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June 11, 1982


JAMA. 1982;247(22):3059-3060. doi:10.1001/jama.1982.03320470015008

A student dropped by my office recently to request an internship letter. I knew him in his first clinical rotation to be very conscientious and attentive to patients and their families. I asked him to recall a situation where he had made a difference in a patient's care while he was a student. After he had done so, he said, "I'll tell you where just the opposite occurred." As he began to describe his presumed failure with a patient who had signed out against medical advice, three days after admission with serious pneumonia, he said, "He was a (you'll pardon the expression, but the house staff uses it all the time) 'dirtball.'"

Now I'm familiar with jargon in our training program and its reported usefulness as a mechanism for protecting oneself in stressful situations.1,2 During my own medical school days in the 1950s, I remember hearing "crock," and in