It being a bank holiday weekend, by tradition this column explores the lighter side of medicine. And what better topic for today than to look at the use of humour in health care?
Doctors and nurses crack jokes and tease one another, just like people in any walk of life. We use humour with patients to lighten the mood, or simply to show we are human. But before we explore humour in medicine, a joke is in order:
When a group of doctors was asked to vote on adding a new wing to their hospital, the allergists voted to scratch it while the dermatologists advised against any rash moves. The gastroenterologists had a gut feeling about it, but the neurologists thought hospital management had a lot of nerve, while the the obstetricians stated they were labouring under a misconception. The ophthalmologists considered the idea short-sighted; the pathologists shouted “over my dead body”; while the paediatricians rather crankily said “grow up!” The psychiatrists concluded the idea was madness; the surgeons decided to wash their hands of the whole affair; and the radiologists could see right through it. The general physicians thought it was a bitter pill to swallow, but the plastic surgeon said “ this puts a whole new complexion on the matter”. Unsurprisingly, the podiatrists thought it was a step forward but the urologists were concerned the scheme wouldn’t hold water. The anaesthetists thought the whole idea was a bit of gas, while the cardiologists didn’t have the heart to say no.
The casting vote fell to the proctologists, who were quite happy to leave the decision to some ass from administration.
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Enhancing relationships
Meanwhile, GP and medical educationalist Dr John Launer looked at the phenomenon of humour in healthcare, and the pros and cons of using it, in a column in the Postgraduate Medical Journal.
He notes that psychologists have identified two broad categories of humour: one is aimed at enhancing relationships with others; and the other designed to boost oneself. Each can have either a benevolent or destructive intent. “Gallows” humour has the potential to be destructive: originally named after the wisecracks that people made immediately before their execution, it is now applied to any jokes told in extreme circumstances. There is a concern that gallows humour functions as a psychological defence, used in order to distance oneself from suffering, or to trivialise it.
“The effect of humour may not always be the same on the person delivering and receiving it. It can also show insensitivity to people’s personal or cultural backgrounds. This may especially be true of non-verbal humour, such as making gestures or pulling faces,” Launer says.
But humour can clearly have positive effects on patients too. In one study carried out in primary care, patients appreciated spontaneous humour from their doctors and perceived that this occurred more often than their doctors recalled using it.
Humanising effect
Probably the most detailed examination of humour in healthcare comes from two studies carried out in critical and palliative care in Winnipeg, Canada. From nearly 300 hours of observations, the researchers found that humour served to "enable co-operation, relieve tensions, develop emotional flexibility, and to 'humanise' the healthcare experience". The two studies also included conversations with patients as well as health professionals, regarding how they felt about humour in medical settings. The authors conclude: "The value of humour resides not in its capacity to alter physical reality, but in its capacity for affective or psychological changes which enhances the humanity of the experience, for both care providers and the recipients of care."
I feel more comfortable using humour the more experience I gain in medicine. Laughing with patients at appropriate times and in a reflective way helps cement relationships and trust.
And Launer’s concluding message in his review of humour in medicine is a simple one: carry on laughing.
mhouston@irishtimes.com, muirishouston.com