Joking About Clients — Understandable and Maybe Helpful — But There’s a Test About When It’s OK

There is a provocative, but also disturbing article in the Washington Post that all who serve others, including lawyers and court and self-help staff, might want to think about.  It is titled, Nurses make fun of their dying patients. That’s okay.

As the article puts it:

.  .  . [W]hile people may readily excuse gallows humor among, say, soldiers at war, they may have a lower tolerance for it among health-care professionals. “Derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves,” Johns Hopkins University professor emeritus Ronald Berk contended in the journal Medical Education. “Those individuals who are the most vulnerable and powerless in the clinical environment … have become the targets of the abuse.”

I strongly disagree. The primary objections to gallows and derogatory humor in hospitals are that it indicates a lack of caring, represents an abuse of power and trust, and may compromise medical care. But in my reporting, I found that nurses who use this humor care deeply about their patients and aren’t interested in abusing their power. Their humor serves to rejuvenate them and bond them to their teams, while helping to produce high-quality work. In other words, the benefits to the staff — and to the patients they heal — outweigh occasional wounded feelings.

To be fair to the writer, she does draw limits:

That’s not to excuse all humor by health-care professionals. For example, mocking disabilities and using racial, ethnic or other cruel epithets go too far.

Consider the case of a Virginia colonoscopy patient who says he set his cellphone to record post-procedure instructions and ended up recording his doctors making fun of him while he was under anesthesia. The patient claims that his doctors called him a “retard” and joked that he might have syphilis or “tuberculosis in the penis.” He is suing for defamation and seeking more than $1 million in damages.

“Tuberculosis in the penis” is funny because it makes no sense. But “retard” is an unacceptable word under any circumstances. If the patient’s claims are true, his doctors crossed a line.

But, as a frequent flier at the wonderful Johns Hopkins, I found myself disturbed by the thought that people who need to go the hospital might defer because of fear of being laughed at.  Consider the following from the article:

The nurses I interviewed maintained that situations and symptoms, more often than patients, are the targets of jokes. I learned that some units have a dedicated “butt box” for items retrieved from patients’ rectums — glass perfume bottles, an entire apple, etc. — though after Indiana nurses pulled out a G.I. Joe, the real unfortunate hero assumed pride of place in the nurses’ station.

Hard not to see this as funny, but shyness and anxiety already prevent too many from getting needed care.

This is what I think.  If you could share the joke with the patient, then it is probably OK, regardless of whether they actually hear the joke.  If you could not, then the joke is creating “us versus them.”  And, that is not to mention the fact that some patients under anesthesia may be hearing or remembering more than we realize.

Humor, as the article says, helps patient care teams bond, but it should also help patients and caregivers bond too.  I often find myself joking with doctors and nurses. (I am particularly proud of one joke I developed about the string that is used to retrieve a urinary tract stent, and its possible relationship to an IUD string — “gives new meaning to the phrase “tying the knot.”)  It a way of making my clinicians’ day go better, thanking them for the help, seeing them as human beings, and, frankly, of reminding them that I am human too.

All the same goes for lawyers, self-help, and court staff.

I still remember with pain visiting a self-help center in which one of the staffers had an ugly doll on her desk, labeled “self-represented litigant.”  Some customers of the center might well have seen it.  That it was there was obviously a management as well as a staff attitude problem.  I am still embarrassed that I said nothing.

There is an extra problem in that humor can be a way of saying “I am on your side,” and while that is totally appropriate in a medical staffer, or a legal advocate, if we are in a neutral role, we need to be a bit cautious.

Again the solution is a simple test, the same one for anything someone in a neutral role says to a litigant: “Would you say the same thing if the opposing party were there?”

So, in the end, both tests are the same.  Transparent humor is OK.  But “us against him, her, or them,” is not.  (But disease and unwanted death are acceptable enemies, by my lights at least.)

P.S. I strongly urge that the linked article in Medical Education be read.  It includes suggestions for how medical education could be changed to ensure greater patient respect. We should think similarly about our own educational processes.  This would be particularly relevant to clinical programs, with their high level of client contact.

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About richardzorza

I am deeply involved in access to justice and the patient voice movement.
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