Wednesday, April 30, 2014

Book Review: The Secret Life of Doctors by Brian Goldman

Book Review: The Secret Language of Doctors: Cracking the Code of Hospital Slang
by Dr Brian Goldman, HarperCollins, Toronto, 2014, 268 pages, no index.  Hardcover,  350 pages.
Dewey Number: Not available at this time


The first thing you need to know about this book is that it is well written.  That is a blessing and a problem.  Blessing: It is clearly written and therefore straightforward to read.  The problem is that it is so entertaining that we can miss the darker implications of what we are reading.

This book, written by a Canadian doctor and therefore having a Canadian context, is helpful in unravelling the arcanum of medical jargon.  Remember, the purpose of jargon is to keep outsiders, out.

The trouble is when we read this book we understand that a great many of the terms are derogatory.  As an example, the author describes Hispanic patients as having  ay-tach.  This is specifically descriptive of Hispanic patients overdramatizing their symptoms in an effort to be seen.  This is by the author’s admission a derogatory term and not used (much).

However, when we read about things like circling the drain or even better, failure to die syndrome, we know there is more going on than a professionally protective insider lingo.  We realize there is a darker side to medicine: even doctors sometimes think their patients are better off without them.  Hence, GOMERS.  (Get out of my emergency Room’s) 

There is also status dramaticus: in which the patient is exaggerating.  My interest in reading this book is to find out what the doctors say, and to see what their attitudes are behind what they say.
It’s not pretty.  By far, most of the terms I encountered were demeaning toward the patients.  This is one reason I applaud this book: the author is trying to point out to his colleagues that such language is in fact derogatory and needs to stop. 

Yet let’s look at one case: Failure to Die.  This implies and says that a certain type of patient (Like a HOWDY: Hypertensive obese white diabetic yahoo) is better off dead and therefore a waste of time treating.  This tells us that doctors think that there are possibly certain classes of patients for whom treatment is a general waste of time.  This is used of elderly patients, usually characterized with dementia.

It’s a short few steps to start acting on that definition once we have it.

This is why this book is a good resource: if you are in a situation with medical types and you hear any of this jargon and it is applied to you, you can be sure that you are not getting the highest level of respect.  And therefore the highest level of care.

Which is why this book is important, especially for those who are chronically ill, disabled or for those whose family members have other health challenges.

Consider the following quote:

“That last one tracks with my experience in the ER  Instead of acknowledging that they fear being sick, I see patients who fight to ward off the fear by looking to the physician to magically take the fear of illness away.” [79]

This illustrates the idea that patients need help; it also shows that some doctors think that patients might be a bother.  Especially if they have other issues.  In another place, the idea of futile care theory shows up.  In the example, a patient has arrived in the ER who is blind and has dementia. 

“This is cruel, to keep this guy alive,” Cynthia argued to her teammates...There were murmurs of support, as Cynthia and the team spoke in a cold and spare way about the futility of keeping the man alive.  What strikes her later as she recalls the episode is that they were joking about the choice; to the team, the fact that there was a choice at all was amusing.  The idea that there was any point to the man being saved was that preposterous.” [89, italics in original]

Remember, this patient has arrived in the emergency department in need of help.  He was dependent and the care team didn’t think he should live.  He was given antibiotics and lived.  The author then says, “what also bothers me about the case Cynthia described is that these life and death discussions took place around the man as if he didn’t’ exist.” [90]  This is the experience I have had; I was treated as a cypher in emerg.  In addition, there are cases I have reviewed in my learning which mirror just this notion: the person ceases to be a valuable human being but is a problem to be disposed of as fast as possible.

So the attitudes reflected in care teams are making it easy for euthanasia enthusiasts to make inroads to ethics.  Their work has been done for them.  This is the danger of this book: that no-one will take a critical view of the book and discuss the darker implications.  In a book review, I can only go so far, but to those who make their living looking at medical care and its quality, this book is a must read.

The book resonated with my experience as someone who has had health problems, but it also was chilling: I found myself thinking through scenarios and what to say and not to say into the future.  I also thought to myself, how is it possible that we expect medical types to be professional when it comes to things like the end of life, and yet we can read such juvenile things?


This is why this book is important.  We need a reminder that doctors are human, but we also need to know how to counter jargon when we see it.  Remember, in Canada, a doctor doesn’t have to tell you what is on your chart.  That also means that they don’t have to tell you that you are a beamer.  Or that you are expected to be circling the drain.  Both those phrases are shown in the book.  If we are to hope to keep disabled and chronically ill people seen as human, we need tools to speak against verbal dehumanization of patients.  This book is one such possibility and that makes it worth reading.

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