funny old ward

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Last night I ate next to a consultant who works in the FHWC; his abbreviation, not mine, and probably best if we keep it that way for now. Acronyms have a long and chequered history in medical discourse. Some are genuinely useful - most patients are TATT (tired all the time), an increasing number are TEETH (tried everything else, try homeopathy) and some are just PAFO (pissed and fell over) - but the majority of abbreviations are pejorative. In the good old days when patients weren't allowed to read their notes, you'd often come across an OAP (over-anxious parent), a SIG (stroppy, ignorant git), an FLK (funny looking kid) or a GRIES (Guardian reader in ethnic skirt). These are probably just reflections 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're read out in court. Yes, defensive medicine has dealt rather a body blow to the medical acronym.

However, you can still find them if you know where to look. Casualty departments, where time is of the essence, are full of abbreviations that often have regional overlay. If you work in Winchester, cerebrally challenged patients are NFA (Normal for Andover), whereas in Taunton they're NFB (Normal for Bridgewater). As with all abbreviations, there are frequently several interpretations - NFB also means "not for burning" (ie at death, this patient does not wish to be cremated, much to the annoyance of the junior doctor who won't then collect the pounds 34 "ash cash" for filling in the cremation form.) Also, FAS up north means "fat and stupid" whereas down south it's "fickle and smelly". Such offensive acronyms are rarely recorded in the notes now, but a few weeks ago I was amazed to unearth a TF BUNDY in a discharge letter from an orthopaedic surgeon. Loosely translated, it's totally fucked but unfortunately not dead yet.

The safest abbreviations are disguised so that even on translation, their meaning isn't immediately apparent. HP means handbag positive - the patient, usually an elderly female, is lying in her hospital bed clutching her handbag, a sure sign that she is confused and disoriented. Or perhaps she just doesn't trust the nurses. On a similar theme, PP is pumpkin positive, ie when you shine a pen torch into the patient's mouth, the brain is so small that his whole head lights up.

But the only sure way to keep your abbreviation safe from the lawyers is to invent your own, making it so long that when you're being cross- examined by some rottweilerish wigged doctor-basher, it flies from your mind. Some TATT patients have also been described as OHSIMCWWHEALA (otherwise healthy semi-intellectual middle-class worriers with high expectations and low achievements).

Labelling patients by disease, appearance or belief is, at a stretch, a legitimate behind-the-scenes coping mechanism for those in a stressful job, but these prejudices do have an unfortunate tendency to spill over into consultations. The FHWC is a clinic for treating women with certain endocrine disorders and, in case you haven't guessed, the F and H are for fat and hairy.

To his credit, the consultant who used the abbreviation at dinner did so only to explain the dangers of labelling. One of his patients, "a larger than average woman with a downy covering", was found to have a benign tumour in her pituitary gland in the brain. Anyway, this tumour would have remained there for keeps with no life-threatening consequences but was almost certainly causing her appearance by excreting more masculinising chemicals than strictly necessary.

The staff presumed that she would like to have it treated ("because no one likes being F&H") and urged her to have something radio-active beamed up her nostrils to destroy it. This she duly agreed to and hey-presto, she returned to the clinic three months after treatment slim and hair- free. She was also distraught. Her husband, it seems, had left her because he preferred her former appearance and that was why he married her. Worse still, he'd moved in with a woman he'd met in the waiting room of the FHWC. Sticks and stones can break your bones, as the adage goes, but acronyms can destroy your marriage.

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