Humor as Used in the Doctor-Patient Relationship: Constructive and Destructive

As a followup on my previous post presenting doctor jokes and their meanings, I would like to extend the thread to an excellent paper titled “Humor in the Physician-Patient Encounter” by Jeffrey T. Berger, MD; Jack Coulehan, MD, MPH; Catherine Belling, PhD published in the Archives of Internal Medicine 164: 825-830:April 26,2004. The therapeutic but also the possible negative effects of humor in doctor-patient relationships is discussed. Empathetic humor is advised: “Humor in medicine, however, may also be grounded on a recognition of the human condition that is shared by patient and provider. Such humor relies on empathy and compassion rather than on irony and avoidance. It embraces rather than excludes.” Examples of constructive but also destructive humor to the relationship by both the physician but also by the patient is presented. An excerpt of a concluding guideline to humor in clinical practice follows:

Useful parameters for humor in the therapeutic relationship include the following:

• The physician should be assiduously
conservative in selecting the
content and manner of humor, because
patients are often intrinsically
power disadvantaged and may feel too
inhibited to express their disapproval.
Encounters based on empathy,
respect, and authenticity diminish
the perception of power imbalance
and facilitate a deliberative model of
the physician-patient relationship.
While humor may assist in this process,
poorly selected quips or comments
may also distance the physician
and serve as a barrier.
• Gently self-deprecating humoror
externally focused humor(eg,
weather or parking) carries the least
risk, in terms of miscommunication,
especially when the physician’s
relationship with the patient is
not well developed. In such situations,
a joking comment humanizes
the physician and is unlikely to offend
the patient.
• To minimize the impression
of flippancy, the physician should not
rely exclusively on humor as a mode
of communication during a physician-
patient encounter.
• Physician-generated humor
should be grounded in empathy; ie,
the physician should have a relatively
accurate understanding of the
patient’s values, limits, predispositions,
and receptivity.
• The physician should be
receptive and respond in kind to
the patient’s attempts at constructive
humor.
• To clarify the patient’s
meaning and to help resolve anger,
confusion, or other barriers to trust
and continued communication, the
physician should directly confront
inappropriate or destructive
patient-generated humor.

I hope you all have a chance to read the entire article. I can tell you that I am going to make this article reading and discussion fodder for my first and second year medical students as they learn how to relate to patients. Where I teach, humor, as an element of patient interaction, has not been a point of discussion for these student groups in the past. Do any of the physician visitors to my blog recall this topic in early medical school teaching? Also how do you use humor in your practice? ..Maurice.

Note: Thanks to primary author Jeffrey Berger, M.D. for making me aware of the article and permitting this posting.