Penises and Professionalism

(Many details in the following narrative were omitted or altered to maintain HIPAA compliance. The writer has rotated through several departments in several regions and states. No penises were harmed in the writing of this blog.)

     Despite all of the implausible explanations that have been given in the Emergency Department, there is only 1 way to break a penis.

• No, sir, you did not slip in the shower and break your penis.
• No, sir, you did not roll out of bed with a nocturnal erection and break your penis.
• No, sir, you did not wash yourself too quickly and break your penis.

“You, sir, were having sex; your partner came down forcefully on your penis; things did not go where they were supposed to go and you broke your penis.“ That is it! That is the only way to break a penis. Why are people so ashamed to admit they injured themselves while engaging in sexual intercourse? A man would rather admit to illegal acts than admit that his partner is responsible for the painful deed. Is it because they fear being laughed at by anyone who knows the truth? 

     When a man who weighted all of 110 pounds came into the emergency department with a broken penis, I did not have to ask how he did it. I already knew. But being the good medical student that I am, I inquired about his injury. He made up an excuse about falling in the shower, but I knew that this was not the case. When I left, I shared a knowing smile with the nurse. I mean, we couldn't help it: a broken penis is funny.

     A few minutes later, the man’s partner arrived at the ED. She was crying hysterically, apologizing for breaking the man's penis. And just like that, the truth came out. The nurse’s tight-lipped smile could no longer hold back the laughter. Adding to the humor of the situation was the size of the woman, especially in comparison to the patient. To be polite: she was quite large. The man’s partner was about as wide as she was tall and several times larger than the patient was.

     The nurse and I quickly excused ourselves and met at the desk where I had been sitting, far from the patient’s room. We did not say a word. We both began horse laughing until our bellies hurt. Other ED personnel quickly inquired about our spontaneous laughter. Without pause, the nurse recounted the story of the tiny man, the “healthy” woman, and the broken penis. At that moment I stopped laughing.

      Was it wrong for her to tell other members of the ED staff about this patient?

      Was it wrong for us to be laughing about the situation at all?

    Should I have reminded everyone about the importance of professionalism at that point even though I had just finished busting a gut at this patient's expense?

     I know it would be very unprofessional and unethical for me to laugh in front of a patient about their problems. I know that ED room doors are not adequate sound barriers and I should never say anything outside of a room that I do not want the patient to hear. But what are the rules beyond that? Am I allowed to find humor in situations, even if my patients do not share that feeling? Am I allowed to discuss this experience with other ED staff? Where is the line?

     According to the 2006 article, Making Fun of Patients: Medical Students’ Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings, medical students rarely initiate cynical humor without hearing it from an authoritative figure first. The paper evaluated many aspects of cynical humor in medicine in an attempt to uncover the underlying cause of any “ethical erosion” of third year medical students. The article describes how medical students become physicians by following the lead of their superiors, and during this process some students may learn that derogatory humor toward patients is acceptable. As a solution, the article suggests that attending physicians assume personal responsibility for becoming good role models and residency program directors emphasize the importance of professional behavior to their residents. Communication and discussion is of the utmost importance.

     Although I largely agree that cynical humor and derogatory comments should be discouraged, I question the effectiveness of a work environment that is completely void of these modes of expression. In an average 80-hour workweek, time outside of work is limited. Where one may be able display a distinct “work-face” and “home-face” in a job with typical work hours, it is important to be able to express oneself naturally when work and life become intertwined. Honest expression without fear of repercussions is as important to individuality as it is to learning. It can also be an important part of the bonding process between co-workers. In a high stress environment like the ED, it is often beneficial for staff members to let off steam and lighten the mood with humor. If hospital personnel find a particular situation humorous as we did with our patient, is it inappropriate to share a laugh over the incident? 

     Looking back, I do feel that the nurse and I should have enclosed ourselves in the break room before laughing. I also feel that it was not necessary to share the man’s fate with other staff members. 

     Would it ever be appropriate to joke about this case?

     Tell me what you think and we will have some experts weigh in later in the year.

-Bruce MS4

Wear D, Aultman J, Varley JD, Zarconi J. Making Fun of Patients: Medical Students' Perceptions and Use of Derogatory and Cynical Humor in Clinical Settings. Acad Med 2006;81:454-62.