A urine sample? You’re taking the piss.

Dr Jo Oranje

As a New Zealander, it is perfectly conceivable that I might feel pissed off at having to piss off when it pisses down while I’m on the piss at a piss up. And if I’m unexpectedly asked by a medical professional to provide a urine sample, I might retort: “You’re taking the piss!” If my doctor or nurse speaks English as an additional language (EAL) and is unfamiliar with this idiom, she might interpret this literally: “Yes, that’s exactly my intention.” But this assumes the practitioner is aware that ‘piss’, in this context, is a noun. In fact, ‘piss’ is one of those complex English words that can operate in many word categories. In the sentences above, piss has taken roles in verb phrases, noun phrases and an adjectival phrase. I didn’t pluck this one word out of the air (or pull it out of my finger, as my Polish neighbour says).

‘Piss’ is listed in Appendix B of Cole’s Medical Practice in New Zealand,1 the guide issued by the Medical Council for doctors beginning practice in New Zealand. First published in 1988, it is now in its 12th edition (2013). Appendix B is titled “Take our word for it: New Zealand slang expressions”, and is four pages long.  The six entries for ‘piss’ are sandwiched between ‘piker: one who gives up easily’ and ‘plaster’, as in ‘band aid’ (and as opposed to ‘plastered: drunk’). Appendix B cautions doctors:

When Kiwis (New Zealanders) talk, they may use slang words that you do not understand. Here are a few that may be used in a medical context. Be warned, however: don’t try these at home; many of these words and expressions are considered vulgar, rude or offensive: do not use them until you are sure you will not offend.”

Yet little direction is given on which examples are risky in this way—although a specific warning is given to (North) Americans about the New Zealand meaning of ‘fanny’.

International medical graduates comprise 40% of doctors working in New Zealand (Pande, 2016)2 and a similar proportion of New Zealand’s registered nurses have international qualifications (The Nursing Cohort Report 2014, 2015).3 Like me, you might have heard people complain that internationally-trained doctors or nurses “don’t understand English”. In fact, they do understand English: all health practitioners registered in New Zealand must meet their respective registration council’s English language requirement. This could amount to having gained their medical qualification from an approved English-first-language country or attaining a particular score on the IELTS test.4 These achievements do not, however, indicate the individual’s ability to communicate in New Zealand’s colloquial language or negotiate New Zealanders’ cultural perspectives. It would therefore be more accurate for the complainant to say “They don’t understand my English.”

In the past, the University of Otago offered a medical selective paper that was intended to expose international students to the kinds of New Zealand colloquial language and aspects of culture that might arise in a health setting. As the name ‘selective’ suggests, the paper was not compulsory; it was one of a handful of humanities papers offered to medical students from which they were required to select one—as an interest paper and a contrast to an otherwise science-loaded course. I understand the paper was offered only once or twice, by the University of Otago’s Linguistics programme’s teaching fellow (a position that no longer exists).

Knowledge of this kind is crucial for students of medical professions. The medical selective, limited as it was, provided more meaningful and realistic content than either Appendix B of Cole’s Guide or an off-the-shelf dictionary of Kiwi slang. If offered again in future, it should include a reflective approach where students (and not just international students) learn to become aware of their own language and cultural viewpoint. This will reveal how an individual’s viewpoint always impacts on interactions with others, affecting interpretations of behaviours and language.

Even members of the same language/culture have differences based on personal backgrounds, beliefs, and age. Age, for example, affects the way language is used. Some language features are used by people only when they are a certain age—we grow into them, and grow out of them—and some are used only by people of a certain generation. There are many examples of the latter in Cole’s Guide. ‘Cheerio’ in the sense of ‘good bye’ (as opposed to ‘small red sausage’) is still used by my parents’ generation but is no longer commonplace. There is no explanation of this point for readers of the guide. Furthermore, there are few, if any, entries representative of the current young person’s lexicon, some of which are ripe for confusion in a health setting; ‘wicked’, ‘mean’, and ‘sick’, can all be used to mean ‘great!’.  Even for native and proficient speakers of New Zealand English, only context tells us whether ‘yeah, nah’ is a positive or a negative expression.

We all need to appreciate how complicated and nuanced our own version of English is before we criticise others for not comprehending us. The impact of the subtleties of colloquial language cannot be underestimated, but taking a sophisticated, explorative, and reflective perspective can mitigate confusion or offense. A recent discussion with my South Korean friend, in which she said I was “passing away,” to mean “passing by,” could have caused much more distress had she been a medical professional, and I her inhibited patient!


Dr Jo Oranje has a PhD in applied linguistics and education, and a graduate diploma in second language teaching. Jo’s work in intercultural teaching and learning was motivated by her desire to learn about other cultures; along the way she discovered an awareness of her own culture to the benefit of her teaching and learning of languages, cultures, and life.

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[1] Coles Medical Practice in New Zealand 2013
[2] The Cross-Cultural Adaptation of International Medical Graduates to General Practice in New Zealand
[3] The Nursing Council Cohort Report 2014
[4] International English Language Testing System (IELTS)

One thought on “A urine sample? You’re taking the piss.”

  1. Good article, and worth also noting that people’s language ability deteriorates during times of stress (e.g. when in pain or facing unfamiliar medical professionals and/or procedures). To that extent, even native speakers familiar with a range of idioms may have difficulty understanding their patient (or clinician), who may fall back on and/or try to suppress their most familiar manner of speech. Moreover, the difficulty in describing symptoms leads some patients to reach for figurative language, creating a whole new layer of interpretive difficulty for both native and native speakers of other languages.

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