PETERSO N, C. 694
Cad . Saúd e Púb lic a, Rio d e Jane iro , 14(4):671-699, o ut-d e z, 1998 Dep a rt m en t of
An t h rop ology Hu n t er College N ew York , U SA.
N a n cy M . Flow ers Th is is a fa sc in a t in g a c c o u n t o f p re se n t - d a y m e d ica l sla n g a s cu rre n t in h o sp it a ls o f Rio d e Ja n e ir o. It in vit e s c o m p a r iso n wit h m e d ic a l sla n g u se d in o t h e r c o u n t r ie s, a s t h e u se o f sla n g u n d o u b t e d ly re fle c t s t h e so c ia l c o n d i-tio n s u n d er wh ich m ed ica l p erso n n el wo rk.
As Pe t e r so n p o in t s o u t , wh a t is st r ikin g a b o u t Bra zilia n m e d ic a l sla n g wh e n we c o m -p a re t h e vo c a b u la r y t h a t h e c o lle c t e d wit h th ose collected in h osp ita ls of th e Un ited Sta tes (e .g., Ko n n e r 1987; Co o m b s e t a l. 1993) is t h e variety of d ep recatory term s th at refer to Bra zil-ia n h e a lt h c a re se r vic e s. Co o m b s e t a l. (1993) co lle ct e d 247 t e r m s, o f wh ich t h e m a jo r it y re fe rre d t o ‘t h e p la ye rs’ ca re give rs a n d ca re re -ce ive rs a n d t h e ir re la t io n sh ip s. On ly 17 t e r m s re fe rre d t o h e a lt h ca re se r vice s, a n d we re re la -t ive ly m ild co m p a re d -t o -t h o se u se d b y Bra zil-ia n d o cto rs. ‘St. Elsewh ere’, a term p o p u la rized by a televisio n p ro gra m , refers to a co m m u n ity h o sp ita l iso la ted fro m a ca d em ic cen ters; ‘Do c-in - t h e - Bo x’ is a wa lk- c-in clc-in ic. Ko n n e r (1987), a n a n t h r o p o lo gist wh o d e cid e d t o go t o m e d -ic a l sc h o o l wh e n h e wa s in h is m id - 30s a n d wh o wro t e a b o o k a b o u t h is e xp e r ie n c e s, in -clu d es a glo ssa r y o f 234 term s. Aga in , few refer t o h e a lt h ca re se r vice s p e r se. He in clu d e s ‘St . Elsewh ere’ a n d ‘Mon ey Ch a n gers’, u sed by h o s-p it a l s-p e r so n n e l t o re fe r t o s-p r iva t e s-p h ysic ia n s, e sp e c ia lly t h o se in su c c e ssfu l gro u p p ra c t ic e, im p lyin g th a t th e ir wo rk ca n n o t b e tru ste d b e-ca u se o f th e p ro fit m o tive.
A n u m b e r o f e xp la n a t io n s h a ve b e e n give n fo r t h e wid e sp re a d u se o f m e d ica l sla n g, e sp e-cially in a h osp ital settin g. Coom b s et al. (1993), u sin g a q u e st io n n a ire d e sign e d t o t e st t h e fa -m ilia rity o f d o cto rs with -m e d ica l sla n g a t va ri-o u s st a ge s ri-o f t h e ir ca re e r s, fri-o u n d t h a t t h e u se o f sla n g wa s u n c o m m o n a m o n g m e d ic a l st u d e n t s u n t il t h e y le a ve cla ssro o m s a n d la b o ra -t o r ie s a n d b e gin -t o b e in vo lve d wi-t h p a -t ie n -t ca re. “Sla n g in crea ses sligh t ly in t h e fin a l yea r of m ed ical sch ool, an d p eak s d u rin g th e in tern -sh ip yea r, con sid ered t h e m ost d ifficu lt of a ll, w h en t h e h ou rs a re lon g a n d t h e resp on sibilit y of p atien t care ex ten sive” (Co o m b s e t a l., 1993: 992). Ph ysicia n s wh o h a ve b e e n in p ra ctice fo r 20 o r m o re ye a rs a re h a rd ly m o re fa m ilia r with h o sp it a l sla n g t h a n b e gin n in g m e d ic a l st u -d en ts.
Th is su gge st s t h a t sit u a t io n s o f h igh st re ss a n d fru stra tio n , su ch a s th a t wh ich yo u n g d o c-t o r s o fc-t e n fa c e d u r in g c-t h e ir ye a r s o f h o sp ic-t a l resid en cy, often resu lt in th e u se of ‘ga llows h u -m o r’ to d efu se ten sio n . However, in th e Un ited St a t e s, o n ce d o ct o r s we re e st a b lish e d in t h e ir
c a re e r s t h e y c o u ld , a t le a st u n t il re c e n t ly, e x-p e ct to e n joy x-p ro fe ssio n a l in d e x-p e n d e n ce, h igh p re st ige, a n d fin a n c ia l se c u rit y. In Bra zil, a c-co rd in g t o Pe t e rso n , m e d ica l sla n g re fle ct s t h e “m alaise an d discon ten tm en t” of d octors ca u gh t in th e p resen t crisis of th e Bra zilia n h ea lth ca re syst e m , a c r isis t h a t d e st r oys c o n fid e n c e in t h e ir p r o fe ssio n a l fu t u re. Bu t d o c t o r s a re b e -co m in g in cre a sin gly u n h a p p y wit h ch a n ge s in th e Am erica n h ea lth ca re system a s well, a n d in h ow th ese ch a n ges a ffect th em .
In t h e Un it e d St a t e s, a cco rd in g t o a re ce n t a r t icle in t h e N ew York Tim es(St o lb e rg, 1998), a s m a n a ge d c a re ra p id ly re p la c e s t ra d it io n a l fe e fo r se r vic e , d o c t o r s a re lo sin g t h e ir in d e -p e n d e n c e . Ac c o rd in g t o t h e d ire c t o r o f t h e Ce n t e r fo r He a lt h Po lic y a t t h e Un ive r sit y o f Pen n sylva n ia , “Now you h ave d octors su bject to ou t sid e m a n a gem en t , m ost d oct ors b ein g em -p loyees of a n orga n iz a t ion or h igh ly m a n a ged . Th e loss of au ton om y an d con trol is astou n d in g. Th e d octors are battered” (Sto lb erg, 1998:A1). A p h ysicia n wh o se p ra ct ice wa s t a ke n ove r b y a for-p rofit m ed ical grou p th at su b seq u en tly wen t b a n kr u p t glo o m ily p r o p h e sie d t h e c o m p le t e c o lla p se o f Am e r ic a n h e a lt h c a re sin c e , “a n y syst em in w h ich a cru cia l com p on en t is so d e-m oraliz ed n ae-m ely d octors can n ot p ossibly su r-v ir-v e” (St o lb e r g, 1998:A14). If t h is is t h e c a se , m a y we n o t e xp e c t t h a t fu t u re c o lle c t io n s o f Am e rica n m e d ica l sla n g will in clu d e d isp a ra g-in g t e r m s fo r m e d ic a l se r vic e s t h a t p a ra lle l th o se a lrea d y cu rren t in Bra zil?
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