The Secret Language of Doctors

Cracking the Code of Hospital Culture

Brian Goldman

• Publisher: Triumph Books
• Year: 2015
• Print ISBN: 9781629370927
• eBook ISBN: 9781633191792
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Most people have visited a doctor's office or emergency room in their lifetime to gain clarity about an ailment or check in after a procedure. While doctors strive to ensure their patients understand their diagnoses, rarely do those outside the medical community understand the words and phrases we hear practitioners yell across a hospital hallway or murmur to a colleague behind office doors. Doctors and nurses use a kind of secret language, comprised of words unlikely to be found in a medical textbook or heard on television. In The Secret Language of Doctors, Dr. Brian Goldman decodes those code words for the average patient. What does it mean when a patient has the symptoms of "incarceritis"? What are "blocking" and "turfing"? And why do you never want to be diagnosed with a "horrendoma"? Dr. Goldman reveals the meaning behind the colorful and secret expressions doctors use to describe difficult patients, situations, and medical conditions—including those they don't want you to know. Gain profound insight into what doctors really think about patients in this funny and biting examination of modern medical culture.

1. The Bunker

6 p.m. Handover

In a small, secluded room behind the nursing station of Ward 6 West, residents gather for the daily ritual called handover, or patient sign-out. It’s the moment when the army of staff doing scheduled tests, interventions and operations shifts down to a skeleton crew of residents on call whose job is to monitor patients and attend to any sudden emergencies. It’s also when residents who aren’t on call finally get to go home. But first, they have to give their colleagues the heads-up on every patient under their charge.

The rectangular room where they meet is nicknamed the Bunker. The room contains four cubicles equipped with computers, a printer and a coffee machine. A small sofa bed is off to one side. The walls’ blue paint is scuffed with furniture marks. In the middle of the room is a small conference table ringed with chairs.

The Bunker is where residents meet with the ward chief—the attending or most senior physician in charge of the patients—to write up chart notes and to talk frankly about patients and fellow doctors who work on other floors and in other hospitals. The room, teeming with two sets of residents—the ones on call and the ones handing over—is hot and stuffy.

“Room 22, bed B, 82-year-old male,” says Rick, a first-year resident in internal medicine. “Admitted ten days ago with a fractured pelvis. He also has moderate Alzheimer’s dementia, GERD and type 2 diabetes. OT and PT say it’s not safe for him to go home. He’s awaiting placement.”

“What’s his code status?” asks Sandi, the senior resident on call.

“He’s Full Code,” answers Rick. “We tried to get the DNR but the family said they’re thinking about it.”

“Thinking about it?” repeats Sandi. “Can we do a Hollywood Code?”

“You’re on call, so it’s your show,” says Raza, the senior resident on Rick’s team. “But the family is there 24/7. I think they’d know it if you run a Slow Code.”

“You may hear about a consult we did on ortho,” says Raza. “Eighty-eight-year-old female five days post right total hip replacement. Post-op, she was overhydrated by the ortho resident and put into CHF. She had a bump in her troponin. We’ve given her Lasix and she’s feeling better. She’s stable now.”

“Saved another FOOBA,” says Sandi.

“That’s the third one this month,” says Raza.

“Next patient is Room 24, bed C, 58-year-old female,” says Rick. “Admitted over the weekend with type 1 diabetes and DKA triggered by a urinary tract infection. Unfortunately, she developed a pressure sore on her sacrum. Plastics is consulting on that.”

“Pressure ulcer?” asks Sandi. “How the hell does a 58-year-old diabetic get a pressure ulcer on her bum?”

“She’s a beemer,” says Raza.

“How big is she?” asks Sandi.

“Three clinic units,” answers Raza. “We tried using the Hoyer lift but it wasn’t rated for her.”

“Sounds like a horrendoma,” says Sandi.

“It gets worse,” says Rick. “We don’t have a bariatric commode or wheelchair to get her to the bathroom. She had a Code Brown in the bed.”

“Who got to clean that up?” asks Sandi.

“Thank god for LPNs,” says Raza. Everybody in the room laughs.

* * *

The dialogue you just read was created to illustrate just how much medical jargon can be packed into a brief discussion.

The 82-year-old man has GERD, which stands for gastroesophageal reflux disease, better known as heartburn. The residents referred him to OT and PT—occupational therapy and physiotherapy. That’s standard procedure for a patient with a cracked pelvis to determine whether the fracture will keep him from going home; an OT/PT assessment is also used to find out if a patient is likely to fall at home and what preventative safety measures might be necessary.

Raza’s 88-year-old patient on the orthopedic floor went into CHF—congestive heart failure—after the orthopedic resident gave her too much intravenous fluid. A “bump in her troponin” means the woman had a slight increase in the level of a protein called troponin, which indicates that she suffered a mild heart attack.

The 58-year-old woman was admitted to hospital with DKA, which stands for diabetic ketoacidosis, a life-threatening condition in which both the sugar and acid in the bloodstream rise to dangerous levels. A “plastics consult” means she was seen by a plastic surgeon, the specialist who usually manages skin ulcers.

But the residents also used a bunch of words and phrases that aren’t found in any medical textbook I know of, yet they were understood by everyone in the Bunker. If you sat in on that conversation, you might have thought you’d wandered into a very boring French film. Now, let’s provide the subtitles—starting with the 82-year-old man.

• • “He’s awaiting placement” means there are no ongoing medical issues and if he could go home safely, we’d have sent him out by now.
• • “What’s his code status?” means “Do we have to do CPR (cardiopulmonary resuscitation) if his heart stops?”
• • “He’s Full Code. We tried to get the DNR but the family said they’re thinking about it” means the family wants him to be resuscitated if his heart stops. They can’t see the handwriting on the wall—that there’s no point in doing CPR if his heart stops—and they aren’t ready to sign a Do Not Resuscitate order.
• • “Can we do a Hollywood Code?” means that if his heart stops we’ll do a pretend resuscitation in which it looks as if we’re trying to save him but we aren’t.

Now, we’ll take look at the acronym Sandi the resident used to talk about the patient on the orthopedic floor who was put into congestive heart failure. “Saved another FOOBA” means the internal medicine team saved another patient who was “found on orthopedics barely alive.” It’s a dig at orthopedic surgeons, who have a reputation for being so focused on what needs to be fixed surgically that they ignore signs of other diseases. FOOBA is a play on FUBAR, a military slang term that has entered common vernacular and stands for “fucked up beyond all repair.”

Finally, let’s unpack the slang that was used by the residents to talk about the 58-year-old woman in Room 24, bed C:

• • “How the hell does a 58-year-old diabetic get a pressure ulcer on her bum?—She’s a beemer” means the woman got a pressure ulcer on her buttocks because she has a high body mass index, or BMI, a polite way of saying that she is morbidly obese. In other words, she’s so large that she developed a pressure ulcer from lying on her backside too long because she was too weak to move and she weighed too much for nurses to shift her position in bed.
• • “Three clinic units” is a sneaky way of saying the patient weighs 600 pounds. One clinic unit refers to a weight of 200 pounds.
• • “Sounds like a horrendoma” refers to a horrible or awful condition.
• • “We don’t have a bariatric commode or wheelchair to get her to the bathroom. She had a Code Brown in the bed” means that she is so large that when she had to defecate, several nurses—who didn’t have special lifting equipment—could not manage to move her to the bathroom or commode or even to place a bedpan underneath her, so she defecated in her bed.
• • “Thank god for LPNs” refers to licensed practical nurses. Poop runs downhill. Residents can laugh about a Code Brown because they aren’t the ones who have to clean it up.

That is a crash course in the Secret Language of Doctors and what the language reveals about how these doctors view patients and their families in the culture of modern medicine.

* * *

Doctors share a culture that many hardly realize exists, much less talk about. In a 2008 paper published in the journal Academic Medicine, Dr. Carla Boutin-Foster and colleagues defined medical culture as “the language, thought processes, styles of communication, customs, and beliefs that often characterize the profession of medicine.”

Much of what is written about the culture of medicine focuses on the qualities of the ideal physician—what Boutin-Foster listed as “honesty, empathy, altruism, honor, and respect.” These attributes are considered the core values of medical professionalism. The doctor’s white coat is a powerful symbol of medical culture. Many medical schools hold a White Coat Ceremony during which first year students receive a white coat along with a lecture that teaches positive cultural values to young doctors to be.

But, there’s another side to medical culture—one that reflects how doctors cope with the not-so-nice aspects of medicine—everything from exhaustion and sleep deprivation to frustrations with Obamacare, not to mention frustration with certain kinds of patients and families, fellow doctors and allied health professionals.

They share these feelings only with trusted colleagues. To know what they really think about you, a loved one, or the heart surgeon about to remove a cancer inside your belly, you’d have to eavesdro...

Table of contents

• Contents
• 1. The Bunker
• 2. Slangmeister
• 3. Code Brown and Other Bodily Fluids
• 4. Status Dramaticus
• 5. Failure to Die
• 6. Swallowers
• 7. Caesarean Section Consent Form
• 8. Incarceritis
• 9. Harpooning the Whale
• 10. Frequent Flyers
• 11. Blocking and Turfing
• 12. Cowboys and Fleas
• 13. Horrendomas
• 14. Circling the Drain
• 15. Slang Police
• Acknowledgements
• About the Author