Occupational category consisting of doctors, nurses, paramedics, and others whose
professions involve health care. The folklore of these groups, who often refer to
themselves as “healthcare professionals,” includes slang, jargon-based word play, joking,
occupational sayings, mnemonics, folk stereotypes of patients and colleagues, stories,
skits, and other festive behaviors. Parallels to much of this material can be found outside
the healing professions, but the content of the medical material reflects the work
experiences of those who provide health care. Although medical professionals use
traditional patterns to create new folklore, much circulates nationally. Some items, such
as certain sayings and stereotypes, are more than fifty years old. Overlap exists between
the folklore of different subgroups within the healing professions, but the folklore of each
varies according to their different training, responsibilities, and position within the
hierarchy
The specialized language of health-care workers is the foundation on which all other
genres rest. In addition to formal scientific and technical terminology, medical language
includes informal clipped forms, acronyms, and slang usages. Word play based on all of
these forms occurs during casual conversations. For instance, medical workers sometimes
refer to “Amphoterrible” instead of the toxic drug “Amphotericin B,” and the common
laboratory abbreviation “WNL,” “within normal limits,” is said to stand for “we never
looked.” The suffix “-oma,” meaning tumor, may be combined with the word
“horrendous,” to form “horrendioma,” meaning “an unusually sad or mistake-ridden
case.” Although these examples are traditional, medical workers use similar techniques to
create new jokes, often making pointed comments in the process.
Mnemonics are another form of humorous verbal lore that circulates among medical
professionals. These fanciful, often bawdy verbal devices are used as aids in memorizing
anatomical structures and other necessary medical and scientific information. Medical
students, for example, recall structures in the chest by remembering “the five birds of the
thoracic cage”—the esophagus, the azygous, the hemizygous, the vagus, and the thoracic
duct (“four geese and a duck”). Although the use of mnemonics peaks during the
preclinical years, when many students create their own, some are used later to remember
elements of proper diagnosis or clinical practice.
Numerous proverbial sayings communicate aspects of medical culture and belief. For
example, the saying, “When you hear hoof beats, look for horses, not zebras,” reminds
students and physicians alike that a patient’s symptoms are more likely caused by
common illnesses than rare. Another saying, “See one [procedure], do one, teach one”
(sometimes parodied as “See one, do one, kill one”), emphasizes the need for medical
students to learn quickly from their teachers so that they, in turn, can teach others.
Much of the folklore of health-care professionals revolves around traditional images of
different kinds of patients. Patients are stereotyped on the basis of characteristics such as
lifestyle, personality, hygiene, mental status, and the perceived seriousness of their
illnesses. Among the terms applied to patients are “crock,” an old term for a presumed hypochondriac; “turkey,” a marginally sick patient; “vegetable” and “gork,” both applied
to hopelessly comatose patients; “gomer,” a senile, and debilitated elderly patient—the
term is sometimes said to be an acronym for “Get Out of My Emergency Room,”—and
“dirtball,” a dirty, often homeless elderly alcoholic male (the term is most common in
Veterans Administration and other public hospitals.) The hostility evident in such
characterizations reflects not only a sense of moral and social superiority, but also the
difficulties and frustrations of dealing with patients who cannot benefit from, or may not
even need, the attention they receive, or who refuse to take adequate care of themselves.
Overburdened health-care workers often feel that the large amounts of time they must
devote to these patients prevent them from giving better care to others.
Other stereotypes deal with the health-care worker’s own colleagues, evaluating them
in terms of their “typical” personalities and presumed degree of professional competence.
Intensive-care and emergency-room nurses, for instance, are said be tough, as are surgical
nurses, who must withstand the reputed abrasiveness of surgeons. Internists consider
surgeons to be ignorant technicians and are themselves said to be “compulsive,”
“uptight,” and “indecisive” because of their emphasis on diagnostic details and
propensity to order tests. The well-known saying, “The internist knows everything and
does nothing, the surgeon knows nothing and does everything, the psychiatrist knows
nothing and does nothing, and the pathologist knows everything and does everything—
but a day too late,” expresses many of these stereotypes and hints at the feelings of
inadequacy doctors experience when they cannot help their patients.
Narratives about patients, both in the form of serious case histories and informal
stories, play an important part in the working lives of health-care professionals. The case
histories, that are orally presented on rounds and written in patients’ charts, follow a
stylized structure that includes some formulaic elements. Very different narrative patterns
shape the stories doctors and nurses tell about their patients in other settings. These
stories follow standard American conventions for personal-experience narratives and may
include imitations of patients as well as other dramatic devices. Most such stories are
humorous and, influenced by the folklore of patient stereotypes, focus on the individual’s
personal idiosyncrasies rather than his or her medical problems.
Experiences in which the normal routine is disrupted form the grist for many
narratives. Stories about particularly arduous or otherwise unusual nights on call are
common, as are those concerning encounters with members of other departments. Many
young doctors tell “first day on night call” stories, which often end with the frightened
new graduate responding to an emergency by yelling, “Call a doctor.” Medical students
tell accounts about pranks played with cadavers during their anatomy course. In most
cases, the lifespan of personal-experience narratives in medicine is relatively brief. New
events, new patients, and thus new stories constantly replace the old.
Other forms of storytelling found in medicine include oral historical narratives,
especially accounts told to students and residents by older doctors about how much
harder it was when they were residents, and anecdotes about the “grand old men” of
medicine. Stories often coalesce around particularly memorable colleagues—for
example, a surgeon known for his outspoken nature and operating-room antics. In
teaching contexts, occasional apocryphal stories about the fatal consequences of mistakes
are told as cautionary tales for doctors-in-training.
Medical life is punctuated by numerous traditional events, ranging from the daily
battery of meetings and ritualized rounds doctors and nurses make on their patients to
intermittent events such as going-away parties for staff and long-term hospital patients or
seasonal celebrations such as Christmas or graduation parties. Dinners given in June, the
end of the medical-training year, sometimes include mock award ceremonies during
which members of the community receive facetious honors or symbolic gifts—for
example, a ball and chain given to the incoming chief resident. In many places, medical
students or residents put on satiric skits poking fun at the foibles of the individuals at the
medical center and of the health professions in general. Such skits, which draw on all
other genres of medical folklore, allow the students and (vicariously) the audience to air
their grievances in a safe setting while creating a sense of community among groups
between which there is normally some friction.
Among the most noticeable characteristics of medical folklore are its cynical outlook
and black humor. Although popularized by television shows such as St. Elsewhere and by
Samuel Shem’s cult novel The House of God (1979), which is based largely on hospital
folklore, this humor remains controversial, even among health-care professionals, who
object to the way it dehumanizes patients.
But medical humor must be judged within the context in which it is created. Taking
care of patients is stressful under the best of conditions. Health-care workers constantly
deal with hostile patients and encounter tragic situations that they cannot resolve.
Mistakes, sometimes fatal, are easy to make, and even minor procedures cause patients
pain. These problems are aggravated by the conditions of overwork and lack of sleep that
plague many medical professionals.
Like other occupational groups whose work involves danger, humor is one way in
which health-care workers deal with the stresses caused by their jobs. The bravado of
medical humor serves as a defense mechanism, a way of denying the anxieties,
insecurities, and emotional pain felt by its users. Although they sometimes overstep the
bounds of propriety, medical professionals use their humor to handle feelings that might
otherwise undermine the equanimity and objectivity they need in order to function.
Anne Burson-Tolpin
References
Burson-Tolpin, Anne. 1989. Fracturing the Language of Biomedicine: The Speech Play of
American Physicians. Medical Anthropology Quarterly, n.s., 3:283–293.
——. 1993. A “TravestyTonight”: Satiric Skits in Medicine. In The Doctor and Drama, ed.
D.Heyward Brock. Literature and Medicine (Special Issue) 12:81–110.
George, Victoria, and Alan Dundes. 1978. The Gomer: A Figure of American Hospital Folk
Speech. Journal of American Folklore 91:568–581.
Gordon, David Paul. 1983. Hospital Slang for Patients: Crocks, Gomers, Gorks, and Others.
Language in Socirty 12:173–185.
Hufford, David. 1989. Customary Observances in Modern Medicine. Western Folklore 48:129–
143.
Liederman, Deborah B., and Jean-Ann Grisso. 1985. The Gomer Phenomenon. Journal of Health
and Social Behavior 26:222–232.