The use of humour is believed to have several positive psychological and physiological effects on health. Many doctors and patients believe it has a place in the consultation. Dr Rachel Birch, medicolegal adviser at Medical Protection, addresses this issue in more detail and presents a case where humour had unintended consequences.
In recent years it has been recognised that the use of humour may well have a positive impact on patients. In fact, in some parts of the world, “laughter therapy” is even being used as a new form of complementary treatment. Many hospitals employ clowns to cheer up patients and visitors and to try to lessen the impact of illness and being in an unfamiliar environment.
Laughter may provide clinical benefits to patients, including lowering blood pressure, reducing stress hormone production, elevating mood, reducing pain and lowering anxiety.
As humans, many of us use humour to cope with difficult situations and express our true feelings, fears and frustrations. As doctors, I am sure we can all recall busy shifts where laughter was the glue that held the team together and enabled us to cope with challenges.
Could it be that humour could help patients too? Whilst some articles report that patients would like healthcare professionals to use humour, others outline the potential risks that patients could become distressed or offended.
It is clearly something that should be judged on a case by case basis, as the following case scenario illustrates:
Dr K had been working as a part-time sessional GP for the past 6 months. Mr A came to see her in her morning duty doctor surgery. She had met him twice before, presenting with recurrent chest infections. He was a jovial man who worked as a teacher, and had previously joked that he caught his infections from the young children at the school.
He presented with breathlessness, cough and a raised temperature. Examination revealed him to have a further chest infection and Dr K explained to Mr A that he would require antibiotics. As she handed him the prescription she joked that he should perhaps wear a face mask at work so that the children couldn’t cough and splutter on him.
One week later Mr A came to see his usual GP, Dr F. His infection had resolved but he was concerned about the number of infections he was getting. He was worried he could have lung cancer as his father had died from this. He also complained about Dr K’s “light-hearted attitude” to his symptoms - he did not want to make a formal complaint but wanted Dr F to talk to Dr K about this.
Dr K arranged further investigations and fortunately Mr A did not have lung cancer. Dr K raised Mr A’s comments with Dr F, and Dr F was sorry that Mr A had interpreted that she wasn’t taking his health seriously, at a time when he was very worried.
Two weeks later Mr A came to see Dr F again in the duty doctor session, with a further chest infection. Dr F apologised for upsetting him with her comments and he accepted this, before concluding his consultation with a funny story…
As this case demonstrates, an attempt at humour can backfire if the situation is wrong. Mr A was probably already worried about underlying malignancy when he came to see Dr K. He didn’t mention it to her, but it is possible that there were cues that she could have picked up on.
If patients are stressed or angry, comments that would usually make them smile could be felt to be insulting or insensitive. Pain and feeling unwell also can have dramatic effects on patients’ judgement of and tolerance for humour.
Remember that patients may use humour to mask concerns about their health, so a joke made during a consultation may actually be a cry for help.
It is very important to be aware that what is funny to one person may not be funny to others. Cultural and religious beliefs may also come into play. The General Medical Council advises doctors to be polite and considerate to patients, to respect their dignity and not to express personal beliefs in a way that is likely to cause patients distress. It is important to any attempts at humour do not go against such advice.
In some cases, although not all, it may be easier for a GP who knows the patient well to gauge when to use humour and when to avoid it. They may be party to relevant background information, such as family members being unwell or work stresses.
The RCGP ran a workshop at their 2016 Annual Conference helping doctors to recognise aspects of their own emotions and personalities and how they can be best used for the benefit of patients. Our own personal sense of humour is an essential part of our personality. It may be that, with further self-awareness within our training, humour becomes more common as a communication tool within the consultation.
Learning points for sessional GPs
- Think first before you introduce humour into a consultation - how well do you know the patient?
- Whilst some patients may welcome humour and find it assists their communication with GPs, others may perceive that they are not being taken seriously.
- Pain and distress can affect a patient’s experience of humour.
- Patients may use humour to try to express what they are really feeling.
- Reflect on your own personality and how this can have a positive effect on your consultation style.
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.