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In Practice

Using humor in the doctor’s office

Dan Page for the Boston Globe

At the festivities marking the end of our grueling first two years of medical school, I was voted the funniest girl in my class. I hasten to add, lest this admission seem immodest, that the competition was not very stiff. Medical students (and the doctors they become) are a pretty serious lot. And yet, humor had always been so much a part of my life that it seemed unlikely I could subtract it from my identity when I added “M.D.” to my name.

I come from a family of joke tellers, and have a large repertoire myself. My father, an orthopedic surgeon, was a quiet man, not much for small talk (or big talk, for that matter), but he became uncharacteristically garrulous when he told a funny story. Dad stretched out the lead-in to a joke to such an extent — Have you heard this one? The one about the man? You know, the man and the dog? — that the preamble was often funnier, and longer, than the joke itself.

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I know that he believed in the therapeutic power of humor. Once, I saw a cheerful, elderly patient with him in his office. After she’d gone, I wondered how she managed to get on so well. As I listed her many ailments — lung cancer, fractures, tuberculosis of the spine — my father interrupted: “You forgot to mention her smile.”

The medical benefits of laughter were recognized in Hippocrates’ time, but it was not until 1979, with the publication of journalist Norman Cousins’s best-selling book, “Anatomy of an Illness,” that the humor therapy movement gained momentum. Cousins described watching Marx Brothers movies and episodes of “Candid Camera” to treat his debilitating arthritis. Bernie Siegel’s popular “Love, Medicine, and Miracles” also encouraged self-healing through humor, as did comedian Gilda Radner, during her illness with ovarian cancer.

In recent years, medical professionals, too, have become more interested in humor. Research has shown that laughter can alleviate anxiety, improve immune function, facilitate blood flow, and decrease the discomfort children experience during invasive procedures. The Association for Applied and Therapeutic Humor brings together hundreds of clowns, comics, and clinicians at its annual conference.

Incorporating humor into my own medical practice was not easy, initially. I feared transgressing boundaries, being inappropriate, not being taken seriously — especially as a young doctor.

My first clinical use of humor was entirely unplanned. I was a medical student rotating through surgery, on night duty in the emergency room. A man about my age, kind of a tough guy, came in with what turned out to be an abscess in his scrotum. He took one look at me and declared that he wasn’t taking off his pants for a lady.

It may have been the hour (2 a.m.) or my mental state (exhausted), but something made me announce: “Listen, if I find anything in there I’ve never seen before, I’ll shoot it.”

He grinned, said, “Hey, you’re OK!” and dropped his drawers.

As I moved beyond training and into my own practice, I used humor hesitantly. I remember the first patient to whom I told a joke. He had given up red meat to improve his cholesterol and told me he was eating so much fish and chicken he didn’t know whether he should swim or cluck. It seemed to be an opening to tell him about the man who’s advised by his doctor to give up sex, alcohol, and rich food. “Will I live longer, Doc?” the patient asks. “No, it’ll just seem longer,” answers the doctor.

OK, so it’s not a exactly a side splitter, but he liked it, as have many other patients of mine. I think that’s because a joke — any joke — breaks down barriers, including between a doctor and a patient. That odd, primitive vocal outburst we emit in response to something funny is so uniquely human that it’s hard to imagine a better way to remind ourselves of our common humanity than by sharing a joke with someone.

Any seasoned clincian will tell you that one of the pleasures of a long-term practice is that, with time, you become more comfortable being yourself. You also become better able to identify those patients from whom you must hold yourself back. As the years have passed I’ve told more jokes to fewer patients — the same patients who tell me jokes in return.

I still sometimes underestimate the value of humor, though.

The other day I visited a patient in the hospital, a woman who loves to tell jokes. I was concentrating on her chart, trying to figure out why her condition wasn’t improving as expected.

“I got a good one for you,” she said. I cut her off.

“Not just now,” I replied. “I need to go check your labs.”

I congratulated myself, briefly, on my restraint. Surely there are times when humor simply isn’t appropriate? But later I got to thinking about how jokes work. One person reveals information bit by bit, and then springs a surprise on the listener. Freud wrote of how a joke teller wields control, creating tension, and then choosing the precise moment when the tension will be released.

Maybe what my patient needed at that moment — uncertain about her fate, tucked too tightly into her hospital bed, tethered to various tubes and wires — was to be in control.

Maybe the most healing thing I could have done for her right then was to let her hit me with the punch line.

Dr. Suzanne Koven is a primary care
internist at Massachusetts General Hospital. Read her blog on Boston.com/Health. She can be reached at inpracticemd@
gmail .com.
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