Dr Phil Hammond, GP, lecturer and presenter of BBC2's Trust Me, I'm a Doctor

Breezing through the Nursing Times on the bog (sorry, toilet), I came across this fantastic story about a nurse who 'escaped with a caution' from her governing body (the UKCC) for using 'vulgar and explicit language' in front of patients.

The nurse, who for legal reasons can only be identified as 'Nightingale', defended the use of the word 'cock' to describe a patient's penis at a Kent nursing home.

"I've used it many times before and do not believe it to be disgusting. I was a tomboy as a child and have always sworn a bit."

Where do you stand on the 'cock' issue? Before you decide, read on.

Nurse Nightingale also admitted to referring to two patients as 'bastards'. However, while owning up to the word 'bum', she denied telling a patient to move her 'fat arse' and was sure she'd never told a 60-year-old woman eating a banana:

"It must be a long time since you sucked on one of those."

OK, so maybe she overstepped the mark a bit, but should such earthy dialogue always be discouraged?

I know a GP who regularly calls out over the intercom:

"Come on in Mrs Jones, you big jelly belly."

And the patients love him for it, even the Mrs Jones' of this world.

How does he get away with it? Is 'fat arse' intrinsically more offensive than 'big jelly belly'? Are doctors allowed to get away with this type of language more than nurses? Or is it because he's a GP in inner-city Birmingham and she's a nurse in leafy suburban Kent?

He also happens to be a senior partner who was raised in the area he works in, and has dedicated his whole professional life to the patients in one practice. They love him, whatever he says, and even if they don't they wouldn't dare complain.

Such a model of family practice is now scarce, with today's GPs preferringEto work part time in lots of surgeries. As a locum, it really isn't de rigeur to waltz into an unfamiliar waiting room firing 'jelly belly' from the hip.

But there may still be room for slang in the consultation. Many patients are confused, not just by the meaning of life but also by the meaning of 'How often do you open your bowels?'

It's embarrassing to admit such ignorance in front of the doctor, so they take a 'Who Wants To Be a Millionaire' guess between:

  • Every day
  • Once a week
  • Never
  • Only after Communion.

Not only can this lead to an unnecessary colonoscopy, but if they ask to phone a friend for the answer, they may well end up with a psychiatric referral.

How much easier life would be if we could say 'poo', 'turd' or 'big job' without fear of ending up in front of the Professional Conduct Committee.

But these are dangerous times and we have to tread carefully. So after much consulting with the BMA, the GMC, the Patients' Association and my solicitor, I'm able to offer you the following simple guideline:

Put everything in writing and let the patient decide.

Say Mr Biggins needs his catheter changing. Send him a letter, well in advance, along the following lines.

'Dear Mr Biggins. Sister Redwood will be calling later this morning to offer you one of the following. Please tick which you would prefer her to do:

  • Pop a little tube down your wee willie winkie
  • Reinsert a Foley's gauge 16 under sterile conditions
  • Drink a cup of tea (remember she hasn't got a certificate to do male catheterisations) and call out the doctor.'

Please feel free to use these guidelines, but, as ever, I would appreciate your feedback as to their usefulness.

Next month: Guidelines in use of the vernacular for patients who can't read.

  • Dr Phil Hammond is a GP and author of the best-seller Trust Me, I'm a Doctor (Metro, £9.99).

Guidelines in Practice, November 1999, Volume 2
© 1999 MGP Ltd
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