Name-calling

Since the dawn of time, once humans acquired the gift of speech, they have felt the need to name everything and everyone in their immediate world. While doing research for an Osher course I am teaching on ancient historians, I learned that the Romans used three names for most people. The first was the praenomen (first name), the second was the gens (family name), and the third was the cognomen (common name) by which the individual was called. The cognomen was based on either some physical characteristic or on some momentous deed, such as a military victory. Thus, the famous Julius Caesar’s full name was Gaius (praenomen) Julius (of the Julian family) Caesar (“fine head of hair”). Occasionally a fourth name, a second cognomen was added. The Roman general who defeated Hannibal was Publius Cornelius Scipio Africanus. His first cognomen, Scipio refers to the ceremonial rod (scepter) he received for earlier battlefield accomplishments and Africanus was added after the defeat of Carthaginian general Hannibal resulted in Roman acquisition of territory in North Africa.

Every profession has its own lingo and jargon. For example, common terms in the restaurant business include: “hockey puck” (a well-done hamburger or sausage patty), “nuked” (cooked in the microwave), “Pittsburgh rare” (burned on the outside – raw on the inside), “redneck” or “stiff” (a customer who doesn’t tip) and “bubble dancer” (a dishwasher). After years of using my CB radio when driving on long trips, I’ve come to appreciate truckers’ colorful lingo: “Smokey Bear” (a state trooper), “alligator” (a tire fragment in the road), “Bambi” (a deer – dead or alive), “4-wheeler” (any passenger car or pickup truck), “roller skate” (any small car), and “yard stick” (mile marker). And, of course, in medicine we also have contributed quite a few terms of our own.

During a recent follow-up appointment with my cardiologist, he told his fellow how he had known me since his residency days. He told the fellow that in those days, Internal Medicine people were known as “fleas.” When asked, “Why?” by the fellow, he said he didn’t know. And so, with a smile, I told them, “Fleas are the last thing to leave a warm body.” There are other explanations, which I’ll mention below. The conversation made me think of the names some of our colleagues call each other. We also have names for some of our more difficult patients.

The medical profession is one in which there are daily life-and-death struggles. The current COVID-19 pandemic is a good recent example. There are numerous reports in the medical literature of physicians and other health care workers suffering from post-traumatic stress disorders (PTSD). To lighten the psychologic burden, physicians have used various degrees of levity to reduce the stress level. Name-calling, in a friendly manner and without malice, is one coping mechanism that has been used in one form or another for centuries. The exact origin of these nick names is not always known. What follows is a compendium of various names for different specialists and patients that I have encountered over my long medical career.

Medical specialists

Internists, as mentioned above, have been referred to as “fleas” for as long as I remember. The term also is applied to Family Medicine specialists. Pediatricians have been called “mini fleas” or “baby fleas.” In addition to the explanation given above, the term reflects the reaction other practitioners have to internists, particularly in the academic setting. The medicine team (in academia) typically is large and descends on patients and consulting colleagues en-masse, much like a swarm of insects. In the old days of radiology, prior to digital imaging and the use of PACS systems, medical teams from the various services would descend on the radiology department for their daily x-ray rounds on their patients. In many instances, they would literally get under the radiologist’s skin by crowding into their personal space, and on occasion with some of the questions they asked. One attending annoyingly always asked, after being told our opinion on the patient’s findings, “Now why do you say that?” or “How do you know?” It took a great deal of self-control, particularly from a curmudgeon such as myself, to not give a snide answer. When I think about this individual, I am reminded about another, less-flattering definition of “flea” represented as an acronym: “Facetious Little Egotistical A—hole.” The majority certainly are not.

General surgeons often are called “blades,” an obvious reference to their ability to physically separate patients from their disease(s) in most instances. (When I was a medical student, we referred to the surgical residents as the “know-nothings” because of their habit of answering our questions with a generic “I don’t know.”) Other colorful names refer to the many surgical specialists: Urologists are called “plumbers;” Neurosurgeons (as well as neurologists and neuroradiologists) are called “wise (wo)men” because of their knowledge of the brain and nerves; Orthopedic surgeons are simply called “the bones” or occasionally “bone heads.”

As for other specialties? I’ve encountered anesthesiologists referred to as “farters” (gas passers). Psychiatrists and psychologists are collectively known as “shrinks” or “head shrinkers.” Pathologists have been called “zombie docs” because everything they work on is already dead.

And what about my own field, radiology? We sit all day in dark rooms looking at shadows (images). Hence, radiologists are frequently called “shadow merchants.” One of my mentors, a curmudgeon’s curmudgeon, who worked for decades in his pitch-black reading room in the basement of the outpatient clinic at the old Duke Hospital, was known as “The Creature from the Black Lagoon.” This appellation was given because of his penchant for wanting to be left alone as well as his caustic personality. However, if you were willing to abide by his personality, he was an excellent teacher.

Patients

Difficult patients present physicians with special challenges. Usually they are old, have dementia, have multiple incurable medical issues and are incontinent of urine, feces and words (or are uncommunicative). These patients are collectively designated “gomers.” The term was made popular as a result of Samuel Shem’s (nom-de-plume of Stephen Bergman) darkly hilarious novel,1 “The House of God,” first published in 1978. However, the term, which is supposed to be an acronym for “Get Out of My Emergency Room” was in use way before Shem’s book was published. I encountered the term as a medical student in the 1960s, when a medical intern who had gone to Pitt medical school told us that they called the patients we called “gorks” (“God Only Really Knows”) “old gomers.” “Gork” also could be used in adverb form, “The patient was ‘gorked out’ (comatose).” Furthermore, “gomers” and “gorks” often demonstrate “the O sign” (an unresponsive patient with his/her mouth open), which, according to Shem is reversable, and “the Q sign,” where the patient’s tongue protrudes to one side. This, again according to Shem, carries the poorest prognosis of all: impending death, if the patient is not dead already.1 I said the book is dark.

Psychosomatic diseases, real or perceived, are a bane to all physicians. It is a diagnosis of exclusion, after all attempts to explain the patient’s symptoms have been exhausted. These patients are commonly called “crocks.” On bedside rounds, the attending often tells the team that the patient has an elevated “serum porcelain level” to convey his/her diagnosis. Alternatively, these patients may be said to be suffering from “Meshugasi Syndrome” (from meshuga, Yiddish for crazy). I doubt that either term is used today, since it is easy for patients so diagnosed to look the terms up on Google. (Yes, they’re really listed along with other derogatory medical jargon.)

Unfortunately, some “crocks” have real diseases that evade our ability to detect them, depending on the availability of the technology. I remember a patient I had as a medical intern (in 1968) who had severe chronic abdominal pain. Abdominal radiographs, upper GI and barium enema exams as well as intravenous urograms were repeatedly normal, as was physical examination. One morning, the patient was found dead in bed. Post-mortem exam revealed a small distal abdominal aortic aneurysm that was eroding into an adjacent lumbar vertebra, explaining her pain. My resident, from Georgia, upon seeing the findings said, in his deep southern drawl, “Fellahs, there’s a lesson here. Crocks daah (die), too.” Unfortunately for the patient, CT scanning and ultrasound exams had not been developed. The important lesson is that for most patients with a diagnosis of psychosomatic illness, the symptoms are real, and in fact a small number of these patients indeed have real abnormalities accounting for their symptoms.

Sigmund Freud’s view of humor was that it was a conscious expression of thoughts that society usually suppressed or was forbidden.2 As long as the humor, in this case name-calling, is meant in a benign fashion, it is considered harmless.

However, in today’s politically divisive atmosphere, it is best to use humor only when you truly know your audience. As a good example, I remember the not so “good old days,” when it was expected that a speaker at a conference or a refresher course would tell jokes. Many of the “old timers” were very colorful characters. Today, fortunately, speakers are business-like and jokes are tacitly forbidden, since they are bound to offend someone. Finally, we should always remember that no matter how unpleasant some of our patients are to us, they are still our fellow human beings.

Dr. Daffner, associate editor of the ACMS Bulletin, is a retired radiologist who practiced at Allegheny General Hospital for more than 30 years. He is emeritus clinical professor of Radiology at Temple University School of Medicine and is the author of nine textbooks. He can be reached at [email protected].