In an especially unsettling example of bad medical humor on Facebook, Kansas radiologist Dr. Milton Wolf recently admitted to posting several graphic images of patients. In one case, he uploaded an image of a man who had been shot in the temple as well as an X-ray that showed bullet fragments scattered throughout the man’s brain. Wolf went on to comment that the man wouldn’t be able to complain about having his X-ray taken. In another case, he posted a picture of a patient who was nearly decapitated, saying, “What kind of gun blows someone’s head off completely? I gotta get one of those.”
That and a couple other breaches of professional and human decorum on Facebook in pursuit of humor made news because Wolf is a serious contender for a U.S. Senate position. The Tea Party-aligned physician is also the author of a book titled First, Do No Harm: The President's cousin explains why his Hippocratic Oath requires him to oppose Obamacare. Wolf and Obama are second cousins once removed.
Making fun of seriously injured patients is actually the inverse of what’s scientifically proven to work well as a joke on Facebook, according to an extraordinary recent study from Dartmouth. Matt Davis with the Dartmouth Institute for Health Policy and Clinical Practice led the recent study of how humor works on Facebook. They did what they call the first study of social networking conversations pertaining to health and medicine to examine the prevalence, characteristics, and success of doctor jokes posted on the site, which was recently published in the Journal of Medical Internet Research.
The jokes they looked at were a lot more mainstream than Wolf’s, but they regularly found twinges of darkness. “Joking about doctors and health issues is probably a good way of dealing with stress,” Davis told me.
Davis and his colleagues monitored 33,326 public Facebook users for six months, keeping track of every joke posted on a wall that referenced doctors. Thirty percent of people mentioned the word doctor during that time, though only one percent made a “joke”—which they counted only if it was a canned joke. (An introduction followed by a punch line; one meant to stand alone as a humorous statement, free from context.)
The researchers measured a joke's success in terms of electronic laughs elicited as well as the total number of likes received. They operationally defined an electronic laugh as containing one of the following responses: LOL, ROTFL, or an interjection like “baha” or “haha.” For the 11 jokes in which an electronic laugh was included in the post by the joker, as in, when you write “LOL” after your own jokes—they also operationally defined anyone who posted a doctor joke during that time as a “joker”—it was not considered evidence for (or against) a joke’s success.
In approximately half of the unique doctor jokes, the joke was made at the expense of doctors and/or the healthcare system. A quarter of the jokes “relied on dirty humor,” 20 percent were puns, 14 percent pertained to popular culture and media, and 6 percent related to current events and politics. “Jokes at the expense of doctors tended to be more successful in eliciting an electronic laugh (46.5 percent vs 37.3 percent),” the researchers write, noting that the association was statistically insignificant. “In our adjusted models, jokes that were based on current events received considerably more Facebook likes.”
Jokers were more heavily represented in the Northeast, which is the region with the highest density of physicians per capita, and the South. Jokers were less likely to hold advanced degrees than non-jokers, and they were more likely to be divorced, separated, or widowed. Jokers had a median of 227 Facebook friends compared to just 132 among non-jokers.
“Scholars have worried about the declining status and authority of physicians for the past three decades or more,” Davis and colleagues write. “Although doctor jokes have been around since ancient times, joking about doctors may contribute to this decline. Other evidence suggests declining career satisfaction among physicians as a possible result of this declining status. Although it may be difficult to know if doctors think doctor jokes are funny, we do know that generally people tell jokes with the intention of amusing others and this may be accompanied by a complex range of motivations, from the expression of disagreement or dissatisfaction to an indication of endearment and friendship.”
“I absolutely got the impression that some people were posting from their hospital beds in some of our data,” Davis told me, “and their social network was trying to lighten the mood.”
When Milton Wolf recently responded to being called out for his Facebook posts—a tortuous denial of any wrongdoing that is viscerally strenuous to watch—he did let a little humanity slide out. “I’ll tell you the burden you carry when you’re a doctor and you have people who come to you and put their lives in your hands.”
Serious research from social network data isn’t errant. “There’s all this interest in identifying risky behavior, depression and suicidal tendencies [by analyzing social networking data],” Davis said. “It’s a big question mark. This is kind of just showing that it is possible. Hopefully it’s also a sign to the research community, which takes itself (ourselves) very seriously, that we can have a little bit of fun.”