nature of the Proverb // Harvard Studies and Notes in Philology and Literature.- vol. 14.- (1932). P. 273-307 2. CAUDLE P. Jargon. //www.uncp.edu/home/Canada/work/allam/1914-/language/jargon.htm 3. DIRCKX J. Urines are cooking: Perspectives on medical slang and jargon // Eperspectives. - September, 2004.- P. 16-27. 4. DOBSON R. Doctors issue warning over misuse of slang // British Medical Journal. vol.327.-2003.- P.360. 5. Doctors slang is a dying art //www. news.bbc.co.uk./go/pr/fr/-/1/hi/health/3159813.sm 6. FOX A., Cahill P. Medical slang.//Student British Medical Journal.- vol.10.- July, 2002. P. 225-226. 7. IVES P. In Defense of Jargon.//www. eng,hss.cmu.edu./bs/31/ives.html. 8. KINDSTRAND J.F. The Greek Concept of Proverbs, - Eranos, 76 (1978), 71-85. 9. McDONALD P. Slang in clinical practice // British Medical Journal.- vol. 325.24.08.2002. P. 444. 10. MIEDER W. Popular view of the proverb.- vol.5. - 2.-1999. //www.deproverbio.com/ DPjournal/DP,5,2,99/MIEDER/VIEWS.htm# 11. The Shorter Oxford English dictionary.- Oxford, Guild Publishing, 1985 12. PARSONS G. Between two worlds: Medical student perceptions of humor and slang in the hospital setting// Journal of General Internal Medicine. vol.16 (8).- 2001.- P. 544-549. 13. What is a proverb? //www.cogweb.ucla.edu/discourse/proverbs/definitions.html. 14. www.wickipedia.com REZUMAT

Articolul prezent este dedicat specificului discursului medical neformal englez n baza jargonismelor, slang-ismelor i proverbelor. Se menioneaz c termenii -gemeni (termen medical propriu i echivalentul su neformal), precum i paremiile formeaz o zon intermediar ntre terminologia medical oficial i sociolectul medical. Utilizarea rspndit a fenomenelor terminologice studiate se datoreaz aspectului psihologic al muncii specialitilor din domeniul medicinii. Recenzent: Tatiana Podoliuc, conf.univ., dr. Data prezentrii articolului: 25.06.2007