Secret codes for clinicians? (13.06.2014)
Brian Goldman, MD describes and dissects – in his new book – many terms used in clinical settings, which you may not have heard within the realm of bioethics.
If his name seems familiar, it may be because Dr. Goldman has hosted “White Coat, Black Art” for the Canadian Broadcasting Company (CBC Radio) for the past seven years. Or perhaps you’ve seen or heard his 2010 TEDx talk, regarding medical errors (1). Or you may have seen him acting as health reporter for The National, on CBC television.
“The Secret Language of Doctors” (2) was written primarily for patients and caregivers, but is well worth a read for those of us in bioethics as well. As you read this post, I’ll ask you to bear in mind Beauchamp and Childress’ four commonly accepted principles of bioethics (3):
- Respect for autonomy
Then as you read the few ‘secret language’ examples I’ve provided, from this book, consider whether they fail to respect any of these principles of biomedical ethics.
Could it be argued – for example- that ‘secretly’ referring to a patient in a derogatory manner, among clinicians, could semi-intentionally create a – psychological or social – harm to the patient? Or are these expressions and terms simply examples of harmless M.A.S.H.-style gallows humour that many clinicians use to deal with the stresses of their life-and-death roles?
Ask yourself whether the use of ‘secret’ derogatory terminology among clinicians risks damaging, or completely eroding, a patient’s trust; whether in their physician, in the healthcare centre, or in the sphere of medicine as a whole.
If you feel that this ‘secret language’ fails to respect any of the principles of bioethics, or risks the loss of patients’ trust in healthcare or in medicine, then please speak up if you ever hear it being used.
In this book, Dr. Goldman renders intelligible the ‘codes behind the codes’; many hospitalists’ special use of everyday terms. A good example – of a common phrase being used among clinicians to convey a completely different meaning – is one I’ve often heard; ‘frequent flyer’. I’ll provide the decoding, or translation, of the term below – along with a few other examples from this book:
- ‘Beemer’ = A patient with such a high body mass index, or BMI, that they’re considered to be morbidly obese
- ‘Discharged up’ = Died
- ‘High five’ = Indicates a patient with HIV; a play on words for HIV as ‘hi-V’
- ‘Frequent flyer’ = A patient who repeatedly presents to a hospital’s emergency department/room (ER/ED) or other healthcare facility; they often lack any other access to medical care, so visit the ED/ER for minor issues
- ‘Hollywood code’ = When medical staff pretend to perform cardiopulmonary resuscitation, usually to placate any of a patient’s caregivers or family members who’re present at the time
- ‘Horrendoma’ = A particularly awful or horrible condition, clinical sign, or symptom
- ‘Referred to outpatient pathology clinic’ = Died
- ‘Yellow Submarine’ = An obese patient with cirrhosis
- ‘Status dramaticus’ = An overly dramatic patient
And, of course, there are many apparently incomprehensible acronyms used in the same derogatory ways:
- FOOBA = Found on orthopedics barely alive; meant to be insulting to orthopedic surgeons, rather than to patients
- FTD = Failure to die; said of an elderly patient for whom the clinician views treatment as medically futile
- GOMER = Get out of my emergency room; of patients with chronic or incurable but medically uninteresting conditions
- LGFD = Looks good from door; refers to a clinician who fails to properly assess a patient (I’ve also heard this referred to as a fly-over, for a clinician’s failure to fully assess a ‘frequent flyer’)
I’ll close this post with a question (blame my background in philosophy and ethics!):
If you or a loved one were a patient, would you view any of these terms differently than you would solely as an individual involved – or working – in bioethics?
(1) Goldman, Brian. Doctors make mistakes. Can we talk about that? TEDx Toronto. 30 Sep 2010. Web: http://doctorbriangoldman.com/appearances/ted-talk-doctors-make-mistakes/#sthash.NujihNoh.dpbs
(2) Goldman, Brian. The Secret Language of Doctors. HarperCollins Publishers. 29 April 2014. ISBN: 9781443416016: http://www.harpercollins.ca/9781443416016/the-secret-language-of-doctors (3) Beauchamp, Tom & Childress, James. Principles of Biomedical Ethics, 7th Edition. Oxford University Press. 23 Oct 2012. https://global.oup.com/academic/product/principles-of-biomedical-ethics-9780199924585?cc=ca&lang=en&