This chapter explores referential metonymy as an atypical use of reference. After reviewing relevant literature on referential metonymy, we consider the extent to which it is inherently atypical. Using examples of metonymy from medical discourse contexts, including nurse handover discourse and medical students self-reflections, we situate metonymy as a type of reference, that is, metonymic reference, and examine features which establish its use as atypical reference. We show that typical or atypical uses of metonymic reference depend on a variety of factors. While metonymic reference is essential in some contexts for safe and efficient reference, we also show that in some cases its use can signal stigmatisation of patients and/or difficulties of medical professions in maintaining moral. In these cases, referential choice becomes especially significant.