No laughing matterBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2119 (Published 21 March 2012) Cite this as: BMJ 2012;344:e2119
- Daniel K Sokol, honorary senior lecturer in medical ethics, Imperial College London, and barrister
“Hilarity and good humour, a breezy cheerfulness,” wrote William Osler, “help enormously both in the study and in the practice of medicine.”1 Dreary is the workplace where humour is absent.
Dr Jones would have concurred with these statements. Banter, he would say, formed part of the culture. Yet, Dr Jones is soon to appear in front of a disciplinary panel for making inappropriate remarks to colleagues in the operating theatre. He commented on a nurse’s posterior. This made her feel uncomfortable. He also made an off the cuff remark about a colleague’s sexuality, and on another occasion he joked about a racial stereotype. When questioned by his lawyer about these incidents, he dismissed them as “friendly banter,” innocuous chatter, and described the informal, bawdy culture in the surgery department. The lawyer knows it will be an uphill struggle. His counterpart will have plenty of ammunition when cross examining Dr Jones. In the cold light of day he will come across as a rude, disrespectful, unprofessional clinician, a macho type of the bad old days lacking in sense and judgment. His eminence in the field may have acted as a shield in the hospital, but it will afford scant protection in the courtroom. Although people may have laughed at his jokes at the time, few colleagues will agree to give evidence on his behalf.
Dr Jones is fictitious, but there are clinicians like him in hospitals throughout the land. Some of them feature in cases listed on the Fitness to Practise page of the General Medical Council’s website.2
It is easy to think of professionalism as a façade that needs to be oriented towards patients, relatives, and members of the public. They are the ones whose trust must be acquired or, hopefully, maintained. They are the ones, it is said, who will complain or sue you. In the course of my medical ethics education I have found much about the doctor-patient relationship but precious little about how doctors should behave towards colleagues. Obligations to colleagues featured prominently in older medical ethics texts, but the issues were mainly about setting up a practice or the proper way to split fees and about not pinching the patients of other doctors, not disagreeing with colleagues in front of patients, and not giving free advice to the rich as it reduced the work available to the profession.3 4 In modern medical ethics the ethics of the doctor-colleague relationship is overlooked.
In my experience it is often medical students, whose sensibilities have not yet been blunted, who report inappropriate conduct in the operating theatre. Perhaps they remembered point 46 of the guidance in the GMC’s Good Medical Practice: “You must treat your colleagues fairly and with respect. You must not bully or harass them, or unfairly discriminate against them by allowing your personal views (this includes your views about a colleague’s age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status) to affect adversely your professional relationship with them. You should challenge colleagues if their behaviour does not comply with this guidance.”5
One doctor’s “banter” is another’s offensive remark. A risqué joke might amuse most of the people but deeply offend one person. The mention of a racial stereotype does not necessarily make the speaker a racist but runs a high risk of reflecting poorly on him or her. A good question to ask is, “Would a reasonable, impartial observer consider this remark to be inappropriate?” If the question cannot be answered with conviction, it is best not to crystallise the potentially offensive thought into words. One danger with using this method is that the speaker’s judgment may be so poor that he or she will wrongly think that a reasonable, impartial observer would find the remark both funny and morally neutral. The cautious approach, therefore, is to refrain from making jokes about the “age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status” of a colleague or patient unless there is plainly no risk of causing offence to anyone within hearing distance. The adage “if in doubt, leave it out” very much applies in the context of workplace humour.
Both the “reasonable, impartial observer” and the “play it safe” methods will result in the waste of jokes and witticisms. The doctor in a quip attributed to Steve Martin would need to adopt a more conventional approach to breaking bad news: “First the doctor told me the good news: I was going to have a disease named after me.” However, I doubt it will lead to a sterile workplace, one in which humour is as welcome as meticillin resistant Staphylococcus aureus and Clostridium difficile. Funny people generally have a broad repertoire and will find less hazardous ways to induce mirth. The methods should lead to fewer offensive remarks, fewer suspensions or erasures from the GMC, fewer people dreading coming to work, greater self respect, better role models, and new heights of medical professionalism.
Cite this as: BMJ 2012;344:e2119