Two Cancer Patients Walk Into a Bar…

Like cops, soldiers and other professionals regularly confronted with the specter of death, doctors sometimes relieve the stress of their reality through humor.

How can a doctor, whose job is supposed to include the compassion of nonjudgment, laugh about your dread disease?

While such behavior can be deplorable in the wrong setting, at the wrong time, it can also be beneficial, suggests a report by the Hastings Center, a nonprofit research institution dedicated to bioethics and the public interest. Writer Katie Watson is a professor in the Medical Humanities and Bioethics Program at Northwestern University’s medical school, and she also teaches improvisation and writing at the comedically renowned Second City Training Center in Chicago.

Watson says there’s a lot of literature about humor in medicine — clinician-patient relations, and the health benefits of laughter — but relatively little about what occurs between health-care providers who might treat serious, frightening or painful subject matter in a light or satirical way.

“The claim that being a physician is so difficult that ‘anything goes’ backstage misuses the concept of coping as cover for cruelty, or as an excuse for not addressing maladaptive responses to pain,” Watson writes. But “blanket dismissals of gallows humor as unprofessional misunderstand or undervalue the psychological, social, cognitive and linguistic ways that joking and laughing work. Physicians deserve a more nuanced analysis of intent and impact in discussions of when gallows humor should be discouraged or condemned in the medical workplace.”

Watson examines why we joke and looks at various uses of humor that serve as a bonding and coping mechanism among insiders. She notes how standards have changed in the “backstage” humor of doctors and medical students – “cadaver antics,” in which medical students clowned around with body parts, were once a rite of passage, but today they’re rarely tolerated. Students are taught to treat cadavers with respect, as former people.

Like other fine-line definitions, whether gallows humor is appropriate turns on the ethical question: “When is joking a form of abuse – of a patient, of trust, or of power? A joke about a patient’s condition told in front of the patient or the patient’s family is unethical because it has the potential to harm them.” But sometimes the butt of a doctor’s joke isn’t a person, it’s a condition. Like death.

That’s not harmful, Watson suggests. And it might help the people who must deal with it, who must, she writes, “integrate this terrible event and get through the shift.”

And that might help the next patient get better care.

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