SHPOS: The acronym doctors use for worst of the worst patients

SHPOS: The acronym doctors use for worst of the worst patients

A medical acronym, SHPOS, helps a doctor summarize a patient’s history in just five letters. But unlike emotionally neutral acronyms doctors use, such as LOL—little old lady—SHPOS is a derogatory term that describes a hospitalized patient who is felt by his doctor to be a “subhuman piece of sh*t.” The acronym has been around since at least 1980, when it was first mentioned in print, but must have existed long before it was memorialized in the journal Man and Medicine. Some doctors drop the SH prefix, going straight for POS, but the phrase “subhuman” is really where the expression gets it power. What makes a patient, formerly known as a human being, a SHPOS? A SHPOS becomes a SHPOS when a health care worker hates him.

The term is known to physicians everywhere, passed by word of mouth from resident to intern to medical student. Psychiatrist Abbey Strauss described the phenomenon in a 1983 paper: a patient who is “childlike, unreliable, occasionally arrogant, demanding, insensitive, self-centered, ungrateful, non-compliant, and wrongly motivated.” Strauss describes a type of SHPOS who might be called a “difficult patient.” His paper focused on the way physician and patient narcissism create the SHPOS interaction. As a psychiatrist with an interest in antisocial personalities, I would add to his description the words abusive, threatening, racist, misogynistic, and rageful.

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