Humor has its place in medicine: it can reduce stress, help prevent burnout and improve interactions with patients. It can even be helpful clinically, as jokes made by patients may reflect their underlying concerns or shame. Yet, humor can be a double-edged sword; when used inappropriately in the workplace, it can also taint interactions between health care providers and detract from professionalism.
The us of humor directed toward other physicians is a frequently-discussed issue in medical professionalism. As authors Nagler and Mannix point out in a reflective essay, jokes that perpetuate stereotypes of medical specialties can create an “us vs them” atmosphere, driven by ideas of superiority. The targets of such “humor” are not just other physicians — medical students as well as other health care professionals are often on the receiving end, thus alienating these groups within interdisciplinary care settings. As such, it is essential that the next generation of medical professionals learn to collaborate, employing humor not to ridicule, but to connect with colleagues.
Hierarchy is heavily embedded in “traditional” medical culture and when physicians poke fun at nurses, pharmacists or medical students, their seemingly innocent mocking can perpetuate this hierarchy. For example, a recent French study of humor in medicine confirmed that medical students are regularly portrayed as absurd and docile by superiors. Such humor only perpetuates the stereotype and essentially creates a self-fulfilling prophecy: why should a medical student be more assertive or participate in team discussions if only to be mocked or ridiculed?
The same goes for other health care professionals. If a physician pokes fun at the expertise of a nurse or a clinical pharmacist because they view themselves as professionally superior, it can undermine collegiality. Ultimately, rigid hierarchies may discourage students or other health professionals from asking questions, participating in discussions or even raising concerns about potential medical errors to physicians. Hierarchies compromise both workplace satisfaction and patient care outcomes, and accordingly, it is essential that health care professionals strengthen interpersonal bonds by laughing with colleagues, rather than at them.
Jokes that portray physicians as the “us” that save patients from medical students and other health care professionals (or “them”) can be particularly dangerous. An extreme example occurs in Ronald Epstein’s infamous medical school anecdote in which he (a student at the time) feared pointing out a mistake he had witnessed in the operating room. During a lymph node dissection, Epstein noted the patient’s kidney turning blue, and when he finally mustered up the courage to alert the surgeon, his comment was initially ignored.
A few minutes later, the kidney began to turn purple, at which point Epstein mentioned the issue to the scrub nurse, who moved up the chain of command, eventually addressing the surgeon. A vascular surgeon was later called in to repair the renal artery, but the patient’s kidney function had been compromised and never returned to baseline. This adverse event exemplifies how adherence to a medical hierarchy, in which the “docile” and “absurd” medical student’s concerns are not treated with the same regard as that of their superiors, can ultimately compromise patient safety.
In conclusion, humor has a place in medicine and can be used to bring joy to challenging situations that may otherwise be the worst time of a patient’s life. Yet, when jokes are directed at other members of the medical team, they can reinforce hierarchies and hinder teamwork. Health care workers are united in their deep regard for patients — quality humor should bring them together, not push them apart.