How slang says a lot about medicine

Slang has long been a part of the medical profession, and while it often showcases the frustrations health professionals face, it can also say a lot about how to improve the health-care system, says emergency room physician and radio personality Dr. Brian Goldman.

Goldman, who practises medicine and Toronto's Mount Sinai Hospital, and hosts the CBC program “White Coat Black Art”, was in Sudbury Wednesday to promote his new book “The Secret Language of Doctors.”

In the book, Goldman explores the slang health-care professionals have used over the years to describe their patients and the stressful situations they face on a daily basis.
Goldman admits he didn't think much about the slang he heard in the emergency room until he started working on the book.

“That's the interesting thing about slang, you use it and don't know why you're using it,” he said.

Through his research, he discovered historical slang most people would find incredibly offensive today.

Thirty years ago, for example, some doctors would write the letters FLK in some patients' medical charts, Goldman said.

The acronym stood for “funny-looking kid” and referred young patients who had the physical attributes associated with Down syndrome.

Another acronym, still in use by some doctors today, said Goldman, is FTD. It stands for “failure to die” and refers to critically ill patients, mostly elderly, who are on life support but continue to cling to life.

Goldman said one method to deal with slang in hospitals would be to discipline the medical professionals who use it.

But discipline, he said, would not address the core reasons for the slang, and would likely not end the behaviour.

A better approach, he said, is to understand what slang says about doctors, their patients and the health-care system.

“I think we're increasingly frustrated with the patients that we're looking after,” Goldman said. “We run the risk of blaming them for being overweight, for being frequent flyers, for having mental health issues.”

The use of slang also points to an increasing lack of empathy in the medical profession, Goldman said.

He argued medical schools need to do a better job at attracting candidates who are able to empathize with other people, even if it means de-emphasizing their grades and Medical College Admission Test scores.

“Ask questions like, 'Do you like patients? Do you like being around people?'” Goldman said.

Some medical schools in Canada, he said, have started to teach courses in narrative medicine, which teaches future doctors to understand their patients' stories through archetypal characters in literature.

Goldman said because the courses are so new, the jury is still out as to whether or not they are effective at helping medical professionals be more empathetic. But he said the courses seem to be a good idea intuitively.

The most effective way to help doctors better relate to their patients, is for them to become patients themselves, Goldman said.

“I wouldn't wish it on anybody,” he said.

But he said one of his mentors, Dr. Rob Buckman, became a better and more caring doctor after he was diagnosed with an auto-immune disorder.

Goldman said his parents' deaths helped him become a better doctor as well, because he was able to see the medical system from their point of view, and understand the needs of patients in their last days.

“I've learned to value visiting hours,” he said.