Comedy is when you fall through an open manhole.
Tragedy is when I fall through an open manhole.
It’s an old joke and a helpful segue to understanding dark humor in the medical community. Physicians see a lot of desperate and hopeless situations. We have to deliver bad news. Sometimes frequently.
Gallows humor is defined as grim and ironic humor in a desperate and hopeless situation.
Physicians frequently use gallows humor. They do it blow off steam. To head off compassion fatigue.
Is it unprofessional?
In most situations, I don’t think so. In fact, I think it can even be healthy.
But, it depends.
First, let’s be honest. Gallows humor is pervasive. It is heard in the ICU. It is heard in the operating theatre. It is heard in the emergency room.
“The good news for this patient is that he will have a disease named after him.”
I’ve heard something like that. The physician said it. The patient never heard it. Do I think less of this doctor for having said it? I do not. The doctor was certain his patient would never hear it. And it relieved a hopeless and horrible situation. The one hour he spent speaking with the family, answering questions, and offering consolation is what his patient remembers.
Then there’s the old story of the patient who presented to the ER with a vibrator stuck in his rectum.
“The bad news is we cannot remove it without surgery. The good news is we can change the batteries.” ‘
There are some patients who actually would find that funny. But, it’s not worth testing with a real patient. Still, the back and forth banter with health care professionals is not unexpected and, in my estimation, not inappropriate. Most importantly, I do not find it unprofessional.
Now for the caveat. My conclusion is based on the foundation that patients are not included in this conversational banter. They are not made to feel small or disrespected. They are not made to feel they are the butt of a big joke.
Which brings me to the lawsuit D.B versus Ingham. D.B., the patient, had an outpatient colonoscopy. D.B. was wheeled into the suite with his clothes in a plastic container under the gurney. His smart phone was in this bag. And it recorded everything. D.B. said he had pressed record to remember the post-op instructions. He just forgot to turn it off.
Some of the back and forth:
When a medical assistant noted the man had a rash, the anesthesiologist warned her not to touch it, saying she might get “some syphilis on your arm or something,” then added, “It’s probably tuberculosis in the penis, so you’ll be all right.”
“And really, after five minutes of talking to you in pre-op I wanted to punch you in the face and man you up a little bit,” the anesthesiologist told the unconscious patient.
The anesthesiologist also allegedly said she was going to note in the man’s chart that he had hemorrhoids, although he didn’t.
The three-day trial ended in jury verdict of $500,000. The plaintiff argued medical malpractice and defamation.
The take home message is that once a patient learns his doctor is embracing dark humor, and they are the subject of the joke, all bets are off. Don’t expect to be immune in regular court or the court of public opinion. Or with licensing boards. In the age of the internet many fine people are being remembered for the worst 5 minutes of their life. This is unfair and unfortunate. But, it is a fact. So, remember it is not crazy for OR banter to be recorded. It is not insane for paper thin walls to transmit your conversation. It is not unheard of for a patient to wake up during surgery and hear what was being said.
So, tread carefully. Put headphones on your surgical patient with his favorite music on play. Speak softly when walls are thin. And don’t forget smart phones are everywhere.
If something you heard was qualified as dark humor and relieved “a desperate and hopeless situation”, feel free to share.
What do you think?
ABOUT THE AUTHOR
Jeffrey Segal, MD, JD
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal received his M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
If you have a medico-legal question, write to Medical Justice at infonews@medicaljustice.com.com.
I would agree that gallows humor, within the doctor’s lounge, and for the purpose of handling otherwise nearly unbearable emotion, is not, within bounds, unprofessional.
I also agree that when anywhere ANY patient could overhear, it is unprofessional to speak disrespectfully about any patient, and that anyone who does this deserves such a verdict as was rendered in the cited case.
And I would add that with any patient entitled to read their own medical record, that all words and ABBREVIATIONS should be carefully considered as if they were certain to be read from a witness stand….by us!
Really, all just common sense. But sometimes forgotten, to our detriment.
My entire career included attempts at humor with my patients.
How I did it: First is a small humor effort–always spontaneous, never rehearsed, rarely, if ever, the same joke twice. Two possible outcomes–patient laughs or does not. If not, no more humor. If laughs, keep things as light as reasonable. Which makes for a more enjoyable doctor-patient relationship, and a ore educational one for the patient. even for me sometime.
Simple algorithm. It only worked, though, because I can be spontaneously and screamingly funny. But don’t try this out of the home until you can do it smoothly. If you can’t do that, best to play it straight. Or find a wingman.
Unfortunately, most physicians, especially older ones’ may not be aware of the extreme “sensitivities” installed in corporate institutions and workplaces by the Leftist regimes that have dominated our culture and universities.
Most of these are centered around the “toxic masculinity” of men and especially those who are perceived to have a power position at the workplace. Professional males are definitely a target.
There are a number of staff members, mostly female, who are very attuned to hear ANY comments you make, which are “disparaging” toward anyone, but especially females. It makes no difference even if those comments are NOT made to THEM.
You run the risk of being identified as a homophobe, racist and misogynist. These are VERY serious charges in today’s world in the West. They can lead to you being identified as a “disruptive physician. ” There are no legal or other defenses against this charge. Even abject apologies do not suffice.
I cannot recommend any gallows humor be made publicly, especially when females are present. These might be people you have known for many years and “trust.” But that trust can be turned over to a complaint to an executive committee that will change their opinion of you permanently. Social media play an important part of this and your “humor” may spread like a virus.
This also translates to non-professionals, such as scrub personnel, custodial and other people around you who hear what you have to say.
I have personally known professionals who have been “written up” by executive committees on jokes they told that would cause no harm as little as 5 years ago.
You have to understand that in our culture, men are now considered “toxic and the main reason why females are treated badly.” It makes no difference whether or not that is in fact true.
Your professional career is just a comment away from termination. Yes…it is THAT bad.
Michael M. Rosenblatt, DPM
Dr. Rosenblatt is unfortunately completely correct.
The only unfortunate consequence to this patient is that he recorded it and then heard it.
I am assuming that it was legal in the state that this case took place in for a recording to occur without the consent of those being recorded. And, just because someone gave consent to a recording for post op instructions preop, did not automatically confer consent on additional recordings. In some states this would constitute a violation of the law for recording someone or even a third party without consent.
Secondly the first amendment covers protection of free speech. This clearly falls under this realm. Even though there are those in the legal community who would like to twist the clear meaning of the first amendment, what the personal in this case did was to express personal feelings, and this should not change whether the patient liked it or not. It should still be protected speech.
Third, I find that self deprecating humor about myself of an innocuous nature is helping at ease patient tension.
Fourth, I would not make any comments about a patient at any time during my encounter or before or after for fear of exactly what happened in this case.
Fifth the conversation between the physician and other personnel was never meant for the hearing of the patient. As such recording this conversation was a form of eavesdropping or spying, no matter how innocently this came about. Once could argue that this was not so innocent recording, and was in fact intended.
Sixth, what exact harm came to the patient as a result of this private conversation? It was the patient that made the content public. His feelings were hurt? How is that compensable in a malpractice case for a conversation he was never supposed to hear that was never going to be made public and had ever expectation of being private and remaining private?
This case is just another in a long line of poorly decided cases by lay juries that seem to be incapable of deciding the case on the basis of facts and decided the case on the basis of emotion. This was a egregious miscarriage of justice.
Humor can be helpful and relieve stress. I agree with the article’s stance on the first examples. The cited case was not gallows humor. It was just plain abusive towards the patient. Can an MD really give good care to a patient if they think it’s ok to speak like that? We took an oath. I think those comments do harm to our profession and to the patient. How is it toxic masculinity? The anesthesiologist was a woman. It’s wrong if a woman says it, or if a man says it.
O-sign, Q-sign, The patient boxed. ParkerIV (excessive scrotal edema in an SICU patient). SHPOS, GOMER.
“Keep me from the Gallows Pole” – Robert Plant.