Tuesday, June 7, 2011

Can Medicine Be Humorous?

Writing a medical blog can be treacherous. One has to walk a fine line between humor and condescension, particularly when talking about a patient. Some recent events put a spotlight on this problem. A minor firestorm erupted in the medical blogosphere when a physician tweeted about her encounter with a man with priapism. The ensuing discussion focused on the possible HIPAA violations this person may have committed by talking about a patient's medical condition without his consent. Many were also appalled by the possible insensitivity of this doctor toward her patient, especially when she made the "fish or cut bait" remark. This was deemed behavior unbecoming of a medical professional. Just my two cents worth, I fail to see what all the fuss is about over this tweet. I had to reread it several times and follow the discussions afterwards before understanding why people are upset. Personally, I think the anger is an overly sensitive reaction to this particular tweeter's spontaneous and likely innocent remarks.

Then there is the recent news that a patient who had a billing dispute with a medical clinic paid his $25 medical bill by dumping 2500 pennies on the clinic's office counter. The clinic called in the police who arrested him for disorderly conduct. Sure we all may laugh at that man's poor judgement. But perhaps there is a deeper back story we are not privy to. Maybe he tried to negotiate with the clinic's billing department but was given the run around which led to his frustration. Maybe he went to the clinic for help but was not successfully treated to his satisfaction yet was still billed the disputed $25. Perhaps he has an anger management issue which caused him to dump the coins inappropriately on the office counter. Should we all be snickering at this man's emotional eruption? Perhaps it is the medical clinic that should be investigated for causing this man to get so angry he poured thousands of coins onto the counter.

We doctors like to think we are pillars of society. Highly educated, leaders of the community, doctors think people look up to us as unselfish caregivers and benevolent father/mother figures. Then how does one explain the endless stories on the web of the incompetence of each other's medical specialty. These are exemplified by the multitude of cartoonish videos that thrive on this culture of mutual condescension in the medical community. We physicians may think these anecdotes are quite funny. But let's not kid ourselves. The blog is an open public forum. Anybody can watch these anecdotes of medical incompetence. They may wonder if doctors really are that mean to each other and think so little of their colleagues' medical judgements. Are these physician produced videos also acts of betrayal and should be silenced for possibly injuring the reputation of the field?

Where does that leave a medical blogger? Writing about the nutty patient case is uncaring and medically unethical. It may even be a violation of federal privacy laws. Commenting on the acts of physicians and nurses may cause one to be labeled as unprofessional and a traitor to the glory of medicine. All too often, the patient stories I read in medical journals like JAMA are the tearjerkers where a doctor has the profound realization of life's fragility after an encounter with a patient's difficult struggle with disease and death. No humor there. And certainly not the kind of topic I want to expound upon day in and day out, week after week, month after month. I would become the most depressed anesthesiologist in the world if those are the only stories that are sanctioned by authorities to be publishable.

So dear reader(s), you can see the difficulties I face when I witness a situation during the course of my work that I think would be of interest to others. I could write about it with a sense of humor at the expense of the patient or colleague, or I could write a straight up prose which most would find dull and uninvolving but at least would pass muster with the medical censors. This blogging business is a difficult one indeed. Maybe I'll just write about my pet goldfish. I don't think HIPAA laws cover the privacy of aquatic animals.

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