10 Questions With GiggleMed

DJ Smith / Apr 24th / Comments

GiggleMed.com material comes mostly from a two doctors who choose to use pseudonyms and one graphic artist. Their aim is bring positive aspects of humor to an increasingly stressed healthcare workforce – a sort of morale healthcare reform initiative.

DJ: How would you describe your audience?

GiggleMed: Most are in healthcare, and nearly all have Glasgow Coma Scores greater than 10.

The audience is made up of nurses, physicians, techs, pharmacists, medics, social workers, therapists – basically everyone in healthcare – and we’re all pretty stressed. We are being hit from a whole host of angles and most of them are outside of our direct control.

You know, it’s stressful enough when you’re responsible for someone else’s life, someone else’s wellbeing. Now add time constraints, being inundated with forms, hyper-analysis of our documentation, the threat of litigation, administrative bean-counter metrics, hard economic times, etc. Oh, and we also have to know our profession – the medicine, the procedures, the processes, the protocols. Across the board we are spending more time with paper and computers than we are with people. And that wears on us. It wears us down. Mostly because it is not why most of us are here. We’re here to help people.

Now add to this environment the fact that healthcare is highly specialized. And like other professions (law, architecture, engineering, sales, internet marketing, drug cartels, prostitution, etc.), it has its own language. We don’t call it “itching,” we call it “pruritis.” Whenever a group has their own language, there can be a unique humor that surrounds that language.

So to finally answer your question, the GiggleMed audience includes anyone within the Global Healthcare-Industrial Complex who feels stressed, or just wants to smile, or both.

DJ: Where did the idea for GiggleMed come from?

GiggleMed: It all started when that bed pan fell on my head…

Actually, the idea for Chart Farts® came first. While preparing for an ultra-stressful, in-your-face, grill you kind of presentation, I came across a medical malapropism or charting blooper. Another resident wrote in the patient’s chart “non-verbal, non-communicative, and offers no complaints.” Of course, I thought that wording was hilarious. I pointed it out to a few nurses and another resident, but then I moved on, preparing for the stress of my presentation.

Well, I’m not sure what came over me, but I added it to the end of my slide presentation. I added it at the very, very end… after a blank slide, just in case I wimped out and decided not to use it. Picture this… there I was… a nervous medical resident, about to give my first presentation at a critical care morning report conference. All of my peers were there – interns, residents, and medical students – scary in its own right. But also, the Chief of Medicine, the residency Program Director, the Director of the CCU, the Chief of Pulmonary Medicine, and several other supervising medical physicians were there. You can imagine that it would take some cajones to actually go through with showing that slide.

Well, I gave my presentation. I waded through some rolling of the eyes. I fielded some tough questions that interrupted my presentation and, overall, I was handling myself pretty well. So as I fearfully approached the end of my talk, the part where residents get ripped new orifices, I decided, “I’m gonna get ripped if I don’t show the slide, so who cares if I get ripped apart showing it.” (No resident feels good while another resident is being completely humiliated, so I could at least lessen the blow for the onlookers with a little humor.)

So I showed it and I put it up there right before the questions would begin. And guess what? Not one question. Not one new orifice. Instead, a bunch of deep belly laughs. So I tried it with the next presentation a few weeks later and got the same thing. No questions, tons of compliments, and lots of smiles.

I was onto something and I actively looked for these things. I called that first slide “Medical Terminology 101.” Soon people all over the hospital were sending me these bloopers. I was amazed at the number of these things. I posted them on a Web site that I made for the department. At that time I continued to call it “Medical Terminology 101.” It was a big hit.

One night, right after passing 150 malapropisms on the list, it came to me – “chart farts.” I jumped out of bed at 2:47 a.m., and I mean jumped, and I bolted to my computer and registered ChartFarts.com. ChartFarts.com skyrocketed to the point where there are thousands of original medical malapropisms. I officially trademarked the phrase Chart Farts®, because the word “malapropism” doesn’t imply humor. In fact, I thought, “chart farts” should completely replace the term “malapropism.” No other phrase really captures the way these things interrupt and punctuate the reading of a professional document.

Well, when I decided to start making related products – medical humor-related shirts, mugs, books, stickers, etc. – I realized that “farts” is no name for a site that caters to health professionals, at least not the mature ones. So I came up with a list of about 40 possible names and emerged with GiggleMed. GiggleMed.com, LLC was formed in 2006.

DJ: On your Web site you tell the story of offending a representative of The Joint Commission with a T-shirt you were wearing. Have you had problems with anyone else?

GiggleMed: So far, no one else…

Now, I must say that one Joint Commissioner does not necessarily represent the feelings of everyone at the Joint Commission. Besides, the shirt only said, “Joint Commission Came & All I Got Was This Lousy T-Shirt.” If you’re offended by that, you should probably be scheduled for sphincter manometry and be given a prescription for Chill Pills BID.

Aside from that one Commissioner, no one else has been offended or upset enough to complain. I think we have a pretty good rule to curb the middle school instincts in our humor. Basically, anything more crude or offensive than “fart” is first passed through the “Wife test.” If our wives (also physicians, but with higher standards) get upset, we don’t post it. And if either of us ends up sleeping on the couch because of it, we remove it from our “idea folder.”

There has been a very rare naysayer or non-believer in the originality of the Chart Farts. In general, they don’t realize how ubiquitous these things are. One person accused me of regurgitating old malapropisms from other sources, but the fact is some of these things repeat. The more common repeats are “chicken pops,” “grand mama seizures,” “Eurosepsis,” “very close veins,” and “fireballs in the uterus.” These are common enough that I’ll probably hear or see at least two of these in the next week.

DJ: It has been said that laughter is the best medicine. Do you think that healthcare is afraid of humor?

GiggleMed: Afraid of humor? No. Afraid of lawsuits? Yes.

Just like there used to be good humors and bad humors, now there is appropriate humor and inappropriate humor. Everything has its place and its time. And everything has its function, too. It’s not enough to say that it should not be harmful. Actually, it should also be beneficial when it occurs in the workplace, especially a workplace where there are people who do not feel well or may have received some bad news.

Inappropriate humor should be feared. There are certain humor red flags that should be avoided in healthcare, for sure. Jokes and mockery that are directed at an individual is one such example. Others include humor that is perceived to be politically charged, sexist, racist, or culturally insensitive. Not only could it be offensive, but it could become a problem for the one using the “humor” and the institution that employs that person. There could be professional and legal implications. And it doesn’t matter what you think of it; what matters is how it is perceived.

Now, that being said, every group begins to develop a culture if they are exposed to each other over time. In the management and administrative world, a lot is made of culture, and we wholeheartedly agree. If you’ve worked in a high-stress, look-over-your-shoulder, or backstabbing atmosphere, you know the downside to a negative culture.

Instead of just trying to avoid a negative culture, you can actually create a positive culture at your workplace. Some of it is top-down, like encouraging feedback and constructive criticism, or rewards and acknowledgement for good contributions, etc. Some of it can be top-down or vice versa, and one component is using humor appropriately.

We use humor in our workplace in a very directed way to drive a positive culture. The patient satisfaction and staff satisfaction rates are through the roof at our workplace. And people come right out and describe it as “both professional and fun,” even patients. When is the last time you heard a patient describe their experience in a hospital as “fun”? Let me re-phrase that – when is the last time you heard a patient with a negative urine tox screen describe their hospital experience as “fun”?

DJ: Your Chart Farts are quite funny and beg the question, what were these
physicians thinking?

GiggleMed: Need… sleep… Must finish… dictation…

Actually, Chart Farts are not limited to doctors. Doctors, nurses, transcriptionists, and patients are by far the largest contributors. There are a few other groups that sporadically contribute – such as respiratory therapists, medical secretaries, techs, and EMTs. There are even some from news media.

Chart Farts have several contributing factors that bear mentioning. Accents, poor penmanship, lack of knowledge, lack of experience, interruptions, and being too busy or spread too thin are the biggies. An example might be when a doctor with a thick accent is dictating and a transcriptionist that is unfamiliar with the procedure or diagnosis is transcribing what was said. The doctor says, “patent foramen ovale,” and it is transcribed as “a plate, a frame, and a valley.”

Sometimes it is lack of knowledge or experience when a new nurse or intern has to document something they are unfamiliar with. Their supervisor says, go get a Foley catheter and they document that a “Folate catheter” was inserted.

Interruptions are huge, actually. Questions, pagers, phones, machine alarms, etc. You’re cruising along in one train of thought and up walks another healthcare worker to ask you a question. You answer the question, but try to get back to what you’re doing, and BAM! You write something related to the conversation you just had.

There are times, even, when a transcriptionist’s macros cause the problem. “Dr. Rao” becomes “Dr. Right Anterior Oblique.”

My favorites come from the triage person in the ER writing down the patient’s own words. Either one of them could screw it up – put them together and it’s exponential.

DJ: Do people ever accuse you of trivializing healthcare?

GiggleMed: So far, not that we’re aware of. If someone does, we’ll probably just trivialize their accusation.

DJ: Do you think using humor (such as in your post about the C.diff sticker),
can change people’s behavior?

GiggleMed: Absolutely. With Chart Farts, I get people coming up to me regularly saying, “Whoa! I almost put a chart fart down today,” or “Those things are hilarious, ever since you’ve been sending them through e-mail I’ve noticed 3 or 4 times a day where I almost write one. It’s amazing.”

One physician I know tells all of the new interns on orientation, “Write this down. This is important. Your single-most important goal on this rotation … Are you writing this down? Your single-most important goal is to avoid saying or writing anything so stupid that I will submit it to ChartFarts.com.” Of course, he chuckles and it’s a joke, but he agrees that there is value in exposure to malapropisms. They’re embarrassing if you write one, but it’s a good embarrassing, unlike the orifice-ripping I alluded to in Question #1.

Now in the example you’re talking about, with the C. diff sticker, I wrote a post on the GiggleMed.com blog after my friend and colleague (the other GiggleMed doc) took a picture of someone’s morning coffee on an isolation cart. I thought, we tell people day in and day out about food and drinks at the nurse’s station and there are Joint Commission recommendations and regulations regarding it, there are hospital policies, there’s even disciplinary action but, frankly, these things are not working.

Instead, what if we put a GiggleMed sticker on there saying, “What’s a Little C. Diff Shared Among Friends?” with a small, somewhat serious warning under it? What if we put one of those on that drink? I bet you’d see more of a change than you do with all of that other stuff. Plus, no one will attribute the reprimand to their supervisor being a jerk or the policy being stupid. Your drink on the isolation cart is the problem, not your supervisor, not the Joint Commission, and not the policy. But let’s say it in a good, funny way.

DJ: Do you believe more healthcare professionals should follow your lead and
interject humor when helping patients?

GiggleMed: Like I mentioned before, there is a time, a place, and a purpose for humor. Not everyone is skilled at recognizing those times, places, or purposes. And not everyone is skilled at delivery, either.

Should everyone do it? Probably not.

But if there are healthcare professionals out there that have a good sense of appropriateness for humor, then yes, they should. Doing so could make an uncomfortable patient a little more comfortable. It could take a scared family member and let them know that everything is going to be all right. It could make a stressed out nurse smile, or a busy secretary laugh, etc. It can make this complex healthcare web a little more bearable for everyone.

DJ: What do you hope to accomplish through GiggleMed?

GiggleMed: World domination, of course, but we’d both settle for early retirement.

Our goals are several. Our tagline or slogan says, medicine is fun again. Healthcare used to be an admirable profession. It used to be enjoyable and immensely rewarding. It used to be that having a patient say, “You know what? You saved my life,” or “If it weren’t for you, I don’t know if I could’ve made it through that,” or a family member says, “Even though we lost Mom, I think she couldn’t have had a better nurse or better care than the care you gave her.” It used to be that these things were our fuel.

Now, though, we are looking at Patient Satisfaction survey numbers and where our institution ranks nationally. Where’s the humanity in that? It’s a stat, a marketing ploy. The question becomes, “How can we get a 10 out of 10 in this metric?” instead of “How can we make this the best experience possible for Mrs. Jones?”

Well, we want to restore that. It’s not all about humor. Humor is one component of our humanity. We want to make medicine fun again so that the right people are entering these honored professions, so that the ones we have don’t burn out, and so that we can make the healthcare experience better for everyone. If we make medicine fun again for the broad spectrum of healthcare workers out there, a cultural transformation will occur in healthcare that must not be neglected with all of these plans for healthcare reform.

DJ: What does the future hold for Dun Tzu and GiggleMed?

GiggleMed: Well, as you know, we use pseudonyms, and “Dun Tzu” is one of them. Dun Tzu is our subliminal attempt at discouraging malpractice lawsuits (Don’t Sue). In addition to Dun Tzu, we also have “Tony Below-Knee” which is a puppet with a South Philly Rocky type voice. His name comes from a Chart Fart where someone wrote, “Baloney amputation” (below-knee amputation). Also, it helps that the South Philly voice is really the only one I have any talent for.

Be on the lookout for several new forms of media for our humor -iPhone apps, musical parody, videos, video games, and more books. We do offer themed Chart Farts in fortune cookies for large gatherings, but we haven’t really started advertising that yet.

We are also exploring the behavior issues we discussed in Question #7 with plans for supplementing healthcare educational materials with humor. And there’s possibly a contest coming up. More on that later.

Bonus Question:

DJ: If you could change one thing about healthcare what would you change?

GiggleMed: Here’s ONE thing… One list of things I would (or would not) change about healthcare:

1. Get the word “healthcare” recognized by spell checkers throughout the world.

2. Eliminate the middleman – that’s you, Insurance Boy.

3. Launch a return to eponyms. They just sound cool, plus, they make me look smart.

4. Make all physicians and nurses who order or administer a medication or procedure first try it – in a hospital gown.

5. Disassemble all hospitals’ Forms Committees.

6. Hire ugly drug reps.

7. Eliminate “just wanna let you know” from nursing vocabulary.

8. Mandate penmanship classes for all physicians.

9. Institute a smoking ban for all respiratory therapists.

10. Form a large oversight committee that could randomly show up and inspect the Joint Commission offices, protocols, and processes. And maybe another task force to provide oversight for that committee.

11. Put public service ads about prostate health on all public urinals.

12. Formally institute a Code Brown Rapid Response team for the comfort of our patients, their guests, and anyone else within nose-shot of the nurse’s station.

13. Start a nursing reality show about what exactly happens when nurses are “on break.”

14. Replace patient call bells with Twitter accounts.

15. Change the name of Go-Lytely to Go-Profusely.

DJ: I would like to offer a special thanks to GiggleMed for taking the time to answer our 10 questions. It has been an absolute pleasure getting to know Dun Tzu. I’m sure our readers will agree that healthcare can be fun again. If you would like to learn more about GiggleMed you may visit their sites which include:

http://GiggleMed.com (blog/home)
http://twitter.com/GiggleMed (Follow GiggleMed on Twitter)
http://ChartFarts.com (medical malapropisms)
http://JCAHOfun.com (Joint Commission humor)
http://cafepress.com/gigglemed (funny medical humor gift store)

If you or someone you know would like to be interviewed for The Pulses’ “10 Questions With…” please e-mail dj@talstone.com with a brief explanation as to why you or someone else should be interviewed along with contact information. You can also follow DJ at http://twitter.com/TalstoneDJ. Until next time – keep your pulse strong.