Page last updated at 10:18 GMT, Monday, 18 August 2003 11:18 UK
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.
[img_r]http://newsimg.bbc.co.uk/media/images/39413000/jpg/_39413907_203surgeons_vague300.jpg[/img_r]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 abbreviations 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 abbreviation.
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.
[img_r]http://newsimg.bbc.co.uk/media/images/39414000/jpg/_39414029_203alcohol_aande300.jpg[/img_r]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.
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.