Should you really be joking about doctors at a time like this?
#3. Punching DOwn: What is fair game to joke about in medicine? Plus a brief note about YouTube's Dr John Campbell
Newsletter number 3!
I promised you that these wouldn’t be frequent from the off, and I believe I am delivering on that promise, by not delivering. Season’s greetings! Or as those joy-hating atheists say, Merry Christmas! I sincerely do hope you are all well wherever you are in the world and enjoying whatever December means to you.
I have had not had much time to make videos lately, and while you might assume that’s pandemic-related (and there is no doubt things have been really busy for weeks now), YouTube’s taken a back seat while I’ve moved house and moved cities. Just a small town boy (now). However, I have got some a few projects nearing fruition for the new year which I’m looking forward to sharing with you.
I mention my busy-ness not as some tragic COVID flex but to segue into today’s topic. I’ve started several video scripts in the last couple of weeks. Writing has always been my favourite part of the process, so I tend to write way more than I ever film but these three were essentially complete, and yet the creative flame flickered out at the final moment. I literally had the camera set up in a room, still full of moving boxes, and then just had an unexpected and complete loss of motivation.
I found it interesting when someone pointed out that starting a lot of things but not finishing them is a hallmark of ADHD and as someone diagnosed as an old man, I hadn’t made the connection. I certainly do start a lot of things that I don’t fi
I still hope to salvage two. I’ll jettison the rest but the one that I bailed on at the 11th hour was about comedy and medicine. Two subjects close to my heart. I didn’t feel up to making a video but then I realised hey goddammit I’m a nascent dark web intellectual, I have my own substack, I can make this into an opinionated and overly long newsletter! Thank you for reading this failed video idea.
Dr John Campbell YouTube Channel.
Before we get to that, something else I haven’t made into a video (but may) is quite important so I’ll quickly mention it. You might’ve heard of Dr John Campbell, a retired (I think) British nurse who has become a very influential and popular COVID educator. I get asked to comment on his videos a lot. Early in the pandemic I had nothing to add, he was doing a sterling job calmly informing people and explaining things without layering his own interpretations nor opinions on top.
But this year I am afraid he has frequently posted incorrect information. He now has 1.8 million subscribers and gets many many millions of views, so I finally felt I ought to say something. He also has over 1700 videos on his channel so I cannot appraise nor even watch them all, but instead I chose one in my wheelhouse as an example of the kinds of errors he makes. As I say in the twitter thread, I believe John’s intentions are good and he is not deliberately trying to mislead, but he does not critically appraise the data he presents, and as I’m sure you know, the medical literature is full of shit.
Here is a twitter thread I made about the video:
Hasan Minhaj, US comedian, posted a video yesterday which was a follow up to a bit he did on Jimmy Fallon a few months ago, where he poked fun at DOs, doctors of osteopathic medicine. That bit angered some members of the osteopathic medicine community and the latest video has wound some people up too. In keeping with a general theme on my channel, I’m actually writing this at work in the middle of the night. I get to do my on calls from home now but have to come in for primary PCI (emergency heart attack-stopping artery opening). We just finished a pretty hairy case and I could be helping my registrar with the paperwork but I told her no – my substack readers take priority. I just had to write a response to this DO controversy for three reasons:
Where stand up comedy and medicine intersect, cosmic forces draw me near
Hasan actually raised some genuinely good points in the latest video that I want to discuss and as a doctor who isn’t an MD nor a DO (the UK qualification is MBBS because we’re posh), I don’t have a horse in this race so figured I’m well placed to start this conversation and;
I keep tabs on all other brown dudes that tell jokes on stage so I get push notifications about Hasan offending DOs, updates about Aziz Ansari’s dating habits (though come to think of it maybe that feed’s been restricted as it’s gone kind of quiet), and of course daily emails about Kumail Nanjiani’s evolution into an Eternal solely via the medium of tandoori chicken and rice and nothing else whatsoever. Now I realise that sounds like I’m putting myself in the same category as those guys but I’m not – aside from saying we’re all South Asian. So to continue Hasan’s analogy, if he’s Coca Cola, I’m not even RC Cola, I’m Thums Up.
For those that don’t know, in the US – and only the US as far as I know – you can become a doctor via two parallel routes. The more conventional, well known MD doctor of medicine route, as in House MD. Or you can study osteopathic medicine and become a DO, the most famous of whom might be YouTube’s own Dr Mike, who has also made a video about the differences between MD and DO, so I won’t go into that as you should take a look, but suffice to say you end up doing the exact same job.
DOs and MDs can enter the exact same residencies, prescribe the same drugs, earn the same money, work in all 50 states of the US and so on. One difference is that most countries don’t recognise the DO qualification. In Europe, an osteopath is actually something quite different (who might typically have a clinic specialising in back pain, akin to a physiotherapist).
Indeed, every single European that I’ve told about this system had never heard of it. Jimmy Fallon had apparently not heard of it (although we all know these interviews are scripted). DOs account for 11% of practicing doctors in the US, which is a lot of doctors. They are represented in every specialty and at every level. Therefore I think the point about people not knowing about it speaks to the fact that when you go to see your doctor, it makes no difference. You probably won’t have a clue which your doctor did and it doesn’t matter.
DOs and MDs both are academic overachievers, both pass very tough exams to get in and get out (ie licensing and board certification). I learnt about DOs via making friends with doctors at conferences or online and having no inkling they went through a different training programme often until a long time after meeting them. So to reiterate, it really doesn’t make a difference down the line.
Therefore, as an outsider, it’s hard to understand why are some of them are getting so upset? A big instagram account that I follow and enjoy focused on perhaps the main criticism that has been levied at Hasan with this bit, that he’s “undermining” or “sowing division” in the medical community during a pandemic. Really? You think the anti-science, anti-doctor crowd are watching Jimmy Fallon? Is someone going listen to a joke about DOs from a stand up comedian and say “well shit I was going to get vaccinated but now that I know that some doctors do slightly better in their entrance exams than others I have decided COVID isn’t real”? Did any of them even watch the full bit, he sings the praises of the DO he went to. He says they’re great doctors. He and Jimmy signed off with “thank you and shout out to the DOs”.
I tease some of my friends that did graduate entry medicine in the UK (which is a shorter course than those of us who started at 18), or those who went to recently-opened medical schools as opposed to ones that are hundreds of years old that they’re not proper doctors. It’s patently absurd as we’re all doing the same job and they had to jump the same hurdles to get to where they are, just the way DOs and MDs do.
Perhaps I was actually sowing division.
I will always stand up for comedy, so the fact he doubled down in his follow up video is something I enjoyed. He went after their MCAT scores. The MCAT is an entry exam for medical school.
There is doubtless a contingent of MDs who think they’re a cut above DOs. Pompous pricks are an inevitable fact of life. But should a comedian not be able to use internal professional politics as material?
I’ve talked to three of the DOs that I know yesterday and they all said they thought it was funny. They know they’re good, successful doctors. In fact one is an interventional cardiologist like me but is way more talented than me and does way more complex cases. They don’t care.
I fully accept I don’t know the exact atmosphere in the US between MDs and DOs but to me I can’t see any reason to feel insecure. I looked up DO MCAT and GPA scores, they’re a little lower than MDs, but not by much and they’re both well above average. I also noted that the DOs complaining about the original bit didn’t seem to mind him taking the piss out of Caribbean medical schooling, that’s fine I guess.
We do have a similar kind of thing here, quite a lot of people go to Eastern Europe to go to medical school before coming back to work in the UK, and I think it’s fair to say those that go there didn’t get into UK medical school – which is nothing to be ashamed of. There’s so much luck involved, from what school you went to to what social background you come from.
I had a bit about Eastern European medical schools that I used to do back in university. I’d say that in the middle of these countries like Slovenia, Romania and Hungary…hardly known for their welcoming attitudes to ethnic diversity, you find these concentrated pockets of brown because almost everyone at these medical schools is South Asian. When a white person doesn’t get into medical school, they just think “well I guess I’ll do something else. Maybe go into politics”, but you think a brown kid can look his aunty in the eye if he’s not a doctor?!
And you can tell that bit is over a decade out of date because now South Asian kids can’t look their aunty in the eye unless they’re CEO of a tech company or a freaking astronaut.
Normal people know that how you did in an interview when you were 17 is meaningless. Getting into medical school is a lottery. Is a Harvard grad better than a Caribbean medical school grad? You can make a guess but that’s all it is, a guess. These are overlapping normal distributions, there are good and bad doctors from every type of school. Doctor Oz is an MD, need I say more?
If people google which is better, DO or MD, you’ll only find articles that say they’re about the same or that DO is better than MD, I haven’t found any saying the opposite way round.
Are DOs a marginalised community? Scraping two pennies together struggling to get by due to the discrimination they receive? As Hasan points out when he asks if you can poke fun at someone earning $200k a year with a 5 series BMW and their own private practice, these are successful, well paid overachievers.
Did surgeons or radiologists get upset when they were depicted as dumb or unhinged in Scrubs? The cardiologist on ER was a total jackass. One of the heroes of medical comedy, someone whose genius I can only aspire to achieve and whose opinions I always value, also now an internationally known legend, is Dr Glaucomflecken who is just a master at poking fun at different groups within medicine. One of the most common butts of his jokes is the cardiologist. My cardiologist friends and I love it. It’s hilarious. Our WhatsApps are always awash with his latest skewering of our profession.
At this point in writing this email, I went to visit Dr Glaucomflecken’s twitter and realised he had already addressed the DO issue and had made a video poking fun at MDs that look down at DOs. I can’t watch it as he removed it because he felt it inadvertently offended primary care doctors (GPs), although I note all the comments suggest he got the balance right and I’m sure he did. The fact he’s so thoughtful as to take down the video is a testament to how much he thinks about exactly these issues and it also makes me wonder if I’ve got this whole thing wrong but I’m this far into the email, sunk cost fallacy and all, I can’t back out now. I’ve gone against the Glauc, I’ve made my funeral and have to sleep in it. And actually maybe that’s the point, this isn’t objective, we can have differences of opinion.
Are my comparisons above invalid? Perhaps you think mocking a cardiologist is not the same as mocking a DO, because one is ‘punching down’? You’ve probably heard that expression related to comedy quite a bit recently.
Power dynamics exist. Me as a consultant making a joke at a first year doctor’s expense is more likely to be in poor taste than me as a cardiologist making fun of radiologists because the first has an unbalanced power dynamic (but seriously, those radiologists are up to no good).
I’m not saying it’s impossible for a doctor to make a joke about a nurse but it’s hard to get right and easy to sound condescending. It’s also the reason I’ve never made a joke about a patient. Some doctors do, like in best selling books like This is Going to Hurt, but it’s not for me, I would hate someone to think that doctors are making fun of patients. My targets tend to be me most commonly, or charlatans peddling quack therapies (which includes MDs, DOs and alternative practitioners – not the patients going to them), the pharmaceutical industry, hospital administrators, and of course, Americans.
I understand DOs might feel slighted because they have heard derision from MDs. That sucks, especially when you all do the same job. But surely that’s a minority? I ask this sincerely as an outsider. MDs may have achieved ever so slightly higher academically to get in but as someone who has taught students at Imperial, St George’s, UCL and Cambridge; and I’ve taught junior doctors, PAs and nurses, I can tell you that the A levels you got (for Americans, read ‘MCAT’), and the institution you went to, or the course you studied, bear effectively no relationship to how well you do your job and how well you take care of patients.
We either acknowledge that some score you got as a kid bears no relevance to your worth as a doctor or healthcare professional now, or we continue to treat the whole topic with kid gloves and perpetuate the idea that one is actually worse than the other, so should not be joked about.
But of course Hasan Minhaj is not an MD mocking a DO anyway, he’s a comedian, so can hardly be accused of the same snobbery MDs. Indeed, a nurse – normally poorly paid and overworked – with less power in the healthcare ecosystem than a doctor, might look at this whole thing and say they’ve been putting up with stereotyped media depictions and snobbery from doctors for decades.
This is just the same debate we keep having in different spheres, that some people will default to getting offended. They don’t look at the content of a joke but the topic. This joke’s about a minority group? That’s illegal. Like that time Nimesh Patel made a joke about a gay black guy and was booted off stage at Columbia, even though the joke was actually about how hard it is to be doubly discriminated against as a gay black man.
I told you, I keep tabs on all brown comics.
Why don’t we save our energy and outrage for things that really erode trust in the medical profession, like medical misinformation and MDs or DOs who bring the good reputations of both of their degrees into disrepute? I guess doctors can have sense of humour failures like anyone else. Which is ironic, because isn’t there some expression about laughter and medicine?
Right it’s 3am I better drive home.
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This is wonderfully interesting analysis- deconstructing comedy and the outrage machine the same way one might deconstruct some bad statistical analysis. Love it!