Laughter (at a patient's expense) may not be the best medicine
There is an interesting column in last week's New York Times science section. (An aside: will someone please explain why I can't get an a la carte NYT subscription? Tuesday science, Wednesday dining, and Sunday magazine -- love them! But who needs Monday's skimpy paper lying around?). In the opinion piece, Boston psychiatrist Michael Kahn takes his colleagues to task for badmouthing patients. Through such behavior, he explains, we may unwittingly compromise patient care.
Of course it is possible to chuckle about “whales” and “cows” in private and still be respectful at the bedside. But in stereotyping obese or elderly patients, we may be diminishing them in the same way we diminish (or dismiss) the alleged borderlines and sociopaths.
Kahn argues that we may miss crucial opportunities to understand our patients by presumptively labeling them with psych diagnoses or by focusing on their irritating traits rather than what underlies them. Our frustration with our patients -- however well deserved sometimes -- can impair our ability to appreciate the whole person sitting before us.
I think there's one more point to be made here. Kahn may be giving us too much credit. I'm not sure that we can continue to be empathic and respectful at the bedside while making fun of patients behind the scenes. Call it venting; call it letting off steam; call it funny, which it very often is. In the long run, such conversations, even in private, keep us from being the clinicians we want to be. As a new nurse practitioner, I remember noticing how my colleagues talked about their patients. Those who were the meanest and most frustrated were also the least kind to patients, the least tolerant of their concerns, the scantiest of counselors (also the least welcoming of a new NP, I might add).
We might not all be the great maskers of emotion that we think we are. And over time, a steady diet of ridicule and sarcasm can corrode even the most generous of clinical souls.