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Tuesday Feb 24, 2015

Overcoming the Slings and Arrows: How Humor Can Save Us

The stress of medical education and -- later -- day-to-day practice can be crushing, sometimes manifesting as anxiety or depression, or both. The expectation that as time goes by, we will be required to handle more and more arduous tasks -- such as paperwork, telephone calls, etc. -- without adequate reimbursement can be extremely frustrating.

I believe that one of the most important things we can do when we feel our stress level overloading is to focus on positive memories, particularly those that made us laugh. Not only is it good to remember these moments for ourselves, but sharing them with others can be helpful, as well.

Fortunately, I have a wealth of such encounters to draw from. One in particular that I recall continues to remind me that it's important for us to be able to laugh at ourselves.

It was when I was an intern, and I had been up all night admitting patients. I was exhausted, but the day team needed the sign-out on the new patients, and it was my job to give it to them.

Mr. Smith is a 64-year-old gentleman whose wife called 911 after she was unable to arouse him," I began.

Everyone immediately burst into laughter. What had I said? I was so tired I couldn't figure out what was so funny.

"We're calling EMS for that now?" someone asked. "We're going to have a huge influx of patients to the emergency department!"

It finally dawned on me that "arouse" was not the word that I was looking for, but being so tired, I couldn't figure out what the right word should have been. After waiting for everyone to calm down, I was barely able to finish the report coherently. I was utterly embarrassed, but I still laughed the whole way home.

The second story I'll share spotlights my current practice setting, a clinic with a patient population made up exclusively of individuals with developmental disabilities. It's a challenging environment, as you might imagine, but it also can be extremely rewarding. For me, one of those rewards has been the gentle humor I've found in recognizing and celebrating the innocence of some of my patients.

Sarah is one of them.

Sarah is in her mid-50s and struggles with both intellectual disabilities and bipolar disorder, among other issues. Because of worsening incontinence related to behavioral issues, she began wearing Depends some time ago. Typically, she would become anxious when I tried to explain things to her, such as the reasons behind her symptoms and the plan to address them. (Fortunately, her supported-living staff was always there to assist.)

One day, at the end of what seemed like a particularly stressful visit for her, Sarah's countenance abruptly softened, and she developed a sweet tone.

"Dr. Jones, you're a very good doctor -- all things considered," she told me.

I wasn't quite sure what she meant by the backhanded compliment, but I said, "Thank you," anyway.

She followed that up with, "So, when are we going to get married?"

Hmm. Although flattered, I knew I needed to figure out how to answer this delicately so as not to upset her but also to not allow any hope. But despite this realization, my eventual blunt and not-too-delicate reply was, "We're not."

"OK," she said.

Phew! I dodged a bullet there, I thought, as she went on to the next topic.

"Now, Dr. Jones, you know that I like to be fancy, and I like to wear lingerie and beautiful women's underwear. Would it be OK if I wore fancy underwear over my Depends sometimes?"

I could tell that the answer to this question was far more important to her than my response to her marriage proposal had been, and I rose to the occasion.

"I think that would be just fine."

She smiled, satisfied with our unusual conversation.

It's our willingness to get to know our patients on an emotionally intimate level that gives us the chance to have memorable experiences like my interaction with Sarah. That and our ability to laugh at ourselves allow us to survive our often challenging profession. So, when you find yourself being overwhelmed by the daily grind, remember those times, and be sure to share them with others.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11.

Posted at 12:29PM Feb 24, 2015 by Kyle Jones, M.D.

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