Health: Do you have a nasty case of SIG?

Health Check
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The Independent Culture
SO FAREWELL then TATT and GOK. Goodbye SIG. Those colourful abbreviations, familiar to generations of nurses and doctors, are under attack. Nurses who vent their feelings about patients by recording rude or abusive comments in their notes such as TATT ("Tired all the time") and GOK ("God only knows") risk being charged with serious professional misconduct, their regulatory body warned last week.

The UK Central Council for Nursing and Midwifery is to issue new guidelines on record-keeping to all 640,000 registered nurses in October.

Last week it said that the use of offensive or subjective remarks in patients' notes, often recorded in code, was unacceptable and could be dangerous. Clearly, patients who ask to see their notes - as they now can - and discover the acronym SIG ("Stupid ignorant git") are not going to feel well-disposed towards their carers. As Phil Hammond, the doctor- comedian and former Independent columnist observed in these pages: "The use of acronyms is a reflection of the anti-holistic tendency some doctors have to reduce people to labels for ease of intellectual or emotional processing. Or perhaps it's just for a laugh. Either way they don't sound nearly as funny when they are read out in court."

Fair point, doc. But as we know, black humour is used across the world to cope with death and suffering. Doctors, soldiers, aid workers, reporters all resort to in-jokes and barbed references to keep their emotional distance from events that might otherwise overwhelm them. If jokes are banned, the consequences could be worse.

The UKCC will have none of it. Sue Smallman, the council's paediatric nursing officer, said she had seen FLK ("Funny looking kid") and GOK (see above) in patients' notes. "They might be funny to you but they are not very professional," she told a nurses meeting in Birmingham.

The council maintains that even where acronyms are not derogatory they can be confusing. It cites the example of NBM, which is understood by some nurses as "nil by mouth" and by others as "no bowel movement" conjuring the image of a patient being wheeled to theatre with All Bran backed up to his throat. A spokesman said they could see the funny side but that was obviously potentially dangerous.

To illustrate their determination to root out ill manners and abuse, the council last week struck off a nurse who had written "Pain in the neck" and, later, "Pain in the bum" in a patient's notes. Beverley Anne Carey, acting manager of a residential care home in Luton, had not even bothered to use the acronyms PIN and PIB to disguise her views. She was found guilty on seven charges including failing to keep patients clean and failing to call out a GP when a patient was in pain. To assist readers who may be puzzled by acronyms they have come across in their medical notes here is a list, compiled with the help of the good Dr Hammond. It is unlikely to be complete.

TATT: Tired all the time, used for heartsink patients - those who make their doctors' hearts sink - who make repeated visits to the surgery but have undefined symptoms

TEETH: Tried everything else, try homoeopathy - see above

PAFO: Pissed and fell over - to account for unexplained abrasions

FLK: Funny looking kid - where the diagnosis remains baffling

GOK: God only knows - ditto

OAP: Over-anxious parent - not to be confused with...

SIG... Stroppy ignorant git - nor with...

GRIES: Guardian reader in ethnic skirt

TFBUNDY: Totally f***** but unfortunately not dead yet - for those with a tenacious grip on life

NFA/B/C: Normal for Andover, Bridgewater, Carmarthen, etc - to refer to cerebrally challenged patients according to surgery location

HP: Handbag positive - to denote a patient, usually an elderly woman, lying in her hospital bed clutching her handbag, a sure sign that she is confused and disoriented

PP: Pumpkin positive - when you shine a pen torch into the patient's mouth, the brain is so small that his whole head lights up.