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The Racist Language That Masquerades As a Diagnosis

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“The patient in Room S3 has a full-blown case of status Hispanicus,” the charge nurse said as she leaned against the doorframe. “With some aye-aye-itis mixed in there as well.”

I barely flinched when I heard the words that had come out of her mouth. I didn’t even look up from the EMR. After months of working in the ED as a medical scribe, I had become increasingly fluent in the language of medicine. My vocabulary had multiplied in number. Now I knew words that only a privileged few understood, diagnoses that included aphasia, bronchiectasis, cachexia. The phrases that the charge nurse had used — “status Hispanicus” and “aye-aye-itis” — were merely differentials.  

Status Hispanicus was a subcategory of status asthmaticus, or a severe asthma exacerbation. It was a life-threatening condition found exclusively in the Hispanic population, with symptoms that ranged from difficulty breathing to overdramatization of distress. Similarly, aye-aye-itis was an inflammatory disease of unknown origin also found in the Hispanic population. This illness was marked by patients being unable to withstand their pain and unnecessarily yelling “aye-aye-aye!” at the top of their lungs. There were additional terms that could be used to diagnose the typical Hispanic patient, each of them different but the same in essence: Hispanicus dramaticus, Hispanicus hystericus, total body dolor (TBD).

As a scribe, I watched in silence as doctors and other health care professionals verbalized these diagnoses to one another behind the scenes (out of earshot of patients themselves, of course). Now, as a second-year medical student, I dread the day when I will soon re-enter the clinical space and hear that same language again — rhetoric that masquerades as an objective clinical diagnosis but harbors something far more virulent underneath. 

Studying medicine is often described as learning a foreign language. Some say that medical students pick up approximately 15,000 new words during their four years of training, while other estimates range as high as 55,000. This influx in linguistic repertoire not only expands one’s clinical knowledge, but also offers a different perspective through which to see the world. A broken bone, for example, becomes a fracture. A bout of vomiting turns into an episode of emesis. A kidney stone transforms into nephrolithiasis or urolithiasis or renal calculus.

If medicine is a language unto itself, then the physician’s greatest responsibility is to act as communicator, interpreter, and translator. In order to bridge the gap between the patient’s lived experience and the realm of clinical medicine, the physician must render complicated and dense information digestible. They must avoid verbiage that may otherwise confuse and even intimidate the patient. After all, language has power — and whoever wields that language wields power as well.

The abuse of language in medical settings, then, speaks to the unequal power dynamic that exists between physicians and patients. Medical mnemonics that are frequently used to memorize clinical information, for instance, have a reputation for being sexualized and racist. Although this sort of language continues to be evoked in medical education, recent efforts are ongoing to expand the lexicon of medicine in the name of patient respect and inclusivity. By carefully choosing the words they speak into existence, health care professionals can avoid forming judgments that reinscribe racism, sexism, and other discriminatory frameworks.

I am well aware that phrases like “status Hispanicus” are not exclusive to my suburban ED. A few physicians have discussed encountering this vocabulary in their own careers, most notably Dr. Danielle Ofri in “What Doctors Feel: How Emotions Affect the Practice of Medicine.” Ofri rightfully argues that these “derogatory terms, by definition, serve to distance doctor from patient, and this directly detracts from the ability to be empathetic.” Ofri goes on to explain that physicians use this language to not only protect themselves from their patients’ mortality, but also express their own discomfort through humor. Medical students, in turn, echo the same language in order to become a part of the in-group. “Medical slang and inside jokes,” Ofri writes of trainees, “are a way of achieving this.”

In “The Secret Language of Doctors: Cracking the Code of Hospital Culture,” Dr. Brian Goldman also discusses how this medical slang functions to separate physician from patient — not necessarily out of protection, but due to the physician’s inability to believe the patient’s pain or symptoms. “Status Hispanicus,” “ay-tach,” and related terminology thus downplay the patient’s condition in favor of somatization and perpetuate a diagnosis that is based on the grounds of race. Or as Goldman plainly admits, “contempt to members of certain ethnic groups.”

Both Ofri and Goldman, however, fall short of taking their linguistic analyses to their logical conclusion: that the use of this language is not just racially coded or charged, but racist itself. Indeed, it directly contributes to the pathologization of race, in which race itself becomes the problem — or rather, the clinical disease that must be controlled instead of the physiological condition.

The pathologization of race has had dire consequences throughout the history of medicine, often responsible for the creation of diagnoses that nowadays would be regarded as unacceptable. Dr. Samuel Cartwright, for example, is infamous for his studies on the “the diseases and physical peculiarities of the negro race” during the 19th century. Enslaved African Americans, he hypothesized, suffered from various mental illnesses that needed to be treated: “rascality” (a disease that made slaves disobedient and indignant), “dysaesthesia ethiopica” (a disease that made slaves lazy and indifferent), and most notoriously, “drapetomania” (a disease that made slaves run away from their masters). Cartwright proposed these three terms not as inside jokes or slang, but as objective medical diagnoses that centered race as pathology.

“By pathologizing these observations into defining racial features,” historian Christopher D. E. Willoughby concludes, “Cartwright fashioned a powerful new argument for proslavery advocates, underscoring the rhetorical power of scientific discourses.” The language of medicine has historically served to legitimize racism itself — so then why, I must ask, are we tolerating it in the first place?

“Status Hispanicus” and the like are contemporary terms used to refer to Hispanic patients, but I have heard other words reserved for different patient populations: status Haitianus (for Haitians), incarceritis (for those who are imprisoned), and more. I assume that this language varies from region to region and hospital to hospital, depending on the surrounding demographics. Every clinical space, as Ofri and Goldman argue, is marked by its own lingo and jargon. As a student physician, I acknowledge that I am still in the process of learning the language of medicine — but this other dialect, the one that goes out of its way to pathologize race under the auspices of medicine, is a rhetoric that I have no intention of ever speaking into existence.

What medical jargon would you scrap from EHRs and hospital hallways?

Saljooq Asif, MS is a second-year medical student at New York Institute of Technology College of Osteopathic Medicine. He is also a Lecturer in the Program in Narrative Medicine at Columbia University, where his scholarship focuses on the broader health humanities in relation to narrative ethics, racial justice, popular culture, and more. He is a 2021-2022 Doximity Op-Med Fellow.

Illustration by Yi-Min Chun

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