Getting your anatomy right

Medicine has named all the parts of the body, but we still don’t know what to call them. At the start of my training on the wards, we observed a consultant surgeon while he taught us how to examine a patient. The patient was a barrister who had been admitted for a gallbladder operation.

He was very obliging, and finding the business of bedside teaching amusing. Which it is, provided that you’re well enough to enjoy it. Few other professions require their trainees to learn in public, and the opportunities to make a fool of yourself are wide ranging. Before you even consider your ignorance, there is the physical comedy: getting your stethoscope trapped so that when you try and straighten up you are pinned to the bedrail; not understanding how the bed works, so you become the student who was found huddled on the floor pumping the foot pedal with your hands.

The consultant examined the patient’s hands and eyes, and took his pulse. He looked at his tongue, and his neck. Then he lowered the head of the bed, so that it was flat, and asked the barrister to raise his pyjama top, exposing his skin from his nipples to his hips.

“I’m just going to have a quick feel of your tummy,” he explained. Someone snickered at the mention of “a quick feel”. “No one’s called it my ‘tummy’ since prep school,” said the barrister. The consultant ignored him, instead drawing intersecting lines across the exposed skin with his finger to show how doctors divide the abdomen into a noughts and crosses square.

Contrary to what you might think, there are no unnamed spaces on the human body. The crook of your elbow is your antecubital fossa (“ditch in front of the elbow”). The space behind your knee is your popliteal fossa (“ditch behind the knee”). The drop of tissue that dangles down the back of your throat is your uvula (“little grape”) – and it is not the same as your epiglottis, which is a flap, invisible from the outside, that stops food going down your windpipe. The area between the eyebrows is the glabella (“smooth”, because it’s not – ordinarily – hairy). The half-moon on your fingernail is the lunula.

Technically speaking, the anatomical structure the consultant was looking at was the abdomen, which is schematically divided by doctors into a three-by-three grid. From top right to bottom left the squares are named: right upper quadrant, epigastric, left upper quadrant, right flank, umbilicus, left flank, right iliac fossa, hypogastric, left iliac fossa. The organs are clustered in each square – the liver and the gallbladder reside in RUQ, for example. When a patient has RIF pain, you know to think of appendicitis.

But what doctors in England haven’t quite solved yet is how I should ask you to show me this space. The medical word, “abdomen”, is not used by many people. But “stomach” is factually wrong. (Your stomach – LUQ – is the springy bag in which your food first lands to be churned before it continues on through your intestine; most “stomach ache” is felt nowhere near the real stomach – what most people point to is their umbilicus, underneath which lies the small bowel.) “Belly” is American. “Tummy” is a nursery term, but English doctors use it in parallel with the anatomical terms. You learn to say “poo” for faeces, too. But if questions such as “Have you had your bowels open?” and “Have you passed any stool?” are met with blankness, there is not much alternative.

Sophie Harrison is a hospital doctor in South Yorkshire.

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