Humor: It's good for the Doc too.
When I try to convince people that humor is important in medical care and practice, I trot out examples from the panoply of evidence that shows how humor helps people with disease, cancer, difficult treatments, and pain. The evidence is fairly clear and it's mounting. Humor is beneficial in a variety of ways when we treat individuals. Humor is restorative, regenerative, and, let's face it, enjoyable. Humor helps folks tolerate pain and stress more readily, makes people literally feel better, and improves patients’ outlooks on life and their condition. But there is another way that humor also beneficial in treatment situations.
When I began to do my research into humor in medicine, I was focused, as most people are, on how humor helps the patients. I completely overlooked another important benefit. Humor is also beneficial for those providing the treatment and care. That's right, humor helps the caregiver. From family members to physicians alike, humor makes the interactions and relationships between caregivers and patients stronger and better. And this will certainly have salutary effects on how effective the healthcare relationship is.
The problem now is that there is little evidence or research how humor helps those other than the patient. Some studies show that caregivers’ lives are improved, but these are typically in-home or family member caregivers, not staff you may see at an office or hospital. There is a good reason why the evidence is so scant. We think of physicians and medical professionals as ones who “deliver the best patient care.” In language very much inspired by business and marketing; care is patient oriented. This is not a bad thing. Who wants to go to a place where they even remotely suspect patient care is not the topmost priority? But the care professional/patient relationship involves two or more people. And like any relationship, there are ways we know that augment and diminish relationships. Humor can do both to be sure, but let’s focus on humor as an augmenting factor, especially for the physician.
How do we know that humor is helpful to the doctor as well? One way is to simply ask physicians. Before writing this post, I had just completed a talk on humor and medical care and I went to visit a local dermatologist who had a reputation for using humor to great effect with his patients, Dr. S. Tafeen. I was very interested to get a first-hand account of how he used humor in his medical practice. I wanted to understand why he chose to feature it so prominently, and then see what sorts of benefits that the humor had for his patients. I also wanted to know if there were issues that had arisen. I was clearly patient focused in my approach.
I asked Dr. Tafeen why he used humor and what caused him to really feature humor as a part of his interactions with patients. His answers were in line with the data. It helped patients to relax and be more communicative. It helped patients during procedures that were unpleasant and or painful. It also made the relationship so much better with his patients. I asked him if his humor had ever backfired. He paused, acknowledged that it had, and then told me, pointedly, that it had happened twice to his knowledge. Dr. Tafeen isn’t a new dermatologist; he’s been practicing for nearly 30 years. I then asked how he dealt with the failures. In another pointed and matter-of-fact response, he said he apologized, both with a hand-written letter and in person. The apology had the desired effect. The offended persons accepted the apology.
As Dr. Tafeen and I discussed humor more and more, I imagine he sensed my focus on patient care and he made an interesting point. He stressed that his use of humor wasn’t only about the patient. He was clear that joking with his patients helped him to enjoy and cherish the relationship he had with his patients. And with the exceedingly high levels of physician burn-out he found that humor made him want to remain treating his patients. It made him want to stick around and remain a doctor.
I cannot tell you how much I had missed this factor. Humor is as important to the doctor as it was to the patient. I might say that it was even more important in Dr. Tafeen’s case. To my narrow thinking and limited understanding of the way in which humor helps with both patients and care providers I simply never thought of how important humor is for the health care professional. It’s truly nice, and quite humbling, to have a part of the world you’re interested in opened up to you, despite your focus. We academics have been teased of our myopic approaches. Dr. Tafeen related stories of looking forward to the visits he got from patients that reciprocated his humor. People who not only enjoyed the jokes, but also shared their jokes with him and his staff. Even if he knew the basic joke or had heard it before, he dearly enjoys listening to his patients tell. While this isn’t terribly surprising, it isn’t something that one typically thinks about when one imagines the patient-physician relationship. Could you imagine an ad for a hospital where doctor humor is mentioned as a plus?
Is humor part of the patient centered care model? Not one we would typically expect, but one we should hope is there. There is plenty of evidence that humor is important in working environs. Just as with patients dealing with pain and illness, we all deal with stress in our work lives. Physicians, nurses and care staff do as well. Further, is there anything perhaps more intimate that certain relationships with our physicians. Given that I am now of an age where certain exams must occur (the wonderful prostate exam), my physician knows me in ways my spouse doesn’t. 😉 Health care professionals more often than not deal with patients who are ill, distressed, or both. In such a place where good news is less typical, certainly good humor would make those days more bearable. Looking forward to not only dealing with a patient and her ills, but also her humor would make me open that chart with a smile, rather than a groan. Humor is just as important to the patient as the physician. And I heartily thank Dr. Tafeen for opening my eyes to this part of the relationship.
The positive for researchers like me is that we now have another window for research, the effects of humor on the treating care provider, we also now have some strong anecdotal evidence how important humor is beyond the patient. Dr. Oliver Sacks once reminded medical care providers not to “look at the disease the person has, but rather the person the disease has.” I think in our understanding of humor we can also see how important it is not to see the medical provider as more than a vehicle of treatment, but also a partner in the care activity: a person who treats, not simply a deliverer of treatment. And if humor makes us do our jobs better, then medical care providers will benefit from an increase of their daily dosage of humor too.