Glimpse into med­i­cal lex­i­con both hi­lar­i­ous and dis­turb­ing

Winnipeg Free Press - Section G - - BOOKS -

ARE you now or have you ever been a GOMER? Has a doc­tor ever re­ceived a Prince of Whales award for treat­ing you? Per­haps worst of all, are you suf­fer­ing from FTD? If the lat­ter, you may need flow­ers de­liv­ered. But right now, in the un­spar­ing lan­guage of doc­tors and other med­i­cal people who are sup­posed to be your care­givers, you are old and ter­mi­nally ill and, in­con­ve­niently, you are Fail­ing To Die. The Se­cret Lan­guage of Doc­tors, Dr. Brian Gold­man’s sec­ond book, is dis­turb­ing and hi­lar­i­ous, some­times con­cur­rently. In easy-to-un­der­stand lan­guage, it un­veils scores of clan­des­tine acronyms and caus­tic phrases — a pri­vate med­i­cal lan­guage de­signed to de­scribe and fre­quently dis­par­age pa­tients and their con­di­tions. This lan­guage is as tightly fo­cused as surgery, and can be just as painful. How hi­lar­i­ous you find it, of course, de­pends on whether you are one of its many tar­gets. Gold­man, an emer­gency physi­cian at Mount Si­nai Hospi­tal in Toronto and host of White Coat, Black Art on CBC Ra­dio One, demon­strates the wide­spread use of this vivid lan­guage in North Amer­ica through many in­ter­views, ci­ta­tions from med­i­cal jour­nals and quo­ta­tions from news me­dia. Not all med­i­cal ar­got is malev­o­lent or even se­cret. Tele­vi­sion dra­mas such as ER have made Code Blue a widely rec­og­nized warn­ing for a car­diac ar­rest. Other phrases are easy to de­ci­pher: Code Brown, for ex­am­ple. Hints: it flows downhill, and doc­tors del­e­gate its cleanup as far down the nurs­ing hi­er­ar­chy as pos­si­ble. But much of this lan­guage and many of these jokes, some of which Gold­man char­i­ta­bly as­serts “come from frus­tra­tion mixed with de­spair,” go un­heard or at least un­no­ticed by pa­tients. This book could change that. Hos­pi­tals are not likely to hand out The Se­cret Lan­guage of Doc­tors to help pass the time wait­ing to see a doc­tor — but per­haps they should. The 15 chap­ters fo­cus on cat­e­gories of med­i­cal lan­guage and at­ti­tudes. Sam­ple ti­tles: Sta­tus Dra­mati­cus (pa­tients who are “ir­ri­tat­ingly over­anx­ious in de­port­ment and un­der­whelm­ing in ill­ness and in­jury”), In­car­ceri­tis (pa­tients in cus­tody will try the cra­zi­est stunts to get out of jail) and Cow­boys and Fleas (many doc­tors ap­par­ently de­spise other spe­cial­ists; surgeons are cow­boys, in­ternists are fleas). Cre­at­ing some wel­come bal­ance, Gold­man re­ports on many com­pas­sion­ate med­i­cal prac­ti­tion­ers and dis­plays his own enthusiasm for cur­ing pa­tients and keep­ing them healthy. “With more than 30 years of prac­tis­ing medicine in my rear-view mir­ror, I’m still con­vinced that doc­tors and other health pro­fes­sion­als are among the most eth­i­cally grounded people on the planet.” In­ter­est­ingly, Gold­man re­veals that his benev­o­lence to­ward pa­tients has lim­its. He ex­plains one of the most sat­is­fy­ing el­e­ments of his work in Emerg: “My in­volve­ment with pa­tients is tran­si­tory. When I have a pa­tient who is push­ing one of my but­tons, I al­most al­ways have an out: I can re­fer that pa­tient to some­one else.” He ex­presses re­pen­tance for his own oc­ca­sional use of doc­tors’ se­cret lan­guage. “Ev­ery time I think of the pa­tients I se­cretly mocked and ridiculed, I feel ashamed.” Could this book be the good doc­tor’s penance? Though Gold­man’s news is not all bad, his con­clu­sion to the book is dis­heart­en­ing. “That the slang I un­cov­ered ex­ists in such vol­ume and is spo­ken by so many doc­tors and other health pro­fes­sion­als can mean only one thing. If you’re old, de­mented, frail, men­tally ill, overly anx­ious about your health, mor­bidly obese, ad­dicted, in po­lice cus­tody or if you just call on us too of­ten, we’re not keen on hav­ing you as a pa­tient.” That would in­clude GOMERs — pa­tients who should Get Out of My Emer­gency ward be­cause doc­tors can’t treat what re­ally ails them. They may be fre­quent fly­ers who grav­i­tate to the ward for some­thing as ba­sic as com­pan­ion­ship. The Prince of Whales Award? At an un­named med­i­cal school, that an­nual prize rec­og­nized the anes­the­si­ol­o­gist who ad­min­is­tered an epidu­ral seda­tive to the fat­test woman in labour, ac­cord­ing to an anony­mous med­i­cal res­i­dent quoted in the book. The sex­ist at­ti­tude that un­der­pins much of the nas­ti­ness of the se­cret med­i­cal lan­guage per­sists de­spite the grow­ing per­cent­age of fe­male doc­tors, Gold­man re­ports. Per­haps, though, the tra­di­tional con­nec­tion of testos­terone and med­i­cal hau­teur lies be­hind the only pa­tient­gen­er­ated acro­nym men­tioned in The Se­cret Lan­guage of Doc­tors: NMD. That’s the re­quest of a woman giv­ing birth for No Male Doc­tor. Dun­can McMona­gle is a Win­nipeg writer and edi­tor with great ap­pre­ci­a­tion for nurses. He is mar­ried to one.


Be­yond stan­dard tech­ni­cal ter­mi­nol­ogy, med­i­cal staff have de­vel­oped a num­ber of code words and acronyms to de­scribe


The Se­cret Lan­guage of Doc­tors: Cracking the Code of Hospi­tal


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