Phil Hammond MD

Hospital humour: it's black, brutal and poo-y

"What are you going to do when the press finds out you're teaching medical students about humour?" What indeed. Academic conferences are dangerous places to launch your ideas, with people queuing up to subject your work to the kind of critical appraisal you probably should have done yourself before you opened your mouth. My presentation, "Should Medical Humour Be In The Syllabus?", was to academic GPs (there are such things) and the chairman's verdict was "nice idea, but lacking in intellectual focus".

This isn't the first time such a criticism has come my way. Indeed, the metamorphosis from frivolous stand-up comedian to credible sit-down lecturer has been painfully slow. The Independent, it has to be said, has not helped. Writing for the popular press is viewed with a mixture of contempt and envy, not lessened by the decision of the health page editor to have MD added to my name. A masters' degree represents the pinnacle of achievement for academic GPs. I do not have an MD, or at least I didn't until the Independent gave me one. It wasn't my idea, but no one believes me.

So what about medical humour? It's black, it's brutal and there's lots of poo in it. It's a reflection of the culture doctors inhabit and many feel it's entirely appropriate given our dehumanising working conditions. It follows that we won't develop a more empathetic and patient-centred sense of humour without dramatic improvements in our lot. Forty hours a week tops, flexible working patterns, hospital creches and M&S sandwiches on demand. This seems unlikely in the immediate future, not least because junior surgeons are demanding to go back to the old 144 hours a week regime to give them more practice with the knife. In the meantime, the best we can hope for is a damage limitation exercise to stop these brutalising attitudes spilling over into teaching and consulting.

My theory is that if you get all this nastiness out in the open at medical school, the students can discuss it, prepare for it and work out how appropriate it is for themselves. So I asked a group of final years to recount their experiences of a) doctors trying to be funny but succeeding in offending and b) what the students themselves found funny. a) was horribly predictable, full of devil's anecdotes of harassment, prejudice and humiliation - and certainly nothing that could be excused by the working conditions. As one female student observed of a consultant surgeon's operating banter: "First he asked me if I was from the home counties. When I said yes, he started calling me Tinkerbell and said I looked the sort of girl who'd had a horse between my legs. Then he asked me if I'd lost my virginity up against the wall of a horse-box while my mother was outside watching a gymkhana. The surgical registrar and the other theatre staff started laughing too. It was like being in a monkey house. He asked me if I minded him being sexist in theatre - "Women like to know what men want". Then he made a hole in the gall-bladder and said "look what you've made me do."

Fortunately such outrages are rare, but less overt harassment is common and unpublished research suggests that in at least one medical school, 70 per cent of the students have been verbally harassed and 30 per cent have been physically manhandled by their teachers (punched, pinched, squeezed and patted). Unsurprisingly, the students develop a disdainful sense of humour, and the commonest target for their scorn is the incompetence of senior colleagues. "We were on a ward round with a consultant paediatrician, and he burst into a room without knocking where two parents were sitting on the bed, cradling a Down's syndrome baby. Without acknowledging them at all, he turned to us and said "Got the diagnosis?" - and then left the room."

Well, at least he left the room. This story seems to encapsulate all that's wrong with medical training - an incessant hunt for the diagnosis with all the holism of a mincing machine. Although the target for the student's ridicule was a doctor, the victim, as always, was the family. On a brighter note, many medical students recall stories of kind doctors and of humour shared with patients, often while they were doing their nursing attachments. "I thought I'd hate nursing," said one, "but I really enjoyed it - you get much closer to the patients". "I agree," said another, "but two weeks was enough."