A patient by any other name

20 09 2012

Handling patients’ names in the wards or in the office is a tricky task.  HIPAA states that we can never use names when speaking about patients in public (or any area where not everyone within earshot is directly involved in that patient’s care).  Medical ethics states that we should always refer to patients by their names, because using any other identifying factor—like room number or primary medical issue—is dehumanizing.  So what do you do when saying “that one guy” is inadequate?

Most of the time, I saw a mixed bag of names, conditions, and room numbers used by health professionals to identify patients.  Occasionally a patient had a relatively unique characteristic that was used instead.  In pediatrics, family medicine, and internal medicine, the residents and attendings tended toward using names while rounding on the floor or in the clinic.  OB/Gyn used primarily room numbers.    All of these were irrelevant in psychiatry, where there was a separate, locked-so-the-patients-couldn’t-get-in conference room where the patients were discussed—we didn’t tend to unnecessarily chit-chat in the halls.

One difference that I noticed in surgery was that while most identification was via room number, they often skipped mentioning the primary medical issue altogether and simply referred to the patient by the problematic body part.  Many patients were named The Appendix, The Gallbladder, and The Head.  Occasionally, the descriptions would allude to the problem, like The Pneumo (short for pneumothorax) and The Traumatic Amp (short for amputation; this was likely used because calling this person The Arm isn’t exactly accurate.

Other patients were referred to by personality or physical characteristics.  One particular patient was referred to as “our chunky monkey upstairs” because—as you may have guessed, her BMI was quite high.  I also helped to care for The Meth-Head and Smelly Crotch Guy.  Childish nicknames, yes, and not politically correct, but true to a certain extent.

Some of the nicknames given to patients during check-out, though, were appalling to me.  The first one that took me aback was Fat Ass.  I heard that and thought, well, it’s crude and offensive, but the woman does weigh like 500 pounds.  Doesn’t make it right, but again, true to a certain extent.  As the rotation went on, though, I heard residents and PAs referring to patients as The Colossal Douchebag, The Whiny Little P*ssy, and That F*cking Piece of Sh*t.  None of the names was ever repeated outside of that conference room or the surgery office, and none was ever spoken in front of an attending (that I knew of).

What, then, should medical students do in that situation?  Report them?  Stay quiet?  That part of medical ethics, I am sad to say, I didn’t remember.  I chose silence, mostly because I had the feeling that telling an attending would not only reflect poorly on me in my evaluation, but also because I got the impression that they would neither care nor do anything about it.  Besides, I was not part of the group and had no business interfering with how they did their jobs, and those patients, regardless of their offensive new names, did not seem to receive any decreased quality of care.  I have to admit that I wasn’t totally silent—I did laugh a bit when I first heard Smelly Crotch Guy’s nickname.

To end the post on a lighter note, there were a few things about the culture of surgery that amused me.  For example, they use a lot of fun euphemisms.  A pneumothorax is a “puh-neumo” and a hematoma is a “hema-tomato.”  A patient who is “supratentorial” is one with psych issues, and the reason for admission is also called the “primary malfunction.”  The critical-care-related things were used most often, probably because docs really need to have a certain amount of emotional distance and humor about serious situations, or they will lose sanity.  An patient who will be “chewing plastic” soon is one who probably needs to be intubated.  The patients who have no brainstem reflexes—and therefore are likely brain-dead—are described as “not doing any tricks.”

My favorite saying, not because I like suffering but because I thought it clever, referred to the most critically ill and actively dying patients.  They were called “DC to JC,” which is short for “Discharge to Jesus Christ.”  All things considered, this is the kindest euphemism for death that I have ever heard.  Better than “worm food,” anyway.

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