Laugh a little: Medical professionals, engaged in serious business, need to reclaim their humor

Serious question: Is it OK for medical professionals to laugh at themselves or make fun of the profession in public? Some say no. I say it’s not only OK, but humor might be good for the professional — and the profession.

In medical school, my friend Emily and I filmed a satirical video about the ridiculous things medical students say and do as they learn their trade. At the time, a sketch called “[expletive] Girls Say” was going viral. In it, a man dressed as a proto-millennial female — hair in Hollywood waves, slight sibilance, exquisite vocal fry — delivered quick-cut punch lines in rapid succession.

We watched it during a break between gynecology lectures and decided in an instant that we needed to make a similar video about our medical school foibles. I had written sketch comedy in college and Emily had edited short films, so we were certain we were the perfect pair to tackle this (ridiculous and unnecessary) job.

We drafted a script during the next hour, ignoring a lecture on estrogen. Then we cast our friends, filmed it over the course of a day, and sat editing the footage on a filthy cream-colored couch in Emily’s apartment.

The sketch was silly — I fumbled with a blood pressure cuff, mispronounced disease names, tried to elicit my own patellar reflex, and succumbed to hypochondria — but we obsessed over the details, wanting to get the timing just right. When we’d finished, we agonized about whether to remove the expletive from the title or keep it faithful to the original.

Then our paranoia started to spiral. We were to be doctors, after all, and “professionalism” was as sacred to our instructors as the mechanism of action of beta-blockers. Would publicly posting the video get us in trouble?

This wavering raised a host of other concerns. Even though we fancied ourselves to be “non-traditional” medical students, we had more in common with our type A classmates than we cared to admit. Would the video make people think we weren’t taking medicine seriously? That we weren’t smart enough to be in medical school, or weren’t cut out to be doctors? Would patients see it and refuse our care? Would instructors see it and assume we didn’t care?

Though medical satire is likely as old as medicine itself, we weren’t sure what the rules were in 2012 when it came to medical students posting things on the internet. But by then we had invested too much to bin the project altogether. With our hearts in our throats, we uploaded it and sent the link to everyone we knew.

“Do you think a thousand people will watch?” we asked each other, secretly hoping for two thousand.

We hit 10,000 views overnight, and within a few days were getting texts and emails from medical students across the country. Then messages came in from further afield: Ireland, Malaysia, Brazil. A friend I hadn’t seen since college told me that the video was a “staple of first year med in Brisbane.”

We seemed to have stumbled upon something fundamental.

“It’s really funny to see medical students in other countries are doing exactly the same thing as we do,” wrote one commenter from Japan. “We’re the same everywhere in the world! Amazing!! I don’t feel so alone anymore,” wrote another. “So true!” wrote a student from Poland.

Nursing students, physician assistants, and practitioners of all kinds saw themselves in our antics: “OMG that is me.” “I’m not even a med student but this is hilarious.” “I do that all the time!”

We had (forgive me) touched a nerve.

When the video reached beyond the world of medicine, we expected the comments to change. But while there were a few detractors (“how many people that graduate from med [school] are actually any good? This scares me…” wrote one), and while more than one anonymous denizen of the internet likened me to a “female version of Sheldon Cooper” (my ever-helpful father clarified that this was “not a compliment”), most commenters voiced solidarity. Even our deans, who we feared would find the video improper, contacted us to say how much it had made them laugh and remember their own first tries.

Professionalism in medicine is often defined in terms of its opposite: examples of unprofessional attire, attitudes, or behavior. These are regularly used, both explicitly and implicitly, to teach medical students how not to act. “Professionalism” is also increasingly being called out as a code word to enforce racist, ableist, and sexist traditions in medicine.

Trainees in the health professions know they must put their patients’ needs first, stay abreast of new developments and discoveries, advocate for their patients, and be good citizens. But the ideals taught during medical school are often not upheld in actual practice, causing a pernicious type of disillusionment.

And trainees receive mixed messages: Speak up for what you believe in, but respect the hierarchy. Learn, but don’t learn on my patients. Be yourself but, as one of my colleagues was chided, don’t wear those baby blue heels to clinic.

When medical students and trainees internalize the idea that their personalities or external interests are something to subvert or ignore, and that humor is nothing but time wasted, medicine becomes a far less enjoyable and far less humane enterprise.

Sometimes the lesson that trainees internalize is that anything less than consummate perfection (whatever that is, and it changes frequently) is failure; or that to succeed, one’s “medical self” and “personal self” must remain distinct from each other. When the stakes are as high as they are in health care, imperfection is a terrifying prospect.

And yet.

All health professionals start somewhere, and the process of learning to care for another human being within an imperfect health care system is complex, scary, surreal, and, yes, sometimes funny. This doesn’t end upon graduation — committing to lifelong learning means making errors and fumbling awkwardly the first few times you do something for the rest of your career.

It shouldn’t have to be said aloud, but needs to be: Becoming a medical professional doesn’t mean amputating your sense of whimsy, or diluting your personality, or abandoning the parts of you external to medicine that make you a whole person. Medicine as a profession must become more diverse, more accepting, more humane, and more cognizant of the humanity of its practitioners.

Humor is a great way to explore some of the more questionable traditions of this profession — there’s a reason why the comedy account of the particularly incisive Dr. Glaucomflecken has nearly half a million followers on Twitter.

When Emily was applying for residency programs, she temporarily took the video down from YouTube, fearing that association with it would mark her as “unprofessional.” I shared her worry, and we agreed to put it back online only after we had both successfully matched. A month after we took it down, someone I’d never met contacted me via social media, begging me to put it back online: “We still have 2.5 years of medical school to go,” she wrote, “we’re gonna need it.”

In showing our fallible, silly, real selves, we had found a community that discovered some relief in taking itself ever so slightly less seriously. We gave our classmates and ourselves permission to laugh, to be imperfect, to blunder. We helped our instructors remember their own failings, perhaps finding new sympathy for the parts of themselves that once felt dumb, hopeless, and out of place.

A decade later, the video still re-enters my life now and then: One of my co-interns recognized me from it on the first day of general surgery orientation. An emergency department resident would quote it every time I walked by, often forcing her colleagues to watch it on the spot. A few years ago in a restaurant, a woman at the next table tapped me on the shoulder, asking, “Aren’t you that girl?” And during an interview last year for a job as an attending physician, one of the interviewers brought up the video. (Fear not: I was hired!)

Much of medicine is unambiguously no-nonsense. But if we can find levity in our own limitations, maybe we can treat ourselves — and one another — more compassionately.

I sometimes wonder whether I will ever outgrow the video, but as it has now been viewed nearly a million times, in terms of its “impact factor” it will probably remain the biggest thing Emily and I do for the remainder of our professional lives. Which, when you think about it, is pretty funny.

Alessandra Colaianni is a head and neck surgeon at Oregon Health and Science University in Portland, Oregon.