Survival of the Wittiest? Humor in the Clinical Setting

Some say laughter is the best medicine. In fact, humor has been shown to improve countless health metrics ranging from physiologic improvements in blood pressure and the immune system to psychologic improvements in trust and confidence. It's all supported by research and myriad real-world examples. In health care, we see humor used by patients and health providers alike. But is that punchline all it's cracked up to be?

The Potential Benefits

Let's be fair: discussing concepts of humor might not seem applicable to clinical practice. However, humor is pervasive and offers opportunities to connect with people in a meaningful way. We've all had experiences joking around with patients or employees and other health providers. A jovial repartee is easy when we share experiences. Think of how easy it is to joke with old college friends. What's key is having the ability to perceive a concept from another's perspective.

A crucial ability for the emerging physician, these soft skills in communication can become fundamental tools in providing patient-centered care. So, how does this all work? The successful jokester must first have an appreciation of "social competence" or norms about the world and current circumstance. In referencing these norms, humor is accomplished, as Peter McGraw, director of Humor Research Labs (HuRL) at the University of Colorado Boulder, explains, when people make "benign violations": when the context of a situation isn't so mundane that it's expected, but also isn't so aggressive as to incite negative or conflicting emotions. Recognizing that sweet spot requires a situational awareness of not only the context of the joke, but also the receiving audience.

When humor is used in an office setting, the doctor is tapping into the context of shared perception whereby a person can find a comment funny and validate their understanding of the topic. As we know, the ability of a provider to understand and share feelings with their patient is known as empathy. And when patients feel as though their provider can relate to them or their situation, it can facilitate a boon to outcomes.

As patient education is a current hot topic, it's suitable to investigate opportunities to improve communication and ways that might improve compliance. When everyone on the team can collaborate and is on the same page, the patient reaps the benefit. In fact, a 2016 article explains that empathy can contribute to patient and physician satisfaction, as well as enhance the effects of therapy.¹

So, should we turn a phrase, throw in a pun or otherwise joke with patients; or might this seem unprofessional or even inappropriate? Authors who investigate humanities and social sciences, such as Hardy (2019),² have commented that the respectful use of banter may be appropriate. When engaging with clinical sympathy, humor can drive attitudes in a positive direction and foster doctor-patient relationships.

The Potential Pitfalls

There is, however, a line. We've all experienced the person who uses humor to deflect their feelings about chronic pain, lack of understanding from other health providers, or dire comorbidities. In a 2011 report, Katie Watson explored this concept of "gallows humor," or humor that makes light of concerning or worrisome contexts.³ In the report, Watson points out that jokes about a patient or condition invites the ethical question: "When is joking a form of abuse – of a patient, of trust or of power?"

While we see humor being used as a coping or defense mechanism that allows us to deal with our fears and concerns, engaging in these sensitive topics may be risky. This risk may be further multiplied when working with patients, as it puts us into contact with their defense mechanisms as well. How are they dealing with symptoms? What are their coping mechanisms? Which attitudes are they choosing to display?

Being unfamiliar with these approaches may weaken the provider's ability to be empathetic. With patients, Hardy adds that "unreflective use of humor can lead to patterns of disrespect, and by extension lower levels of care."

What to Do...?

Fear not! Deprecating and commiserating scenarios that lead to patient laughter has potential benefit. Watson concludes that context plays a vital role in the ethical appropriateness of gallows humor. As it has the potential to harm them, a joke directed at a patient or condition directly toward them or at their expense is decidedly wrong. However, lightening the mood with innocuous observations, or similar, that avoid offense, likely has a powerful benefit.

Oczkowski (2015)⁴ concludes that humor, when not made at the expense of others, can elevate morale and create solidarity. Doctors needn't create formal stand-up routines or engage in slapstick clowning-around. Being accepting of a person's concerns, whatever the approach, is a great start.

References

1. Rm M. Empathy for patient centeredness and patient empowerment. J Gen Pract, 2016;4(1).
2. Hardy C. Humor and sympathy in medical practice. Med, Health Care & Philos, 2019 Oct 21 (epub ahead of print).
3. Watson K. Gallows humor in medicine. Hastings Center Report, 2011;41(5):37-45.
4. Oczkowski S. Virtuous laughter: we should teach medical learners the art of humor. Critical Care, 2015;19(1).