Personal Views: Guy Fawkes's influence on medicine after 400 years
Authors: Peter McCann
Journal: BMJ (2005)

I recently criticised for one of my lectures. Curiously, the criticism was not about the contents of the lecture, but rather how its contents were delivered. One of the more senior doctors approached me after the lecture and told me how disappointed he was at my habitual use of what he clearly thought were derogatory terms such as guy and chap when I was describing patients.

Did I really use those terms that often, I thought? I wondered whether it was indeed a sin to use these words. The senior doctor felt it was insulting to patients to describe them as such and that these words were an unwelcome “Americanism.” When I am on a ward round or in clinic I have always felt it important to address people politely when speaking to them directly. However, over the next few weeks I did notice that when talking about patients to my colleagues I often referred to them as “this guy last week.”

This got me thinking even harder. Was anybody else doing the same thing? Perhaps I had learnt this habit from my senior colleagues. Over the next two weeks I listened to how 15 different consultants described their patients to their junior staff while conducting a ward round. To my relief, 11 of them used the word guy at least once to describe their patients (but, like me, never to the patient directly).


Many working class patients have been surprised when I have called them “sir”


So, it seems that many of us use these terms. Had we all been influenced by American English? Bill Bryson style, I did some etymological research. Guy has a distant origin. One derivation is from the old Germanic Wido or Wito. In Old English this was reflected as wudu, meaning a wood, tree, or forest. The French translation was guy and certainly the name was popular among the Normans some 900 years ago (http://privatewww.essex.ac.uk/~alan/family/S-Guy.html). When the Normans conquered Britain the name became popular here too. The French also used the name Gui, meaning a guide.

In an example of semantic progression, the modern use of guy seems to stem from Guy Fawkes's failed plot to blow up the Houses of Parliament in 1605. After this time it became popular to burn his effigy or a guy. The term was used in the English language to mean any person of a grotesque appearance and by 1836 was recorded as describing a person wearing unusual or bizarre clothing. Over the rest of the 19th century the meaning evolved to generally refer to a man. In the early 20th century it became popular in American culture as a replacement for more English terms such as bloke, fellow, and chap. From popular American culture the term has become once again popular here, almost 1000 years after first being introduced.

As for chap, this seems more straight-forward. It is an archaic term used in English for hundreds of years. It is an abbreviation of Chapman, which is a hereditary surname describing a trader or a pedlar from medieval times. Chapmans often sold chapbooks that were popular simplified stories such as Tom Thumb, Aesop's Fables, and The Pilgrim's Progress. Chapman is a derivative of the old English Ceapman, first recorded in Cambridgeshire before the Norman invasion of 1066.

It would therefore seem that both the words guy and chap are archaic in origin, and have had their use in the English language for many centuries before the Americas were discovered by Europeans. Whether patients would find it insulting to be called such terms is difficult to know, but I would not be, especially after understanding what the terms mean. I know that traditionally we like to call patients “gentleman,” “madam,” or “sir.” Technically speaking, gentleman refers to a man with a coat of arms but not a title, a middle rank between the nobility and yeomanry. It is recorded as far back as 1225 from the French gentil, which in turn is from the Latin gentilis, meaning of the same family or clan. Sir is an old French word, derived from cher or sur, which meant gladness, joy, or good hospitality. Madam is from the old French madame or ma dame, referring to a married French lady.

Whatever address we use when describing patients, we must remember that offence can easily be given. I have met many working class patients who have been surprised when I have called them “sir.”

I would be interested to know what readers felt should be the best address for patients, when describing them to our colleagues and directly. As for addressing people by the Old English terms guy or chap, I feel partly vindicated because it seems just as reasonable as calling them archaic French titles such as madam or gentleman.