There is one thing I've learned through all my years as a physician, an attorney, and as a patient - if you can't laugh at yourself, you have more problems than just an illness. A joke that is made in general terms, like the one you cite above, can be funny even if you have a psychiatric illness. It is only when the "joke" becomes personal, and is made at the expense of a particular person, that offense should be taken.

Think about it another way. There are jokes made about physicians all the time. We all know the one that says that "Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing, and Pathologists know everything and do everything, but a day too late." As physicians, we can enjoy the joke, no matter our specialty, because it isn't aimed at any one of us, but at some of the idiosyncrasies of our profession. Moreover, I needn't even say that attorneys not only enjoy "lawyer" jokes, but make them up and spread them themselves. It doesn't mean they believe they fit each joke, merely that the can laugh at themselves.

Patients, too, are able to laugh at themselves much more than most people think. I've had many patients with handicaps, for example, tell me that what makes them the most uncomfortable is not when people joke about their type of handicap, but when they try to ignore it and pretend it doesn't exist. Many actually feel excluded because they are made uncomfortable by people emphasizing the handicap by trying to ignore the 10 ft. white elephant in the room.

There are people who will take offense at almost anything, and there is little we can do if they insist on that attitude, but I do not believe that represents most of us. As long as the "joke" isn't made at the expense of a particular individual or with the knowledge that it will injure someone, we shouldn't be so thin skinned that we cannot laugh at ourselves.

Yes, Brendan, "laughter is the best medicine"... but will most patients accept that their trials and tribulations fighting their illness for recovery is something to laugh about? Perhaps, laughing about some idiosyncrasy in the social life of the community will be a useful distraction but I wonder about "best medicine" for a joke about one's own illness.

And Eric, you write " It is only when the 'joke' becomes personal, and is made at the expense of a particular person, that offense should be taken." What do you mean by "personal"? Do you mean that the joke is not one generic for the specific illness but one which specifies in its narrative specific personal events experienced by the patient about his or her illness? For example, "It's fortunate and great that Jim had to be hospitalized and undergoing emergency surgery for his acute abdominal pain so he didn't have to watch his favorite Green Bay Packers lose in the Playoffs! ..that would give any Packer fan a sore gut!" Hmmn? What this kind of joke does is to diminish the personal significance of a traumatic personal event and assume that the one expressing the joke is aware of the priorities personal to the patient. ..Maurice.

Brendan, couldn't a patient making fun of his or her illness be a form of unneeded or unnecessary self-denigration? Those cancer patients losing hair from chemotherapy would more likely hide their physical defect to avoid "empowering jokers" than joking ("Oh.. my husband has always complained about me spending less time with him and too much time in the beauty parlor working on my hair.") about it. ..Just wondering. ..Maurice.

An example (not mine):

The GP met Fred back in the consulting room following further history, review of investigations and specialists letters and further examination and said, "Fred, I have some good news and some bad news."
"Oh, no. Give me the good news first, I guess," Fred replied.
"I'm going to name a disease after you."

There is humor here, though to me, a bit malignant.

Beyond providing an attempt to relieve tension, stress and fear on the part of the patient, I think that some humor expressed by physicians to patients are to relieve the stress of entering the unknown on the part of the physician and not necessarily to benefit the patient. Or it may be part of putting the physician and patient by a chuckle together onto the same level..which I think is important. ..Maurice.

Beth,
Both you and Maurice raise good points about "hospital" humor. A patient should never be in a position of thinking that physicians (or anyone else in the hospital for that matter) are laughing at them. On the other hand, there are times when joking is all you can do to keep from coming apart. I remember, during my intern year, sitting in a small "office" adjacent to the Emergency Room and joking about some patients. I doubt anyone outside the room could hear us with the door closed, but the reason for the joking was that we had two heart attacks, a stroke, a stabbing, a man who had an arm amputated in an auto accident, and three EMS vans lined up about to bring more patients into the hospital. We were exhausted, frequently frustrated and feeling impotent because of how little we could to to help many of our patients, and knew that our "shift" had a long way to go.

I also remember that night being the first time I had to go out and tell a family that their husband and father had died, and there was nothing we could do to stop it. I used every excuse I could to try to get out of the task, but couldn't. Doctors have a mindset regarding disease; it is a war we are always determined to win. Just think of the language we use when discussing it; we "fight" it, we "battle" it, etc. When we "lose," or can do nothing, it is frequently more frustrating than most people out of the profession can imagine. I have never lost a patient when I didn't spend a long time wondering and researching whether there was something else I could have done, or something I should not have done, that might have made a difference.

If you talk with soldiers, you will find that they do the same thing. They joke about the combat they are facing, the deaths of their enemies and sometimes even their teammates (unless they were close with them, of course) because it's all they can do. It is even a well known reaction that when a soldier is walking into combat, and his buddy, next to him, steps on a mine or is shot, the first reaction is sometimes a smile. It is an unconscious reaction saying they are glad it was not them; it doesn't mean they feel less about their friend, but that they are happy to be alive. It is then usually followed by extreme guilt because of their initial reaction.

Doctors are human but, more than any other profession (I believe) what we do is also who we are. When we fight that battle and cannot win, we feel impotent and sometimes the only way to cope with that feeling is to joke, laugh, and move on. It may not be right, and should certainly never be done within earshot of patients or their relatives, but it is human and should be judged by that yardstick, not the ideal.

I would just like to re- point out that it also has to do with your faith, faith culture and social-culture settings. Using socially and culturally acceptable means in "Cheering" some-one else up is different than "laughing at his illness." The intent is to do good, not harm.

I have seen professionals crying, laughing and rejoicing with their patients and families to the DELIGHT of the patients and their families. It promoted healing. It has to do with the social-cultural-religious community settings in which the person lives.


A cheerful heart is good medicine, but a broken spirit saps a person's strength.
http://bible.cc/proverbs/17-22.htm

Watch this video on how these popular gospel singers ( deceased) laugh at their illnesses openly in order to relieve tension, stress and comfort each other

Gaither going home performance:

Going Home:

http://www.youtube.com/watch?v=IFGeQFGs4bY

Brendan, you write "The intent is to do good, not harm" and I would agree about the healthcare provider's intent (hopefully it is universally "to do good") but, unfortunately, one can never be sure that the patient and/or family would recognize that beneficent intent.

May I change the orientation of this discussion? What about the significance or value of a physician joking to the patient about him/herself? Will this improve or hinder a constructive and therapeutic doctor-patient relationship? Will joking about oneself indicate to the patient the physician's humility and perhaps lower him/herself from some imaginary pedestal? And these questions could lead us to an entirely different topic: should a physician ever be so honest and truthful to patients and families to inform them about his or her professional deficiencies or even failures.. which in a way, a physician joking about ones self may be doing just that! ..Maurice.

Maurice,
First, I have joked with my patients many times about my own ideosyncracies, and I have never had anything but a good reaction from them. In fact, they usually share something they find humerous about themselves, and it forms a stronger person to person (as opposed to physician-patient) bond.

As for whether we should admit our own deficienties, I have a standard word of advice I give to all my patients (and anyone else who will listen). I tell them that if they find that a doctor can never say, "I don't know," they should run, not walk, to the nearest exit. I would not want to be the patient of a physician who is so arrogant that he or she believes they can know everything in their field. The best answer that can be given, and the one that I've found inspires the most confidence is, "I don't know, but we'll find out." It also has one other beneficial effect; when you say you do know, your patients will more readily believe you.