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By BERNIE BELLAN It’s a testament to the drawing power of Dr. Brian Goldman that, on a night when he was set to appear in the Rady JCC to speak, the most-watched event in American television history happened to be on at the same time: The Super Bowl.

Yet, as I walked into the Berney Theatre – five minutes late, as it turned out, because I, too, had been glued to the TV watching the first half of the Seattle-New England game, I was astounded to see there was almost a full house in attendance – and, even more amazingly, as I was only five minutes late – the event had already begun!
(When was the last time that a Jewish event began on time?)
Seated on the stage of the Berney Theatre was Goldman, probably best known as the host of the CBC Radio program, “White Coat, Black Art”, who was fielding questions from local CBC Radio host Ismaila Alfa. For roughly one hour Alfa conducted what turned out to be a very entertaining interview with Goldman, primarily centred on Goldman’s most recent book, The Secret Language of Doctors.
As one might expect, given the theme of that book, Goldman was asked to delve into various aspects of medical slang, but rather than simply offering up a recitation of some of the saucier – often rather offensive terms with which he has become acquainted over the years, Goldman provided a thoughtful analysis of why it is that individuals who are in various forms of medical practice resort to so many euphemisms when it comes to describing patients and their maladies.
Following Alfa’s interview of Goldman, Goldman said he was ready to take questions from the audience – and that he was prepared to answer any question related to medicine, not just questions about medical slang. (Coincidentally, earlier that day, the CBC Radio program, “Cross Country Check-up”, had devoted two hours to a discussion of Canada’s medical system, and I asked Goldman a question related to what had been discussed on that show.)

When asked by Alfa how he came to write The Secret Language of Doctors, Goldman explained that, at the time that he was just beginning to begin his practice as an emergency room physician, a book titled The House of God was all the rage within the medical fraternity. Written by a psychiatrist by the name of Stephen Bergman (who adopted the pseudonym of “Samuel Shem”), The House of God peeled back the veil of secrecy that shrouded the inner workings of a typical big-city hospital. Goldman noted that, although the book was meant to be satirical, it was highly sexist in its treatment of its female characters, and would be considered quite dated in 2015.
Still, the way in which it dealt with some of the secret language of doctors was quite the eye-opener at the time it was released (1978), Goldman said. One phrase that was used in the book extensively, “gomers”, caught on quickly in hospitals everywhere, he suggested. (“Gomer” is an acronym for “get out of my emergency room”, Goldman explained.)
In time, as he became acquainted with more and more slang, Goldman decided to write a sort of “tell-all” book – much to the dismay of some of his colleagues. He began to send inquiries to other medical practitioners, asking them whether they could offer up any choice examples of slang that were peculiar either to their area of practice or to their geographic area. As it turns out, British slang was some of the most inventive – and offensive, and Goldman hid none of it when it finally came to writing his book.
Among the most popular slang terms used in hospitals are ones that refer to frequent patients. The term “frequent flyer” is self-evident, but how about “crocs” or “cockroaches” – for “people you can’t get rid of”?
Goldman said that the, himself, came up with a term to describe patients who have difficulty “coping” – “dyscopic”. (That’s not meant as a pejorative, by the way; it simply combines the commonly used Latin prefix “dys”, which means “bad”, with a straightforward descriptive gerund. A “gerund”, by the way, is a noun made from a verb by adding “ing”. This article is turning into an English lesson.)
Unfortunately though, all this use of slang and what Goldman described as the “objectification” of patients has led to individuals within the medical fraternity “blaming the patient for coming back again and again”, rather than attempting to delve deeply into what may be leading to that type of behaviour.

Goldman referred to a novel study conducted by Dr. Jeff Brenner in Camden, New Jersey, which attempted to focus on what factors were leading certain individuals to be disproportionately higher users of the medical system – individuals Brenner referred to as “super utilizers”.
It turned out that, as most emergency room personnel soon realize in dealing with those types of patients, “most of the time the problems is not that they’re coming back, but that they have no place that’s more appropriate.” Added to that, there is an ongoing issue of patients not taking their prescribed meds.
What Brenner found is that there were certain “medical hot spots”, Goldman explained: “individual spots that had excessive use of emergency rooms”. In response, Brenner advocated actually going out to those “hot spots” to deal with the patients on their home turf. In some cases clinics were actually established right in specific apartment buildings that were found to be the homes of most of the patients who were disproportionate users of the medical system.

But the issues involved in dealing with those types of patients, Goldman noted, can’t be isolated as “medical” issues. In large part, there are “mental health issues” and, when it comes to those sorts of situations, Goldman admitted that individuals working in emergency rooms are “way out of our league”. The same problem, he suggested, occurs when it comes to dealing with many “seniors’ issues”. Dealing with seniors’ “placements”, for instance, is something with which medical students are simply not trained to deal, he noted.
Continuing in that vein, Goldman decried what he said was written about in another well-known book about “the hidden curriculum of medicine”, by Dr. Fred Hafferty. That book, Goldman said, explores “the gap between what they teach you in medical school and what you need to know.”

Yet, it was dealing with his own father’s death not too long ago that revealed as much to Goldman about what it was like to be on the outside looking into the medical world as anything, he admitted.
“I probably learned more about medicine by being the son of parents who were avid consumers of medical services,” he explained. In his own practice as an emergency room physician for more than 30 years, Goldman had repeatedly seen patients who were “circling the drain”, as he put it – or who were “entering the drain” – two phrases used commonly to describe patients who are on their last legs.
But “circling the drain” is not meant to make light of those patients, Goldman insisted. “Its’ the language of disappointment: I tried to help this person but now I’m presiding over their death.”
“We have to keep reminding ourselves it’s about the patient,” however, Goldman noted; “it’s about the family.”

As the interview progressed, Goldman did begin to offer a steady stream of examples of medical slang. (One would hope that, rather than deter anyone from reading his book, this article will impel you to rush out and buy a copy – or get it from the library.)
Here are some of the terms he mentioned that hospital workers use to couch their communications with one another:
• “hanging crepe” – giving a patient’s family a really bleak assessment of a patient’s prospects
• “PBAD”, short for “Pine Box at the Door”; another way of saying a patient is about to die
• “PBADLO” – “Pine Box at the Door, Lid Open” – even worse than “PBAD”
• “discharge up” – another euphemism for saying a patient has died
• “consult pathology” – preparing for an autopsy
Then, there are all the nasty terms that hospital workers use in describing obese patients, such as “whale”, “seal”, “fluffy”, “or Yellow Submarine” (an obese patient with liver cirrhosis). Goldman observed that “weight prejudice is one of the last forms of prejudice you can exhibit in a hospital and get away with.”
Yet, not all medical slang is meant to poke fun at patients alone. Surgeons are referred to as “cowboys”, while internists are referred to as “fleas” (“the last to leave a body”).
British hospitals are home to some of the nastiest slang terms, Goldman said he learned. For instance, a really incompetent surgeon can be labelled a “Double o zero” – meaning a “license to kill”, while a “Jack Bauer” is a doctor who’s been up for more than 24 hours.
One more term that Goldman referred to was “blamestorming”: “When a mistake has been made, blame is usually laid at the feet of the most junior staff” who was involved.

Following Alfa’s interview with Goldman, Goldman said he was ready to answer any question that anyone from the audience might have to ask. As I noted earlier, I took the opportunity to point out that, by coincidence, the CBC had conducted a two-hour examination of Canada’s medical system earlier that day on “Cross-Country Checkup”. I referred to the observation made by a professor of medicine from British Columbia who had appeared on the show that per capita, Canada spends among the most of any country in the world on health care, yet our health outcomes rank Canada last when compared with nine other OECD countries. Further, I repeated that professor’s observation that Canada is now turning out more than 3,000 graduates from its medical schools on an annual basis, whereas only 20 years ago the figure was just a little more than 1500 graduates. So, what would Dr. Goldman do to improve Canada’s medical system, I wondered?
He answered this way: “We spend 75 cents out of every dollar when it comes to health care on chronic diseases, not acute diseases, but we’re cranking out doctors who are trained to treat chronic problems. Instead of inventing slang about them (patients), I’d like to hear that they’d actually like to look after them.
“We should make prevention publicly funded,” he suggested. “In most provinces we call prevention a luxury item.
“Whatever we spend on primary care – double it,” he stated. “Don’t spend money on more doctors – we’ll never have enough.”

Goldman went on to applaud some of the new ideas that are being implemented in various forms, including clinics where doctors are paid a specific amount to treat an individual patient rather than paid per office visit. Further, in some clinics, rather than having a doctor spend a short ten minutes in which he or she has to assess a patient, then possibly prescribe a form of treatment, those clinics employ “health coaches”, whose job it is to meet with the patient first, “go in there and get all the information they need, then summarize it and give it to the physician.
“The next morning the health coach can call you and ask” (for instance): “How’s the diabetes medication working?” (This is similar to the Camden, New Jersey approach, where patients are closely monitored to make sure they’re complying with the prescribed regime.)
Goldman was also very keen on a “team-based approach” to teaching medicine, so that medical students, nursing students, and physiotherapy students, would all attend rounds together and learn in what he described as a “problem-based learning” model – something, he said, that has been pioneered successfully at Ohio State University.
Just as Goldman railed against the constant use of medical slang to disguise hospital workers’ attitudes, he urged greater “transparency” in general, when it comes to all forms of medical care, even when it comes to discussing death.
He learned a great deal from the recent deaths of both his parents about the importance of candour, Goldman said. We shy away from discussing death but, quoting from Sharon Carstairs, Goldman observed that “Death is a part of life. We should celebrate death as much as we celebrate birth.”

 

 

 

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