Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When a mnemonic becomes dangerous

Jay Wong
Conditions
April 9, 2020
Share
Tweet
Share

Fat.

One tiny word. One voluptuous, full-figured concept.

Several weeks ago, amidst a conversation regarding the risk factors for cholelithiasis (i.e., gallstones) during a chief concern small group session for preclinical students, my preceptor ushered in an aurally convenient yet unsettling mnemonic utilizing alliteration that has apparently been in the works among medical education for a while now, known as “the 4 Fs”: female, fertile, forty, and … fat.

Yes, you read that right.

Despite my instructor’s best efforts to soften the blow by visibly cringing and sharing her own disapprobation towards this memory trick, the pregnant pause that ensued in that small classroom that afternoon was not only palpable but its silence deafening. The moment the word represented by the final “F” was uttered, my eyes darted around the room only to reassuringly see a mix of familiar reactions that engendered a feeling of tacit solidarity around me: some were of utter disgust, others of restrained discomfort, and a few of surprise and confusion.

I gulped.

Immediately, I wondered why this mnemonic was extant and why we have not extricated ourselves from using it. What kind of journey has it gone through to survive the protean conditions of an ever-evolving medical education landscape that positions itself as an entity that seeks to affirm dignity in and foster respect towards patients where “chief complaint” has now become “chief concern” and “compliance” changed to “adherence” under new educational jurisdictions?

Ostensibly, this bewilderment towards “the 4 Fs” presupposes the idea that “fat” confers stigma upon and connotes a pejorative meaning towards the individual it is intended to characterize. Barring the progress and efforts of various factions of the contemporary fat-acceptance movement towards the reclamation of the word “fat” as a positive, the spearheading of its volitional self-directed use as a form of self-empowerment and restoration of bodily agency, and a more nuanced discussion around what the word “fat” currently connotes to different groups of people and stakeholders. “Fat” as a human descriptor continues to occupy a largely derisive space among many social circles, one of which is prominently the medical community.

And thus I became curious about what other mnemonics are still formally (or informally) institutionalized and used in medical didactics that reprehensibly encode subliminal prejudice and discrimination that could lead to differential treatment of and harm, even, towards patients by those justifying its use simply on the grounds that the mnemonic makes things “easier to remember.”

And to that end, where do we draw the line?

If there were a mnemonic to remember risk factors or a particular disease script involving developmental impairment, is it appropriate to use the word “retarded” along with other words that begin with an “r” sound?

What if having multiple sex partners is a risk factor for a particular condition, can we use “slut” as one of the words that would be enumerated among a diagnostic checklist of other non-neutral “s” sounding descriptors?

Where do we draw the line between just inoffensive enough to keep something for the sake of smooth information storage and recall ease and too disparaging that irrespective of memory convenience we need to do better and come up with an alternative way to learn and teach the concept?

Moreover, you may be inclined to wonder how we could possibly ascertain the subjective appraisal and reception of our words by our patients when one person is so vastly different from the next, and if there is some litmus test or general heuristic we can employ to navigate all subsequent approaches to mnemonic construction in medical education that would effectively reduce harm towards patients and ameliorate discomfort and hostility within the medical learning space.

To that end, I implore you to ask yourself, “Would I be okay saying this to my patient and not just to the medical trainees, employees, and students I am teaching or to myself in my own head?”

To return to our original example, if your patient asked you, “On what basis did you determine that I was at an elevated risk for cholelithiasis?” Would you feel comfortable responding with, “Well, you are a female, you are in your 40s, you are fertile, and you are fat.” If the answer is “no,” or you felt even a scintilla of unease just now imagining yourself uttering that response to your patient, then you likely should try to reassess the language you are using to learn, encode, and teach risk factors for gallstones, for example.

ADVERTISEMENT

Reflexively, I parlayed my understanding of how the current modeling industry works and suggest that — similar to how fashion models who represent more curvy — voluptuous body archetypes are no longer called “fat” or “plus-size” even, but instead “full-figured” to be more language-sensitive and politically correct, we adopt and incorporate “full-figured” into the lexical repertoire as not only a replacement for “fat” in “the 4 Fs” but also “fat” in general in any setting used to talk about patients.

I am particularly an exponent of using “full-figured” specifically for “the 4 Fs” as opposed to other positive descriptors such as “curvy” and “voluptuous” because “full-figured” preserves the integrity of the aural convenience of alliteration employed by “the 4 Fs” that justifies its continued use and does not require a complete overhaul of the mnemonic.

Words are powerful. They can change the course of a patient’s life. And we have the responsibility of ensuring that that change is a positive one. Whether we like it or not, the language we use to understand our patients shape our unconscious (and conscious) biases and preconceived notions, and are formidable propagators of prejudice, discrimination, and even insidious harm when deployed inappropriately.

As medical professionals, we owe it to our patients to be lodestars for dignity affirmation and respect conferral. This begins with heightened self-accountability, a re-evaluation of our diction, and an extirpation (and replacement) of unpalatable, deprecatory words baked into our everyday medical education and communication. We should extend our commitment to optimizing care into challenging the lexical status quo and making better the lives of those we took an oath to serve — our patients.

Jay Wong is a medical student. He received his undergraduate degree in molecular, cellular, and developmental biology from Yale University. He can be reached at his self-titled site, Jay Wong, and on Twitter @JayWongMedicine.

Image credit: Shutterstock.com

Prev

Why we must be cautious about hydroxychloroquine

April 8, 2020 Kevin 0
…
Next

When a trauma surgeon is sick and afraid to die

April 9, 2020 Kevin 0
…

Tagged as: Gastroenterology, Surgery

Post navigation

< Previous Post
Why we must be cautious about hydroxychloroquine
Next Post >
When a trauma surgeon is sick and afraid to die

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Jay Wong

  • Ethical humanism: life after #medbikini and an approach to reimagining professionalism

    Jay Wong
  • The war on drugs: America’s secret racist war today

    Jay Wong
  • You’re outraged by police brutality and racism. OK, now what?

    Jay Wong

Related Posts

  • Kratom: harmless herbal supplement or dangerous drug?

    Dennis Wichern
  • The dangerous precedent of Alfie Evans

    Vamsi Aribindi, MD
  • Facebook has become a dangerous platform for misinformation. Or has it?

    Mark Tosca, DO
  • Why private equity is a dangerous employer

    Kara Grant
  • Qualifying conditions for medical marijuana

    Patricia Frye
  • Settlements in the opioid cases need these non-negotiable conditions

    Rosanne Aulino, RN

More in Conditions

  • JFK warned us about physical fitness. Sixty years later, we’re still not listening.

    Alexandre Bourcier, MD
  • My journey from misdiagnosis to living fully with APBD

    Jeff Cooper
  • Why shared decision-making in medicine often fails

    M. Bennet Broner, PhD
  • She wouldn’t move in the womb—then came the rare diagnosis that changed everything

    Amber Robertson
  • Diabetes and Alzheimer’s: What your blood sugar might be doing to your brain

    Marc Arginteanu, MD
  • How motherhood reshaped my identity as a scientist and teacher

    Kathleen Muldoon, PhD
  • Most Popular

  • Past Week

    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Registered dietitians on your care team [PODCAST]

      The Podcast by KevinMD | Podcast
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • ER threats aren’t rare anymore—they’re routine

      Patrick Hudson, MD | Physician
    • JFK warned us about physical fitness. Sixty years later, we’re still not listening.

      Alexandre Bourcier, MD | Conditions
    • The silent threat in health care layoffs

      Todd Thorsen, MBA | Tech
    • Why true listening is crucial for future health care professionals [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Do Jewish students face rising bias in holistic admissions?

      Anonymous | Education
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • “Think twice, heal once”: Why medical decision-making needs a second opinion from your slower brain (and AI)

      Harvey Castro, MD, MBA | Tech
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Registered dietitians on your care team [PODCAST]

      The Podcast by KevinMD | Podcast
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • ER threats aren’t rare anymore—they’re routine

      Patrick Hudson, MD | Physician
    • JFK warned us about physical fitness. Sixty years later, we’re still not listening.

      Alexandre Bourcier, MD | Conditions
    • The silent threat in health care layoffs

      Todd Thorsen, MBA | Tech
    • Why true listening is crucial for future health care professionals [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...