Duties and responsibilities
When joking isn’t funny
An article for physicians by physicians
Originally published Spring 1999 / Revised May 2008
Respect and observation of professional boundaries allows you to express concerns about patient care without fear of reprisal.
Of interest to all physicians
Physicians and staff members who work closely together, especially in a high intensity area such as the emergency department or the ICU, often laugh and joke together. While this is often useful in alleviating some of the stress of the high intensity work, it can sometimes lead to a blurring of the professional boundaries. That, in turn, can leave a physician vulnerable to criticism for other reasons.
Consider this case:
An emergency physician was accustomed to laughing and joking in a risqué fashion with the nurses and the other physicians. Working in close quarters, he made accidental but intimate contact with one of the nurses and made a jocular comment. At a later time, he was displeased with the nurse's professional performance, and criticized her quite sharply. The nurse subsequently filed a complaint with the hospital administration alleging sexual harassment. The specific incident was referred to in detail, and alleged to be part of a continuing pattern of inappropriate jokes and comments. The physician did not deny the jokes and comments, but stated that they were a part of everyday life in the department and that every member of the department, male and female, physician and nurse, participated. Although the physician apologized to the nurse, a formal investigation was held and the physician was advised of the hospital administration's concerns about his conduct. Concerns were also expressed regarding the atmosphere of sexual joking within the department.
One lesson that may be learned from this is that careful observation of boundaries will make it possible to express legitimate concerns about patient care without fear of a reprisal in the form of an accusation of boundary violations. An atmosphere of mutual respect will enhance inter-professional cooperation in patient care.