The Ethics of Humor?

From this week's NEJM:

…I hope always to uphold the code of proper patient care. But I also realize that to treat a human being well, one must remain human. And therein lies the quandary: How will we ever reconcile our inevitable ? and necessary ? human imperfections with our desire to abide by the highest standards of professional conduct?

Joking with – and about – patients is a slippery slope.  I often laugh with my patients (somtimes they don't laugh at my adolescent jokes though .. ) … but I do think that humor is part of the connection that is built between people.  It's fun to laugh, and if we can't have fun (just a little) together – then we're really not sharing much are we?   I don't understand why some physicians feel the need to be separate from their patients on some "higher plane" where humor and sadness can't be shared.

But – let's be honest – just as we joke about our friends, siblings and parents – physicians joke about patients too.   Have I ever said something to/about a patient that I regretted?  Yup.  Have you ever said something to/about your best friend that you regretted?  Yup.

But your best friend isn't your customer – and patients are entrusting their physicians to be kinder to them than we are to our friends. 

Or are they?

I recently said something to a patient that offended him.  Physicians do this all of the time.  Most of my "new" patients are escaping from another physician who insulted them in some way – and I'm sure (ok .. I HOPE) that these insults were not intentional.  Usually it comes up in the first few minutes: 

"what brings you here?" 
"Oh – I used to see Dr Smith but he didn't listen to me/insulted me/never called me back."
"I see – well – do me a favor – if I ever say something to you that makes you upset – or if you feel like I'm not hearing what you are saying – tell me so that we can work through it."

I usually emphasize that I'm human too.  Sometimes I have a bad day like any other tired, grumpy person.  Sometimes I say something that I think is funny but it's only funny to me – and is offensive to the other human in the room.


So when I offended my patient – he e-mailed me a few days later and told me so.

I'm glad he did – because it gave me the chance to explain what I was thinking – and demonstrate to him that I wasn't as insensitive as my silly comment made me sound.

We worked through it – and I do think that our relationship is stronger now.  I know him a bit better and he knows me a bit better – so our mutual goal – his health – can be a common focus again. 

And – yes – we can have some fun while we get there.