UO > Feature > It's a Laughing Matter

Mike Moore’s sonar has picked up an alarming trend in the medical world: physicians are afraid to laugh in the office.

Yet as a professional speaker, teacher, and humorist, the Toronto-based consultant still admits to a few butterflies in his stomach when he agreed to address a medical conference whose audience consisted of 150 palliative care workers. “I was reluctant because these people deal with death and dying. And


	Fun and play contribute positively to patients’ healing, says Matt Weinstein, founder of Playfair, a consulting firm in Berkeley, California. @2006 Tom Seawell

here I’m walking in with the topic ‘Light Up with Laughter,’” he says. “But within 10 minutes, my fears and anxieties about the audience were neutralized because they were hungry for the relief and therapy that humor can give.”

Part of this squeamishness is understandable. There’s emotional safety in hiding behind a quiet medical mystique and terminology. And, many physicians are afraid they will be perceived as less competent if they’re caught playing on the job. Yet this profession has more of a rationale for having fun at work because fun and play contribute positively to patients’ healing, points out Matt Weinstein, the emperor/founder of Playfair, a consulting firm in Berkeley, California and the author of Managing to Have Fun (Fireside, 1997). For starters, laughter increases T-cell production, which fights and bolsters the immune system.

Ken Davis, MD, has practiced family medicine at Sadler Clinic in Conroe, Texas, for 26 years. He seized on the results of a study released in March 2005 by Dr. Michael Miller, the director of preventive cardiology at the University of Maryland Medical Center. The studies show that heart attack victims who watch just 30 minutes a day of videos they deem funny improve more quickly and with less medication, fewer complications, and fewer subsequent heart attacks. Davis now makes that a routine part of his discharge orders for heart attack patients.

“There is medical research that shows doctors who employ humor in the office with their patients and at the bedside get sued less often,” he says. Davis has no reason to question those findings. “It’s risk management—people feel more comfortable with you, see you as more human,” he says.

He shares the laugh with Mark Pettus, MD, a nephrologist who serves as a clinical associate professor of medicine at the University of Massachusetts Medical School and practices in Charleston, South Carolina. Pettus, too, buys into health reasons like the fact that laughing lowers cortisol levels, an excellent antidote to the “flight or fight” mode so many patients find themselves in when they are under stress. Still, he’s very cognizant of the stereotype of physicians as a picture of seriousness; office feedback a few years ago revealed that his informal style of humor left some of his staff wondering if Pettus was more interested in being a stand-up comedian than a doctor.

“I do need to be careful about being too funny, but there can be a balance,” he says.

Physicians who find that magic equilibrium stand to gain far more than they realize. “Humor is a social glue because it promotes bonding with people. And if there’s one profession that needs that sense of bonding, it’s one that deals with people in very difficult, frightening, and insecure times,” Moore says. Take the family practitioner with Providence Hospital Systems in Waco, Texas, who impressed John Christensen, the playground director (a.k.a. president) of Charthouse Learning in Minneapolis—best known as the publishers of FISH! This doctor hugs his patients, gets down on his knees to examine a child’s ear, and takes the time to explain the anatomy behind an earache.

“We’re talking about a single mother who drives 50 miles to see this doctor, and because he’s not in her health-care system, she pays cash,” Christensen says.

The foundation to perking up the mood lies in grasping what humor is—and isn’t—in a professional setting. According to Joel Goodman, the founder and director of The Humor Project in Saratoga Springs, New York, too many leaders think humor in the workplace is childish. Instead, consider it childlike, which is a very mature, adult coping mechanism.

“It’s a way of looking at life so as to reframe stressful situations into laughing matters,” Goodman explains. So, for example, Davis recently told a patient who presented with leg pains after visiting him about stomach and headaches in the previous two months. “Well, another month and this will move right out on the end of your feet and be gone,” he said to the patient. “She thought it was humorous,” the doctor says. He’s also not above cheering up a stressed out mom with rowdy, misbehaving kids by passing her a box of Kleenex while wearing the little red clown’s nose he keeps in his lab coat pocket. It’s just his way of subtly saying, “The news I’m about to give you isn’t serious in the overall scheme of things.”

Pettus cautions colleagues that physicians shouldn’t confuse humor with comedy—it’s actually rare to find someone with Patch Adams’ gift in this niche. He prefers to define humor as an expression of a positive emotional state—happiness, for short.

That explanation also blows apart the common theory that a person must be born with a sense of humor. Goodman enjoys how comedian Steve Allen once described it to him, “Certain people may be born with a genetic ceiling or a floor in regards to humor, but it’s what we do in our lives that influences whether we end up on the ceiling or the floor.” Now after working with more than 2 million people in the past 30 years, Goodman is convinced the average person can develop and improve a sense of humor.

So in the real world, humor is less about joke telling and more about storytelling. That’s why Moore cautions doctors that humor is not an add-on, or trying to yuck it up with a patient who has just been diagnosed with cancer. In his book, it’s more about learning to poke fun at your own short-comings via vignettes that apply to the moment. He would applaud Pettus’ practice of sharing his personal withdrawal troubles when cutting back on carbohydrates and Coca-Cola to patients addressing weight issues.

Finally, laughing at a patient specifically crosses the line into cruelty, as most physicians instinctively know, but don’t be afraid to use patient interactions to fuel your funny bone, either. One of Davis’ favorite chuckles to share comes from an older gentleman for whom the doctor was helping to regulate his blood pressure. Probing to see if he suffered from sexual dysfunction as a side effect of the medication, Davis couldn’t seem to get through with the tactful approach. So he finally asked the patient, “Has the medicine taken the lead out of your pencil?”

“He looked at me and said, ‘Well, you know, doc, it has. But that’s OK because I don’t have anybody to write to anyway,” Davis laughs.

Or take the clever play on words that won Goodman’s admiration: A hospital colonoscopy team posted a banner during a holiday party that read “Christmas is a good time to look up your friends.”

“Ask yourself if the humor is appropriate, timely, and tasteful. If you can answer yes to all three, then the humor will probably work for you and your patient,” Goodman says. “The more the physician is aware of who the patient is, the more likely she will be successful in determining whether to proceed.” Davis agrees. He says most of the patients he cuts up with have been in his patient record for years. With new patients, he sticks to a sunny smile and upbeat attitude until he can gauge their openness to more.

Any leader without a sense of humor is like a grass cutter at a cemetery, according to Moore: He has a lot of people under him paying absolutely no attention. So Christensen says the first step is to find your own comfort zone—and it’s as easy as answering, “Who are you being?” in Christensen’s way of thinking.

The question, of course, is the cornerstone of the popular FISH! program, which consists of four daily practices. (Christensen used to call them principles, but recently changed his language to better drive home the idea these are action steps, not thought processes.):

• Be there. Just like the pediatrician who took the time to hug his patients, recognize that the people in the exam room aren’t just your next stop on the way to somewhere else.

• Play. Sure, America latched onto the “fun hat Friday” and “macaroni Tuesday” definition of play and quickly implemented silly games to keep office auras lighthearted. But at some point, that narrow definition hits a wall, Christensen contends.

True play involves putting our innate sense of creativity to work. After all, the original FISH! practitioners—those hourly workers at the smelly fish market in Seattle—began entertaining crowds by throwing fish simply because it required 31 steps to trudge the fish from the outer display to the cash register. “They were bored,” Christensen says. “Creativity is asking ‘what if?’”

• Make their day. Don’t worry about a big production, he urges. In the medical arena, this can be as simple as a gentle touch on the arm of an elderly person, or thanking someone for coming to see you today.

Pat Curry, a resident in Watkinsville, Georgia, can’t praise Jeffrey Zweig, MD, enough. The gynecologist helped ease her post-surgical concerns by offering her homemade cookies he’d baked himself for the office. And a year later, she still has the e-mail jokes he sent her in the weeks running up to her surgery—cornball country sayings, quick one-liners. “He acknowledges that no woman on the planet wants to go to the gynecologist,” she says.

• Choose your attitude. Davis isn’t one to laugh at a funeral. But he does chuckle at the memory of arriving at the mortuary for his father’s visitation, only to be met with the burning question, “Did you bring his underwear?”

“I once heard that humor is tragedy plus time, so sometimes even when we look at some of the serious things that happen to us or our patients, we can find something to smile about later,” Davis says. Experts like Moore suggest keeping a small notebook handy to jot down a word or two of these experiences so you can rebuild the mirth at a later time.

Yet Christensen warns that even the most congenial of physicians will struggle at first to get the office personnel and nurses to play along. Consider it a trust factor—play can’t soar until it has that personal relationship launching pad. And there’s no doubt you want the staff on board next, Playfair founder Weinstein says, because their reaction radiates to patients.

He suggests building this camaraderie by announcing a program that offers a bottle of wine or a dinner certificate to the person who can tell the best story of how they dealt successfully with a challenging patient that week. “All of a sudden, your staff sees the reward in dealing with pains, and problem patients feel wanted, so they calm down,” Weinstein explains.

But don’t stop there. Deliver a rose to someone who “rose” to the occasion during a hectic day. Declare a “celebrate Norma” week in honor of the receptionist. Prepay the nurses’ lunch. Fill in for an office duty at noon so friends can eat together. Invite staff to bring in anonymous photos of their pets and see who can correctly match the most dogs and cats to their owners. And to keep the good times rolling, eventually enlist the people who work for you to form an informal “smile” committee to brainstorm ideas as well. (Just be sure to put some funds in their hands to work with, Weinstein says.)

Davis’ end of Sadler Clinic proves it works. He credits humor for keeping his nurse at his side for 22 years, his five partners for more than 20 years. Their nurses, too, have stuck around for two decades. “To be in these close quarters dealing with serious issues every day and all still love each other ...,” he trails off. And if love sounds corny, think bottom line. Turnover costs money, so keeping folks smiling saves the practice big bucks.