Gallows humour in hospitals 'can help doctors and patients feel better'

Gallows humour about death and patients’ problems made by doctors and other medical professionals may be beneficial, an article has concluded.

Black humour may help them cope with terrible events and therefore improve their future performance.

Katie Watson, a U.S. medical researcher who also teaches comedy writing, decided to explore the ethics of black humour in medicine when a doctor friend told her a story in which he and some colleagues tried unsuccessfully to save a pizza delivery boy who had been shot while delivering their dinner.

Doctors, patient on gurney

Not only can gallows humour help medical professionals cope with stress, it may also benefit patients, says Prof Katie Watson, an assistant professor in medical humanities and bioethics at Northwestern University, Illinois

After finding the pizza box where the boy dropped it, one of the doctor’s colleagues made a joke: ‘How much you think we ought to tip him?’
A joke about a patient’s condition told in front of the patient is unethical because it has the potential to harm them, Miss Watson said.

But she concludes that the tip gag was not wrong.

‘To me, the butt of the joke is not the patient. It’s death,’ she writes in an article in research journal the Hastings Center Report.

Some jokes about patients' problems are clearly wrong, says the study by a U.S. university, but others are not only ethical, but beneficial too.

'Was it wrong to make a joke?' wondered Prof Watson, an assistant professor in Medical Humanities and Bioethics at Northwestern University, Illinois.

In an article commissioned by the Hastings Center, an independent New York state research body, she writes: 'It is about moral distress, power imbalances between doctors and patients, and good people making surprising choices.'

While there is a lot of literature on humour in medicine generally, particularly about the doctor-patient relationship and the health benefits of laughter, Prof Watson says there is little that addresses gallows humour.

Such humour, she says,treats serious, frightening or painful subject matter in a light or satirical way.


Hospital staff use a code to describe patients and their ailments to colleagues in often unflattering terms. Here are some examples:

GROLIES: Guardian Reader Of Low Intelligence in Ethnic Skirt

HANDBAG POSITIVE: Confused elderly woman lying on the bed but still clutching her handbag

TEETH: Tried Everything Else, Try Homoeopathy

DIGGING FOR WORMS: Varicose vein surgery

DEPARTURE LOUNGE: Geriatric ward

FREUD SQUAD: Psychiatrists

LOBNH: Lights On But Nobody Home

ASH CASH: Money paid for signing a cremation form


'The claim that being a physician is so difficult that "anything goes" misuses the concept of coping as cover for cruelty,' says Prof Watson.

'However, blanket dismissals of gallows humour as unprofessional misunderstand or undervalue the psychological, social, cognitive, and linguistic ways that joking and laughing work.

'Physicians deserve a more nuanced analysis of intent and impact in discussions of when gallows humour should be discouraged or condemned in the medical workplace.'

Prof Watson's analysis draws on literature from the humanities and social sciences on why we joke and on various uses of humour, including 'backstage humour' that serves as a bonding and coping mechanism among insiders and 'bullying jokes'.

She also observes changing standards in the backstage humour of doctors and medical students.

Clowning around with body parts, once considered a rite of passage for medical students, is now 'rarely tolerated'.

Deciding when gallows humour is acceptable, says Prof Watson says, turns on whether joking is abusive - of a patient, of trust or of power.

A joke about a patient's condition told in front of the patient or their family is unethical because it has the potential to harm them.

Not only did the pizza joke not harm anyone, she says; it may have helped the residents "integrate this terrible event and get through the shift'.
In so doing, suggests Prof Watson, the joke may also have helped the next
patient get the best possible care.


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