Even in medicine, workplace humor is important and can improve morale, reduce stress, and facilitate working relationships. The key, however, is to be appropriate.
Benign, inoffensive humor is often best in medical contexts. Gallows humor should usually be avoided.
When a colleague makes a callous joke, this behavior is unethical and should be addressed, according to the AMA.
Everybody jokes around with their colleagues at work, and physicians are no different.
Physicians assert that humor’s needed for them to do their jobs well, helping them bond with others and cope with stress. But patients may not take to medical humor so well, fearing they could be ridiculed. According to research, patients who know that they’ve been the topic of jokes told by their physicians were offended and hurt.
There’s a delicate balance between the need for humor in medicine and the need for it to be appropriate—and not poke fun at patients.
The pizza joke
In the literature, there’s a joke that’s made the rounds which does a good job of highlighting the dilemma of jokes made by physicians on the job.
A group of residents routinely orders pizzas from a local joint. They know the delivery driver well and have developed a rapport. One day, the driver is mugged and killed while delivering a pizza to the residents. The pizza is found near the ER door.
After a brief period of initial shock, one resident jokingly asks, “What happened to our pizza?” The residents find the pizza near the ER door and decide to eat it. Another resident says, “How much do you think we ought to tip him?”
Whether these jokes are funny is besides the point. The question is if residents should be joking about the death at all. Are ethical imperatives being violated? If so, what should be done to stop this?
Four types of humor
Authors of an article published in Family Practice Management (FPM) broke down humor into four types:
Affiliative humor—Finds common ground and shared experience to laugh about. It positively correlates with work engagement, and inversely correlates with burnout.
Self-enhancing humor—Involves laughing at oneself in misfortunate contexts and can serve as a coping mechanism. Data show this is negatively correlated with depression.
Self-defeating humor—Involves making fun of yourself to amuse others and can fortify bonds if used occasionally. Research shows this is positively associated with depression and work engagement, and is negatively correlated with burnout.
Aggressive humor—Disparages others and is typically verboten in the workplace.
The authors recommend that benign humor (ie, affiliative and self-enhancing) are best for the workplace.
Humor may breach these category definitions. For instance, self-deprecation could be self-enhancing and affiliative, but when done in excess, it becomes self-defeating, which can be hurtful to the speaker and the group.
As for the joke about the pizza delivery driver, this is characterized as gallows humor—joking about painful or frightening subjects. According to the FPM authors, gallows humor “can be aggressive and injurious, but if used only in proper settings, it can be benign, or even group-enhancing.
Research shows that gallows humor can relieve tension among individuals facing highly stressful circumstances, including medical professionals.
The danger with gallows humor, though, is when the object of the humor is a member of the team or community. In such cases, the humor becomes aggressive.”
Best approach to joking
Fear not: There’s a place for appropriate jokes in healthcare. In fact, research has demonstrated that shared laughter is a healthy coping mechanism in the face of stress. It can also boost interpersonal relationships and group dynamics.
Laughter decreases cortisol and catecholamine levels (ie, stress hormones), boosts endorphin levels, and heightens immune response. Humor can also facilitate physician-patient relationships and decrease burnout.
The key to joking around in the workplace is to be tactful.
The authors of the FPM article offer the following strategies:
Avoid political humor, which is often divisive and polarizing. It’s usually seen as aggressive.
Make fun of yourself first to avoid being mistaken as aggressive. Do so sparingly, however, as too much self-defeating humor can erode respect and sap group dynamics.
Know your audience and anticipate how a joke will be taken.
Be subtle with your wit, with subtle witticisms perceived as affiliative and not detracting from clinical interactions.
Use humor in moderation, and stay competent in your duties. Being incompetent and funny is a bad combination.
Calling out mean-spirited humor
Authors of an article published in the AMA Journal of Ethics advise that those who make callous jokes be apprised of this transgression. The person who notifies the joker should be a higher-ranking team member who doesn’t fear reprisal.
Ultimately, joking that comes at the expense of patients—or is dehumanizing, diminishing, or objectifying to them—has no place in healthcare. It should always be addressed, whether made around patients or behind the scenes.
“In general,” wrote the AMA Journal of Ethics authors, “talking to a person about an inappropriate or poorly timed joke should happen in a private setting. Only when joking is egregious should it be called out publicly, and, even then, the feedback should never be given in a way that shames the person. Rather, it should be offered in a nonabrasive way that redirects the focus toward patient care and with the understanding that people often make jokes out of feelings of discomfort or vulnerability."
What this means for you
It’s common for us to joke with our coworkers to blow off steam. But it shouldn’t cross the line, and if it does, it should be called out, per the AMA. Patients shouldn’t be the butt of jokes—either during clinical interactions or behind the scenes.