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According to The Onion founder Scott Dikkers, "Comedy is meant to afflict the comfortable and comfort the afflicted."
As physicians, our patients are the "afflicted," so how can we use comedy to comfort them? Before we get to the how, let us start with the why.
Why make patients laugh? Because laughter is the best medicine. After steroids. Steroids are the best medicine. Laughter is the second-best medicine, and it has fewer side effects. Another reason is that patients often come to see us because they are in distress; something is making them uncomfortable, anxious, or worse. Being in this state can make it challenging to process and retain complex health information. One way to build rapport and make patients more receptive to new information is to make them laugh or at least chuckle or smirk. Comedy is a coping mechanism and can make the uncomfortable less so. If done well, a laugh in the exam room can make you everyone's favorite doctor.
Before we address how, we should establish a simple and immutable law of comedy in healthcare (and everywhere): never punch down, especially with patients. This is in the same vein as comforting the afflicted and afflicting the comfortable. When you are deciding what can be joked about, first establish what and who is "comfortable." Everyone appreciates authorities and institutions being humbled, which is why it is OK to afflict the comfortable. Insurance companies, healthcare systems, electronic medical records, celebrity physicians, and health influencers are some examples of the "comfortable." Not all jokes need to be about afflicting the comfortable, but none can be about afflicting the afflicted.
But what if we aren't innately funny? Consistent with the work of Carol Dweck, PhD, of Mindset fame, being funny is not an innate characteristic but rather something that can be learned through an iterative process. This is how everyone learns to be funny. It may seem innate in some people, but that is because they started young, getting positive responses here and there, and that reinforcement led them to continue to explore humor to get attention. Kids are more disinhibited, so they are more likely to take risks and, therefore, learn faster about what is funny and what is not. In comedy classes, the first step is often helping people to lose those inhibitions and help them feel free. But to be clear, disinhibition is for comedy classes and not the exam room.
A good start to letting comedy have its place in the exam room is not even about being funny but being a good audience. If a patient makes a joke, be sure to laugh or at least chuckle (unless it is inappropriate, then set boundaries). They are the stars of the show, and no star wants to make a joke that leads to crickets.
A next step would be low-risk jokes, like corny jokes or "dad jokes," or classic comedy tropes, like referring to the internet as the "interwebs" or referring to children as "sir" or "ma'am." These are easy ways to lighten the mood; not comedy gold, but a good start. Those comedy tropes can also save a bad joke. If a joke falls flat, tell the patient that you plan on sticking to your day job and will not be taking your comedy tour on the road, "and don't forget to tip your server."
Confidence is important in the delivery of the joke. A bad joke made with confidence is often better than a good joke made without it. Those "dad jokes" are not necessarily clever or funny, but being told with the bluster and bravado of an overconfident helps them land.
We often deal in what would otherwise be considered taboo, which can be great fodder for comedy. Maybe that is why our urology colleagues are often our funniest. Comedy can also come from contrast, having the classic "straight man" or serious person with their silly or disinhibited counterpart. If we happen to be giving a particularly boring lecture or teaching a patient about a mundane condition with low stakes, this can be an opportunity to be a little silly or wacky to get a laugh.
It is OK to be self-deprecating because, as physicians, we are the comfortable ones who can be afflicted. However, the jokes need to refer to something that does not carry any stakes or gravitas. Avoid jokes about your acumen at practicing medicine, which would shake their faith in your ability to treat them. Your handwriting, typing skills, ability to run on time or take your own medical advice, bad haircuts, social awkwardness, and bad jokes are all fair game.
In his book How to Write Funny, Dikkers discusses what he calls "funny filters," or ways in which different things are funny. There are some types of humor that are not safe to use in the exam room, like shock humor. Saying something shocking, often about sex, drugs, or violence, would not be appropriate, whereas reference humor, referring to a common human experience (a la Jerry Seinfeld), possibly specific to the healthcare system, is a nice way to bond with the patient. An example would be referring to all the paperwork that needs to be filled out, even if the patient just came in to have their ear wax cleaned. They spent 45 minutes filling out paperwork and came in for a 3-minute visit to have cerumen disimpacted.
Callbacks are often used by professional comedians at the end of a set. They refer to a joke that was made at the beginning of a set. It makes the audience feel like they are on the inside with a shared experience. This would be more advanced, but a callback to something that was said at the beginning of the visit could do the same with the patient, making them feel like an insider.
A caveat to all of this is to read the room. If the mood is not right, do not take risks; do not make jokes. Deal with the seriousness of the situation with the same degree of gravity that the patient is.
But if the mood is right, laugh at your patient's jokes, be confident, possibly corny, a little bit silly, comfort the afflicted, and start thinking about afflicting the comfortable.
Bradley B. Block, MD, is an otolaryngologist.
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