The Secret Language Of Doctors

by Brian Goldman

All of us have visited the doctor or sat in the emergency room for long hours awaiting treatment. When we finally do reach the other side of the swinging doors, we enter into what seems like another world, with practitioners in white coats and scrub suits speeding from patient to patient, consulting with one another amid controlled chaos. Beneath the cacophony of medical equipment and routine codes announced over the loudspeaker, doctors and nurses use a kind of secret language, usually out of earshot of their patients but sometimes in front of them. The words you'll learn in this book are not expressions that you'll likely find in a medical textbook or even hear on a television show. In fact, most health professionals would rather you didn't know that this underground language exists at all.

In The Secret Language of Doctors, bestselling author Dr. Brian Goldman pulls back the curtain to reveal some of medicine's darkest modern secrets, decoding the colourful and clandestine expressions doctors employ to describe difficult patients, situations and medical conditions—and sometimes even other colleagues. You'll discover what it means to exhibit the symptoms of "incarceritis," what "blocking" and "turfing" are, and why you never want to be diagnosed with a "horrendoma." In the process, you'll gain profound insight into what doctors really think about their patients' personalities and even their chances of making it out of the hospital alive.

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.

Genres: Nonfiction, Medicine, Health, Medical, Canada, Unfinished, Health Care

368 pages, Kindle Edition

First published May 1, 2014

About the author

Brian Goldman, MD, is one of those rare individuals with great success in not one but several adrenaline-pumping careers. Goldman is a highly regarded emergency physician at Mount Sinai Hospital in Toronto. He is also the host of the Canadian Broadcasting Corporation’s award-winning radio show “White Coat, Black Art”, where he takes listeners behind the scenes of hospitals and doctor’s offices. Goldman unpacks and demystifies what goes on inside medicine’s sliding doors – with edgy topics that include the whistle blowing in health care, burnout among health professionals, racism in health care and how to getting to the head of the line in health care.

Goldman is on a lifelong campaign to confront medical errors and create a culture of safety for patients. He has proven unafraid of using his own medical mistakes for examples on how doctors can improve. His TEDtalk – “Doctors Make Mistakes. Can We Talk About That?” has been watched by close to a million viewers, and has been featured in The Huffington Post and NPRs TED Radio Hour.

Dr. Goldman has worked as a health reporter for The National, CBC Television’s flagship news program, for CBC-TV’s The Health Show, and served as senior production executive during the launch year of Discovery Health Channel, Canada’s only 24-hour channel devoted to health programming.

He is the author of the bestselling book The Night Shift: Real Life in the ER, which takes readers through giddying heights and crashing lows as Goldman works through a typical night shift in one of Canada’s busiest ERs. His book The Secret Language of Doctors – published by Harper Collins in 2014 – is a biting look at medical slang. The book cracks the coded words doctors use in hospital elevators and hallways that reveal what the doctor really thinks about your mother’s obesity, your grandfather’s dementia or her colleague’s competence. Often funny and always revealing, The Secret Language of Doctors reveals deep flaws in modern medical culture, and how to fix them.

Reviews

[CanadianReader · Rating 4 out of 5]

This book isn't so much about doctors' slang (the "secret language" of the title) but about doctors' dislike of certain patients: the elderly (i.e. those who suffer FTD "failure to die"); the obese; and the anxious (among others). It’s a sobering and concerning read. Most realize that medical work can't be easy, but I'm not sure how I feel about having doctors' attitudes laid quite this bare. If you've only suspected doctor bias in your own experiences, Goldman’s book will confirm it for you. Although well written, it’s not exactly enjoyable. I preferred Danielle Ofri's How Doctors Feel, which acknowledges biases, but is at least written with some degree of compassion. If you're aging—who isn't?—Dr. Goldman's text contains some worrisome information about how you will be handled. Not for the faint of heart.

[Erika · Rating 2 out of 5]

The title is good, because it draws you in, but the book itself was only okay. I get that at handoff, there would be lots of patients to discuss, but he pulls out all the slang in the first paragraph of the book, and then the rest is just covering a little bit of how and why it's used.

The narrative irks me too. In one chapter, he's at Bergman's home, watching him eat a grapefruit and following him out to the office and describing how he looks, then the author is covering quotes from other medical professionals and off on another topic. And I can understand listing peoples credentials the first time that they're introduced, but it's like the author was expecting you to not read all the chapters at once, or out of order, because people who are quoted multiple times have to be reintroduced each time. Then there were just the standard word errors (extra/missing) that come from it being an eBook.

I do like that he tries to bring up valid points about the lack of geriatric doctors or that hospitals don't bother to buy equipment for obese patients, and ways to maybe change that, but the attempts fall rather flat other than just bringing them to light. It also makes me dread going to a hospital for anything, though knowing some of the stresses that doctors are under makes me want to be a better patient if I ever am.

[StMargarets · Rating 3 out of 5]

This was an interesting book. The author is a Canadian emergency room doctor and his subject is the slang medical professionals use for their patients and each other. The slang is interesting if you like wordsmithing, but it's the underlying attitude that generates the slang that is compelling (and alarming).

The sheer volume of slang for less-than-desirable patients (examples: whales for obese patients, bed blockers for elderly patients who are waiting for a place in a nursing home, GOMER - Get Out of MY Emergency Room, etc . . .) show just how stressed the medical profession is - and just how hostile of an environment a hospital can be for a vulnerable patient and their relatives. All of this rang true to me based on the anecdotes I've heard from friends who have been negotiating the medical system for their elderly parents.

The author says flat out that doctors really aren't trained to deal with the elderly - and because of advances in medicine - they're getting more and more patients who are compromised by dementia or Alzheimer, but are still kicking. The doctors' and nurses' frustration comes out in such gallows humor as calling a bedpan mishap "code brown," citing FTD (failure to die) for a patient lingering on, and calling CPR done on someone who probably isn't going to make it a "Hollywood resuscitation." (Apparently only a small percentage of patients live beyond a few days after CPR is needed - but TV dramas overwhelming use CPR as a short-hand for a dedicated doctor/nurse with a happy ending)

If you think the patients are unfairly maligned - the way professionals talk about each other is also brutal. Internists and surgeons are in constant competition - surgeons are "cowboys" and "knife happy", internists are "fleas" who overthink everything. Anesthesiologists are "gas passers", Obstetricians are "baby catchers", etc . . .At the bottom of the prestige totem pole - ER doctors and family doctors who are seen as passing the buck with referrals.

The author did not confine himself to Canada for his research - he cites doctors from hospitals all over the US. He does note that some environments are more hostile - notably large teaching hospitals. None of his caveats are comforting, to say the least.

I wish he had added some recommendations for how to fight some of these ingrained attitudes in medical personnel, while also advising how patients can negotiate the system we have. Obviously some big changes need to happen - especially with elderly and obese patients.

[Rachel · Rating 3 out of 5]

My impression was that the medical slang theme was largely an excuse to write a book. There are plenty of parts where the author goes into stories and explanations without talking about language. And it's good; he's a good writer with plenty of experience to write from.

I particularly liked that he wrote so much about his conversations with Dr. Stephen Bergman, who wrote The House of God using the pseudonym Samuel Shem. I loved that book several decades ago when I read it. Today, I'd probably find it sexist and insensitive--but it would still make me laugh. Dr. Bergman has matured since then and I enjoyed seeing his comments.

I like the stories and I understand how doctors end up using all the terms that they do, including the ones that are derogatory towards patients and other doctors. But that doesn't excuse insensitivity and just plain meanness. So racism and (some) sexism aren't considered acceptable, but it's not so bad to call an obese person a whale? I guess "frequent flyer" is more descriptive than pejorative, but calling patients "cockroaches"? Not okay in my view. The author goes back and forth about how he feels about these terms. Although he doesn't find the worst terms acceptable, he comes out (or it seemed so to me) against "political correctness" (and thus, imo, against being respectful). Kind if like,"oh well, doctors will be doctors."

[Angela Misri · Rating 5 out of 5]

What a great read! I finished this in one day, and really enjoyed it. Much like his show on CBC, I can hear Dr. Goldman telling me the stories in this book with his awesome sense of humour underlying each point. This is not a "serious" medical text book, it is an interesting read for anyone who is curious about the medical culture. I felt like Dr. Goldman was walking me from patient's room to gurney, talking to me about common everyday occurrences and explaining many of the things that happen 'behind the scenes' in hospitals. For most of us, hospitals are a place of fear or uncertainty, but I found this book oddly reassuring - humanizing the amazing people who work in the medical field and just opening my eyes (and ears) to the reality of their daily lives.

[Louise · Rating 3 out of 5]

MY REVIEW:
HarperCollins|April 29, 2014|Hardcover|ISBN: 978-1-44341-601-6
Have you ever wondered what doctors and nurses are really saying as they zip through the emergency room and onto elevators, throwing cryptic phrases at one another? Or why they do it? Do you guess at the codes broadcast over the loudspeaker, or the words doctors and nurses use when speaking right in front of patients?
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 is 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.
Goldman's second book is very different from his first titled "Night Watch". Although I enjoyed reading this second, I was finding myself a bit bored after a while. There were too many quotes from other books, too many statistics and not enough "secret language". I thought the book was going to be packed with more slang than it contained and less statistical information. To be honest, by three-quarters of the way through the book, I found myself skipping page after page after page just to hurry the book along. I felt too mired down in quotes from this person or that, or this book or that. Although I learned a few things, it wasn't what I thought it was going to be which is a bit disappointing.

[Marianne Perry · Rating 4 out of 5]

I read this book because it was selected by fellow book club members. Goldman raised a number of issues related to the medical profession plus introduced me to an extensive vocabulary spoken in Canadian and US hospitals.
Dyscopia, for example, refers to patients having difficulty coping. Code White is a missing patient and FTD, failure to die. These terms are part of medical argot; a vocabulary peculair to a particular group. He also explores why medical slang was developed and the reasons it endures citing doctor bonding, quick communication of information and diffusion of stressful situations. Some of the terms seemed disrespectful to patients, however, with referring to the obese as "harpooning the whale" an example.

The following quote from Chapter Fifteen represents a major concern Goldman noted with the medical profession today, which I brought to our club's attention. "If you're old, demented, frail, mentally ill, overly anxious about your health, morbidly obese, addicted, in police custoday or if you just call on us too often, we're not keen on having you as a patient. And that is a growing problem for doctors. That's because the "undesirables" I just listed have rapidly become the typical inhabitants of hospitals."

Goldman's comment that current medical education provides only cursory training in geriatrics was troublesome given the aging population of our countries. A worthwhile read and definite motivation for taking good care of our health.

Marianne Perry
Writing inspired by genealogical research to solve family mysteries.
www.marianneperry.ca

[Kyle · Rating 2 out of 5]

The title pretty much tells you everything you need to know about this book.

It sets up numerous scenarios in doctors' offices, emergency rooms, and other places that medical practitioners inhabit, lets the scene play out as if you were a fly on the wall, and then explains what all the medical jargon means in layman's terms.

It's not a particularly compelling read, but it is certainly packed full of interesting information (like, Hollywood Code is not as glamorous as it sounds!).

The most interesting argument in the book for me is how necessary it is for doctors to stick to a secretive vernacular. In a profession where split-second decisions can save lives, it becomes necessary to speak in succinct, direct ways. Tip-toeing around sensitive information may kill someone; however, being blunt and literal could send a patient into spirals of panic and fear and un-cooperativeness. So it is very necessary for doctors to speak in a code that only they can understand but conveys the relevant info to one another. It is, frankly, a whole separate language indicative of the training and intelligence required of medical practitioners.

Insightful, but not exciting.

2.5/5

[EM · Rating 3 out of 5]

If we could give 1/2 stars, I'd rate this book 3.5 out of 5. It was a very interesting and eye-opening read, but I feel torn about what I learned.

It seems that doctors have a very dark sense of humour, which must go with working in a hospital. From a language perspective, some of the slang invented is quite clever.

Some things about this book bothered me though. One was the doctors' behaviour in "turfing" patients and *celebrating* those turfs. I got the impression that it's like a game for them to manage to ward off a referral from another doctor or department. Meanwhile, these patients are in need of care!

I also felt like they have contempt for patients and if your case isn't complicated (i.e., interesting) enough, then they don't really want to treat you. I guess after working in a hospital environment, they must become a bit jaded after seeing so many different cases, but regardless, I felt that the empathy and "human" aspect of their behaviour was missing.

As a language professional, the slang was interested. What left a more bitter taste in my mouth was the doctors' behaviour.

[Steve Goodyear · Rating 4 out of 5]

For a word-nerd like me, this was a very nice read. I loved the insights into the code switching and the different puns. It also helped feed my curiosity about how doctors interact and their day.

[Sam · Rating 3 out of 5]

Interesting content, but a bit repetitive at times.

[Gillian Burles · Rating 3 out of 5]

Interesting read though I confess I started to skim half way through as the themes were repetitive. But he’s a good writer with a comfortable style so it’s a compelling read.

[Garth Mailman · Rating 5 out of 5]

Doctor Brian Goldman is an Emergency Room Physician in Toronto. He is also host of the CBC program White Coat/Black Art. Despite the title this book is more an assessment of the state of Medical Health Care in North America than a dictionary of medical slang/argot/jargon.

In his position he gets to see acutely ill patients but often does not get to provide after care. However, he works in a system that rewards through-put and not quality of care and therefore pays a doctor more for dealing with a cold, a cut, or a broken arm; than spending the time it would take to counsel a patient about the lifestyle choices that underlie their medical issues. Doctors have come to be regarded as wizards who can cure all ills whereas too many medical conditions are the result of lifestyle choices—smoking, diet, exercise. Rather than depend on doctors and medical science to provide all the answers patients need to take responsibility for their own health.

The language thrown around hospitals between nurses and doctors therefore becomes both a means of transmitting a great deal of information in as few words as possible and an expression of their frustration—blowing off steam. Of making derogatory comments in a language that the public hopefully will not understand or misinterpret.

Most of us look to hospitals as centres of healing, in French the word is Hotel Dieu. Imagine then the let-down involved in learning that nurses treat each other in an appalling fashion with a definite pecking order that heaps abuse on new recruits. That rather than being patient centred doctors shunt patients around to ensure they don't die on their watch and refuse admissions to their wards or engage in delaying strategies that endanger patient's health. That various specialities demean one another and use derogatory language. If this is how they treat one another what does it say about their patient care.

[Amy · Rating 5 out of 5]

This was an interesting and intriguing read which kept me going chapter to chapter. I found it fascinating, not so much for the medical slang which it documents, but because it talks about the culture of medicine which patients don't often see. Written in the semi-ironic and humerous tone which I enjoy in Brian Goldman, this was an entertaining book.

[Chung-yee · Rating 3 out of 5]

Humourous stories to decode those "interesting" diagnostic language. Couldn't stop laughing about Code Browns.

[Brent · Rating 4 out of 5]

A wonderful insight into the medical jargon used by health professionals; for better and for worse.

[Sherry Monger · Rating 3 out of 5]

3.5
Dr. Brian Goldman hosts a radio show/podcast called "White Coat, Black Art" on CBC. In this interesting book, Goldman lets us in on the slang used in the ER and other parts of the hospital in order to communicate quickly, and often colourfully with colleagues. Some terms are funny, but some are downright disrespectful. Explaining the meaning of theses terms opens a window to the world of high stress medical care where doctors and nurses are often exhausted and frustrated. You don't want to be a GOMER or a FOOBA - nor do you want to be blocked, dumped, or turfed if you are in need of urgent medical care. The most disrespectful terms are reserved for the morbidly obese and the poor/homeless whose problems are chronic - thwarting the goals of medical personnel to diagnose and treat.

[Mary · Rating 3 out of 5]

This is a largely derivative work, borrowing heavily from the creativity of Samuel Shem (Stephen Bergman, MD), and presents a lexicon of disparaging terms used by medical professionals to characterize patients. The gallows humor of the hospital is pressed into service to inform the reader on the topic of What Is Wrong With Medicine. It's a decent effort, but nothing, nothing will ever match the hilarity of House of God, which taught as much and more. Very glad to see Bergman credited but the writer could have taken a step back from the politics of medicine to explore the emotional toll of providers' daily death defying acts.

It's a good warning to patients, too. Don't let your provider get away with acronyms. You're the patient. You can't consent to what you don't know.

[Diane · Rating 1 out of 5]

Although the author declares himself a "keen observer" of social culture, I found this volume lacking in focus. Some bits were on the history of some slang used by some doctors in some places, some bits were frightening as it appeared that doctors really don't like people, some bits were space fillers with names and associated health care units, a lot of bits were repetitous quotes from The House of Glass (which I haven't read), and there were annoying self-referential bits "an ER doctor such as myself".

And then it concluded with a whole chapter devoted to "I hope you read this". Well, I did. Unfornately, I was getting snarky before I finished it.

[Tony Palazzolo · Rating 3 out of 5]

Curiosity brought me to this book. With me aging and my daughter finishing her residency in Internal Medicine I thought I was getting a glossary of doctors’ slang. I guess I did and some anecdotes too. I was hoping for more humor but I guess you had to be there or be a doctor.

On to Sam Shem’s The House of God.

[Reader · Rating 4 out of 5]

A glimpse into the very human world of doctors and medicine, to be taken with understanding as well as a desire to improve our systems in ways to allow more thorough care and relieve the stress from both sides of the stretcher. Though some may take offense (rightfully) by the slang, it is good to know where it comes from and why it's there, and recognize it as a symptom, not a disease.

[Kelli · Rating 3 out of 5]

This book is humorous, disturbing, somethimes horrifying but relatable. It is easy to identify family and friends and situations in the stories he tells unfotunately that means that we have often been disliked by our doctors.

[Elaine · Rating 2 out of 5]

Dr. Goldman spent a lot of time researching for this book.
However, I was sad after reading this just because of the language and the attitude implied by the terminology invented by the profession. Got less and less interested halfway through the book.

[Mrscowie · Rating 1 out of 5]

Awful, insulting and degrading. If in fact, doctors are speaking like this, and I hope they aren't, instead of couching their degrading bullshit as 'argot' with some kind of intrinsic value Dr. Goldman should be as horrified as I was.

[Jeremiah · Rating 4 out of 5]

Good book on medical argot. Interesting three step approach to bad news delivery was hidden in there. What do they know?, deliver sensitively, respond to patients emotion.

[Kevin Rey · Rating 5 out of 5]

Pithy, earnest, informative, easy to read.

[Jon · Rating 3 out of 5]

Although interesting, this book would benefit from better editing. I found many sections to be overly repetitious. All in all, the book could be half as long and just as good.

[Michelle Barker · Rating 5 out of 5]

Read for research, but I thoroughly enjoyed it. Entertaining (if also a bit disturbing) and well written, this is an un-Grey's Anatomy look at the real world of doctors and medicine.

[Doug Adamson · Rating 4 out of 5]

Informative, interesting, and thought-provoking.

[Kelly Greenwood · Rating 3 out of 5]

Eye opening.