By Franz Wiesbauer, MD, MPH - 9th Sep 2018 - The Medmastery show

Why doctors need a funny bone

Photo by Lidya Nada on Unsplash

Humor in medicine: is it really that important?

In 1884, a bizarre account was published in the Philadelphia Medical News. In a letter to the journal, Dr. Egerton Yorrick Davis, a retired US Army surgeon, details a situation where he caught a man in bed with one of his maids. He explains that the man was locked to the maid; an awkward case of vaginismus, which led to what Dr. Davis called, penis captivus. He then described how he used chloroform to get the maid to fall asleep and release the spasm. Such was the rarity of the case, that it pops up from time to time in medical publications to this day.

This wasn’t Dr. Davis’ only fascinating encounter with medical oddity. Over many years, he also submitted letters to journals describing unusual cures for ectopic pregnancy (apply electricity to bring the embryo into the uterus), hysteria (a shock of electricity to the throat), and descriptions of bizarre reproductive rituals that he’d observed around the world.

Of course, these rare cases would have been extremely informative had any of them actually been true. As it turned out, Dr. Davis wasn’t even a real person. He was the alter ego of Dr. William Osler, the man who built Johns Hopkins Medical School.

If you’re wondering why one of the greatest minds of modern medicine would submit fabricated (and downright ludicrous) case studies to prestigious medical journals, then it might help to recognize that Dr. Osler was an A-class prankster. He was known for his practical jokes and pranks on fellow physicians, much to the amusement of his exasperated colleagues. Osler delighted in living on the lighter side of life, not in spite of, but rather due to, his desire to serve and advance the medical profession.

In his view, medicine may be a sombre profession but to practise it well, a physician had to be in touch with her less serious side.

Hilarity and good humour, a breezy cheerfulness, a nature ‘sloping toward the southern side’, as Lowell has it, help enormously both in the study and in the practice of medicine. To many of a sombre and sour disposition it is hard to maintain good spirits amid the trials and tribulations of the day, and yet it is an unpardonable mistake to go about among patients with a long face.—William Osler

This was the same man who (purportedly) took a urine specimen from a diabetic patient and passed it around one of his medical lectures, after dipping his finger inside and tasting it. Each student followed his example, expressing their disgust in turn, until it had been passed around the entire lecture hall. Asked to describe their observations, they all agreed that the urine was very sweet. Osler, who had intended to test his student’s power of observation, cheekily replied—perhaps; but if you’d really been observant you would have noticed that I placed my middle finger in the urine but the index finger in my mouth.

Osler did not hesitate to bring hilarity to any situation that would benefit from it. As physicians, we may find it difficult to do the same in our own professional lives. Either we feel that the profession deserves to be treated with more reverence, we fear losing credibility, or quite simply, we don’t see the value in bringing humor into the workplace.

But Osler was onto something. Studies have shown that doctors who display a sense of humor with patients are less likely to be slapped with malpractice claims and are able to better relate to their patients. Humor is the easiest way to make someone laugh and making someone laugh is the easiest way to get them to like you (most of the time).

Laughter is a universal language. We may not all laugh at the same things but we all laugh. In fact, it’s one of the oldest ways of communicating. Examples of jokes have been found in ancient Egyptian and Roman literature (though admittedly, we probably wouldn’t find them funny today) and reflect a universal human experience: laughter helps us connect with each other.

As a doctor interacting with thousands of patients every year, finding a simple way to build rapport with each patient isn’t easy. So how do you shortcut the process? You guessed it. Make them laugh.

Building your funny bone

If you’re not naturally funny, building a sense of humor can seem impossible. But it doesn’t have to be. You don’t need to be a stand-up comedian to be a good-humored physician. You don’t even need to be funny, if we’re being honest. You just need to be able to make your patient feel good. Often, a wide smile, kind eyes and an upbeat conversation is all you need to quickly build rapport with a new patient. Humor is just the icing on the cake.

For those of you who aren’t moonlighting at late-night comedy fests, here are some quick tips on becoming a more good-humored physician, or at the very least, making your patients smile.

Keep it G-rated

Comedians are great at politically incorrect humor. People expect it. But please don’t try this at home, docs (or more precisely, the clinic). Humor can go terribly wrong if you decide to play out of bounds. Cheerfulness and an upbeat attitude when meeting patients is often enough to bring a sense of light-heartedness to the consultation.

Laugh at yourself

Self-deprecating humor might seem counterintuitive in the context of a doctor’s office but it instantly humanizes you without necessarily detracting from your credibility. Here’s a great example from the BMJ:

A famous Egyptian poet and doctor, Ibrahim Nagi, saw in his private

clinic an obviously poor patient with complaints suggestive of

malnutrition. He thought the patient was more hungry than sick. He

refunded the fees, gave the patient some extra money, advised him to buy

some chicken or meat to cook and have a good meal which should make him

feel better. Two months later they saw one another by chance. The doctor

asked: “How are you feeling now”? The patient said: “Great and fighting

fit thanks to you doctor.” “What did you do then?”-—asked the doctor. The

patient said: “With your money and mine I could afford the fees so I went

and saw a really good doctor.”

Admit it. You laughed.

Sharpen your wit

George Bernard Shaw is a famed writer yet he used to have the wit of a pebble stone. He wasn’t born with it but he managed to build it anyway. We can’t all be Kevin Hart but we can all learn how to see the humor in mundane situations. It is literally a case of training your wit muscle. Watch more comedians on Youtube, read more joke books, and practise writing funny captions for intriguing images. It’s not rocket science but it can help you gain a more light-hearted perspective of the world, which will naturally filter through when you see patients.

Pencil smiles

You’ve had a long day and the last thing you want to do is see another patient. I get it.  But they’re coming anyway and if you’re struggling to be cheerful, try the pencil smile. It’s very simple: stick a pencil between your teeth and force yourself to smile (not in front of a patient, obviously). Your brain can’t distinguish a fake smile from a genuine one so you’re likely to feel good enough after doing this, that smiling for your next patient won’t seem so impossible.   

Remember, the whole point of this exercise is to create instant rapport with your patient. The most important tip of all is to remember to just smile. If you’ve had a bad day, your patient doesn’t need to know about it. In the age of online medical ratings and doctor approval scores, sometimes you only get one shot to make an impact on a new patient.

Don’t waste it.