Cynical humor directed towards patients, it is mostly about the culture

Dr Shock
January 6, 2009

house-group1

Patients can say and do funny things no matter how ill or even depressed they are. Medical students are often surprised to find that patients often respond to humor, even in discussions of the most serious consequence. Good humor can promote a conversation with a patient and it can be a bedside skill worth acquiring. Humor can be a way to fight the isolation of the disease, it can be an assurance that a situation is neither new nor unmanageable. But good humor used in direct contact with a patient is completely different from the derogatory and cynical humor used by some used in hallways outside patient rooms during rounds, conference settings or areas where residents congregate, or within private conversations.

During the process of being a medical student to clinical rounds, residence and being an attendant derogatory and cynical humor can emerge. The development of cynicism in medical students is part of the professional socialisation process they undergo as they seek to establish their professional identities. Most often they become less cynical when working as a resident and attendant. Recent research report cynicism at all levels, from student through to attending physician.

Motives offered by the residents and attendings were:

  • to relieve ‘frustration’, ‘stress’ and ‘anger’
  • ‘to make light of difficult work’
  • ‘to distance oneself’
  • ‘to stay sane’
  • ‘countertransference’
  • ‘defence mechanism’
  • a response to ‘increased demands’ in the care of patients
  • response to fatigue and to ‘feeling too needed’
  • a means of promoting camaraderie
  • as a method of shorthand when communicating with peers

Ill effects of derogatory and cynical humor:

its widespread use can ‘perpetuate a culture’…..might lead to preconceived ideas about a patient that may not always be accurate…..it could ‘cloud your judgement’.

Humor can be of benefit for the patient doctor relationship, derogatory and cynical humor are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Good medical education with attention to professional behavior is a starting point to prevent this attitude. Doctors can set standards for all students and doctors will have to be appropriate role models in this. But cynical humor can also reside in the cultural environment of a department, it’s the hardest part to eliminate. The staff of a department should communicate the ‘rules of conduct’ regarding appropriate and inappropriate forms of humor in the classroom and clinical environment and then model by example in practice.

Using humor to manage or cope with stress, anxiety, tension, depression, self-esteem and other psychological states is not new. A large body of research evidence supports its effectiveness and there have been several studies of its use in medicine, especially in intensive care and emergency departments. But the forms of humor used are critical.

What do you think?

ResearchBlogging.org
Delese Wear, Julie M Aultman, Joseph Zarconi, Joseph D Varley (2009). Derogatory and cynical humour directed towards patients: views of residents and attending doctors Medical Education, 43 (1), 34-41 DOI: 10.1111/j.1365-2923.2008.03171.x
Ronald Berk (2009). Derogatory and cynical humour in clinical teaching and the workplace: the need for professionalism Medical Education, 43 (1), 7-9 DOI: 10.1111/j.1365-2923.2008.03239.x

 

13 Responses to “Cynical humor directed towards patients, it is mostly about the culture”

  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm
  1. With the increasing use of the blogosphere by healthcare professionals, I wonder what you impressions are about cynical humor being exposed to a much wider audience – many readers of whom are the butt of the jokes and not the intended insider/peer cohort intended recipients?

    What are the ethics around this?

    DO you think there is a risk of potential or actual harm?

  2. annie on January 6th, 2009 at 2:17 pm
  3. I think your referring to medbloggers that use cynical humor in their posts. That is a different subject because you can either decide to read it or not, in healthcare there is a special relationship between doctors (med students) and patients, not much to choose. That puts it in a different perspective.
    Kind regards Dr shock

  4. Dr Shock on January 6th, 2009 at 2:23 pm
  5. I disagree. When bloggers identify themselves as physicians, they are communicating in that role, regardless of the venue. Patients trust both individuals (their personal physicians and nurses) as well as groups of people identified by social contract and statute as professionals charged and entrusted with their care (physicians and nurses). I don’t believe that you can dismiss this out of hand.

    Choosing to read or not isn’t a satisfactory response. Readers may not be sufficiently aware of a blogger’s background, credentials and choice of subject matter before reading. Conflicts of interest are likely not disclosed. The reader may not be able to determine who the blogger is in real life and whether they will likely cross paths. Some med bloggers use identifying information about patients.

    There is no regulatory body which oversees and has the power to intervene when bloggers breach their profession’s ethics.

    I wonder if there isn’t a risk of real harm to patients in that as readers of medbloggers, they perceive a breach of the physician patient relationship, lose trust in physicians, and change their health seeking behaviors in a way that results in harm or suffering.

    I haven’t seen that study yet, but I’d like to.

  6. annie on January 6th, 2009 at 3:44 pm
  7. May be this post about Three Factors to Evaluate the Quality of Medical Websites is of help: http://tinyurl.com/8eyxpw
    Another blog writing on this subject: Content of Weblogs Written by Health Professionals: More Bad than Good? can be found here:
    http://tinyurl.com/6jbw8u
    Kind regards Dr Shock

  8. Dr Shock on January 6th, 2009 at 4:33 pm
  9. Thanks for the links – interesting.

  10. annie on January 6th, 2009 at 5:34 pm
  11. Would you consider writing something about this for the Medical Education wiki http://medicaleducation.wetpaint.com/?

  12. Deirdre Bonnycastle on January 6th, 2009 at 7:04 pm
  13. Cynical or negative attitudes in converstaions/behaviour can also be seen in different areas of healthcare. In particular I am thinking of an incident I experienced that I am certain happens in emergency rooms all the time.

    In the first I was very ill, with a non-psychiatric illness. The hospital had no rooms so I was kept in Emergency for a week while undergoing care. About the 3rd evening in a patient was brought in kicking and screaming by the police. They placed her in a locked room and she screamed all night. I felt for her, because I understood she was having some mental health crisis.

    Meanwhile at the nursing station I could overhear the doctors and nurses making fun of the crazy person in the locked room. This went on until the lady left emergency. I felt so angry inside that they were laughing at her pain. I kept thinking, I will NEVER come to the emergency room for mental health help. Even if I am desperate, because how are they going to talk about me? I will not place myself in a situation where I can be put down and degraded like that.

  14. aqua on January 6th, 2009 at 7:40 pm
  15. @aqua It is often in the ER that psychiatric patients are seen as a pain in the butt instead of as patients just like any other patient, like the patient with DM or broken leg etc. etc.
    Have blogged about it in the past, gets me going that subject.
    We’re trying to educate the ER doctors about countertransference but it’s easily and quickly lost when working under pressure.
    Kind regards Dr Shock

  16. Dr Shock on January 6th, 2009 at 8:58 pm
  17. I guess I can understand why it happens but this kind of thing could ultimately harm the patient/doctor relationship. I think there is a general distrust of medical professionals nowadays. This is why we see so many people going on-line for help…they don’t trust some of the medical professionals because they may have had a bad experience where they felt belittled.

  18. merelyme on January 7th, 2009 at 3:45 am
  19. Hi Dr. Shock, Sara at “My Sad Alter Ego”, at: http://mysadalterego.wordpress.com/
    is a doctor working in the emergency ward. She recently has written a few articles about the experiences people with mental illnesses have in ER in terms of getting the help they need and not beingridiculed and dismissed. Her writings are very poignant and should required reading for all new drs.
    …aqua

  20. aqua on January 7th, 2009 at 4:06 am
  21. Thanks aqua

  22. Dr Shock on January 7th, 2009 at 9:42 am
  23. [...] recently discussed the results of a study about derogatory and cynical humor used by residents and assistants towards mental health patients. These results were in line with [...]

  24. Pharmacy students also have a negative attitude towards mental health patients | Dr Shock MD PhD on January 29th, 2009 at 6:46 am
  25. [...] Fernandez gives us Ten Reflections on Cognitive Health, Dr. Shock speaks to derogatory humor towards patients (”it’s mostly about culture”), and David Williams tells us why we should ban [...]

  26. Round Encephalon « Neuroanthropology on February 6th, 2009 at 7:23 pm

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