July 5, 2022

Gallows humour

Hi there,

There is a dimension of bioethics that I have completely overlooked, I’m sorry to report. It’s medical humour. One of the articles below reports that 72% of palliative care physicians had been called “Dr Death” or something similar in the past year by colleagues, patients or family – partly, it seems, as a result of their own gallows humour.

Intrigued, I did a bit of digging and found that several articles have been published in recent years on hospital humour. This can be quite coarse, even savage, as you might expect from people with a strong esprit de corps who work under intense pressure doing yucky things. The ethical side is the balancing act between respect for your patients and maintaining your sanity.

For better or worse the cynical wisecracking is disappearing, it seems. Sensitivity to vilification and denigration has become greatly heightened in recent years. This is indisputably a good thing, but as the literature on the subject points out, medicos do need to let off steam. Humour is one way of coping with stress instead of internalising it.

The racier bits stem from a 2003 article in the journal Ethics and Behaviour about slang in British hospitals. It was widely reported at the time. The author told the BBC that one doctor had scribbled “TTFO”, a common acronym for “Told To” um, “Go Away, Please” – on a patient’s notes. These notes ended up in court, to the doctor’s dismay. Fortunately he had the presence of mind to interpret them as “To Take Fluids Orally”.

Other slang included “Walletectomy”, a public hospital term for an expensive procedure in private practice. “UBI” meant “unexplained beer injury”. “Blamestorming”, the practice of blaming other staff for errors, especially if they are not there, might be useful in other professions. “Ash cash” was money paid for signing cremation forms.

Moving into denigration mode, we have “Adult Onset Anencephaly”, a medical term for “the lights are on but nobody’s home”. Similarly, “Pumpkin Positive” meant that when you shine a penlight into the patient’s mouth, his brain is so small that his whole head lights up.

In an even more cynical mode, there is “AMF YoYo”, or “Adios My Friend, You’re On Your Own”. And if the desperate patient grasps at the straw of alternative medicine, there is the term “TEETH” or “Tried Everything Else, Try Homeopathy”.

This selection is British. Any anecdotes from the US or elsewhere?

Michael Cook
There is a dimension of bioethics that I have completely overlooked, I’m sorry to report. It’s medical humour.