This is the first official episode of Curbside Ethics, a podcast that helps clinicians provide ethical, equitable, culturally competent care to their patients.
I discuss the dark humor that is so prevalent in healthcare culture. Why does it exist? What are some of the problems it can cause? How dark humor affect patients, students and other clinicians. How can you avoid jepordizing the physician-patient relationship and how should you interact with colleagues who are habitual offenders.
Welcome to Curbside Ethics. So happy you tuned in. Please share with your fellow clinicians and leave a rating or comment on iTunes. Visit www.StevenBradleyMD.com to request a personali zed ethics consultation from our host.
Transcription
Hello to welcome back to cur side aspects of dr stephen bradley and i seoli and cyope apices. This is the first official episode of this new podcast. I will be drinking over episodes from what was previously called technically force, a supplement to black ofters podcast and will be uploading them the new server, because therapy available under the curb side, ethics platform. Again, the point of this podcast is to help you. The listener. Navigate can make difficult clinical decisions for the welfare of our patient this week, you’re going to unpack the role of dark, humor and health care. Anybody, that’s practice, medicine for some time or follows the instagram tages. You will see that there’s a fair amount of dark humor associated with medicine. Where did this come from? How prevalent is it? What are the undering issues and concerns of using this dark humor? Why do we do it? Should it continue? That’s what we’re going to get into today. We know, and we’ve heard before laughter is the best medicine even going back to hypocrites. He was quoted as saying or advising as patiens to contemplate on comic tings to facilitate their recovery. You know right now it’s hard to really prescribe laughter as a medicine right, there’s so many other critical options, but we do interactions and humor and levity helps to improve that clinical interaction and improve the patient position. Relationship of the times humor can help put patients at ease. You can get through difficult situations together, you can build better relationships, and sometimes it encourages the patient to kind of connect and bond and share more than they otherwise would have with their physition. From a clinician perspective, oftentimes we use humor to relieve tensions to build, come roder of a team. It can help relieve that feeling of burn out. It just brings them levity and pleasure and helps us get through what can sometimes be very dark and dreary days in this profession of health care. If we were truly honest with ourselves, i think dark humor is fairly common in medicine. Some of the concerns with his stark hubers that the chance that it could dehumanize patients it could decrease paced trust in their positions and health care providers. You know it’s just proud upon. It is not very becoming of a profession is built on trust as resident. Physicians and medical students are, with the training pipeline, seeing these behaviors modeled kind of decreases their trust in the system as well. It can go on to build feelings of resentment or moral distress in these budding physicians. Moral distress is that deep, dark feeling that practisers will fill when you’re aware that you’re not really acting like you. Should you want to do something that you think is right, but there is some external issues that are preventing you from doing so it can make you feel very powerless and, and just give you a dark feeling that were so, unfortunately accustomed to in health care, whether it’s going the patients with chronic or terminal conditions or looking at the different systemic resources that we don’t have this. This relief valve of humor is sometimes used and can help us get through these situations. If we’re not careful, though this dark humor can actually do the opposite of what is intended or when it’s intended to be used for good and dark humor can worse in relationships in health care, it can create more distance between different healthcare professionals, positions, colleagues, medical students, residents and the worst of all the patient. Why do we use jokes in health care or an interaction, t other people and what is a joke so a lot of times there’s with humor? There’s this tension? That’s there. It’s the difference between what is expected to be said and what ends up being said, that’s kind of how jokes are formulated and there’s some iron, a that’s involved, other other concepts, a lot of times that physicians and clination and other people turn to humor you’re kind of reaching out and pushing back using as a defense mechanism. I guess a system in which you don’t have control. We know that some of the ideology of this these feelings of resentment. Sometimes you know they come from patients where the inappropriate jokes, that you see whether it’s patients that suffer from suster uses orders. You see the man emergence department and their dub, the frequent flyer, the drug addicts. You know they’re going to keep coming in the patients that are housing deprived and they come in because they don’t have any place to go to get that chicken or turkey sandwich from the emergency department. You know patients with sexual transmitted diseases, where some people can find some kind of deep, dark humor in some of the stories that are associated with this, and if we’re not careful, we can easily start to dehumanize our patients and use that coping mechanism of humor to the detriment of these patients. You know patients are more than punch lines. I think most clinicians, that’s not their intention that they discriminate against and make fun of their patients. But it’s something that, if we’re not careful that defense mechanism can start to bleed over and start to affect patient care or, at the very least, are internalized biases and concepts of about our patients. There have been studies performed on this where, in talking with some students, they identify certain patients that are quite in quo. Fair games for these jokes patiens that are difficult or not compliant or those patients that we think they’re sick because of things that they do they’re more low, more likely to be the butt of this dark humor in the butt of these jokes oftentimes as students, you know we go into medicine because we want to help people, he would have help patients, and once we get into this system, we interact with other clinicians that are more senior, could have been around longer that are jaded with what they’ve seen in medicine when they seen how a system works or better put. Hola system doesn’t work, and now patients don’t get the treatment that they need. Researches are constrained and again that coping mechanism is that dark, humor kind of targeted at this system unintentionally. However, this dark hemor that may come from a senior seasoned health care professionals can then bleed over into the young ultraist ic medical students and residents as started jade. Their perception of the health care system, maybe earlier than it otherwise might occur. One thing that helps when you start to to slip off down this rabbit hole of his dark humor and you maybe get concerned that i might be an enclosed to offending a patient or changing my internal perception of patience for the worst. You got to constantly reframe your your thought process change your frame of mind realize that you’re here, ultimately for the patient and that what is driving that dark, humor, something is there. Something is causing you to use this as a defense mechanism, identify that and target that directly. You know the stories go on and on whether it’s you know, after a code and despite doing everything you can do, the patient still passes away and some people immediately switch over into that defense mechanism of humor or levity and that they did all they could do and maybe crack a joke or laugh about something associated or a parallel to what just occurred and obviously that physician or health provider is not laughing at the patient and the kind of member and all that, but in the greater context of the morbidity that just occurred, it would be seen is very inappropriate. Offensive to the patient, a family members and the other planation s involved. So how do we navigate this process? First of all, i choose to see the best in my coconuts. I don’t assume that somebody’s cruel or vindictive if they have some off colored, humor or jokes. I do take into consideration the concept that this dark humor could be affecting the care that they’re providing to their patients and from that concern i act in terms of saying: hey are you you know? What are you really concerned about, or what makes you go with way was a something you could have done differently and really target the underlying issue that is causing them to act out that is causing them to have is humor as a defense mechanism a lot of times. You know when it comes to jokes as jokes start to o get out of hand, you start to reach that shock value. You know back whether it is howard turn the radio djs and all that part of humor. As you get down, the spectrum is saying something: that’s so ridiculous that people, you know, have no idea. What’s coming next dave chapel, chris rock all that kind of humor is the shock value and again we have to be consented. That does not bleed over into our clinical practice and affect the care that we provide to patience and affect the relationships that we have with fellow positions and clinicians. So how do we address our partners when they may be heading this on this pathway? They may say something that offends ourselves or maybe there’s the possibility of offending medical student resident, or at least hating a bad president for them, one of the best ways to address this behavior. First. Take it all in a context. Rarely should you be calling people out in public and making a big scene try to pull his college aside in a private setting, discuss the feelings that are driving these defense mechanisms. Talk about the specific situation is a situation making. You feel uncomfortable that you know you’re reacting and by using humor, let’s focus on the patient. Let’s focus on what the patient needs right now, in the heat of the moment, you can read erect if somebody starts to say something: that’s a little off. Color and then, when you take them aside, you can refer to the observe behavior say something to the effect. If i notice you tend to make some jokes about patients, i’m worried about this joke you made earlier. If a patient heard it, they would be offended some people that did hear it. I think they’re very uncomfortable with that humor. What’s going on something want to talk about and at the very least effect that you’re there to quote unquote. Quall out this behavior will make them reticent in the future to proceed with with the off colored dark humor at least gives them pause to think about it. How else do we navigate? This will absolutely need to learn and know your environment know who’s around when you’re saying the things that you say so many times we can get carried away, whether we’re in the preappointed or the recovery room or the murden’s department, and we have those amazing, sound proof. Curtains patients could hear everything that we’re saying if they’re they’re listening so knowing who’s around patients, patients fin members, they tend to wander the hallways. You need to have some situational awareness, and this is goes without for other situations, whether you’re discussing patient information, it’s private- or you know whatever you’re talking about the cognizant of what’s around and how you’re saying the things that you’re saying know your audience. You have some fledgling health care professionals. Patient fondly were nearby. You may need to rephrase some of the things that you’re saying and the way that you say them. You won’t be as blunt in front of the family as you would with medical students and other clinicians, and when it comes to humor, if everybody’s, not in the same page, there is a huge dance that that joke could be misconstrued and could have some negative repercussions, so know your environment no year audience and then, of course, first do no harm to think about the long term ramifications. How that could affect your position, patient relationship and we have to do everything we can to make sure the relationship stays open for the benefit of our patients. So what do you think? The dark off color humor that we see so many times on instagram and on the men pages or within the halls of the hospital. How can we navigate and start to move away from this behavior? Our patients need this, our families or colleagues and trainees. We all need to work together to move towards a more palatable, respectful form of humor socialis medicine. Thank you for tuning in to curb side ethics. Every week, when planning to bring you an episode, i we just touch some aspect of health care and help care related ethics, health equity thing that can help you not super clinical, but it can help you provide that are cared to the patient that that you serve a matter. Stephen brady, your house thank for tuning in el catch you next week. I