Blog | Tuesday, October 14, 2014

A taxonomy of medical humor


Medical humor is a time-honored category of humor that probably dates as far back as the first shaman to wield a stick. But it occurred to me that it might be amusing and enlightening if we further categorized medical humor itself. Why? Mainly because I am an inveterate and—as my wife would contend—pathologically compulsive organizer. And for some time now I have been thinking of organizing my ever-accumulating fund of medical humor. Hence this entry.

First, definitions: What is a taxonomy? This term refers to any system of classification, usually applied to the world of living things, for example, such as evolutionary trees of life.

What is medical humor? Although the term may seem obvious, an answer to the question of “What is medical humor?” is not as simple as it sounds. It is not quite the same thing as “doctor jokes,” since there are many kinds of healers. And some jokes feature doctors only incidentally; not all jokes which include doctors are truly about illness and healing. So for my purposes, medical humor refers to jokes about human ailments and the people who minister to them. As a physician, I have heard so many that I could not fail to take an interest in them. Over the years I have collected a large repertoire of jokes of all sorts, and like most collectors, I try to keep my collection in order. Moreover, I suspect at this point if I don’t start keeping some order, I will begin to forget jokes as fast as I learn them.

You may not be aware of it, but the need to classify things, even humor, seems to be an innate human urge. So much so, that some famous authors have even satirized those attempting to analyze humor. I recall reading somewhere a parody in which laughter itself is proposed as a sublimated urge to sneeze. Even as a child without any inkling of my future career path, I recall eagerly opening Readers’ Digest to the column entitled “Laughter is the Best Medicine”, which included at least 2 pages monthly. With so many people dedicating themselves to producing and disseminating medical humor, it seems to me worth an attempt to organize it. What follows is a proposed taxonomy.

In classifying humor, the most obvious but not necessarily the most fundamental scheme might be by topic. Categories come to mind such as: doctor jokes by specialty, medical jokes by ailment, greedy doctor jokes, stupid patient jokes, hospital jokes, medicine jokes, etc. While this sort of system might serve as an outline for a book of medical jokes comprising multiple chapters, it doesn’t seem adequate to the conceptual approach I am aiming for here. A disadvantage to the simple list-of-topics approach is that it doesn’t readily lend itself to creation of a second and third order hierarchical structure, or in other words, a system of categories, subcategories and sub-subcategories. It would be like trying to arrange a supermarket by placing only a few brands of each item to an aisle and having hundreds of aisles.

To some extent, any system of classification outside of biology or chemistry will be arbitrary, but I propose to base mine on the most fundamental of human experiences regarding health, illness, life and death, and those who confront them. Some of you old enough to recall the famous TV series of the 1960’s, “Ben Casey” may recall the chief of surgery, Dr. Zorba, intoning these fundamentals as a hand sketched on a chalkboard the symbols for man, woman, birth, death and infinity. As with all drama, these are the elements of a good medical drama, and in my opinion, are just as apt for organizing medical humor.

So if the reader has indulged me this far in this as yet anything but humorous endeavor, let me set out a proposed system of headers for the first order categories:
1. Prognosis
2. Patients
3. Healing
4. Healers
5. Humor only incidentally medical in its subject

I have arrived at this list partly a priori and partly having thought of a few of my favorite jokes and trying to find common elements. I plan to discuss a subcategory of each category and give a few examples. I note that some humor can only be classified as belonging under several headings, but we will come back to that. So let us discuss Category I, Prognosis. The following classification might run:
• Category: I. Prognosis
• Subcategory: A: Scary Diagnoses.(serious illness)
• Sub-subcategory: 1. Breaking bad news.

Example:
• Doctor: I’m afraid it’s terminal.
• Patient: How long have I got, doc?
• Doctor: I’d say 5 or 6 at best.
• Patient: 5 or 6?! Is that weeks or months??
• Doctor: (looking at watch) “ … 4″

Example:
• Doctor, phoning patient: Well, Sam, I got your lab tests back.
• Patient: You don’t usually call me yourself with the results. Is there a problem?
• Doctor: I’m sorry but I have bad news and worse news.
• Patient: (pauses to brace himself) OK, Doc, hit me with the bad news.
• Doctor: Your blood tests say you have 24 hours to live.
• Patient: That’s the BAD news?! What’s worse than THAT?!!
• Doctor: I meant to call you yesterday.

What I find interesting about these jokes is that they tug at us at so many levels. We laugh as a defense against our awareness that we are not only mortal but that our demise may be much sooner than we expected. We also laugh at insensitivity with which the bad news is conveyed. But the second joke might also fall under a sub-sub-subcategory of breaking bad news jokes that I would entitle “good news-bad news” jokes. You must have heard at least a few. They all begin with the doctor walking into the hospital room or the exam room after a test of some sort and announcing that there is good news and bad news. They concern our need to temper the blow when we deliver bad news and make light of the lengths to which it might go if carried to its ridiculous logical extent.

Category II is Patients.

Patients come in all kinds and say all kinds of things. Subcategories might include: A. Patient Complaints, B. Crazy Patient, C. Doctor-Patient Interaction, 4. Patient Billing, or other doctor-patient relationships.

Let us say that II .A.1 is Patient Complaints. Under that is II.A.1.a, Patient Complaints by specific symptom or organ system. Consider under II.A.1.a, sexual function:

Some are just plain silly.

Example:
• Patient (to urologist): Doc,, I have a genital problem
• Doc: What seems to be the trouble?
• Patient: I have 5 penises!
• Doc: (laughing) So how does your underwear fit?
• Patient: Like a glove, Doc!

Or perhaps in a more reality-based theme, II.A.1.b, Patient Complaints by Ailment:

A man and his wife visit the doctor, who first conducts the wife into his exam room. Shortly, the doctor emerges alone with a serious demeanor and informs the husband, “I’m afraid the blood tests and the neurological exam are somewhat conflicting. It appears your wife has either Alzheimer’s Disease or HIV-AIDS. I’m awaiting further tests.” The husband, dismayed, responds, “That’s awful Doc! What should we do meanwhile?” The doctor responds, “Well for now, you both should just go home and get some rest. But when you get to that Stop & Shop 5 blocks from your house, let your wife out of the car and have her pick up some ham and eggs and milk. As soon as she goes in the store, drive home. If she finds her way back, whatever you do, DON’T HAVE SEX!” (This joke sounds much funnier if the term in the punch line is a bit coarser than the standards for this blog allow.)

The joke here carries some weight because it borders on the “scary diagnosis” realm that might place it in the Prognosis category. Clearly there are more jokes about AIDS and Alzheimer’s than there are about the common cold. The more we fear something, the more prone we are to cover our anxiety with humor. But this doesn’t always apply. Jokes about leprosy can still be found even though it is rare in Western countries and curable with antibiotics.

But on to another subcategory: II.C , which would be Doctor-Patient Interaction.

Example (lifted from Vaudeville act as seen in the movie “The Sunshine Boys” :
• Patient, demonstrating a motion with his arm: Doc, it hurts when I do this. What do you recommend?
• Doctor: So don’t do this.

Some of the humor in this is aimed at the ridiculous response to a seemingly reasonable complaint. Perhaps this falls under II.C.1: Obtuse Doctor

But sometimes the complaint is unreasonable and the doctor’s response is appropriate. Consider II.C.2: Obtuse patient:
• Patient : I have a terrible flatulence problem . It is most embarrassing in Church because it’s the noise, not the odor that seems to bother people. Can you recommend a gastroenterologist?
• Doctor: This could be serious. I want you to see an ENT doctor and a neurosurgeon.
• Patient: How will that help my loud farts?
• Doctor: You have lost your sense of smell. You may have a brain tumor!

Sometimes the patient outwits the doctor, or vice versa. Here’s an old one:
• Patient: Doctor, how soon after the elbow injection will I be able to play a violin?
• Doctor: It only a cortisone injection. You should be playing in a day or 2.
• Patient: That’s great, Doc! Because I don’t know how to play it now!

Category III is Healing. Jokes about healing include those referring to physical exam, diagnostic tests, oddball treatments, surgical procedures, etc.

For III.A. , Examination, an example is III.A.1, rectal exams:
• Doctor: I am concerned about your prostate blood test. It’s on the borderline. I need to repeat your rectal exam.
• Patient: Ouch! Did you just use two fingers?
• Doctor: Yes. I wanted to get a second opinion.

Say III.B is diagnostic testing. Example: (this is just one variation on an oldie-but-a-goody)

A patient comes to a doctor complaining of abdominal pain. After a thorough exam, doctor says “I have an idea but I need to run some tests first.” Patient agrees. Doctor places a cat on patient’s abdomen and after the cat paces up and down (no, that’s not the punch line), doctor leads in a dog that proceeds to sniff the patient’s ass. Doctor announces that the patient has (fill-in-the-blank) disease and hands patient a bill. Patient asks, puzzled, ”Doctor, I can understand your fee, and I can understand the charge for the CAT scan, but what’s this other charge for the dog? Doctor replies, “Oh, that’s for the lab test.”

III.C. Is “Oddball treatments”. Example:

A patient visits the doctor complaining of gas and abdominal pain. After a simple stool test, doctor announces you have a tapeworm. (tapeworms are rare in Western countries but ubiquitous in jokes) Doctor writes a prescription but patient returns from pharmacy and says, “Doctor, that anti-parasitic drug is $500! My insurance won’t cover that. Isn’t there anything cheaper?” Doctor says, sure, but it is a one-week course of therapy here in the office at only $25 per visit.” Patient says he can handle that and agrees. Doctor instructs him: “Come tomorrow with a hard-boiled egg and a cookie?” Patient: “How is that supposed to help?” Doc: “Just trust me. Works every time.” Patient returns the next day and doctor has him bend over. Doctor inserts hard-boiled egg in rectum. Looks at watch. A minute later he inserts the cookie. The patient complains he feels worse than before. Doctor says the treatment takes time, be patient. This continues for the following 5 days. By that time the patient says he is feeling no better and he can’t take much more treatment. Doctor says, “Don’t worry. Tomorrow come back with an egg and a hammer.” The next day, patient bends over as usual and doctor inserts the egg. A minute goes by. Nothing happens. Another 30 seconds. Nothing. Finally, suddenly, a small head pops out of the man’s rectum and says “Where’s my cookie???” WHAM goes the hammer. (Pound the table as you tell the punch line.)

Bet you didn’t expect that one! There are numerous others, some so corny I will only offer them condensed: Chinese herbalist explains his diagnosis of dental abscess to man complaining of flatus that sounds as loud as a Japanese automobile horn: ”Diagnosis simple. Abscess make the fart go ‘Honda’!”.

III.D. is surgery. III.D.1 includes genital surgery. This one might come under patient complaints, since penis complaints are legion. As a matter of fact, penis lesions are complaints. Size is the perennial theme. Example:

A patient goes to ENT specialist complaining of a stutter. After a thorough evaluation, the specialist informs him he has an unusual condition caused by phallic hypertrophy, or in other words, excessive penis length, and offers to send him to a urologist to have his penis trimmed. Patient decides the cure is worse than the disease but after consideration of how his stutter has impaired him on the job and made him shy about meeting women, figures he still has enough to spare that he can afford to lose a couple of inches. At length, he calls the ENT doctor and is duly referred to a surgeon known for expertise in genital reconstruction and transplantation. The surgery and the 2 inches of excess come off without a hitch. At follow-up, the surgeon inquires, “Well, how is that stutter?” The patient replies, “It’s completely cured, Doc! I got a promotion at work and I’m meeting a lot of women. You did a great job, and I don’t want to seem ungrateful but …” The doctor responds, “You seem disappointed. What’s it it?” The patient replies that he is doing OK in bed but he is not satisfying his dates sexually the way he used to. He asks, “Doc, is there any way you can reverse this operation?” Doctor replies with a smile, “S-s-sorry, b-b-buddy, a d-d-deal’s a d-d-deal!”

Some jokes don’t fit neatly into categories. The preceding might fall under doctor-patient relations, where doctor outwits patient, or even under patient complaints, but the theme of unusual surgical procedures seems to dominate over that of penis complaints. Transplant jokes are numerous, and not surprisingly, penises are popular, although brains, breasts, vaginas are mentioned.

Another example: A single man with a penis that is too short seeks help from another surgeon in the same specialty as above. (Perhaps a woman surgeon this time? The male gender for the doctor in the joke above was essential.) The patient is desperate because he cannot maintain sexual relationships after the first few dates due to his deficiency in that department. This time, the surgeon explains that penis transplantation is untested, risky, and expensive and discourages the patient. The patient pleads with him. He is told “Well, yes, there is a new procedure that could help you but it is highly experimental. There is a transplant procedure in which an extension is fashioned from just the very tip of a newborn elephant trunk. The elephant barely misses it once he reaches maturity.” The patient agrees and of course, the operation is wildly successful.

The patient proceeds in short order to meet a girl, fall in love with a wealthy young woman, and is invited to dinner to meet the parents. Dinner is delicious and all is going as well as he could hope, until midway through the meal. Suddenly, to his dismay and deep embarrassment, his penis of its own accord reaches from his pants and takes hold of a baked potato on his plate and retrieves it. The dinner table conversation abruptly stops as the girlfriend’s mother stares in shock and disbelief. After an extremely uncomfortable pause, she breaks the silence with, “I say, young man, would you kindly do that again?” The suitor, caught even more off guard, replies, “I would, Ma’m, but I don’t think my rectum has room for another one!”

One might argue that this joke is only tangentially medical in nature and belongs more under the category of sexual humor in which the medical aspect is only incidental. But there is no getting away from how the joke is set up. Both jokes make some reference to the commonly debated issue of whether length matters and by extension (bad pun intended), male anxiety about penis length and sexual success.

Category IV is Healers.

Some jokes make fun of the doctor. Maybe we can make the first sub-category jokes classified by specialty. Psychiatry, Gastroenterology, Urology and Gynecology are the most popular specialties for obvious reasons. You won’t hear too many hematology jokes. Although you may find oncology among the “life and death category. Psychiatry jokes sometimes fall under Category II.A, Crazy Patient, but how you draw the line depends perhaps on who is crazier, doctor or patient.

Under IV. A.1., which is Healers/Jokes-by-Specialty/Psychiatry we might find the following:
• Patient to psychiatrist, as patient frantically brushes at his clothing: Doc, you have to help me!
• Psychiatrist: What seems to be the problem?
• Patient: You have to get these spiders off me! They’re all over me all the time!
• Psychiatrist: Well, to start with, stop brushing them off on me!

Example: A psychiatrist meets another in hallway. The first says, “How am I?” The second replies, “Fine! How am I?”

Both refer in one way or another to the idea that psychiatrists all must be crazy themselves.

IV.B. might be about healers’ motivations. One of my favorites concerns a doctor’s sensitivity to his reputation in the community:

A nurse rushes into the doctor’s consulting room in alarm saying, “Dr. Jones, come quickly! Mr. Smith just dropped dead on his way out the door of the office! You just told him he was fit as a fiddle! “ The doctor responds, “Well turn him around, for God’s sake, so it looks like he was on his way in !”

Another favorite of mine is about empathy, although it might appear at first to be about good news–bad news. The patient sits down with the doctor in his consulting room to go over his lab tests that just came back.
• Doctor: I have good news and bad news.
• Patient: OK. Hit me with the bad news first.
• Doctor: It’s leukemia. You have about 6 months to live.
• Patient: “That’s really bad! What’s the good news?
• Doctor: Did you speak with my receptionist on your way in?
• Patient: Yes, why?
• Doctor: The blonde with the big boobs?
• Patient: Yes, yes. But what’s the good news?
• Doctor: I’m screwing her!

Finally there is Category V, jokes in which the medical profession is only incidental. These really only need to be categorized along the same lines as non-medical jokes.

I will conclude with an old one about the elderly man and woman who stroll into the doctor’s office and explain that they are concerned that their ability to have sex is deteriorating in their old age and want to know if there is any treatment the doctor can offer. He offers to refer them but they insist on first explaining further. Over the doctor’s protests, they persuade him to observe them having sexual relations. They proceed to have obviously vigorous and mutually satisfying sex. The doctor tells them there is nothing wrong with them, they are lucky to still be able to be physical in their marriage at their age and asks what made them think they needed to see the doctor. They inform him that they are actually not married and are cheating on their spouses, and they are saving a bundle on motels since the doctor visit is covered under Medicare.

At this point, I have hardly exhausted my supply of doctor jokes but I have probably reached the limit of the reader’s patience. Besides, this post has been in the draft stage for nearly 9 months, and the last one was about a near-death experience, so I am beginning to worry that my 8 or 9 readers will get the idea that the last one was a farewell. Now that this opus has been delivered, bad puns and non sequiturs and all, and my followers reassured, I feel I can move on the other topics. Leave ‘em laughing when you go! (per Joni Mitchell)

David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.