Critical Decisions

The ins and outs of our medical decisions

Physicians, Psychopaths and Reality T.V. Stars

Wonder how they're connected?

Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience.

I learned about Scott while reading Jon Ronson’s very entertaining book The Psychopath Test.  Scott is not one of the psychopaths Ronson interviews in his book. Instead, she is someone whose job success depended on being able to identify true psychopaths and keep them off the show.

What struck me about Scott’s story was not her talent at weeding out psychopaths, but instead her ability to cope, emotionally, with what had to be a very difficult job—one that forced her to spend eight, nine or ten hours a day talking on the phone to borderline lunatics, to screwed up narcissists who wanted to parade their misery in front of millions of people on national T.V.

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Ronson describes her coping mechanism:

At first all the tragedy she had to listen to over the phone would grind her down. But you need to be hard and focused to be a good researcher so she devised ways to detach herself from her potential interviewees’ misery.

“We started to laugh at these people,” she explained. “All day long. It was the only way we could cope. Then in the evening we would go to a bar and scream with laughter some more.”

“What kind of jokes did you make about them?” I asked her. 

“If they had a speech impediment, that would be brilliant,” she said. “We put them on loudspeaker and gathered round and laughed and laughed.”

And sure enough, Charlotte soon began to “feel removed from the person on the other end of the phone.” 

As a physician, I have seen this use of desensitizing humor. Worse than that, I’ve engaged in this kind of dark coping behavior. I write about this topic in my book, Critical Decisions, describing how physicians tell snide jokes behind patients’ backs, routine occurrences in training hospitals as interns and medical students struggle to cope with the many miseries their jobs force them to endure. That demented patient whose mouth is propped open in a vacant stare? “A positive O sign,” we joke when describing them to our colleagues.  Does the senile patient’s tongue, perhaps, protrude out of his gaping mouth? “Check out the Q sign in room 307.”

Humor is an important coping mechanism. We all eventually need to find ways to laugh about even the darkest tragedies. 

The dark side of dark humor is that it desensitizes us. In hospitals and medical clinics, such desensitization can cause us physicians to lose empathy for our patients. It can cause us to underestimate their suffering. Perhaps even more importantly, when we physicians lose the ability to appreciate our patients’ perspectives, we also become less able to help them make difficult medical choices. 

Think about that the next time you ask your doctor for medical advice or come to her for emotional support. Your physician has emotions too, sometimes very strong ones. But just as often, she has found ways to reduce the strength of her feelings, so she can get through her work day with sanity intact.  

That means that your job as a patient is to help your doctor understand where you’re coming from.  If you hope to get good guidance from your physician, you need to help her see the world through your eyes. She won’t be able to do that if you remain silent, on the other end of that stethoscope. 

And that’s no laughing matter.  

Peter Ubel, M.D., author of Critical Decisions and Free Market Madness, is a physician, behavioral scientist, and Professor of Business and Public Policy at Duke University.

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