Case 2: Bad Jokes at a Bad Time—All the Time

“Hey Matt! What do you call a ________ who has _________?” John blurts out at the start of a case. I reply, “John, I dunno, what?” He says, “A _______.” You can fill in the blanks. On occasion, this particular surgeon took particular delight in telling racist and off-color jokes. Needless to say, a majority of the OR staff just rolled along with it because it was “Dr. M,” and that was just part of his schtick in the OR. His jokes were only about his particular ethnicity, and he believed he was somehow “entitled” to make fun of his own culture, but it got old. I was tired of it, and so were a lot of staff members, but nothing really ever changed despite our requests that he stop.

Nursing, radiology, and medical students often rotated through the OR, and finally, one morning, Dr. M told yet another racist joke. At the end of the day, the student notified her preceptor, and the next day I was asked to speak with our OR director about the formal complaint from the student. As I was not present, I did not hear the joke, but that is immaterial. Two other witnesses to the joke attested to the nature and confirmed that it was a racist joke.

I had a long-standing, positive working relationship with this physician, and I was relatively new in my role as Chair of the Professional Behavior Committee. I decided to have the one-on-one conversation. I did not know if it would work given his history of telling these types of jokes for many years. I asked Dr. M if he could have a talk with me the following day after he completed his cases. He agreed.

We met in my office, and I got right to the point.

“John,” I said, “you have been telling racist and sexist jokes for years, and I know you think it is no big deal, but it is. A student heard one of your jokes a couple of days ago and reported it. If this continues, you could lose your privileges. We have a responsibility to behave in a manner consistent with our status as physicians. You know this.”

John replied, “Yeah, Matt, I get it. I will pipe down a bit. People sure are sensitive and literally cannot take a joke anymore.”

“Thanks John.” I said. “I do have to type up a letter and have you sign it with the points of our brief conversation.”

This case was particularly simple, and the fact I had gained Dr. M’s respect and trust over several years made the conversation easy. New leaders who step into this situation do not have the luxury of time to build relationships and trust, and a cup of coffee conversation may or may not go well. Dr. M stopped telling these types of jokes, and the problem was solved.

Letter to the Attributed Physician

Dear Dr. M:

Thank you for taking the time to speak with me about your behavior in the OR and telling inappropriate jokes. You have a long track record of taking excellent care of the patients at St. Anywhere, but this behavior detracts from our mission to provide a safe environment to care for patients and offer rotations for students from many different programs. The students and staff deserve to learn and work in a respectful environment.

You have acknowledged your jokes may be offensive and have stated you will stop telling inappropriate jokes in the OR or any other location in the hospital. Please sign and acknowledge that you agree with the statements in this letter. If there is a lapse and another inappropriate joke is shared with staff or students, you will need to attend a meeting with the Professional Behavior Committee for further disposition. Again, thank you for your commitment to St. Anywhere. If you have any further questions or concerns, please do not hesitate to contact me.

Warm regards,

Matthew Mazurek, MD, MHA, CPE, FASA

Chair, Professional Behavior Committee

Chief of Staff

Excerpted from Physicians and Professional Behavior Management Strategies: A Leadership Roadmap and Guide with Case Studies by Matthew J. Mazurek, MD, MHA, CPE, FACHE, FASA.