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Laughter in the best medicine.

I want caregivers who are solid, well-rounded, well-grounded people and who relate well to other people. That probably means they have a pretty good sense of humor. I would also expect any doctor with a sense of humor sometimes to find humor in some of the more difficult aspects of patient care, and even to make jokes about very serious things--about tragedies, poor prognoses, deaths. Humor can also be put to good use in human interactions--it's not just something I'd expect to see in normal, healthy human interactions; it can be an exceptionally powerful tool for moving a conversation forward, and for bringing people in the conversation together. But of course, it has to be used properly. I don't want my doctor to ridicule me.

This is the topic taken up in this issue by Katie Watson, an ethicist and sometime comedian. Specifically, Watson asks if doctors may ever engage in gallows humor--humor that makes light of difficult situations--and if they sometimes may, then when may they, and what kinds of jokes are acceptable? Watson offers some considerations for sorting out acceptable from unacceptable joking, but for me, what is compelling about the article is less its effort to bring order to a somewhat puzzling aspect of human interaction, but its acceptance of the complexity of human interaction and the difficulty of fully ordering it--even of fully understanding it, even when it's right in front of you. Watson leads off with an example of medical gallows humor and concludes by applying her list of considerations to it, yet the conclusion she reaches has a tentative feel: we are on "thin ice," she allows. There is a considerable literature examining different possible models for the physician-patient relationship, and while that work is valuable, it is also valuable to be reminded of the limits of models.

In the lead article in this issue, philosopher Daniel Groll comes even closer to the literature on models of the physician-patient relationship. Indeed, he develops a model for understanding one aspect of physician-patient relationships--namely, disagreements between clinicians and patients about the course of treatment. Groll argues, in effect, that one common model of the physician-patient relationship is mistaken. We should not suppose that, in making a treatment decision, the physician's job is to supply purely technical information, and the patient alone is able to decide what is best to do.

Both of these articles aim, in a way, to give physicians a richer, more substantial, less mechanical, and more human role. They may laugh at the tragedies that arise in patient care. They know more about good patient care than is sometimes admitted. But Nell Kirst's installment of the Reports In Practice column offers, perhaps, a check. Part of the challenge of the physician's role is the built-in limitation of it--and this is part of a rich understanding of the relationship. "The price we pay for being allowed into the sacred spaces of our patients' lives," she writes, "is that, in the end, they are the authors and the heroes of their own stories, and we are only bit players."

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Author:Kaebnick, Gregory E.
Publication:The Hastings Center Report
Article Type:Column
Geographic Code:1USA
Date:Sep 1, 2011
Previous Article:Out of the shadows.
Next Article:Patient autonomy and the twenty-first century physician.

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