Friday, March 13, 2015

The Secret Language of Doctors

In the firmament of admirable doctors, Brian Goldman is a shining star.  I'm not just talking about this TED talk--Doctors make mistakes. Can we talk about that?--which has had over one million views. More generally, he shines a light on aspects of the practice of medicine that are so embedded and pervasive that they are scarcely noticed.

So, it was with anticipation that I read his new book, The Secret Language of Doctors (to be published on April 1, but available for pre-order now.)  It turns out that you can read this book on two levels.  One is the way it's described in its squib:

In The Secret Language of Doctors, bestselling author Dr. Brian Goldman opens up the book on the clandestine phrases doctors use to describe patients, situations and even colleagues they detest. He tells us what it means for someone to suffer from incarceritis, what doctors mean when they block and turf, what the various codes mean, and why you never want to suffer a horrendoma. Highly accessible, biting, funny and entertaining, The Secret Language of Doctors reveals modern medical culture at its best and all too often at its worst.

Yes, on that front, what's presented is entertaining, giving the reader a vicarious view of the inside culture of hospitals.

But I suspect that Brian's goal goes beyond entertainment.  The book presents a warning to the profession that the argot it employs is indicative of educational and structural problems.  Brian slips these points into the middle of his stories.  You could almost miss them.  At one point, he pauses to talk about efforts to create "slang police" to solve the language problem he has documented so well.  Instead, he says, we should "listen for trends that indicate problems that need to be addressed."  Here are some examples:

Doctors call obese patients whales because they aren't being taught that obesity is a disease.  They aren't given equipment to transport bariatric patients safely. They arem't given the tools to operate on these patients effectively.  Instead of [trying to ban] the slang, why not provide the education and support needed to diagnose and treat bariatric patients?

Instead of condemning slang such as cockroach and frequent flyer, teach ER physicians and nurses to attack the underlying reasons patients visit ERs over and over and over again.

If ERs have trouble with geriatric and psychiatric patients, then maybe the solution is to give such patients ERs of their own.

Better places for undesirable patients, better training and better equipment only go so far.  The greater challenge is how to get young doctors to want to treat them.  Both medical schools and hospitals need to recruit leaders and other role models who enjoy caring for twenty-first-century patients.

The alternative?

If doctors don't take up the call, then the other solution is to find different health professionals who like these patients more than doctors do. [For example,] nurse practitioners are salivating at the chance to pick up the slack.

This is all worth a look.  The book will appeal to the lay public. But, I'm hoping that lots of doctors read it, too, to help them think about the underlying meaning of what they are saying in the corridors, break rooms, ICUs, and ORs.


Beverly Heywood Rogers said...

From Facebook:

I am kind of curious about his motivation for writing such a book.

Paul Levy said...

He says, "My mission is to take you inside the Bunker so that you understand more about our innermost thoughts, attitudes and feelings about modern healthcare."

Sawad Thotathil said...

From Facebook:

The term frequent flier is way to categorize and deflect the responsibility of the system. It is not necessarily something the individual physician prefers but is a product of the culture around him

Paul Levy said...

Exactly a point that he makes, Sawad Thotathil. It is a shorthand, but unfortunately can encompass a form of diagnostic anchoring--not to mention depersonalization of the patient.

nonlocal MD said...

As I was reading the quote below one word popped into my mind: women.

"Better places for undesirable patients, better training and better equipment only go so far. The greater challenge is how to get young doctors to want to treat them. Both medical schools and hospitals need to recruit leaders and other role models who enjoy caring for twenty-first-century patients.'

Paul Levy said...

Super point. Noting that there are now many more women in medicine, he proceeds to discuss just that. Excerpts:

One of the things I set out to do was to figure out the impact women are having on the use of medical slang and the attitudes behind it. ....

Are female doctors less likely than their male counterparts to use slang. Not based on what residents have told me.

"I like to thing we are different, but I don't think we really are. I think we don't use as much sexually based slang, but the slang we use is every bit as dark as what the mean use."

The reason is that the conditions that give rise to the use of slang have not changed.

In my opinion, the culture of medicine is strong enough to resist a major gender shift without changing one iota.

nonlocal MD said...

Well, the more informative thing in order to trace the 'brainwashing' would be to ask male and female medical students rather than residents; by then they are already jaded. I remember being very put off by the male residents' comments (there were few female residents back then) on my med school clinical rotations, but before long I had adopted them; how else to survive? This may have happened to the male medical students also, of course.

Beverly Heywood Rogers said...

From Facebook:

Well if he intended it as an expose, I guess it's effective. Or as a form of 'tough love' to get docs to think about it. But if he wanted to start a discussion a more effective way would have been a Perspectives piece in the NEJM, for instance. I don't think it will enhance trusting relationships between patients and doctors.

Paul Levy said...

The actual terms he discussed are readily available on lots of websites. I think he was trying to explore out the context for them.

Quote: "[This] is not an urban dictionary of medical slang. Many such informal collections of terms can be found on the Internet. To present such a glossary is to imply that all doctors speak slang all the time. I have met many colleagues who never use such terms. More important, in my view, slang is not the problem but the symbolic language that reveal much about what ails medical culture and what needs to be fixed."

Sawad Thotathil said...

From Facebook:

But that brings up the question. Can incentives change something so deeply embedded in culture?

Serena Curler said...

From Facebook:

The professionals that are salivating ... as he says ... I don't think np's desire such patients as much as they are perhaps better equipped to care for these patients! I get excited when I get consults on patients that the doctors are asking me to manage because they simply have exhausted their tool box ... This is difficult to control symptoms ... and difficult families and psychosocial issues ... as well as undecided families as far as their goals of care. So ... I suppose I salivate at the chance to say -- hey this recommendation is what you need!

I should also say that I like being a consultant. I do not wish to take over the hospitalist or pcp role.

Bob said...

Sounds like a great book! Very astute observations. I think I'll recommend it to a friend who teaches med students. Examining language tells us so much!!

There was a medical sociology book about medical education that explained such language as a way for medical students to cope psychologically with the stress of what they are dealing with. Gallows humor as a defense. For those of us who understand what the issues are, it is painful to hear this kind of language, because we see the callousness of younger colleagues - or older ones - and despair for the profession. But that's just the challenge, I suppose.

Peter said...

Man improving after intensive medical treatment in ICU.

Attending physician: "You had us worried for a while. You look great!

Patient: "I can't believe it. I feel so much better. I only have one question."

Physician: "Certainly! What's your question?"

Patient: "What's a 'Gork?"