Comedy can be a lifesaver – but as with anything in medicine, you need to know what you’re doing.
“What did you think? How did it go?” I ask my patient, after her recent appointment with an orthopaedic surgeon whom I don’t know very well.
“I liked him a lot! He had a wicked sense of humour,” she replies, before explaining the plan for revision of her hip replacement. “He’s a lot like you,” she adds, and I am immediately offended by the sheer audacity of comparing me to an orthopaedic surgeon my goodness, Jerrie.
Secretly I’m very pleased with the bedside manner and approach of this doctor, and happy that my elderly patient felt so comfortable.
Doctors have personalities. We are more than just our clinical skills or our academic qualifications. We are also complex functioning humans with needs and desires and likes and dislikes and mistakes and quirks and personality. Admittedly, many of us have a similar personality (highly strung, stressed out, Type A with OCD traits and a need to correlate self-worth with achievements*) (*not me though, I am extremely different but perhaps don’t try to verify this with anyone) but nevertheless we are not just “the doctor”.
We bring our personality to our job and medical care, and perhaps as GPs we do this most of all. We are specialists in people and it is impossible to separate the person from the doctor in the longitudinal therapeutic relationships of general practice. Just as I have learnt my patients and families over the eight years I’ve worked at this practice, so too have they learnt me.
For example, I have a notoriously poor relationship with printers, and perhaps have required some four or five printers over the eight years here. This is a significantly higher rate of printer failure than the baseline population, and while I accept there is some outlier behaviour, I maintain that I am being repeatedly given shoddy printers. As a result of frequent paper jams, ink running out two days after ink was replaced, “Drum!” error messages and more, my patients are well used to my frustration. Walking away after a lengthy tantrum at reception on Thursday in which I begged for a new printer and stubbornly insisted that it wasn’t “user error”, I was delighted to hear patients laughing in the background and one commenting “It’s just her weekly fit about the printer, is it”?
I relate to my patients through humour. When I refer patients to psychologists, I usually ask the patients what type of person or personality they click well with, or type of healthcare provider they find easy to trust and work with. “Someone with a good sense of humour”, is a frequent answer.
“We attract what we deserve” is a saying we use a lot in general practice to encourage and rationalise that particular approaches to billing, bedside manner and soft skills or clinical acumen on behalf of the doctor will attract behaviours and patients that are “deserving” of them. To me, humour is a key example of this. I use humour throughout consultations if safe, appropriate, and indicated because my patients enjoy it, it increases openness and trust, and it helps me address the power differential in the role (which will exist regardless of how hard I try to minimise it, because there is always a power differential between the doctor and the patient).
However, more realistically, a patient who values humour in communication is more likely to seek out or stay with a doctor who has a similar personality and approach. So, my patients, with whom I have strong, trusting therapeutic relationships that incorporate humour, are probably also going to do well with other referred doctors or providers who have a comparable approach and personality.
Healthcare workers famously use humour as a coping mechanism to accept and process the horrors and trauma of our jobs, to help protect against burnout and emotional fatigue. The humour can be black and confronting, at times straddling the line of inappropriate or offensive, but this kind of humour is not typically shared with patients.
We use different breeds of humour to communicate with differing groups of people; and this must be done deliberately and appropriately. When a male general surgeon asked my middle-aged female patient to lie on the examination bed and said, “Don’t worry, it’s not to molest you or anything”, I think he missed the mark completely with this perceived humour. The consequence was my patient immediately returning to ask for a second opinion, and a strong recommendation to not send women to him any more (agreed; this behaviour is offensive and not funny).
Perhaps the most risqué humour should be reserved for safe and trusted medical friends and colleagues. There is a time and place for this type of humour, and it’s not in public, not on social media, not to patients and never at the expense of patients. The humour is about our feelings or frustration or situation; not about the vulnerable people we look after.
When I undertook my training in voluntary assisted dying last month, I started the morning sombre and intimidated. I intended to be respectful and serious. Thankfully, within minutes of the session starting, the trainers, guest speakers and other attendees had turned up the dial on humour as a coping mechanism to maximum. I finished the day reflective, awed, emotional, intimidated and strongly bonded through eight hours of heavy humour to the other doctors at the training. I could not have made it through otherwise. I could not have.
Similarly, at the palliative care conference I went to last week, humour featured front and centre in nearly every interaction I had and presentation I went to (“What’s the best thing about pall care providers? Our overwhelming sense of superiority over all other doctors”). Self-deprecating humour, my favourite, made me laugh out loud constantly. Our jobs and our work are too heavy and emotionally burdensome to sustain without healthy coping mechanisms. And perhaps the heavier the emotional load, the more humour is valued and used to lighten it.
I send frusemide memes to the local cardiologist several times a month, and get stern replies that frusemide is no joking matter. In my defence, only the cardiologists and nephrologists are going to be this irritated by frusemide memes and their annoyed reactions are usually funnier than the original joke. Sometimes (with extreme caution) I’ll send a surgical meme to a vascular surgeon or neurosurgeon or general surgeon. There is usually a moment of levity in both our days with the resulting shared laugh, and for me, a gentle grounding back to the person behind the doctor. I’m even in a chat group with my GP mentor called “Memes only” in which we share funny memes daily but have to switch to a text chat thread to discuss literally everything else.
Humour doesn’t have to be part of medicine, but it is for me. I genuinely enjoy the happiness that laughter brings, and the intellectuality of medical humour (or as a vascular surgeon friend recently told me; “It took me three minutes to understand this asthma joke, stop sending me non-surgical memes”).
On Friday, my first four appointments were all new cancer diagnoses; there was no humour at all and no attempt at it. There is no humour in discussions with patients about grief, dying, domestic violence, sexual trauma, rape, negligence, violence, suicide, suicide survival, or recurrent pregnancy loss. There is no humour in discussions about burnout, bullying, toxic workplaces, social isolation, elder abuse, or battered women. There is no humour, either, in unforeseen and unimaginable surgical complications, fractured skulls of babies, early onset Alzheimer’s, motor neurone disease, late-stage cancer diagnoses of young people, female circumcision, and fetal death in utero at term. There is nothing here but sadness, empathy, and grief. And this sadness is so much of medicine and especially general practice; can you fault us for using humour if and when we can?
Dr Pallavi Prathivadi is a Melbourne GP and an adjunct senior lecturer at Monash University, with a PhD in safe opioid prescribing. She was a Fulbright Scholar at the Stanford University School of Medicine in 2020-2021 and the 2019 RACGP National Registrar of the Year.