Hospital staff use slang for patients

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.

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.

Follow (at)SherylUbelacker on Twitter

Just Posted

Bowden Institution Black Press file photo
Bowden Instiution inmate dies from COVID-19 complications

Bowden death the sixth in Canada’s federal prison system

(Contributed)
FOUND: Red Deer youth missing

Red Deer RCMP thank the public for their assistance

President Joe Biden delivers remarks about COVID vaccinations in the South Court Auditorium at the White House, Wednesday, May 12, 2021, in Washington. (AP Photo/Evan Vucci)
Biden team moves swiftly to tackle pipeline political peril

Executive order issued to improve cybersecurity

Street racers gather the evening of Sunday, Aug. 12, 2018, in the parking lot of the Goodwill on Northeast Marine Drive and 122nd Avenue in Portland, Ore. Across America, police are confronting illegal drag racing whose popularity has surged since the coronavirus pandemic and lockdowns began. Drivers have blocked off roads to race and to etch donut patterns on pavement with the tires of their souped-up cars. From Portland, Oregon; to Albuquerque, New Mexico; from Nashville, Tennessee; to New York City, officials are reporting a dangerous, and sometimes deadly, uptick in street racing. (Anna Spoerre /The Oregonian via AP)
US cities see surge in deadly street racing amid pandemic

Shutdowns associated with the pandemic cleared normally clogged highways

Red Deer Mayor Tara Veer and several members of city council helped kick off the spring Green Deer cleanup campaign on Wednesday. Veer said city workers do their best to keep the city looking good, but need volunteer help to get rid of litter that has blown into bushes onto road sides over the winter. (Photo by LANA MICHELIN/Advocate staff)
Red Deer city councillors launch spring Green Deer campaign

Volunteers are needed to keep the city looking good

Toronto FC forward Jozy Altidore, center, celebrates after scoring a goal against the Columbus Crew with teammates from left, forward Tsubasa Endoh, defender Omar Gonzalez and forward Patrick Mullins during the second half of an MLS soccer match, Wednesday, May 12, 2021, in Orlando, Fla. (AP Photo/John Raoux)
Bradley, Altidore scores in Toronto FC’s 2-0 win over Crew

ORLANDO, Fla (AP) — Michael Bradley had a goal and an assist,… Continue reading

A football with the CFL logo sits on a chair during a press conference in Winnipeg, Friday, November 27, 2015. THE CANADIAN PRESS/John Woods
Former defensive lineman Klassen tackling retirement as he did opposing quarterbacks

Klassen spent seven CFL seasons with Montreal, Calgary and Ottawa

FILE - Contestant Lauren Spencer-Smith on an episode of ABC’s American Idol. (American Idol/ABC photo)
‘American Idol’ contestant exits show amid video controversy

A 16-year-old “American Idol” contestant has dropped out of the singing competition… Continue reading

FILE - Ellen DeGeneres appears during a taping of the “The Ellen DeGeneres Show,” in Burbank, Calif. on May 24, 2016. DeGeneres, who has seen ratings hit after allegations of running a toxic workplace, has decided her upcoming season next year will be the last. It coincides with the end of her contract. (AP Photo/John Locher, File)
Ellen DeGeneres to end long-running TV talk show next year

Viewership dropped by 1.1 million people this season

Ottawa Senators centre Josh Norris, right, celebrates his game-winning overtime goal against the Toronto Maple Leafs with left wing Brady Tkachuk Wednesday May 12, 2021 in Ottawa. THE CANADIAN PRESS/Adrian Wyld
Norris scored winner, Senators beat Maple Leafs 4-3 in Andersen’s return from injury

Norris scored winner, Senators beat Maple Leafs 4-3 in Andersen’s return from injury

Rafael Nadal, of Spain, holds up the trophy after beating Daniil Medvedev, of Russia, in the final at the Rogers Cup tennis tournament, in Montreal on Sunday, Aug. 11, 2019. THE CANADIAN PRESS/Paul Chiasson
Tennis Canada could move top tournaments to US if Toronto, Montreal plan not approved

Tennis Canada could move top tournaments to US if Toronto, Montreal plan not approved

Philadelphia Flyers' Travis Sanheim (6) and Brian Elliott (37) celebrate with teammates after the Flyers won an NHL hockey game against the New Jersey Devils, Monday, May 10, 2021, in Philadelphia. (AP Photo/Matt Slocum)
Puck luck? Hockey’s secrecy makes betting on NHL a gamble

Puck luck? Hockey’s secrecy makes betting on NHL a gamble

FILE - John Davidson, left, president of the New York Rangers, and Rangers general manager Jeff Gorton pose at a news conference in New York, in this Wednesday, May 22, 2019, file photo. The New York Rangers abruptly fired president John Davidson and general manager Jeff Gorton on Wednesday, May 5, 2021 with three games left in the season. Chris Drury was named president and GM. He previously served as associate GM under Davidson and Gorton. (AP Photo/Seth Wenig, File)
New York Rangers fire coach Dave Quinn, 3 assistants

New York Rangers fire coach Dave Quinn, 3 assistants

Most Read