Medical Black Humor, that is Neither Funny nor Appropriate.

19 09 2011

Last week, I happened to see this Facebook post of the The Medical Registrar where she offends a GP, Anne Marie Cunningham*, who wrote a critical post about black medical humor at her blog “Wishful Thinking in Medical Education”. I couldn’t resist placing a likewise “funny” comment in this hostile environment where everyone seemed to agree (till then) and try to beat each other in levels of wittiness (“most naive child like GP ever” – “literally the most boring blog I have ever read”,  “someone hasn’t met many midwives in that ivory tower there.”, ~ insulting for a trout etc.):

“Makes no comment, other than anyone who uses terms like “humourless old trout” for a GP who raises a relevant point at her blog is an arrogant jerk and an unempathetic bastard, until proven otherwise…  No, seriously, from a patient’s viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.”

I was angered, because it is so easy to attack someone personally instead of discussing the issues raised.

Perhaps you first want to read the post of Anne Marie yourself (and please pay attention to the comments too).

Social media, black humour and professionals…

Anne Marie mainly discusses her feelings after she came across a discussion between several male doctors on Twitter using slang like ‘labia ward’ and ‘birthing sheds’ for birth wards, “cabbage patch” to refer to the intensive care and madwives for midwives (midwitches is another one). She discussed it with the doctors in question, but only one of them admitted he had perhaps misjudged sending the tweet. After consulting other professionals privately, she writes a post on her blog without revealing the identity of the doctors involved. She also puts it in a wider context by referring to  the medical literature on professionalism and black humour quoting Berk (and others):

“Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerless in the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion.”

The doctors involved do not make any effort to explain what motivated them. But two female anesthetic registrars frankly comment to the post of Anne Marie (one of them having created the term “labia ward”, thereby disproving that this term is misogynic per se). Both explain that using such slang terms isn’t about insulting anyone and that they are still professionals caring for patients:

 It is about coping, and still caring, without either going insane or crying at work (try to avoid that – wait until I’m at home). Because we can’t fall apart. We have to be able to come out of resus, where we’ve just been unable to save a baby from cotdeath, and cope with being shouted and sworn at be someone cross at being kept waiting to be seen about a cut finger. To our patients we must be cool, calm professionals. But to our friends, and colleagues, we will joke about things that others would recoil from in horror. Because it beats rocking backwards and forwards in the country.

[Just a detail, but “Labia ward” is a simple play on words to portray that not all women in the “Labor Ward” are involved in labor. However, this too is misnomer.  Labia have little to do with severe pre-eclampsia, intra-uterine death or a late termination of pregnancy]

To a certain extent medical slang is understandable, but it should stay behind the doors of the ward or at least not be said in a context that could offend colleagues and patients or their carers. And that is the entire issue. The discussion here was on Twitter, which is an open platform. Tweets are not private and can be read by other doctors, midwives, the NHS and patients. Or as e-Patient Dave expresses so eloquently:

I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.

Furthermore, it seemed the tweet served no other goal as to be satirical, sardonic, sarcastic and subversive (words in the bio of the anesthetist concerned). And sarcasm isn’t limited to this one or two tweets. Just the other day he was insulting to a medical student saying among other things:“I haven’t got anything against you. I don’t even know you. I can’t decide whether it’s paranoia, or narcissism, you have”. 

We are not talking about restriction of “free speech” here. Doctors just have to think twice before they say something, anything on Twitter and Facebook, especially when they are presenting themselves as MD.  Not only because it can be offensive to colleagues and patients, but also because they have a role model function for younger doctors and medical students.

Isolated tweets of one or two doctors using slang is not the biggest problem, in my opinion. What I found far more worrying, was the arrogant and insulting comment at Facebook and the massive support it got from other doctors and medical students. Apparently there are many “I-like-to-exhibit-my-dark-humor-skills-and-don’t-give-a-shit-what-you think-doctors” at Facebook (and Twitter) and they have a large like-minded medical audience: the “medical registrar page alone has 19,000 (!) “fans”.

Sadly there is a total lack of reflection and reason in many of the comments. What to think of:

“wow, really. The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”

and

“Oh my god. Didnt realise there were so many easily offended, left winging, fun sponging, life sucking, anti- fun, humourless people out there. Get a grip people. Are you telling me you never laughed at the revue’s at your medical schools?”

and

“It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.”

It seems these doctors and their fans don’t seem to possess the communicative and emphatic skills one would hope them to have.

One might object that it is *just* Facebook or that “#twitter is supposed to be fun, people!” (dr Fiona) 

I wouldn’t agree for 3 reasons:

  • Doctors are not teenagers anymore and need to act as grown-ups (or better: as professionals)
  • There is no reason to believe that people who make it their habit to offend others online behave very differently IRL
  • Seeing Twitter as “just for fun” is an underestimation of the real power of Twitter

Note: *It is purely coincidental that the previous post also involved Anne Marie.

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“Ask a Librarian” a new series in the JAAPA.

22 03 2009

The Journal of the American Academy of Physician Assistants (JAAPA) features a new online column : “Ask a Librarian”. Or as JAAPA states it: the inaugural installment of JAAPA’s first online only department. This column is a co-authored by Jim Anderson, Physician Assistant, and Susan Klawansky, Librarian. It aims to promote collaboration of PA’s and other clinicians with medical librarians, address questions from physician assistants and point to resources, including nnlm.gov.

This is a very good initiative, an example that deserves to be followed by other publishers.

The first questions answered were:

  1. Can you explain what a MeSH Heading is? I always hear that term, but I don’t understand what it means. Is it something I need to know to do a good search?
  2. I need to find an article about an exotic genetic condition of one of my patients. I work in a hospital in a rural and remote area in Montana, and while I have access to the Internet, I don’t have access to a library or a librarian. How can I get help online finding an article, and when I find a reference, how can I get the full-text?

Relevant questions, but the answers are rather superficial and short on the one hand (one paragraph long), but too long-winded at the other hand.

For instance, the second question begins as follows:

Are you in luck! Thanks to the Web, medical librarians are everywhere, floating around in the ether, just waiting for questions like this. As a matter of fact, if you look really quick right now, you might see one sitting there up on your shoulder! But seriously, if you have the Internet, you have a librarian…

to simply tell, one can contact nnlm.gov. for this question (web or telephone)…

This information could be much more to the point. On the other hand I wonder, is there no valuable information in (for instance) the OMIM database that the PA/clinician could get for free?

Again, it is a good initiative and I hope JAAPA will succeed in making this a successful column.

HATTIP : pat_devine (twitter)





Dutch Grand Round 1.6: Grote Visite 1.6

4 11 2008

The 6th Dutch Grand Round (Grote Visite) is up at Dr. Shock (see here).
It’s the second time Dr Shock hosts the Dutch Grand Round.

This Grand Round is a rather complete wrap up of the Dutch medical blogosphere as Dr. Shock does not confine himself to the official Grand Round submissions, but also summarizes his own choice of other interesting Dutch posts.
Many Dutch Medblog Posts are written in English, so it may still be worth while to read most posts if you don’t understand Dutch.

The next grand will be at De gezondheidszorg leuker en effectiever of Marjolein Fermie. You can post your entries for the next Grote Visite at the Blog Carnival (here).





Grand Rounds 5.5

21 10 2008

This week’s Next Grand Rounds is now up at Pallimed.

As I said last week: “Each week the grand rounds seem to get larger and larger. Fascinating how the hosts manage to present it in a digestible way”.

The present host Christian Sinclair, MD has an original solution for it. He made two different sections, one in the main post and one in the comments to

“get back to the heart of what I think Grand Rounds is meant to be. The best of the blogosphere per the host that week.” “I did not want to feel like an automaton transposing links into a link farm.

Although there are two sections all blogpost are included (see here).

Next week’s Grand Round will be hosted by Kim at Emergiblog.





Grote Visite 1.5 (Dutch Grand Round)

21 10 2008

Welcome to the October 21, 2008 edition of ‘grote visite’ or Dutch Grand Rounds.

This week there were 6 submissions to the blog carnival, only 2 of which were genuine (Dutch/health-related/not-commercial/no-spam).

Jan Martens of MedBlog.nl refers to an interesting article on Reuters about teleradiology and remote medicine. During the night shift medical images of patients in for instance the United States and Singapore are sent for appraisal to Indian radiologists because of lower costs and shortage of staff at night. Jan gives various examples of other interesting applications, but wonders whether this kind of telemedicine will be easily implemented in the Netherlands.

I know what lumpers and splitters are, but I’m not familiar with lurkers. As explained by Dr Shock MD PhD, with respect to online support groups, posters are the ones actively engaged by sending postings, and lurkers the ones that use online support groups in a passive way. Dr Shock summarizes recent research, revealing that participation in an online support group had the same overall profound effect on lurkers’ self-reported feelings of being empowered as it had on posters. Please read more details about the research at Dr. Shock’s excellent post Lurkers in Health 2.0, Do They Benefit?”

By the way, Dr Shock has many other recent interesting posts as well and has an international reputation as medical blogger. For instance Pallimed hosting this week Grand Round refers to dr Shock as follows:

Dr. Shock consistently comes up with some very interesting journal articles. I really appreciated his take on impact of medical student biases towards patients with mental illness. So you may read that one as well!

******************************************************************************************

Below are my own choices from blogs form the Dutch medical blogosphere. I hope it will inspire other Dutch Medical Bloggers to participate more actively in the Dutch Grand Rounds.

The blog Health Management Rx of Jenn McCabe Gorman is already reviewed in another blog carnival, i.e.Medicine 2.0 Blog Carnival Edition #33.

People from SugarStats talked with Jennifer McCabe Gorman, one of Health 2.0’s most ‘visible’ online evangelist as they called her. By the way Jennifer wants you to know that her blog, Health Management Rx, is not dead. The reason her posts have been slow is because she is intensively preparing for Health 2.0: User-Generated Healthcare conference, which will be held in San Francisco, California from October 22nd – 23rd 2008.host

Of course we already knew that Health Management Rx was not dead, because Jenn hosted the previous Dutch Grand Round.

Many other Dutch Bloggers are also heavily involved in health 2.0, and many of them are also on Twitter. For instance apart from Jenn: @mdbraber (also in San Fransisco at the moment), @martijnhulst of martijnhulst.nl, @Zorg20 of www.azo.nl (Acute Zorgregio Oost) and @fackeldeyfinds of fackeldeyfinds.com.

October 10th, most of these twitterers were attending the master thesis presentation of Maarten Den Braber (mdbraber) about the value of business models for hospitals, either live in Enschede or virtually (livestreaming!). Interested in this subject? You can find the links to the final document and the powerpoint he used for his presentation on this blogpost.

Below are some excerpts from other MEDNL-blogs, all in Dutch

A previous host of de Grote Visite, Marjolein Fermie of “De gezondheidszorg leuker en effectievergives a short overview of what makes working (in Healthcare) fun.
Another C3-log-ger, Frank Wolterink reflects about franchising health using the same franchise methods as fast-food chain McDonald’s (and others). Very aptly called: ‘Franchising Health Instead of French Fries’ in another (english) post on delivering health care.
Bettinepluut discusses the new “zorgplan” and wonders whether this will really improve the living environment of patients

At A day in the life of a shrink there is a very interesting post on “the” critical care physicians of today, who completely rely on scans and lab results without physical examining and sometimes without even having real contact with the patient. Apart from unnecessary long waiting for some diagnosis (i.e. prominent pancreas cancer metastases felt instantly), this can make the patient feel very lonely. People aren’t numbers!

This blog has numerous posts on music, as has Vrouwmenszorg.web-log, a very nice diary-like blog of a family physician. From Music (Pink Floyd, In a gadda da vida, Child in Time: my style!) and beautiful photo’s to ‘a day in the life of’: “No, don’t dial 911 for an ambulance, but take a taxi and see your doctor first”. Sometimes she writes for Paramedic WorldWide.

Wonder what Vrouwmenszorg or Paramedic Worldwide would think of my previous post on (acute) care (for Addison patients). Apparently paramedics are allowed to give infusions to diabetic patients with a hypo. Read the story “met gillende sirene door de stad” (here) about a young diabetic who hurries too much (and eats too little) on the first day of his new job.

Another colorful blog on acute care, music and personal matter is 100% Mike. One of his post begins with mentioning a very special legacy of his mother: ice creams she won in a contest. The same night an elderly woman came in for a paracetamol, but had to stay for pneumonia and lung embolisms.

Another blog about acute care, from an emergency nurse: ECGreetje. Easy to digest information on hobbies (shopping) and acute (heart) care. Here latest post is on the (recently published) positive effect of the song Stayin’ Alive of the Bee Gees on heart resuscitation, not only because of the text but more so because of the beat, which is exactly the rhythm one should use for a successful resuscitation attempt: ~103 beast per minute. ECGreetje, however, is afraid that she will start dancing when listening to this song.

//forthebirdsblog.blogspot.com/

The Quack (and the Scream) from http://forthebirdsblog.blogspot.com/

The provocative physicians Dr. Lutser and Creiptocheilus keep on ranting against (alternative) QUACK. Dr Lutser, who takes a blog pause for a while, is highly surprised that the advocate of the controversial anti-cancer “medicine” DCA (Dichloroacetic acid), Wim Huppes, does not use this or any other alternative medicine himself, now his cancer has returned.

Cryptocheilus mentions at his blog that he has been banned from the forum of the tv program TROS-RADAR, because he was considered too offensive against mister Braam, another ‘healer’. “C’est la ton qui fait la musique”, perhaps? Good reasoning convinces more than ranting. In his earlier post, Cryptocheilus shows some examples of selective use of evidence and ‘misinterpretation’ of a Cochrane Review by Braam. Pitty that Tros-Radar only hears the tone, without understanding the text.

Finally, clinical librarian and second life specialist Guus den Brekel of DigiCMB has some interesting post on SL, for instance about how to spend an $60,000 grant for a project entitled “AIDS Information and Outreach in the Virtual World of Second Life”. He also gives a nice overview of customizabe-widgets, i.e. for blogs, technology and education.

Liked the review of your post? Would have liked a review of your post? Like to read (some of the) posts? Then Huize Sonnendael, MedBlog, Patient en EPD, Man in de Zorg, Sister Nightfall, Zorglog, Ervaringen met een verpleeghuis, Cees Sterk, Zorg voor klanten, Manager zorg vertelt, Club Confabula, Over ZN, Zo! Communicatie, Ouderenzorg in de nieuwe werkelijkheid, De gezonde patient, Medisch Contact, Huntingtondaily.web-log.nl, MediGO, MaCoAd, Verpleeghuisarts.web-log.nl, Aria Rad, Herre Kingma, Metabool.web-log.nl, Werken in de zorg, Fontys Mediatheek, Ambupleeg, Weblog voor fysiotherapeuten, Verpleegkundige, Dokter Rob, Trimbos Online 2011, Pekke.nl, Electroconvulsive Therapy, Zorggemak.nl en Bas Leerink’s Blog as well as and some of the abovementioned bloggers become a lurker too, or perhaps a poster!

Contributing is very simple, just copy the link to the post that you would like to submit here (the blogcarnival).

Just want to read: the next carnival will be hosted November 4th at Dr Shock MD PhD.

Please contribute to the upcoming Dutch Grand Rounds, so we can advocate health blogs in the Netherlands and keep informed about each other work! Mag ook in het Nederlands, hoor! Graag zelfs!





Grand Rounds 5.4

14 10 2008

Dubious: the third post in sequence about Grand Rounds, I know. It is time for some primary posts after this one.

Just wanna mention that this week’s Next Grand Rounds is now up at Notes of an Anesthesioboist.

Each week the grand rounds seem to get larger and larger. Fascinating how the hosts manage to present it in a digestible way. This week the rounds is organized into six major sections (preceeded by nods to her favorite “movies”).

Well and that is a good excuse to place a little picture of my favorite series: Twin Peaks, which I first saw when watching tv with a colleague during a congress (ASH) in Boston 1990. “Damn good coffee, and hot!”. Damn good grand rounds, too.

Next week the grand round will be hosted by Christian Sinclair, M.D. at Pallimed. Please read the call for submission (with theme) here.





Grand Rounds 5.3

10 10 2008

I totally forgot to inform you that this weeks grand round is (still) up at MDOD (docsontheweb.blogspot.com) in ….. MDOD style (what else would you expect?). Please read the summary here.

Previous week the grand round was hosted at Monash Medical Student.

The Next Grand Rounds will be hosted at Notes of an Anesthesioboist (no typing error) on October 14.

Deadline is Sunday October 12 (midnight, but check the timezone!!).