Tickling the funnybone helps keep doctors sane.

Byline: THE HEALTH FILES by Tim Christie The Register-Guard

DOCTORS FACE extraordinary stress, traumatic situations and life-altering events on a daily basis - not to mention having to deal with HMOs and pharmaceutical sales reps.

And like police officers and firefighters, physicians blow off steam and relieve stress through a time-honored method: with humor best described as black, twisted or just plain sick.

Like the fictional characters in "M*A*S*H," doctors often resort to jokes and stories that another person might find gross, inappropriate or politically incorrect.

"I suppose there is a certain kind of medical humor that probably isn't funny to other people," said Dr. Bob Litin of Eugene, a semiretired urologist. "Some doctors have a somewhat perverted sense of humor and will tell jokes that the layperson would find shocking."

Doctors say the humor typically is not at the expense of patients, but rather pokes fun at other doctors or themselves.

They say humor, black or otherwise, is a critical way to release tension in face of extreme emotional stress.

"Most doctors and nurses soon learn that humor is an especially powerful tool in letting go of the difficult emotions that accompany every day's work," said Paul McGhee, a Wilmington, Del., author of 11 books on humor.

Macabre or black humor, he said, "is essential to fighting burnout and keeping yourself focused - prepared to deal with the next crisis situation that could come at any moment, possibly with someone's life on the line."

Dr. Jerris Hedges, chairman of emergency medicine at Oregon Health & Science University in Portland, said that without humor, doctors would be useless.

"Without an outlet, we would quickly disintegrate into a shivering blob of Jell-O that would be unable to help the patients," he said.

Hedges said most of the humor doctors use among themselves is "politically incorrect and tends to be on the dark side."

Dr. Stephen Bennett of Eugene, a retired anesthesiologist, said some surgeons won't stand for any humor in the operating room. Others get carried away. As the anesthesiologist, standing at the head of the table, he would try to smooth things out and perhaps inject a little humor when appropriate.

"If you're in the OR for eight hours and there's no humor for eight hours," he said, "that is not good for anybody."

Dr. Geoffrey Simmons, who specializes in internal medicine, likes to use humor to help patients deal with the stresses of illness. To poke fun at the time constraints doctors face under managed care, he might poke his head in the exam room and say, "Hi, how are you, fine, OK, that's all the time I have," and leave.

But he's careful to joke only with patients he knows well, and who he knows are amenable to humor. "I wouldn't dare do that with someone I didn't know."

"You deal with such awful things, there's some part of us that needs to find something that's funny to lessen the load," he said.

Sister Aileen Trainor has worked as a nurse and now works in risk management at Sacred Heart Medical Center. She speaks to groups big and small, local and national, on health and humor. She calls laughter a "creative gift" that "breaks the panic cycle" and helps people think clearly.

But she doesn't care for what she calls "groaner" humor.

"I don't approve of the kind of jokes that sometimes can be shared in departments," she said. "It's not appropriate. It has to do with respect."

On the other end of the spectrum is Dr. Douglas Farrago, a family physician in Auburn, Maine, who decided that physicians needed a publication to share their warped sense of humor and created the Placebo Journal (on the Web at www.placebojournal.com).

The journal has a circulation of 10,000, Farrago said, though he couldn't say how many subscribers he had. The fifth edition is coming out soon, and he hopes to put out a Best of Placebo Journal for nonmedical people.

The magazine takes sort of an "Airplane" approach to medical humor: Throw enough silly jokes at the wall, and some are bound to stick.

There are lawyer jokes, corny jokes, hell jokes, raunchy jokes, Viagra jokes, military jokes.

There are actual X-ray images of people with strange objects inside their bodies, such as a remote control.

One article, titled "Bowel Obsession," is about patients who see their doctors with detailed, repeated concerns about the quality of their excretory output.

There are gruesome tales of accident victims and patients with inexplicable afflictions.

A column titled "My Favorite Munchausen" features patients with self-inflicted injuries and illnesses.

A feature called "Those Darn Narc Seekers" is about patients who see doctors in search of drugs.

The 40-page magazine has but a single ad, but a number of fake ads, such as this take-off on a well-known credit card campaign: `Working at a fast food restaurant: $8 an hour. Selling crack on the corner: $60 an hour. Getting disability for fake back injury: $312 a month. Suing your doctor for `addicting' you to pain medication: Priceless. For your chance at the good life, call the law offices of Iwanna, Lye & Steele.'

Farrago makes no apologies for some of the outrageous attempts at humor in the Placebo Journal.

"The bottom line is, nothing is off-limits except compromising care. If someone got hurt, we will not print that," Farrago said. "We don't write about doctors having sex with patients. We leave that to the veterinarians."

Tim Christie covers health and medical issues. Call 338-2572 or e-mail [e-mail].