I suggest, if you don't want to say something directly to him, when you leave the practice, you send a letter to him, with a copy to the practice overseer(who this is depends, a hospital ceo or a financial officer or office manager there) --or without a copy, just to him-- to tell him how you felt, from the start of liking the humor to the point of it feeling inappropriate/dismissive. He may not have a clue, and he might even benefit from the feedback. (I did this once after a dentist humiliated my then 12yo son....and the response was much more (in a good way) than I had expected) We are all human, and can only try---he probably has the same effect on others----and the initial 'warmth' that then becomes dismissive may be confusing (so he will dismiss the latter and look for the former)==as a nurse, I also find many doctors do not deal well with death/illness up close, as they have been taught to Heal, not to be caregivers in the basic sense of the word...