The Geriatrics “Profanisaurus.” Words and phrases we should ban?

23 December 2013

David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.

During the BGS Spring Meeting in Belfast, Prof Des O’Neill – probably the most cultured and literate geriatrician in our midst, asked many delegates, notebook in hand, for tips on enlightening books to further his thirst for broad knowledge. Earnest as ever, I suggested George Haidt’s “The Righteous Mind” and Ha-Joon Chang’s “23 Things They Don’t Tell You about Capitalism!”. Our then Hon. Sec., the redoubtable Dr Zoe Wyrko, mischievously and persistently tried to persuade Desmond that the book he really needed was “Roger Melly’s Profanisaurus” from Newcastle’s Booker-winning publishing house, Viz magazine. I did have a wry smile at the idea of the Amazon package being eagerly opened in Dublin the following week –contents taking pride of place in vertiginous O’Neill bookshelves. I also got to thinking, “sod Roger” – what about “Dave’s Profanisaurus of Geriatric Medicine?”. Though I don’t believe in censorship, we could list some terms that might result in an on the spot fine, a penance of extra fire safety training or a morning spent being the 15th member of the entourage following General Surgeons, P-Diddy style, round the wards.
I want to encourage my fellow BGS-ers to join in the fun and add their own “unutterables” but here is my start.
“Acopia”/”Acopic”. [sic] Whenever I see this term in patients’ notes I take the doctor aside for some gentle “re-education”. The thing I am proudest of writing is my 2008 essay in the JRSM Acopia and Social admission are not diagnoses. As Bytheway and Johnson stated, “ageism can range from well-meaning patronage to unambiguous vilification”. Giving some colleagues the benefit of the doubt, at best the “A” word means, “I have no training in dealing with frailty and no understanding that functional impairment usually comes with treatable diagnoses”, at worst, “older people are a just a bit crumbly, its their age, what did you expect?” or,“I can’t be bothered to try making a diagnosis”.
“Off legs ? Cause” comes under this broad umbrella. After my essay, two enterprising registrars, Drs Kee and Rippingale published an analysis in Age and Ageing of a series of cases of “acopia” – turns out it’s a dangerous diagnosis, encompassing for instance, cancer, severe sepsis, stroke & acute kidney injury. I still have medical colleagues saying to my geriatrician-face “I have an old boy for you, he is a bit acopic”. They do so, clearly unaware of the physical danger they have put themselves in.
“Social Admission” [See “Acopia” – above]. This is sometimes a variant on the theme. Readers, I kid you not, I have seen patients with two broken arms, one wrist fracture, spinal cord compression, sepsis and subdural labelled as “social admission” – not to mention those with severe dementia syndrome. In the case of the patients with fractures, I have been known to say, “so why didn’t you send them to the social worker instead of the fracture clinic then?”. An admission could only count as “social” in someone with no acute illness or injury, no recent change in function or cognition, whose carers have withdrawn and called 999, or perhaps someone with Dementia found wandering in the supermarket. And such people should, of course, not be admitted from the front door of the hospital as we can add no value to their care.
“Bed Blocker”. A couple of years back, when I was still the National Clinical Director for older people, I did 12 radio interviews back-to-back for the minister discussing the rise in “bed blockers”. I pointed out on every breakfast show that these were people, as entitled to care as any other citizen and that if they weren’t in hospital they would still be requiring publicly-funded care. Such terminology is depersonalising and adds to the narrative of older people being a threat to our services and a drain on resources – which is, of course, not true.
“The stroke in D4”. Ladies and gentlemen, this is a person….and someone’s mother, father or spouse. Someone with likes and dislikes, needs and wants, a life-history and deserving of respect as an individual. Reducing them to a number is profoundly disrespectful – think “prisoner 62”. And before you pull the data protection and confidentiality card, a BMJ survey of patients and public showed them to be intensely relaxed about their name being on display above the bed. Most patients expect professionals to share information about them with one another and we don’t conduct our board rounds using megaphones. Try stopping staff and saying “what’s that patient’s name?” and see if they always know.
“Mechanical Fall”. As all well-trained geriatricians know a fall in an older person generally results from a combination of activity, intrinsic risk factors such as gait, balance or eyesight, and external environmental ones. To be truly “mechanical” we need a fit person with no intrinsic factors slipping on the ice or a banana skin. Its just nonsense – stop it! And again, think about trying to make a diagnosis rather than “presenting complaint – fall; diagnosis – fall”. As Roger Melly would say “B****cks!”
“Failed OT assessment” and “Failed Discharge” One does not “fail” an OT assessment. The OT describes your ability to complete activities of daily living, contextualises this by describing premorbid abilities and then considers the support/equipment/rehab required to bridge the gap. I wish people would stop saying this. And as for “emergency readmissions” – they frequently occur in people for whom discharge was very carefully planned and supported. Guess what? Conditions relapse. People get new illnesses. People can panic. We need to accept some risk in helping older people return home.
Well, that’s my Mancunian ha’porth of profanities. Who else wants to join in the fun?


The term 'mechanical fall' should also be band along side all the other made up inaccurate terminology that does nothing more than serve to label older people and dehumanise them.

I would venture to add anyone ever in hospital or on a paramedic sheet saying/writing "strong smell of urine" or "smells of a UTI". My rage is likely to triple if this is directed towards a person who has been on the floor all night. Oh oh and also "don't worry dear, just go in the bed and we'll clean the sheets. It doesn't matter". It always matters

This particular post is not regarding people being referred to disrespectfully according to their age,yet I feel it's relevant. When I was a practising midwife the term for first time pregnant ladies over 28 Years old was 'elderly prim' (primigravida) I refused to write it in their notes. As I approach middle age I never want to be defined by my age when it comes to treatment in hospitals. My aunt was asked if she wanted to put herself through breast cancer treatment given her age. She was 70 years old and running marathons the previous year and probably far fitter than the person half her age who posed the question. Needless to say she went ahead with treatment and lived fruitfully for another nine years. We need to stop generalising about patients where age is concerned. We are all individuals.

The reason that so many of these phrases anger geriatricians so much is that they do precisely that. They imply that there is a cohort of patients who, by virtue of implicit criteria which usually comprise a mixture of chronological age and frailty, deserve less thorough attention. If one adopts a truly needs-based model (as opposed to making assumptions on the basis of age or frailty) then the converse is, in fact, true. The more conditions a patient has, the more complex each of these conditions is, the more medications they are taking, the greater the number of domains of assessment in which they demonstrate problems, then the greater the attention to detail, concentration and time that is required to meet their clinical need. So Jane, you're right, chronological age is a distraction. But one which doctors who apply the terms from the Profanisaurus are frequently beguiled by. When they start using terminology which is more detailed and precise, it will show that they are starting to grapple with the true complexity of the situation.

Please ban the term 'Difficult patient' which is a description covering a range of 'sins' such as ringing the bell more than once, asking for a drink outside of tea rounds, wanting to have a bath etc. It was applied to my Mum in a side ward and when her repeated calls on the bell were not answered she banged on the wall with her walking stick. Those who know me will no doubt be smiling at the thought that I will probably be labelled difficult if this label still in use!

Acopia is a place with a very small population in the province of Cusco, Peru which is located in the continent/region of South America I like putting a picture of it up when playing - 'guess the diagnosis'. Silly but fun

Great stuff. I recall a number of times after my fathers stroke when he was an inpatient and then sent home to be 'reabled' when he was described as 'non compliant'. He was nothing of the sort - he had just had his brain scrambled and needed abit of time for things to calm down. People need to walk in the shoes of those who are frail before using such stupid language.

STRONGLY agree with this and will be reminding myself to use this as often as possible!!!

Re: words and phrases I would like to see banned, please oh please stop calling the transfer of patients from hospital to their home or other place for continued care as ' discharge! When I was a nurse, discharge was something nasty, probably infected, that seeped out of a wound! The use of the word 'discharge' now is used wrongly ,in my book as it implies an end of an episode of care needing no follow up at all and very few transfers out of hospital come into that category. So please can we call it what it should be...transfer of care, (TOC) be it to whichever service is needed to continue recuperation or care. Such a term might even change how the spectrum of care is perceived by everyone from bed managers to the media! Vivienne Williams.

'MFFD' (medically fit for discharge) In other words 'I've treated her for UTI [see above!] by starting a course of antibiotics, now get her off my ward'. - said of 88yr old woman with 'DM2, IHD, COPD, CKD' who also happened to have early (undiagnosed) dementia, recent bereavement, peripheral neuropathy, & constipation, too...

Completely agree with everything & just when you think you've seen it all another classic line rises it's ugly head. I have also sadly witnessed someone with spinal cord compression labelled as off legs ? cause & of course they were "medically fit for discharge" with no diagnosis at this stage. The latest nonsense terms I have encountered are "failed behaviour chart", "failed bed rails assessment" & the ultimate "failed 4 call simulation". All terms drive me mad because they mean nothing!!!

Reblogged this on and commented: Please add the use of the words "We" and "they " when referring to older people! It is patronising, dehumanising, demoralising and sees normal human life as excluding us Oldies. See my blog on the Ageist Trap.

Great blog, can I add the term Geriatrician and Geriatric to the list! I would hate to be called a Geriatic, wouldn't you? From a social worker.

David - where do you stand on the use of the word "Sufferer"? To me, as a GP it is fairly common practice to hear patients refer to themselves as suffering with heart failure, cancer etc but since writing my www.mumhasdementia blog it is clear that many people with dementia deeply resent the word - wishing instead to be referred to as people living with dementia. I can fully appreciate the sentiments behind this - the word 'suffering' implies that it is not possible to live well with a condition and it is perhaps demoralising to use it but I also feel that there are times when 'suffering' IS an appropriate term, particularly in the context of dementia, and to avoid suggesting that someone might be struggling with their diagnosis is to ignore the elephant in the room. By the way - Excellent to see Viz-related literature on the recommended reading list. A colleague of mine was very keen to introduce a 'Literature in Medicine' component to the undergraduate course. I suspect this is what he had in mind.

Add new comment

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.