Is Medicine Fun? Does That Make It Funny?
Roller coasters are fun. Playing sports is fun. Neither is really funny. Like a roller coaster, the practice of medicine can be thrilling and unpredictable, rough or smooth. Like playing sports, to do it well, you have to know what you’re doing—be good at it.
“Fun” is a tough concept to dissect. Is it a brain sneeze? Adrenaline? A lot of dopamine all at one time? It’s all of these things, but it engenders a feeling of well being, much like contentment brought down to Tzero. That plays out as a fulfillment of sorts. We doctors chose our vocations for the contentment and the fulfillment that comes with helping people. And when we are living this dream, it really is fun. But is there room for funny?
Herein lies the distinction between the two. Funny is amusement, often at the expense of another. It is humor, and if you think fun’s tough to dissect, defining funny is a walk through a labyrinthine enigma wrapped in silly putty. Does having a sense of humor in medicine make you think medicine is funny? Maybe…to the patient.
It’s hard to get the joke after your seventh round of chemotherapy or if your spine is held together with a titanium cage. The reality is that humor is in the mind of the beholder, and if your patient is in no mood for it, anything other than the sterile straight talk out of a textbook may become misinterpreted. Malpractice lawyers have used this trick for decades.
“Doctor, you told the family after her surgery that her belly inside was like a bag of spaghetti. Is that how you see a person’s vital organs? Were you trying to be funny? Did you take her surgery seriously? Doctor?”
“Well, no, actually I meant—”
“That’ll be all, Doctor. You may step down.”
You might as well be wearing a clown nose. The lawyer took your spaghetti and threw it at the wall to see what would stick.
Funny is fueled by incongruity, and anything well meant can be made incongruent out of context. Unfortunately, it’s not about a he-said/she-said from a high school lovers’ spat. Lives are on the line, and a misinterpretation can blindside the most skilled physician with a bum’s rush juggernaut of misdirected patient grief and anger.
The parts of the brain that perceive pain are close to the areas that mediate depression, and there is a bit of mix of the real estate up there. One third of those with depression have chronic pain; one third of those with chronic pain have depression. Acute pain elicits anger (think hammer to your thumb); chronic pain elicits anger’s much eviler twin—depression. The link between anger and depression cannot be proven, but a person who is depressed feels victimized, and he or she is angry about it. If you, as the doctor involved, have an outcome that is not optimal, there must be blame. Someone will have to pay. It’s a cinch this won’t be self-laid on the angry person. Keep the silly putty in its moisture-proof plastic egg; keep your spaghetti to yourself.
Can a doctor have a personality without a patient thinking he or she is being treated flippantly? Keep in mind that the old cliché of “being held to a higher standard” applies more strongly for doctors than the bond among quarks. Split it, and the explosion is nuclear, overwhelming, and perhaps even fatal. Worse, your appearance of propriety is held to a higher standard. This means that any misinterpretations by a suffering person, although unfair and falsely maligning, may also be the interpretation of an ill worldview.
Medicine is serious business, and while it may be fun for doctors, it is never funny for the patient. A patient’s pathology and pain, however, have a way of making fun and funny synonymous. The thing to remember is that patients will come to you for care—and with that, implicitly—is caring. They like a personality, but what they really want is caring, knowledgeable, skilled diagnostics and therapy. Putting your personality out to befriend them is fraught with danger. They’re not there to be your friends. They want it pleasant, but not casual; they want it personable, but not personal. Practicing medicine is walking a fine line between fun (contentment, fulfillment) and funny (facetious), seen from opposite sides of that fine line. While the contentment and fulfillment are for you, when the facetious is what your patient feels he or she has been given, that is unacceptable, and if it’s what your patient feels, it’s indefensible.
How far a doctor can go to share a personality is a judgment call, and many doctor-patient relationships enjoy a robust, even entertaining interaction. The deck, however, is stacked against personality when the medicine doesn’t work. Or the surgery. Or the 7th round of chemotherapy. Or the titanium cage.
Beware — for interaction with a patient can be unknown territory… You can’t go wrong having no personality and being no patient’s friend. But where’s the fun in that?