A version of this op-ed, co-written with Doug Farrago, was published on October 26th, 2009 in Medscape.
It’s tough to be a doctor these days. Whether it’s listening to the difficulties of our medical colleagues as they try to best care for their patients, or engaging other health professionals about the uncertainties surrounding health reform, we’ve noticed a tense, sometimes gloomy, atmosphere among physicians.
A recent survey from the Annals of Internal Medicine bears this out. More than a quarter of primary care doctors reported being “burnt out,” in part due to worsening time pressures and a chaotic work pace, which were “strongly associated with low physician satisfaction.”
Worse, an alarming number of physicians, unable to cope with the pressures of practicing everyday medicine, succumb to the stress. Consider that 300 to 400 doctors in the United States kill themselves every year, or roughly one per day. Male doctors have suicide rates 1.4 times that of the general population, while female doctors have twice the rate of depression and 2.3 times the suicide rate when compared with women who are not physicians.
Maybe we all just need to laugh a little. Really.
Although doctors, in general, are known as a pretty serious group, humor is one of the best ways to cope with the harsh realities that we face daily. This concept isn’t new. The phenomenon of using humor in difficult situations was first studied by the psychologist Sigmund Freud centuries ago. He introduced the term, “gallows humor,” which is based on the theory that joking relieves anxiety and laughter can transform unpleasant feelings into ones that are more positive. Indeed, sociologists have pointed to humor as a way for doctors to express a wide array of stressful emotions, including, grief, disappointment, and anger, into ways they find more palatable. A study from the Annals of Emergency Medicine looked at how emergency physicians managed stress, and found that the ability to find humor in everyday experiences was among the most successful strategies to prevent burnout.
Humor itself won’t improve the obstacles facing doctors today, like an increasing bureaucratic burden or a worsening malpractice environment. But by poking fun at some of these inane situations, chronicled in satire-based medical publications like Placebo Journal for instance, perhaps some of that distress can be alleviated.
And think about how patients can benefit from some levity during their doctor’s visit. We’ve heard from many patients who are growing increasingly dissatisfied after receiving medical care, reporting little eye contact, decreased face-to-face time, and feeling depersonalized, all of which are consequences of a medical system that promotes rushed physician encounters. So, as the doctor-patient relationship deteriorates, can a well-placed, appropriate joke help?
Well, yes. Sharing lighter moments can make appointments feel less hurried, with patients thinking, “Hey, this doctor spent a few minutes to tell a joke, rather than going straight to the lab results or x-ray report.” Sensitive topics can be more easily broached, once a shared laugh breaks the proverbial ice.
Indeed, Hippocrates himself suggested that, when interacting with patients, doctors should use both wit and humor, as “dourness is repulsive both to the healthy and to the sick.” When patients are either in a hospital or at a clinic, most are anxious, and sometimes overwhelmed, while dealing with their illness. Sharing a joke or a smile not only can lighten the mood of a tense situation, but can better connect doctors with their patients, as they laugh at something in common. The medical journal, The Oncologist, interviewed cancer doctors who poignantly noted that, “the ability to laugh, for doctors to take a moment to detach themselves from medicine, [was] something that patients certainly appreciated.”
Of course, common-sense applies when trying to be funny in the exam room. Don’t tell sexually or racially-tinged jokes. When meeting a patient for the first time, get a sense of what’s an acceptable boundary of communication. Sometimes, when soliciting a social history for example, patients themselves may tell a joke, indicating they are open to humor on the doctor’s part. And finally, humor is never appropriate when delivering bad news. Patients in these cases want to know their situation is being taken seriously.
With the uncertain prospects of health reform dominating the headlines, and the debate often contentious, it’s a challenge to find anything amusing about health care today. Physicians, meanwhile, struggle to find ways to best practice medicine despite worsening regulatory impediments, along with fighting an uphill battle to rekindle the relationship they once had with their patients.
No matter how glum the situation appears to be, it’s important for doctors to try to find a ray of humor. It can only help.