Globalization is on the rise. With increasing connectivity and collaboration between India and the UK, more and more Indian medics are training in the UK and more are expected to join.
This is a guide to the desi trained medic who comes to the UK for the very first time for further training and gets lost and overwhelmed in a completely new environment, culture, language and a whole set of words and phrases completely unheard of!
This blog post is an aftermath of a series of facepalm situations, blank stares, hain?!-moments, sighs, and multiple soul-shaking LOLs!
So, let’s begin the jargon!
If you are just out of your surgery rotations, that’s not really a pleasant word to begin with. But given the fact that understanding all the new lingo is a pain up your a**, this is the right word to begin with.
That was my first day in one of the busiest A&Es in the UK. As I gazed around and tried understanding what the hell is happening around me, someone suddenly struck me with a question “Is it a single pile for now?”. I stood there as if I’m imitating one of those rocks at the Stonehenge! Motionless, speechless and lifeless!
A 'pile’ refers to a pile/stack of patient notes – Usually the ones waiting to be seen by a clinician.
Usually there are different piles for different areas of the department (Majors, minors, triage) and you pick up the notes from these piles and start seeing your patient. The piles are sometimes combined if there is a smaller number of patients in the department. I was just wondering if the ED is overcrowded, do they call it a pile up then?!
1 2. BIBA
As I stood there on the corridor like a lost man in Rajiv Chowk metro station, one of the consultants walked up to me and said, “start seeing patients and you will get used to it” and handed me some patient notes from the pile.
I started reading the notes. “Patient BIBA, c/o Chest pain 2/52” it said!
“Arrey yaar! Ye BIBA kya hai? and what is this division exercise after chest pain? Is it a code or something? Is that a chest pain classification which I don’t know?” I thought.
Someone then explained that BIBA is the abbreviation for ‘Brought In By Ambulance’! Sometimes it is also written as brought in by LAS (London Ambulance Service) and
the duration of symptoms is denoted as 2/7 (2 days – denominator is the number of days in a week), 2/52 (2 weeks – denominator is the number of days in a year), 2/12 (2 months).
1 3. Bleep!
Finally, I saw this patient with a complex cardiac history and I felt that he needs to be admitted under the cardiology team. I discussed with the consultant and he said, “Bleep the cardiology Registrar”. I nodded like I completely understood what he said and smiled! <>
“Matlab? Cardiology ko call karun? Missed call doon? Or computer alli enaadru press maadbeka?” I thought.
If you are a 90s kid, you would probably know about a piece of technology called a pager which did a peek-a-boo. We still use that in NHS. Bleeping someone basically involves paging someone from a telephone nearby so that they can call you back on that number. Most of the registrars carry this futuristic gadget around their waist which goes into panic mode every now and then. At times you feel a false sense of self-importance if you are carrying one! Also, when it goes off when speaking to a patient you apologize and have a quick look at it so that patient knows you are a very busy bade doc saab!!
1 4. Tannoy!
I somehow managed to bleep the cardiology registrar. He agreed to see the patient and requested if we could do a repeat Troponin. While I went to the cubicle to take some more blood sample the patient was missing. One of the nurses said, “he must have gone out for a smoke!”. “Well! That definitely is a cardioprotective strategy” I thought! I waited for almost an hour and there was no trace of patient anywhere around! I went straight to the charge nurse and said, “Now what?”.
“Did you Tannoy?” she asked while staring at the large computer screen and trying to manage a busy department full of patients.
The question was followed by an absolute silence for few seconds. This desi doc had heard that word for the first time in his life! “Emmmm…. Do what?” I asked with a quivery voice. “Tannoy him...Tannoy him” she said again!
“Ye Tanu Weds Manu kahaan se aagaya yahan pe” was all that I had in my mind!
Announcing something on a loudspeaker which is heard by the entire population of the department is called a tannoy!
Given the fact that it is annoying to hear loud announcements over your head, especially while you are speaking to the patients and during handovers, the name t(annoy) is very apt and well thought of!
Probably the usage of the word comes from the British loudspeaker manufacturing company with the same name and is used as a verb now. It’s more like the Xerox being synonymous with photocopying in India!
1 5. Clerking!
My patient reappeared amidst the smokes (quite literally) and I explained to him the plan that he’s going to be admitted for further investigations and a cardiologist would see him. I also updated the charge nurse who helped me tannoy without getting annoyed by my never-ending questions in a busy department that ‘the patient is coming in’ (the phrase commonly used for admission). She was happy with the plan and told me that she’d book a bed for my patient. Then came the next question, “Did you finish clerking?”
“Clerks toh SBI mein hote hain! and I toh finished 10th, then 2 years PUC then medical college. Clerk toh raha nahi kabhi?! Ab ye kya hai?” I thought.
Writing patient notes is referred to as ‘clerking’. Everyone clerks after seeing the patient. There will be A&E clerking, medical clerking, surgical clerking and so on!
Luckily the nurse was kind enough to explain this to me again after my tannoy goof up!
1 6. Vetting
Since patient number 1 was sorted I picked up patient number 2. This was a 96-year-old grandpa with h/o fall and head injury who needed a CT scan of his head.
I requested the CT scan on the computer after a bit of struggling and a bit of help from kind colleagues. I called up the radiographer to see if I can shift the patient for the scan. Radiographer on the other side of the phone took details and said “It’s not vetted yet! Have you called the radiology reg to vet the scan?”
“*looong pause+blank expression on face* No. Will call them now” I said before disconnecting the call.
Until then I only knew of ‘wet’ and a veterinary wala vet. A quick google search revealed there is a verb ‘vet’ which means ‘to make a careful and critical examination of (something)’.
Someone explained that for most of the CT request I need to call up the radiology registrar and discuss with him so that he ‘vets’ the scan and then only the scan will be done.
Suddenly the radiology registrar’s image turned out to be something like this in my mind!
Mallus in the house, you can call this entire process ‘Vettam’!
(OK. I will stop before someone slaps me for this :-P)
1 7. Breach!
You will hear this very often. Like every 10 seconds probably. The greater number of times you hear something like “your patient is breaching in 8 minutes what’s your plan?” the more trouble you are in!
Every patient who comes to the ED must be assessed and disposed (either admission, discharge or appropriate referral) within a time frame of 4 hours as per national standards. Anyone staying beyond 4 hours without an appropriate plan in the emergency department is considered a breach. Trusts lose money as they get penalized if they are unable to reach this target so there is pressure from top which trickles down to you and you will be constantly hounded by people if you are not quick enough or the circumstances lead you to the edge of 4 hours!
BTW this has nothing to do with the breach presentation you learnt in your OBG postings!
“Really?! You think I don’t even know the meaning of water?” You might ask. Well! Even I thought I knew the meaning until I came across this completely new meaning.
Not a medical lingo but urine is often referred to as water by many patients!!!
So, if someone sees blood in urine and gets frightened – ‘Pani da rang vekh ke akhiyaan cho anju rul de’!!! (#OkBye)
9. Stone!
“Have you lost any weight recently?” I asked the old patient who was concerned about his recent lethargy.
“I have lost about 3 stones in the last 2 months” he said. “Oh! You had kidney stones as well?” I asked him again quickly. Both of us stared at each other for 10 seconds before I could realize he was still talking about his weight!
1 stone = 6.35029 kilograms and is commonly used by patients to describe weight. Count your stones!
(Wait! Where did this image pop up from?!)
10. Blue light / Blue call
As I admitted the old man under medics I once again heard a loud tannoy which said “Adult blue light to ED resus. ETA 6 minutes” and multiples bleeps went off as if there would be a spacecraft launch in few minutes or something! “Ye ho kya raha hai, bhai?!” I thought to myself. It also felt for a moment as if I’m watching some Hollywood thriller with all the action around!
Any priority 1 patient coming to the resus area of the ED is referred as being ‘blue lighted’ and the ambulance staff will notify the ED prior to arrival with an ETA (Estimated Time of Arrival) so that the staff can be ready to do the needful.
But if that turns out to be some drunk guy with low GCS prior to arrival but got up just on arrival to ED and is now GCS 15/15, you can sing this song: https://www.youtube.com/watch?v=nEnLt3pasxE (I know! But I can’t help it! :-P)
Ok! I’ll Stop (for now).
By the way, accents are a different story altogether which will make you go “Kaunsi bhaasa bol raha hai ye banda?”
Well, the Scottish accent? Don’t even get me started!
Maybe it’s worth looking at these videos:
These are the top 10 lingos and some essential tips to make life a wee bit easier! There are many more you will come across, but this is the essential starter pack!
Hope you have a pleasant time in the UK! Jai Hind! 😊
PS: If you don’t understand something, ASK! People are generally very friendly and helpful!
Acknowledgment: Thanks to all the amazing staff at Northwick Park Hospital (London North West University Healthcare NHS Trust) who were supportive throughout and never made me feel unsupported during the process of a massive change and tolerated all the blank stares!
Disclaimer: Views expressed here are the opinion of author only (of course!) and not that of the employer/NHS or any other organization.
Author:
Apoorva Chandra
MBBS, MRCEM (UK)
Higher Specialty Trainee (ST4) in Emergency Medicine
Royal Infirmary of Edinburgh
Scotland
United Kingdom
Twitter: @apoorvamagic
.jpg)
.jpg)
