The use of pejorative terms to describe patients: "Dirtball" revisited.

Background: The use of pejorative terms for patients is well documented. Reasons include frustration and anger in managing certain patients, fostering group solidarity among caregivers under stress, and the alleged "dehumanization" of medical training. Medical students were surveyed to document and understand the phenomenon.

Methods: The 1988, 1989, 1990, and 1996 Johns Hopkins University Medical School graduating seniors were asked about their attitudes towards such use and about the nature of medical school.

Results: Class response rates varied from 75% to 95%, with 8% to 13% of respondents recording having heard no pejorative terms. The reported number of different terms declined during the period from 75 to 55, as did use of "dirtball" and "gomer." Only 2% to 13% of particular classes considered such usage to be helpful, whereas 30% to 50% considered it harmful. Pejorative terms were used most frequently for self-destructive or abusive patients. From 12% to 24% of students thought medical school to be humanizing; 10% to 24%, dehumanizing; and 38% to 59%, both.

Conclusion: Most students had heard pejorative references to patients, but few thought the practice useful. Monitoring such usage may help identify individual or institutional problems and lead to better management strategies for certain subgroups of patients.