We discussed professionalism and ethics a couple days ago, and insulting physician chart code got me thinking again about the line between humor as stress relief and physician paternalism, thinking patients are “lesser” or “dumber,” leading to disrespectful behavior towards patients. (As far as I can tell, everything so far seems to be a “fine line” and “tough call” in med school; everything is also on a “case by case basis” and requires “personal judgment.”)

I don’t think most people start off trying to be disrespectful when they snicker about a patient. For some, it’s a way to deal with the emotional stress of dealing with sickness, disease and death: it’s psychologically more tolerable to deal with these serious matters if the patient isn’t as much a person with a family, but a disease to be cured. One could argue that there are better ways to deal with these issues, but I’m only arguing that the reason isn’t to be insulting to a patient or his or her life.

I think where it gets problematic is when the joking is so routine and commonplace that it becomes normal. When a doctor starts writing “FLK” for “funny-looking kid” in a chart, it makes the child not even a child anymore, but merely a joke. It removes the compassion and the empathy from the doctor. It’s similar to Freud’s concept of fetish–the fact that the object (in this case, the patient) is reduced to one representation (unattractive child), and is no longer viewed as multi-dimensional (a child that has feelings, a family, an illness, needs love, etc.).

Like most responses, I think the answer is somewhere in the middle. There are a lot worse defense mechanisms than humor, but I think it takes a fairly constant, objective self-evaluation to be sure that one’s stress relief does not interupt one’s sympathy, compassion, and caring. Sometimes it’s best to just follow Thumper’s mother’s rule: “If you don’t have anything nice to say, don’t say anything at all.”

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