Three days before I took my Hippocratic Oath, I accidentally dyed my hair purple. In the morning, I desperately searched for help and miraculously found a hair stylist who worked on a Monday. She was very kind. “We can fix it,” she said. “It will be fine!”
I let her comb out my hair, trusting that a professional would make it better. Somehow it came out even more purple. “I love it! Thank you so much,” I lied. (Why is it that I can never be honest with a hair stylist?)
I went home, frantic, and washed my hair several times. No dice. I covered my hair in baby powder. I have no idea why I thought that would work. I ran out of ideas. Then I ran out of time.
The next day, I walked across a large stage and recited the sacred words of medicine. With purple hair. Like a clown. Like a clown whose hair was screaming, “I am not serious enough to be a medical doctor.” Not what I had intended.
Looking back, I can see an excellent example of my dichotomous experience in medicine: intensely serious moments interspersed with comedic interludes. Melpomene and Talia, the tragic and comedic faces of drama.
Humour has an important place in medicine. It is a proven balm for patient experience, it improves our relationships with patients and is a resource for medical practitioners.
Research shows that humour has value for patients. Bessel Van Der Kolk has written extensively on treating trauma and PTSD with various therapies including theater and expressive arts. There is preliminary evidence that humour classes can improve state-and-trait cheerfulness in people who have been diagnosed with depression. A Stanford Psychophysiology Laboratory study showed that, when faced with stressful imagery, humour is a more effective coping mechanism than solemnity.
Humour has been a powerful coping tool for Zane Oak, a queer transmasculine comedian in Victoria, B.C. He says that comedy has helped him in his therapeutic journey. His career started while he was in medical treatment for mental health challenges, seeing a psychologist. “My therapist told me I should be a stand up,” he says. “We were always talking and laughing through sessions.”
He remembers enjoying acting as a child but when puberty hit, he was faced with a host of challenges. He has found that he has been able to heal through comedy and therapy together. “You can see the upside of growth through comedy.”
He laughs as he recalls the time he had to use the women’s bathroom at an office and the key had the “W” worn off – leaving it labeled with the apt pronouncement: OMEN. “You just have to laugh, right?”
Humour improves relationships and eases interactions with patients, normalizing the hospital experience when it can otherwise seem like a trip to an alien world, complete with anal probing. Physicians’ use of humour was perceived as appropriate and positive in a study of patients with recurrent ovarian cancer.
But is humour always helpful in communication with patients?
Let’s perform a risk-benefit analysis. (Doctors live for risk-benefit analyses. Sometimes, when we go out to dinner we do a risk-benefit analysis of the restaurants we are considering. It is, perhaps, not always the best way to make every decision). So let’s talk about the risks involved in cracking jokes as a medical professional.
First up: No one should be making bigoted jokes. Racism, sexism, classism, ageism, homophobia, transphobia, religious prejudice, xenophobia and whatever other “ism” you might think of. These have no place in medicine, let alone in jokes told in that context. I know we have a long way to go, that medicine is a place where people experience discrimination at a vulnerable time, and that it happens far too frequently. I have seen it. Nobody should be tempted to make such jokes.
There are other boundaries, often different for different people. Which makes things … complicated. Early in my medical training, I was shadowing a physician seeing a newborn baby. She was trying to put anxious parents at ease and said, “I do have a very serious diagnosis for your baby – he’s far too cute for his own good!” It did not go over well. The parents faces went from afraid to confused to relieved to mad in the span of seconds. So therein lies the fear that many physicians have – the fear of offending.
And taking medical histories can be weird. How do you gracefully ask, “Please tell me details about your poop,” or “So, how did your grandmother die,” without sounding offensive or intrusive? In med school, we were stumped by how to ask people about their alcohol intake while still sounding respectful. It is a testament to the anxiety experienced by many doctors, and the deep anxiety vortex that is medical school, that during our training we debated respectful ways of asking patients about their alcohol intake. Frankly, we were stumped.
I was fortunate enough to have spent some time with psychiatrists at that point in my training and shared something I learned: The breaking down of the therapeutic relationship is inevitable at some points but is also an opportunity for reconnection and growth. The key is to notice and acknowledge it.
“Humour normalizes the hospital experience when it can otherwise seem like a trip to an alien world, complete with anal probing.”
At the time, filled with anxiety, my peers continued to discuss and try to determine the most perfect of ways to ask every single person who ever existed about alcohol consumption. But in my clinical experience, I have found the psychiatrists’ advice to be true. The doctor who made the joke about the baby who was too cute immediately knew she had said something wrong. She apologized, identified why the joke was inappropriate and reassured the parents their baby was incredibly healthy as well as very adorable. The parents moved from angry to relieved again, and everyone moved on.
For those who are still not convinced, here are some suggested safeguards: In that study about patients with recurrent ovarian cancer, patients said it was better to be humorous when a relationship was already established, to avoid making jokes when delivering bad news and that much of humour comes from personal anecdotes. Also, remember the comedic rule of “punching up” – a guideline that dictates people should only make jokes at the expense of people above them on the socioeconomic ladder, and never below.
There are some situations where comedy is not appropriate, for sure. When you’re giving a serious diagnosis is not the time to tell the story of how you fell down while shovelling your driveway that morning. But most mis-steps can be corrected. Relationships can be repaired …
The risk-benefit analysis is clear – the benefit far outweighs the risk. I don’t think that people need to take a comedy class in med school or anything but exploring cracking a joke here and there can improve patient outcomes and experiences.
So, we know humour is good for patients. But humour is also good for us. Health-care workers deal with traumatizing situations and trauma-adjacent situations a lot. Traumatic stressors risk PTSD and push people toward burnout. One study indicated humour serves as a buffer between stressors and traumatic stressors and burnout in firefighters.
And you don’t need to be a comedy expert to use humour. Zane Oak has some advice to offer those of us who aren’t born with an abundance of funny bones. “When I used to teach cartooning, I would tell people to start ‘thinking funny.’ Just notice the things around you – notice the funny situations, notice when someone laughs at something you say.”
For example, Sara Matyas, a second-year resident at the University of Manitoba, told me she asked a patient to make her wrist go “limp like a spaghetti,” which made the patient burst out laughing. Matyas had not intended it as a joke but it became something they shared, a bright point in a challenging space. We don’t need to be comedy geniuses. Sometimes you just need the capacity to laugh.
Tomorrow, just notice the humour around you. It’s in the moments when you have patients make funny faces during a neurological exam, it’s when your patient laughs at the word “spaghetti” or it’s when you proudly come off shift having just delivered your first baby and promptly bruise your face by opening a locker into it.
Humour helps patients, it helps our relationships and it helps our own well-being. So let me write you up a prescription for humour. And great news, it doesn’t require health insurance!