We live in a hyper-partisan, hyper-sensitive, hyper-litigious society. We are also addicted to our social media. The two can be an explosive combination.

I’m not quite sure what it is about cutting people open and putting them back together that leads to sometimes bawdy conversations, but it seems to happen in every OR I’ve ever been in. For those of us who have worked in ORs for any bit of time (30+ years in my case), we’ve all seen it: the PG-13 conversation or joke that takes a turn into “R” and then rapidly devolves into “X-rated”. In recent years, I am aware of several people whose jobs have been terminated because of saying the wrong thing at the wrong time. In all of these cases, the person who lost his/her job was totally shocked days, weeks, months later to learn that someone in the OR was actually offended by the conversation because no one said anything at the time. And that’s the problem: when everyone’s going in one direction, it’s very hard to find the words and the courage to stand up and say “Guys, I’m not comfortable with this”.

In analyzing OR humor as objectively as I can, there seems to be a common pattern of how we go from PG-13 to X-rated. These conversations, like a snowball rolling down a hill, pick up momentum quickly, and everyone gets caught up in the moment without really thinking about what is being said. Taken out of context, the things that are said sound really, really bad.

Enter “Code Pineapple”, the two words that can stop that momentum, save someone’s career, and get everyone focused back on their jobs. Code Pineapple was invented by a very smart, very funny fellow anesthesiologist I work with. He combined a nearby health system’s “Code Zero” policy (you’re supposed to say “code zero” if you feel a conversation is inappropriate) with a line from the Amy Schumer movie “Train Wreck”. In that movie, in the middle of a very plain vanilla intimate moment, Amy Schumer’s partner feels compelled to blurt out “my safe word is Pineapple”. (It’s hysterical, and Amy you can thank me now for the uptick in the downloads of Trainwreck on Netflix.)

If “Code Pineapple” sounds funny, that’s the whole point. It’s so ridiculous that it makes everyone stop in their tracks, killing the momentum of the conversation, and providing a safe “off ramp” for everyone.

In closing, let me be very clear about one thing. What I am talking about is OR conversations that inadvertently go too far. I am NOT talking about targeted, intentional sexual harassment or bullying of anyone. That is an entirely different, very serious matter that should be brought up with supervisors immediately. There is NEVER a place for that in any work environment.


About the Author: Stephen Punzak, MD is a practicing Anesthesiologist as well as the CEO of One Medical Passport. He founded One Medical Passport because he has always had a vision of how healthcare could run more efficiently using technology.  He frequently writes on medical topics, workflow efficient measures and ASC industry trends.