A Q+A with Dr. Brian Goldman
Professor Brian Goldman (Department of Medicine) is a longtime emergency room specialist at Mount Sinai hospital, a medical journalist, writer and broadcaster. His most recent book, The Secret Language of Doctors, interprets some of the invented “slang” doctors use amongst their peers in hospitals across North America. He is also the host of CBC’s White Coat, Black Art—a radio show that demystifies the medical profession. You can learn more by going to his website, www.doctorbriangoldman.com.
What was your first introduction to medical slang?
My introduction came in 1980, when I was fresh out of U of T medical school. I was doing a residency in pediatrics at The Hospital for Sick Children. The work was grueling and relentless. On average, I worked seventy to eighty hours a week; 110 if I was on call for the weekend. In addition to volume of work, there is a great sense of anxiety when treating ill babies and children, largely in part because they come with very anxious parents.
For my rotation, I was assigned to a senior resident, Dr. George Rutherford III, who had a long and distinguished career in pediatrics and public health. After my first night on call, he came up to me, and asked: “So Brian, how many babies did you box last night?” It was a macabre joke. He was asking how many patients passed away on my watch. Once I got over my initial shock, I realized I was part of a fraternity with its own way of speaking; I was no longer alone. It made me want to learn more about this secret language.
What led you to write your latest book?
My first book, The Night Shift: Real Life in the Heart of the ER, was a bestseller. The success of this book led my publisher, Harper Collins, to ask me to write a book about how doctors talk. I quickly realized a book about jargon and shorthand wouldn’t be very interesting, but slang—or argot—could be a wonderful way to transport readers into the world and culture of modern medicine; to explain it, critique it, and illustrate what we believe and how we think as doctors.
Can you give some examples?
A lot of our language reduces patients to stereotypes, or expresses a singular idea that will quickly sum up a complex situation. For example, a surgeon operating on someone with HIV may respectfully give everyone in the operating room a heads-up by saying “double glove” or “high five” within earshot of the patient.
Other terms can be more pejorative. Patients who often come to the emergency room because they have no other place to receive care are called “frequent flyers.” Patients who repeatedly come back to the emergency room and other parts of the hospital, frustrate us because they symbolize professional failure; after all, if we cured them, they wouldn’t keep coming back. In my opinion, they also symbolize the failure of the system to find a better place to care for them.
You have been prolific in talking about how doctors are human and make mistakes like anyone else. Why is this important?
This is a human profession and no one is perfect, but the pressure put on doctors to be perfect is huge. If a baseball player hits a third of his pitches, we think he’s a big star. If a doctor provides the correct treatment to a third of his patients, we judge him or her incompetent. This is an extreme example, but demonstrates that error is inevitable in the medical profession. We should get more comfortable talking about our mistakes so that other doctors can take the lessons, too. Blaming ourselves can lead to depression and burnout, both of which lead to more errors, and the beginnings of a vicious cycle.
What advice would you offer to current students in the U of T medical program?
Have fun, because if you can’t have fun during your years of study, you may be setting a pattern for the rest of your life. Exercise; enjoy the fellowship of your classmates; give yourself lots of rewards. Develop an interest outside of medicine—don’t define yourself entirely by being a physician. Talk to somebody when you’ve had a complication or bad outcome. Leave yourself open to learning why things go awry, because that’s the beginning of wisdom and making things better.
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