Cynical Humor in Medicine and the Media:
A Case Study of Grey’s Anatomy
by Medhini Anand, Sociology
Abstract: This paper aims to address the way cynical humor used by healthcare professionals is perceived by those not in the field. Particularly, it aims to look at the way this is perceived in the media, via a case study of the popular medical drama, Grey’s Anatomy. The language in the show was then compared with the trends in cynical humor used by actual physicians and medical students, outlined in the 2006 paper, “Making Fun of Patients: Medical Students: Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings.” Specifically, three episodes of the show were analyzed and compared with the original article. The use of cynical humor has an impact on patient care in some way; clearly non-physicians are aware of the language and react to it in some way. This paper looks at the use of this language from a non-physician perspective and expands upon the literature, addressing the impact of cynical humor in medicine and bringing more attention to this issue.
cynical humor, healthcare professionals, Grey’s Anatomy, language, medicine
Introduction
Doctors are supposed to be the figures people go to when they seek help without judgment, but recent research finds that this is far from true. In a study about medical students conducted by Wear et al., various students were observed and interviewed by the researchers to understand the cynical language used by doctors. The study found that this habit was widespread throughout the profession. Medical professionals tended to insult patients behind their backs; topics ranged from jokes about appearance (a specific trait, sexualized quality, weight, etc.), whether a condition was “self-inflicted” (e.g.: smoker gets COPD), or inappropriate behavior from patients (ex: a patient consistently being verbally abusive to their team). These revelations were shocking, as researchers did not expect this behavior to come from physicians. Despite the unspoken rule to never use derogatory language in front of a patient, from the media’s portrayal of doctors, non-physicians are still aware of this behavior. Medical television programs are an increasingly popular form of media, and these shows emphasize this harsher aspect to physicians. One of the most popular medical dramas is Shonda Rhimes’ Grey’s Anatomy, which has a few episodes that highlight this culture of cynical humor in medicine. This paper aims to analyze three episodes where cynical humor plays a role and compare them to the Wear et al. study. This paper will analyze the use of humor in the same context, the justification of this type of language, and the impact on patient care.
Background
To gain a deeper understanding of the analysis, it is important to understand the analysis made by the Wear article. The article opens by discussing how medical students become increasingly cynical throughout their schooling and would begin to refer to their patients using dark humor. The authors used 5 focus groups for a total of 42 voluntary participants in the study. They asked these students a series of questions regarding the types of humor that they have observed, who makes the jokes, rules and regulations surrounding this, motive behind the jokes, and how the jokes make the students feel (Wear et al, 2006, p. 455). From here, the categories of jokes were derived, and most instances of cynical humor occur from a superior (more specifically a resident or attending), outside of the patient’s presence (Wear et al, 2006, p. 458). Many of the students themselves expressed initial discomfort or unease due to the cynical humor from their superiors, but eventually either succumbed to the same behavior, or stopped being sensitive to it (Wear et al, 2006). The types of cynical language used by physicians defined by the paper can fit into two large categories: humor that targets health issues brought on by an individual (ex: obesity via overeating) or humor that targets the behavior of a different or difficult patient (Wear et al, 2006). This second category is much broader, and it includes non-compliant patients, patients with psychiatric disorders, and patients with sexually appealing characteristics (Wear et al, 2006). There is also a set category for patients off limits from cynical language, which is the terminally ill (Wear et al, 2006). Comments regarding physical appearance fell into both categories, depending on the context of the comment, which is why appearance will not be treated as a separate category in this paper. The article argues against the use of cynical humor, attesting that physicians can be strengthened by exhibiting more empathy, rather than these dark comments (Wear et al, 2006) The authors also argue that the use of cynical humor by superior, encourages students to do the same, as they view their superiors as mentors (Wear et al, 2006). Modern studies have asserted similar claims to the Wear study. Julie Aultman, who also worked on the Wear study, authors this paper, and discusses related themes of humor and explains how this detracts from effective care (Aultman and Meyers, 2020). This attests to the relevance of the Wear paper to be used in this analysis, especially as the Grey’s Anatomy episodes discussed are all older content.
Analysis and Evaluation
Season 1, Episode 6: “If Tomorrow Never Comes”
As one of the show’s earliest episodes, “If Tomorrow Never Comes,” played a significant role in establishing the show’s views on cynical humor and derogatory language. Aired in 2005, this episode centers on a woman who comes in with a large tumor, after refusing to see a doctor for months. One of the interns, Alex Karev, treated the woman with care and respect to her face, ensuring that she felt comfortable and adequately cared for. However, behind her back, he shamed her for not coming into the hospital when something was wrong with her, insulted her intellect for not understanding medical issues, and commented on the way her tumor affected her appearance, with the MRI microphone accidentally on. His comments included him saying “If you’re sick of doctors, take a pill. She’s just sick, you know, warped,” when discussing her decision to come in so late (11:51). Firstly, it seemed like the humor itself was quite like the kind observed in the Wear et al. study, with the comments focusing on her appearance and the fact that she “did this to herself,” the latter being highlighted by the quote from the episode. The comments that were the harshest were those centered on her overweight appearance, using words like fat and disgusting often. This fits into the categories defined by the paper- comments regarding physical appearance, specifically regarding illness being the patient’s fault.
This is where the similarities between what was outlined in the article and the show’s content end. In the show, there is no concrete reason as to why Alex speaks about his patient in this manner, whereas the students in the study state that cynical humor is a way for doctors to not dwell as much on serious topics. The show implies that the doctors who use cynical humor do so because it is in their personality, like Karev who is characterized as rude from the start. Other physicians are characterized as “good”, and therefore do not use cynical humor. The article emphasizes that this is a universal, systemic problem. In addition to this, the article implies that derogatory language used by medical practitioners does not impact patient care. Here, it led to the patient refusing care again, as she did not want to be treated by individuals who did not respect her, and almost lost her life.
This episode’s goal is to show that not all cynical language used by doctors in a private environment is private and speaking a certain way about a patient can lead to detrimental events in a patient’s path to health. Individuals who write shows like this are aware of the use of cynical humor in medicine, as well as the type of humor used, as evidenced by this episode. The implications of this are that patients notice derogatory language more often than physicians believe.
Season 6, Episode 21: “How Insensitive”
This episode is particularly relevant to study when analyzing the way cynical humor in medicine is portrayed by the media, as this type of language is the focus of this episode. The episode opens with a lecture for all current residents and interns on proper language, and the narration centers on the type of language used around patients. Dr. Bailey states “Don’t make jokes about patients, not in front of them, not even in private,” in a begrudging tone, demonstrating that while this is an important lesson, even the superiors implementing this initiative struggle to view it seriously (0:54). The episode features a morbidly obese patient who requires the hospital to adjust its resources to serve him, and any interns or residents who were caught saying anything even mildly negative regarding the patient and his health were removed from the case. This shows a contrast to the methods of punishment for this language outlined in the Wear article, as that implies that there are no disciplinary measures in place for uses of derogatory humor, due to it being considered normal in this setting. The article also mentions no type of training that exists in hospitals to detract from using cynical humor. This episode contrasts that line of thinking by removing students from an interesting case when they are inappropriate, which is detrimental to their desire to learn from rare conditions.
Moreover, the comments made by the residents and attendings in this episode about the patient’s wife are interesting. Physicians expressed their confusion that the patient’s wife was conventionally attractive while he was not, in an offensive manner. It provided a new perspective as the article only discussed cases where physicians talked about patients themselves, not their relatives or companions. The episode highlights the fact that physicians should not automatically assume the reasons behind a patient’s current condition and emphasizes the need to utilize disciplinary systems to curb cynical humor in healthcare. While this idea was proposed in the study by Wear and colleagues, the article implied that such disciplinary systems would be difficult to put into practice as cynical humor is so normal in medicine.
The outside perspective brings back this idea of cynical humor having unintended negative consequences and serves as a response to the widespread use of cynical humor in medicine. The writers wanted to show that physicians who do not use cynical humor are more effective compared to those who do, which was achieved by the patient receiving better care from the kinder doctors. The episode also calls for appropriate disciplinary measures to be put in place for cynical humor, while the study implied that this issue was so widespread that having disciplinary measures was pointless. In contrast, the show depicted that students must be taught not to use derogatory language, discipline the students who do use it, and pair students with attendings who do not speak poorly to change the culture.
Season 7, Episode 19: “It’s a Long Way Back”
This episode is significant, although the cynical humor is not the focus, due to the way this language is used. In one subplot of the episode, Dr. Karev is trying to raise money for a pro-bono program to provide children from Africa with life-saving surgeries they require. He decides to solicit one of his older, terminal cancer patients. Despite already crossing a line with the request itself, he proceeds to call the patient rude names, such as “the bitch,” to her face. This violates all unspoken rules outlined in the reference study. Firstly, the article outlines any terminal cases, specifically those involving cancer, are strictly off limits from cynical humor. In addition, derogatory language is outlined to only be used in private locations. However, in this episode, rather than being punished, which is a precedent set by the hospital, he gets the funding he needs from the patient and faces no consequences for soliciting the patient and insulting the patient to her face.
In this case, the language did not impact the treatment of the patient and Dr. Karev justified his language because it reflected how the patient spoke to him. The patient was difficult, non-compliant, and rude. She was also elderly, dying, and alone. Actions like this would have called for discipline both in the real world and at Seattle Grace. By all conventions, insulting a patient to their face is something that crosses the line for a doctor. Someone who is actively working to heal a patient should not disparage the patient in the process, especially to their face. Yet, for some reason, this doctor gets away with it. It is not the first time something like this has been shown in the show, but it is the most evident example, particularly because rather than experiencing any punishment, or even just no reaction, the physician is rewarded, and by the patient at that. The show almost implied that the patient appreciated the rude language. It contrasts the previous two episodes and the reference study, which implies that using cynical humor makes an individual a less effective doctor and negatively impacts patient care.
Conclusions
These results show that cynical humor in medical media has both similarities and differences to cynical language in medicine. The show demonstrated that derogatory comments were made within the same major categories, yet the consequences and reasonings wildly varied. The show portrayed some doctors, such as Dr. Karev, as particularly prone to using derogatory language. However, it shows that the doctors who always respectfully talk about their patients and those who do not both have positive results. While the culture of cynical language is universal throughout the hospital in Grey’s Anatomy, the show portrays this as an issue with specific doctors, rather than being an institutional problem, like the article dictates. There is rarely on-screen justification for derogatory language on the show, rather certain individuals are just more inclined to joke about their patients. Finally, the show implies that doctors who are always respectful tend to be better physicians. Sometimes the show contradicts this, like in the season 8 episode, but overall, this is the trend portrayed. One major takeaway from this is that non-medical professionals still have a solid understanding of the type of language used by medical professionals, and they see derogatory language as a sign of a doctor being less competent.
References
Aultman, Julie M., and Emily Meyers. (July 2020). “Does Using Humor to Cope with Stress Justify Making Fun of Patients?” AMA Journal of Ethics, vol. 22, no. 7, July 2020, pp. E576-582. https://doi.org/10.1001/amajethics.2020.576.
Harper, W. (Writer), Rhimes, S. (Writer), Verica, T. (Director). (2011 April 28). “It’s a Long Way Back” (Season 7, Episode 19) [TV Series Episode], S. Rimes, B. Beers, R. Corn, M. Gordon, A. Heinberg, K. Veernoff, M. Wilding (Executive Producers), Grey’s Anatomy, Shondaland, The Mark Gordon Company, ABC Studios
Harper, W. (Writer), Nowalk, P. (Writer), Rhimes, S. (Writer), Verica, T. (Director). (2010 May 6). “How Insensitive” (Season 6, Episode 21) [TV Series Episode], S. Rimes, B. Beers, R. Corn, M. Gordon, J. Patriot, J. Rater, K. Veernoff, M. Wilding (Executive Producers), Grey’s Anatomy, Shondaland, The Mark Gordon Company, ABC Studios
Rhimes, S. (Writer), Vernoff, K. (Writer), Brazil, S. (Director). (2005 May 1). “If Tomorrow Never Comes” (Season 1, Episode 6) [TV Series Episode], S. Rimes, B. Beers, R. Corn, M. Gordon, J. Patriot, K. Veernoff, M. Wilding (Executive Producers), Grey’s Anatomy, Touchstone Television, The Mark Gordon Company Wear, Delese, et al. “Making Fun of Patients: Medical Students: Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings.” Academic Medicine, vol. 81, no. 5, May 2006, pp. 454–62. https://doi.org/10.1097/01.acm.0000222277.21200.a1.
Citation Style: MLA