Medical comedyBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7106.2 (Published 23 August 1997) Cite this as: BMJ 1997;315:S2-7106
Comic, columnist, GP, academic… and now president of the Association of Evidence Based Satire. Can you follow in Phil Hammond's footsteps?
You've just come off stage after five sellout nights of the hospital revue. Back Passage to India is the funniest show anybody's ever seen, at least by those still standing at the end. It deserves a wider audience… Bracknell Arts Centre, Birmingham NEC, perhaps even Broadway. Fame and wealth await. But how?
If you're single or have a very understanding partner, then the Edinburgh Fringe is your best bet. The largest arts festival in the world is open to anyone and has spawned virtually every contemporary British comic. True, you'll be competing with a thousand other would-be legends, but there are also a thousand talent scouts just itching to book you for Channel 4's late night “rude ‘n' lewd” slot. Yes, it could be you.
The downside of Edinburgh is that it always occurs in the three weeks starting mid-August, hardly the best time to take a holiday if you've just switched jobs. Medical students no longer have the luxury of a month off in summer and may have problems finding a benign money lender. Venue hire, administration and accommodation costs soon mount up, and you'll need at least £1,000 up front. Then ask yourself: “Can I survive for three weeks without sleep, solids, or a change of underwear?”
Comedy is as tough an apprenticeship as medicine, and even the famous will have suffered many stage deaths before they cracked it. The public fascination with doctors at least assures you of an audience well above the fringe average (six) and the tradition of the in-house medical revue gives you ample opportunity to master the basics of stage craft before you go public. Remember, however, that context is everything. What goes down a treat in Guy's bar at midnight may cause a degree of puzzlement in the Thistle Tea Rooms at noon.
An alternative to Edinburgh is to contact your local comedy club. Most run open-mike slots and best newcomer competitions, and if you get through the heats you may find yourself on a fast-track to television or even, um, the Edinburgh Fringe. There simply is no escape from it. Every job I've ever been offered outside the surgery stems from standing on stage at midnight in a Masonic lodge on The Royal Mile seven years ago. It's the best career move I've ever made.
Getting time off
All medical students have the potential to fulfil any number of careers until the unremitting slog of medicine channels it out of them. For some specialties enormous personal sacrifice is the order of the day and it would be unwise to take time out to pursue other interests. Cardiology and comedy just don't mix. But for general practice and the “softer” hospital options time away can be both feasible and advantageous to both careers. It's extremely difficult to combine full time medicine with anything, but the safe haven of familiar locums allows you to take risks with another career and still have money to eat, a luxury not afforded to many actors.
In the absence of an agent, you need to promote yourself. You have to attract enough attention to warrant column inches in national newspapers. Be imaginative. The usual medics' trick of drinking ten pints, dropping your trousers and urinating on someone's geraniums simply isn't enough. Success is a slow fuse and ultimately you will be judged on the quality of your material over several years. Accuracy of observation and precision of dialogue are paramount, as is the ability to present medicine in a way that rings bells with medics and non-medics alike. A sound investment is a non-medical director to weed out all the in jokes and gratuitous exhibitionism.
If the media decide to take notice of you, expect your work to be audited in the extreme. Alas, this is seldom evidence-based. Your show can be selling out with a very high audience appreciation index, but it takes just one opinion to spoil it. (“These two smug self-satisfied medical tossers do for the NHS what Imelda Marcos did for the Philippines.”)1
As with a patient complaint, you go through a profound grief reaction (denial, shock, numbness, death threat) but in time acceptance arrives followed by action. You can either close the audit cycle by trying to eliminate the smugness from your show-or you can inflame it by printing bad reviews on all your leaflets. In comedy-unlike in medicine-the latter works best. You may also get stick from your peers. Publicly exposing the absurdities and iniquities of medical practice isn't everyone's idea of the duties of a doctor but others may be more forgiving. Ged Mercurio was invited to advise the BMA's Junior Doctors Committee after writing Cardiac Arrest - not a bad return for petrifying a nation.
The material v the morals
In general, dissecting comedy is a self defeating exercise. Your humour may be Freud's socially acceptable sublimation of aggression, but does that help you write a good gag? The bottom line for most comedians is that you can only write what you yourself think is funny. If enough people agree with you, you can make a healthy living in a short space of time before burning out. If nobody agrees with you, you can at least afford yourself the luxury of cult status.
For medical comedians it's a tad more complex, especially if you wish to continue practising. Pandering to the sickness and innate cynicism of a desensitised medical audience is one thing, but is it right to inflict such harsh attitudes on an unsuspecting public? Some would argue that traditional medical humour isn't even appropriate for medical audiences, victimising patients and diseases, and celebrating the regressive, macho side of medicine.
The function of humour
I have yet to see a medical revue that's reinforced the objectives of Duties of a Doctor2 - but then should that be the duty of medical humour? For many doctors, the working conditions of the NHS make good medical practice an impossibility and hostile humour a vital lifeline. So, can you be a good doctor and have a sick sense of humour? And is it possible to work full time in the NHS without one? Virtually all the students I teach seem to think the answers are yes and no, and there is soft evidence that hard humour can be beneficial to coping.3 If you think it should remain for medical digestion only, then a healthy income can still be made writing for trade mags or on the after dinner circuit. Writers can disguise their identities with a pseudonym (such as Theodore Dalrymple or Tony Copperfield) and thus be outrageous without fear of media retribution.
As a performer, you have nowhere to hide, so you need to consider your position and your material carefully before going public. In these days of medical demystification, perhaps the best way of giving the public insight into what we're really like is to avail them of our humour. Those who persist in thinking of doctors as Gods, nurses as superhuman caring machines, and death as optional might, in John Cleese's words, “deserve to be offended.” But are there enough non-medics out there who will find it amusing?
The gold standard here is the BBC's Cardiac Arrest, which started with an audience of 10 million before falling away badly over the subsequent series. There were confounding factors-being pitched against midweek football didn't help-but the evidence suggested that not enough patients wanted to witness knackered junior doctors stalking the wards, killing patients through misadventure, and making inappropriate remarks about death. Most people, it seems, prefer the rose tinted view of medicine offered by Casualty and its happy band of carers. Evidence based satire - the way forward?
Cardiac Arrest remains close to the hearts of doctors, but had trouble fighting off allegations of exaggeration. Many just refused to believe it. Think how much more compelling it would have been if each episode had been extensively cross referenced. A glance through recent editions of the BMJ provides ample fodder for such evidence based satire. Has someone really performed a radical neck dissection for the first time unsupervised?4
Is Patterson (still) twice as likely to get an SHO post as Patel?5 If you write a sketch out of the evidence, no one can accuse you of making it up. And if no one laughs, you can always pass it off as research.
And finally…With persistence and luck you may carve out a niche for yourself and, with the help of a good agent, make a living. But don't bank on a job for life-for every Harry Hill there are a hundred Harry Has-beens. So for the sake of your family, don't give up the day job. Besides, you need the material… and medicine needs you.