There. I’ve said it. No shameful secrets left. Nothing more to do than define one’s terms. A medical groupie is someone insufficiently intelligent to get into medical school who nevertheless retains an obsessive interest in every aspect of health and illness. A medical groupie loves hanging around doctors and using medical jargon; show me a collapsed lung and I’ll raise you a pneumothorax.
Medical groupies like me ask all the right questions when a friend calls to say they, their child, or their parent is unwell: When did you first notice? What colour was it? Any fever involved? Nausea? Sleeplessness? We groupies congratulate ourselves when the friend comes back and confirms that our guess as to the diagnosis turned out to be correct. We stroke our chins at that point and wonder aloud whether the treatment will be keyhole surgery or administration of a specific medicine. We can quote the statistics of survival for almost any ailment, post-treatment.
I have a vast library of medical tomes about the history of medicine and disease. Not to mention the number of novels about heroic young doctors coming to terms with their period as registrar, or the fictional accounts of surgeons faced with intractable ethical problems, not to mention more sex than any normal person could handle. Those novels form a kind of unofficial record of medical progress, testifying to the advances in medication, antisepsis and surgery. They even testify to the differences in presenting problems caused by better personal hygiene, particularly in the form of the daily shower: The older novels tend to be populated by patients suffering from things like massive boils, whereas boils hardly figure in modern medical fiction.
One of the precious novels in the sequence came out in 1978 — The House of God and it was by Samuel Shem, a pseudonym chosen by the author, himself a psychiatrist, whose real name was Stephen Bergman. “When it comes to modern medical slang, there’s Before Shem and After Shem,” says Brian Goldman. Goldman is something of an expert on the topic.
He’s spent 30 years as an emergency room physician in Toronto. He’s written columns, delivered a TED talk that’s been viewed more than a million times, and recently published The Secret Language of Doctors, which cracks the code of hospital culture.
According to Goldman, The House of God gave the public the first insider’s look at the underbelly of hospital life. He also maintains that Dr Bergman shook the culture of modern medicine to its very foundation by introducing the public to a jarringly new kind of medical slang.
“By far the most important argot to come from The House of God,” he maintains, “is the term Gomer — an acronym for ‘get out of my emergency room.’ In his book, Bergman describes a Gomer as a patient who is frequently admitted to hospital with ‘complicated but uninspiring and incurable conditions’.”
It wasn’t the only term emerging from the book. “Turf” meant shoving an uninteresting patient into another department or a nursing home. “Bounce” meant the return of that patient by the receiving department or nursing home.
Following blockbuster novels, television programmes were the next great source of medical argot. Up to then, medics and nurses used one language, which was full of respect, to patients, and a quite different language among themselves. By the seventies, however, TV programmes like M*A*S*H* had crossed the barrier, letting outsiders hear insiders’ language.
Some of that language was harmless. Hospital gowns were referred to as “monkey jackets”, which is a benign way to refer to inarguably the worst of the many ritual humiliations of hospital admission. Doctors also, according to an essay written at the time by a medical linguist, used the phrase “chandelier syndrome” to describe the leap towards the ceiling occasioned by the shock of a doctor pressing an ice-cold stethoscope to a patient’s warm body.
Even describing a patient with respiratory problems as “a lunger” or a stroke patient as “a stroker” amounts to little more than the shortening of longer terms in a colloquial way which happens in every profession. Broadcasters refer to their “cans” when they mean “earphones”. We can assume bankers have privately pejorative, but not actively damaging, terms for customers in default on their repayments and garages have their own words for people who park by touch. Dingers? Scrapers?
But some of the medical terms go beyond mild negativity. Take, for example, the word “crock”, applied to patients who present with a variety of symptoms, none of which amount to very much but which the patient regards as potent portents of disaster. Or the term Code Brown. Whereas Code Blue is the method of calling all relevant staff to care for a patient having a cardiac arrest, a Code Brown refers to one who has had an episode of fecal incontinence.
The reason given for the use of this apparently medical term is that it allows medical staff to share information in a way that sounds official but conveys no meaning to bystanders. This rationale is at best tenuous, given how fast such terms travel among laypeople.
In 1993, the journal Science & Medicine identified as many as 300 units of medical argot in common use. Today, according to Goldman, the medical profession possesses “a rich, disdainful cornucopia of slang terms” such as “status dramaticus” or “dying swan” for someone who pitches up in A&E with a dearth of meaningless and mutually unrelated symptoms. Nothing major wrong with them, in other words. This does not lessen their conviction that they are possessed of a rare and life-threatening affliction which requires screaming, crying, and fainting in coils.
None of which necessarily gets them the attention they want and feel they deserve, since many triage nurses apparently believe that the noisier the patient, the less serious is their situation. They believe it’s the quiet ones in the corner who should be watched.
Increasingly, medical staff, particularly those in A&E, find themselves coping with patients who have already self-diagnosed with the help of the internet, and who arrive with a preferred mode of a treatment. It can take time to persuade a fan of Dr Google that the real live doctor or nurse in front of them may be quite competent and may be justified in coming to a quite different diagnosis and treatment regimen. That’s time the ER staff don’t have to spare. Small wonder, then, that they come up with rude ways to describe the time-wasters.
The issue is whether medical argot is essentially a form of harmless if pejorative shorthand the use of which reinforces the sense of teamwork among the medical staff, or is indicative of a deeper contempt for human beings and of a triumphalist self-regard on the part of the professionals. I’m for the first interpretation. But then, I’m a medical groupie.
We can assume bankers have privately pejorative, but not actively damaging, terms for customers in default on their repayments