For anyone who’s been a patient or a family member attending a loved one in hospital, the expectation — or at least the hope — is that doctors, nurses and other care providers are empathetic to what ails them and respectful of their needs.
But away from the bedside, perhaps in hallways or at nursing stations, there may be quick and quiet conferences among hospital staff that suggest they are anything but.
In his new book, The Secret Language of Doctors, Dr. Brian Goldman reveals a veritable dictionary of verbal shorthand used by many physicians, nurses and other health professionals to discuss — and often diss — various types of patients and even their own colleagues.
Patient-directed slang includes such terms as: “Yellow Submarine,” referring to an obese patient with cirrhosis of the liver; “frequent flyer” or “cockroach,” for a patient who repeatedly comes to the emergency department with one health complaint after another; and “status dramaticus,” used to describe patients who noisily magnify their symptoms to get quicker medical attention.
Despite its title and contents, Goldman maintains the book isn’t meant to be just about the jargon that medical personnel trade amongst themselves.
“It’s a book about what the language reveals about the culture of modern medicine and what’s inside the heads and hearts of physicians and allied health professionals, but also the problems that they face, the challenges,” he says.
Goldman, a longtime emergency medicine specialist at Mount Sinai Hospital in Toronto, says disparaging slang used by some doctors and nurses often reflects the frustration they feel when faced with certain types of patients.
For instance, bariatric patients, who could weigh anywhere from 400 to 800 pounds, can pose difficulties for health providers who don’t have size-appropriate stretchers or mechanized lifts to transfer obese patients from the bed to a surgical gurney.
“And I didn’t know until I spoke to surgeons how challenging it is to operate on a patient who is morbidly obese,” he says, explaining that it takes more time to get through layers of fat to reach an organ or other operating site, there are higher complication rates, and patients often need to recover in hospital longer.
Goldman, host of the CBC Radio program White Coat, Black Art, interviewed doctors and nurses across Canada and the United States for “Secret Language.” He found slang was often used about certain groups of patients — the economically disadvantaged, those with a psychiatric illness or addiction, the chronically ill, the frail elderly, and people with dementia.
“I have never heard in the hospital where I work a phrase like ‘cockroach’ used to describe somebody who comes back again. If I did, I would stop that person immediately,” says the 30-year ER veteran.
“And pejorative slang about seniors? I come from a hospital where we treat seniors with respect and dignity,” he says of Mount Sinai, which includes trained geriatric management nurses among staff.
“So I was really surprised to hear that in some institutions that kind of slang still exists.”
Still, Goldman admits he has favourites when it comes to medical argot.
“I like witty slang — and I’m getting into dangerous territory here — because I love puns,” says the bearded physician-author. He thinks he may even have invented one term — dyscopia — referring to a patient or family member who has difficulty coping.
“Code brown” is another. A word play on the drop-everything, come-running emergency “code blue,” code brown is hospital-speak for feces that needs cleaning up on the ward.
Another one he learned during his research from an obstetrician is “caesarean-section consent form,” which is slang for a multi-page birth plan presented to birthing staff by a woman prior to delivery. Such a plan may comprise inclusion of the woman’s midwife or doula, certain music in the delivery suite, instruction that there be no epidural but all-natural child birth, and even no fetal heart monitoring.
“And the last thing that would ever be on the birth plan is a caesarean-section,” Goldman says half-mockingly.
“On the one hand, I should be outraged — it’s a terrible thing to say — but it reflects a certain truism. It reflects that when it comes to a meeting of minds between a woman in labour and her family and the health-care team, there may be differences of opinion. And one of them is about birth plans.
“A birth plan is a misnomer, because you can’t plan everything that’s going to happen.”
That’s not to say that doctors aren’t the subjects of slang labels among their own colleagues: surgeons are often referred to as “cowboys,” internists as “fleas,” and ER doctors like Goldman as “referologists.”
“It means that somebody thinks that the only thing emergency physicians do is refer (to other specialists),” he explains.
“On one level (we) do, but they don’t see all the patients we assess thoroughly and send home without ever referring.
“It doesn’t bother me because I have a thick skin and I’ve learned to laugh at myself.”
Goldman suggests much of the slang involved in inter-specialty criticism may be part of hospital culture, arising from an individual’s sense of personal responsibility for a patient’s well-being and the often hard-driving, high-striving personality traits that help get a person accepted to and through medical school.
There is a movement afoot, called medical professionalism, that would try to stamp out the use of often-disparaging slang. But Goldman believes that would only send the patter — and the problems in the health-care system that it reflects — underground.
“It’s a clue to issues that must be addressed and that’s what I’m much more concerned about,” he says, citing the lack of adequate primary care that results in some patients using hospital emergency departments as a stand-in for a family doctor.
While he concedes there may be some colleagues who will knock him for pulling back the curtain on doctors’ jargon, he hopes the book will spark discussion about how to fix the problems that generate the slang in the first place.
Goldman hopes such discussions would address such issues as medical errors, patient safety, how to keep empathy in health care, and how to train the next generation of health-care professionals to “like treating the patients in increasing numbers that some people use slang to talk about.”
He also hopes “Secret Language” helps humanize medical professionals for the public.
“If you’re a patient or a family member and you’ve stood eyeball to eyeball or sat down with a physician and felt tongue-tied and didn’t feel you could challenge what they were saying ... (if) this will somehow help to put you on a level playing field, then I think that’s a really good thing.”
“If exposing (slang) gets rid of it because we’ve solved the problems in medicine, I think that would be a good day’s work for me.”
“The Secret Language of Doctors: Cracking the Code of Hospital Slang”, published by Harper Collins, will be on bookshelves Tuesday.
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