Is This Some Kind of Joke? Understanding and Using Humor in the Clinical Setting

 

The wrong joke at the wrong time can shatter the doctor-patient relationship, but humor used wisely has health benefits and strengthens bonds in stressful situations.

Fam Pract Manag. 2020 Mar-Apr;27(2):11-15.

Author disclosures: no relevant financial affiliations disclosed.

After Veronica Valdez was sedated for finger surgery at a California hospital in 2011, her anesthesiologist, Patrick Yang, MD, placed stickers on her face so it looked like she had a mustache. Then Yang had a nursing assistant take a picture, which coworkers said they later saw on social media. Valdez also worked at the hospital and, according to the local newspaper, Yang said he thought “she would get a kick out of it.”1

Valdez did not. Instead, she sued Yang and the hospital.

There is a place for humor in health care. While laughter may not always be the best medicine, there is evidence that when used properly it has health benefits and promotes cohesion among coworkers. Sigmund Freud and other psychologists have theorized that laughter relieves inner psychological tension and is a healthy coping mechanism in stressful situations. 2,3 Subsequent research has shown that shared laughter enhances interpersonal relationships and group dynamics.4 Moreover, humor is actually good for us, physiologically. It has been associated with reduced cortisol and catecholamine levels,5 greater endorphin levels,6 and increased immune function.7 Humor can also enhance the patient-doctor relationship and reduce physician burnout.8,9

But misplaced or inappropriate humor can have serious consequences in almost any workplace. Health care, with its strict rules about professionalism and privacy, is no exception. Medical professionals might wonder the extent to which it is appropriate to joke with patients and colleagues, especially in the current sociopolitical climate. Something that makes one person laugh may be offensive to another. It may even irreparably damage a relationship or jeopardize a career.

KEY POINTS

  • Humor can be divided into four types, two of them benign (affiliative and self-enhancing humor) and two of them injurious (aggressive and self-defeating humor). Benign humor is generally better for professional settings, including medicine.

  • Affiliative humor revolves around finding common ground by laughing at shared experiences. Self-enhancing humor revolves around laughing at oneself in situations of misfortune, often as a coping mechanism.

  • Self-defeating humor (disparaging oneself to amuse others) can strengthen bonds if deployed sparingly and in the right context, but aggressive humor (disparaging others) is almost never welcome in the workplace.

How does a physician reconcile these potential upsides and downsides? With humor being so complex and dynamic, how is it safely incorporated into one's professional life while avoiding personal harm? The answer lies in understanding the various types of humor and being able to discern what actually makes individual uses of humor appropriate or inappropriate. It's a little bit like understanding how a particular medication works in order to maximize its benefits while avoiding complications or side effects.

In 2003, University of Western Ontario psychology professor Rod A. Martin and colleagues developed and

ABOUT THE AUTHORS

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Dr. Chiodo, an orthopedic surgeon, is chief of the foot and ankle division at the Brigham and Women's Hospital in Boston....

Brady Greene is a research assistant in the department of orthopedic surgery at the Brigham and Women's Hospital.

Author disclosures: no relevant financial affiliations disclosed.

References

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1. Altman L. Patient sues Torrance Memorial and doctor over operating room prank. Daily Breeze. Sept. 5, 2013. https://www.dailybreeze.com/2013/09/05/patient-sues-torrance-memorial-and-doctor-over-operating-room-prank/. Accessed Jan. 22, 2020....

2. Freud S, Strachey J. Jokes and Their Relation to the Unconscious. New York, NY: Norton; 1960.

3. Nezu AM, Nezu CM, Blissett SE. Sense of humor as a moderator of the relation between stressful events and psychological distress: a prospective analysis. J Pers Soc Psychol. 1988;54(3):520–525.

4. Kurtz LE, Algoe SB. When sharing a laugh means sharing more: testing the role of shared laughter on short-term interpersonal consequences. J Nonverbal Behav. 2017;41(1):45–65.

5. Berk LS, Tan SA, Berk D. Cortisol and catecholamine stress hormone decrease is associated with the behavior of perceptual anticipation of mirthful laughter. FASEB J. 2008;22(1):946.11.

6. Berk LS, Tan SA. [beta]-Endorphin and HGH increase are associated with both the anticipation and experience of mirthful laughter. FASEB J. 2006;204):A382.

7. Bennett MP, Zeller JM, Rosenberg L, McCann J. The effect of mirthful laughter on stress and natural killer cell activity. Altern Ther Health Med. 2003;9(2):38–45.

8. Phillips KA, Singh Ospina N, Rodriguez-Gutierrez R, et al. Humor during clinical practice: analysis of recorded clinical encounters. J Am Board Fam Med. 2018;31(2):270–278.

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10. Martin RA, Puhlik-Doris P, Larsen G, Gray J, Weir K. Individual differences in uses of humor and their relation to psychological well-being: development of the Humor Styles Questionnaire. J Res Pers. 2003;37(1):48–75.

11. McCreaddie M, Wiggins S. The purpose and function of humour in health, health care, and nursing: a narrative review. J Adv Nurs. 2008;61(6):584–595.

12. Watson K. Gallows humor in medicine. Hastings Cent Rep. 2011;41(5):37–45.

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15. Bitterly TB, Brooks AW, Schweitzer ME. Risky business: when humor increases and decreases status. J Pers Soc Psychol. 2017;112(3):431–455.

 
 

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