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 released Tuesday, 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 was really surprised to hear that in some institutions that kind of slang still exists," he says.
Still, Goldman admits he has favourites when it comes to medical argot.
He thinks he may even have invented one term — dyscopia — referring to a patient or family member who has difficulty coping.
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.
"On the one hand, I should be outraged — it's a terrible thing to say — but it reflects a certain truism," he says. " A birth plan is a misnomer, because you can't plan everything that's going to happen."
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.
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.