Sick Notes: True Stories from the GP's Surgery
Page 25
COPD
Chronic Obstructive Pulmonary Disease. The new name for COAD (Chronic Obstructive Airway Disease) which was the new name for Chronic Bronchitis and Emphysema etc etc. I believe they call this ‘progress’.
CPA
Care Programme Approach. A system designed to ensure that all patients with significant mental health problems get all the support and help they need. Includes personalised care plans, risk assessments and a letter to the GP every six months to say that the patient hasn’t shown up for their Care Plan meeting. If we happen to know where they are, could we pop in and make sure they’re OK?
C(A)T scanning
Computerized (Axial) Tomography. Sequential X-rays fashioned by a computer into an anatomically accurate image. Usually referred to as a CT scan, the term CAT scan is now reserved for the punchline of the well-worn ‘Lab tests and cat scan’ joke.
Crackerjack call
‘It’s Friday, it’s five o’clock, it’s… vital that something is done about something, now.’ Something that usually involves psychiatry, geriatrics and incontinence. You will only understand the reference if you watched children’s TV in the 1970s.
Crumble
Widely used in hospital to describe geriatric patients who aren’t acutely ill but who are suffering as a result of old age and frailty.
DBI
Dirt bag index. A rough and ready estimation of the number of hours since a patient’s last bath or shower, calculated by multiplying the number of tattoos by the number of missing teeth.
DH
Department of Health. Went to the expensive trouble of changing its name (headed notepaper and all) because doctors would deliberately pronounce the previous abbreviation, DoH, with a Homer Simpson voice (and often include the palm slap to the face to emphasise the point that they were dealing with idiots.)
DKDC
Don’t know don’t care. There comes a point, usually at the end of a 25-minute consultation with a heartsink patient about their peculiar aches and pains and their funny turns, when the doctor realises that he doesn’t know what’s causing them and has frankly given up trying to make sense of the story. A prescription for vitamin tablets often follows.
DLA
Disability Living Allowance. You have the symptoms, we fill out the form, we both get some money. Result!
DNA
As we have seen, not only deoxyribonucleic acid but also ‘Did Not Attend’ – the patients who book appointments, fail to show up and unwittingly keep GPs’ clinics running on time.
DRCOG
Diploma of the Royal College of Obstetricians and Gynaecologists. Most GPs have this postgraduate qualification.
DRT
Died right there. Paramedical term for a sudden unexpected death.
DRT, T, T & T
Died right there, there, there and there. Paramedical term for a violent death.
DSB
Drug-seeking behaviour. Exaggerating the severity of a painful symptom and casually mentioning the name of the patient’s preferred medicine in an effort to secure a prescription for a codeine- or morphine-based painkiller or a Valium-like tranquilliser. Variants include ONDSB & OWDSB – ‘Oscar-nominated’ and ‘Oscar-winning’, respectively.
DSH
Deliberate Self Harm – self mutilation and head-banging that falls short of actual suicide.
DV
Domiciliary Visit. Rarer now than they were, a system that allows consultants (usually geriatricians and psychiatrists) to visit patients in their own home.
DWP
Department of Work and Pensions. To whom patients forward their sick notes to claim benefit. Famous for writing to patients on Tuesday to remind them that their last sick note ran out the previous Thursday. This causes no inconvenience to the patient or their doctor. Really, none at all.
EBM
Evidence-Based Medicine – the frankly ludicrous (if you’re a complementary therapist) notion that medicine should be based on logic, reason, experiment and scientific principles.
ECG
Electrocardiogram – that thing where they connect wires to your wrists and ankles to check the workings of the heart.
ECT
Electro-Convulsive Therapy. That thing where they connect wires to patients’ temples and throw the mains switch for a second or two until they pull themselves together.
EEG
Electroencephalogram. Similar, but this time we’re monitoring the brain’s activity rather than trying to erase all trace of it.
EMI
Elderly Mentally Ill. The new name for psycho-geriatrics, popular as it’s so much easier to spell.
Fishing trip (aka Shotgunning)
Ordering dozens of tests in the hope that one of them will throw up a diagnosis. Popular with American doctors and recently-qualified UK graduates who are no longer taught how to examine or take a history from their patients.
FP10
NHS prescription form.
FRCS
Fellow of the Royal College of Surgeons. A surgeon who has passed enough exams to be appointed consultant, and who then gets to call himself ‘Mr’ (or ‘Mrs’/‘Miss’ in the case of female docs) again, just to confuse the patients.
GMC
General Medical Council – the doctors’ regulatory body who maintain the Register (from which substandard docs might be struck off) and who are in charge of doctors’ revalidation in the post-Shipman era.
GP
General Practitioner (family doctor). Me.
Granny stacker
A multi-storey storage facility for elderly patients.
Handbag positive
Descriptive term used in A&E for an elderly and usually confused female patient who is sitting up on a hospital trolley clutching her handbag.
IBD
Inflammatory bowel disease. The serious stuff like Crohn’s disease and ulcerative colitis.
IBS
Irritable bowel syndrome. The not so serious stuff like constipation, bloating and tummy cramps.
ICD-10
International Classification of Diseases 10. The list of diagnoses that IT programmers use to set up medical computer systems.
LOLINAD
As above, a Little Old Lady in No Apparent Distress – i.e. not in pain, not short of breath, not overly anxious. Used in A&E records when the cause for attendance isn’t clear.
MB
Bachelor of Medicine. Medicinæ Baccalaureus for the pretentious.
MDT
Multi-disciplinary Teams. Motley crews made up of a doctor (usually) and a selection of paramedical staff.
MRCGP
Member of the Royal College of General Practitioners. A postgraduate qualification in General Practice, these days mandatory for any new GP.
MRI
Magnetic resonance imaging. Really fancy imaging technique that has superseded CT scanning in the ‘I want a test and I want it now!’ scenario.
NAD
Test result – officially, ‘Nothing Abnormal Detected’, occasionally, ‘Never Actually Done’.
NFN
‘Normal for Norfolk’. A clinical sign (classically an extra digit on either hand) that implies a degree of inbreeding. Often accompanied by ‘JLD’ – Just Like Dad – especially in WLK (q.v.) situations.
NICE
National Institute for Clinical Excellence.
OCD
Obsessive Compulsive Disorder. Look it up on Wikipedia. Then check to make sure you got it right. Then check again. One more check wouldn’t hurt. And another, just to be on the safe side. Are you sure? Better check again. Are you certain it hasn’t changed since last time you looked? How would you know? One last look and then it’s time to go out. OK, just one more. Repeat ad infinitum.
OD
Overdose – or far more likely, underdose. If you find yourself being carefully coached about the minimum lethal dose of paracetamol and alcohol by a harassed on-call psychiatrist, rest assured that he’s starting to tire of
meeting up with you in A&E every time your boyfriend/girlfriend/mum/dad annoy you.
OT
Occupational Therapist. A person whose occupation is ‘therapist’.
PALS
Patient Advice & Liaison Service. The hospital department I will advise you to contact when Outpatient services let you down, rather than let you bitch to me about it.
Parentectomy
Admitting a child to hospital simply to separate the poor kid from its panicking/negligent/NFN parents for a period of respite.
PCT
Primary Care Trust.
PDP
Personal Development Plan. This is what I’m supposed to generate, maintain and review at regular intervals. What I’m supposed to develop into has never been made clear.
PFO
Pissed, fell over. Commonly (very, very commonly) used A&E abbreviation.
PGT
Pissed, got thumped. Commonly (very, very commonly) used A&E abbreviation.
Pt c/o
The first symptom the patient mentions, occasionally the one they’re really bothered about: Patient complaining of X.
Pumpkin sign
Another A&E record entry implying that shining a pen torch in to the patient’s mouth would illuminate the entire head like a Halloween pumpkin. Implies an element of oligo-neurality. (Oligo = not many; neurones = brain cells.)
PUNs & DENs
As discussed earlier, PUNs are ‘Patients’ Unmet Needs’ and DENs are ‘Doctors’ Educational Needs’. Not only are we expected to find out what patients really want and, if necessary, look stuff up in textbooks to find the answers for them, we’re also expected to write little essays about the experience in our spare time. A big, big favourite with GPs who wear cardigans.
QALY
Quality Adjusted Life Year. Enables health economists to decide whether it’s worth spending any more public money keeping you alive.
QOF
The fabulous Quality & Outcomes Framework.
Status Hispanicus
A play on ‘status epilepticus’ – an ongoing and uncontrollable epileptic fit. SH refers to patients who scream and gesticulate wildly about the unbearable nature of their symptom (usually pain and or weakness) without conveying any information that might actually help their doctor make a diagnosis. For example, ‘Where does it hurt?’ ‘Everywhere!’ ‘How long has it been troubling you? ‘Forever!’ etc. etc. Apologies to non-hysterical Hispanic readers.
Syndrome detector
Inbuilt diagnostic feature possessed by good doctors. Kick-started by the feeling that something just ain’t right with a patient, it enables the doctor to assemble a selection of apparently disconnected individual symptoms into one recognisable whole, a syndrome.
TEETH
Tried Everything Else, Try Homoeopathy.
TTFO
According to legend, one quick-thinking doctor quizzed by a judge about the meaning of this entry in a medical record explained that it meant ‘Told Take Fluids Orally’.
Turfing
The process of shifting a time-consuming patient from one discipline or doctor to another. Surgeons will turf a patient with recurring abdominal pain to the physicians if there’s no need for an urgent operation, the physicians will turf him on to the geriatricians as he’s over 60 years old and they will, in turn, turf him back to the GP to organise investigations as an outpatient.
WLK
Weird Looking Kid – aka ‘FLK’ for ‘funny-looking kid’: a child that might trigger a doctor’s Syndrome Detector (q.v.) leading to investigations that simply prove that he’s NFN and JLD. Occasionally – very, very occasionally – accompanied by GLM.
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SECOND OPINION
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‘Are you on any treatment?’ I asked him.
‘Yes,’ he said. ‘DF 118, diazzies and amitrippiline.’
An opiate analgesic, an addictive tranquilliser and an anti-depressant.
‘Why?’ I asked.
‘Backache,’ he replied.
‘Ah, a burglar with a backache.’ I said.
He smiled at me, and I smiled back. Then we had a good chuckle together. I knew, he knew I knew, I knew he knew I knew, and he knew I knew he knew I knew.
‘Nice one, Doctor,’ he said as he left the roo
m, in excellent spirits.”
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