Can We Talk? Show
Physician and author Siddhartha Mukherjee with host Dr. Brian Goldman.
We're offering you a crash course in medical communication this week. Not woolly medical jargon like 'space-occupying lesion' or 'toxic delirium' but how we use words to show what health professionals really think about their colleagues, diseases and you. Our residents' panel returns to introduce you to the words they use to grouse about overwork.
I also have a wonderful conversation with physician Siddhartha Mukherjee about his Pulitzer Prize-winning book 'The Emperor of All Maladies' and the language of cancer. As a special web bonus this week, you can hear an extended version of our conversation. See the link below.
It's our mission on White Coat, Black Art to have doctors, nurses and other health professionals speaking candidly about what goes on inside medicine's sliding doors. You may recall that last season, we had on our show a remarkable group of residents from McMaster University talking candidly about end of life issues. They used a turn of phrase - 'circling the drain' - to talk about patients who are dying and what it's like to care for them.
That phrase is just part of the lingua franca learned by residents on the wards. The average medical student learns twenty thousand or more medical terms - everything from aphasia to zygoma. On the wards, they learn even more words - a kind of secret code that reveals what they think about staying up late a night, being overworked, and what they think about you.
We've reconvened our residents' panel to help decipher the coded language of residents. Rick Mann - who was on our Rural Medicine Show a few weeks ago - has just finished his residency in family medicine. Nooreen Popat is a resident in internal medicine now training to be a respirologist. Andrew Burke is a resident in internal medicine. His partner Clarissa Burke is nearly finished training to be family doctor.
They explain the meaning of words that are used frequently on the wards.
* To turf (verb: to find any excuse to refer a patient to a different department or team). The verb can also be used as a noun. A 'turf' refers to a patient who has been referred to a different department or team
* To dump (verb: to refer a patient to a different department or team in the absence of any valid reason or excuse). Again, the verb can also be used to as a noun. A 'dump' refers to a patient who has been referred without valid reason or excuse to a different department or team.
Many of these words come from a book written by Samuel Shem (a pseudonym for psychiatrist Dr. Stephen Bergman) called The House of God. This is a book well worth reading if you want to learn more about what it's like to be a resident.
You may be shocked to learn that young doctors sometimes use pejorative language to talk about you. Don't be. I think it's refreshing to hear them admit that they get tired and cranky at night and may not be too keen on doing extra work. As Rick Mann said, they're just blowing off steam. Most of them do the work! That these young doctors are aware not just of the secret language but that using it doesn't show them at their best bodes well for them and for you.
Turns out residents aren't the only ones who have a special language of their own. So do nurses. Canadian Erin Sullivan is a former nurse who - her words, not mine - has "crossed over to the dark side" and is now a third year medical student at the University of Limerick in Ireland. She's one of many Canadians who have traveled to Ireland, Australia and elsewhere to study medicine. We interviewed two such Canadians - Hannah Smith and Geoffrey Stevens - on a previous epsisode of WCBA.
Erin gives me a lesson in 'nurse-speak', a coded language that nurses use to get residents who are book-smart but lacking in practical know-how to do the right thing when the lives of patients are on the line. She wrote a three part series about this on her blog Asystole is the Most Stable Rhythm.
Here is just one example from her blog:
Nurse-speak: "Are you sure you want to [fill in procedure, medication, etc.] Mrs. Jones?
Translation: "If you do that you'll probably kill the patient".
Sullivan says the reason for the couched language is that in the hierarchical culture of medicine, nurses often feel reluctant to tell a resident straight up they forgot to order a test or are about to do something dangerous. I would hope that part of things is changing. But there's a larger issue in medicine I want to comment on.
I call it the 'Culture of Hinting'. Nurses aren't the only ones who hint. Doctors do it all the time to each other. We drop breadcrumbs to see if our colleagues have read the latest paper. We use the latest term to describe a clinical condition to test others to see if they're up to speed. Radiologists hint at the diagnosis by giving a litany of 'findings' like 'inflammatory stranding' around the appendix' without saying 'appendicitis'. I'm afraid to admit I've sometimes missed the point the radiologist was trying to make and had to call for clarification.
As a medical broadcaster, I'm in the business making things easy for people to understand. Make no mistake: hinting leads to errors and costs lives. As a profession, we have to stop this.
There's the language used by health professionals to talk to each other and about you. Then again, there's the language used to describe a dreaded condition like cancer. No one speaks that language better than Siddhartha Mukherjee - a cancer doctor, researcher and author of last year's astonishing Pulitzer Prize-winning book 'The Emperor of All Maladies'.
This year alone, more than 160,000 Canadians will be diagnosed with cancer -- and enter a world with its own often baffling words.
Those are my words for this week.