By Michelle Read
Writer
Emergency physician Dr. Francis Bakewell recalls the mounting tension as a patient arrived with a horrific nosebleed. “At least I don’t have COVID,” quipped the patient, clutching a wad of tissues to his face.
The unexpected joke relaxed the room, freeing the doctors to turn their minds to treating the patient and sending him on his way.
The benefits of humour in medicine have long been acknowledged, says Dr. Bakewell, director of the Medicine, Ethics and Humanities Program in the Department of Innovation in Medical Education (DIME)—so much so, he feels there’s room to explore integrating humour training into the medical curriculum.
A long history of clinical humour
Having studied ethics, Dr. Bakewell has always been fascinated with appropriate versus inappropriate communications. A physician with The Ottawa Hospital and assistant professor in the Department of Emergency Medicine, he is cross-appointed to DIME and responsible for infusing the Faculty’s curricula with humanities-based concepts to impart to learners a full understanding of human history and experience.
Dr. Bakewell says humour has always been an integral component of doctor-patient communication, explaining that the majority of encounters with patients involve at least some humour, tending to be initiated and embraced fairly equally by patients and providers.
In addition to promoting healing, “humour creates a bond between people,” he says. “It helps to defuse stressful situations, lessen the sting of difficult messages, and express frustration or anger in a socially acceptable way—all beneficial to the delivery of better care.”
There are risks to using humour clinically. Dr. Bakewell cites one study of the clinical interactions of physicians and their patients in which, in many instances, caregivers felt they were joking but the patient didn’t perceive it, thus opening up the possibility for harm or error.
However, Dr. Bakewell doesn’t feel the risks should make people shy away from using humour or from examining and benefiting from its positive aspects. It’s all about balance, he says: being considerate in its use, and not aiming it toward a particular person.
Teaching humour in the medical curriculum
Within medical education, discussion around the use of humour has focused on the negatives, and as a result has, indeed, scared medical trainees off its use.
“Professionalism training often warns students about using it inappropriately but may not provide them with ideas or tools for using it appropriately,” he says.
Research on humour in medical education is sparse, says Dr. Bakewell, despite dozens of theories in philosophy, psychology, sociology and other fields as to why humans joke and how humour works. Some theories have prominent applications in medicine, which opens up opportunities to develop a framework for a future research into humour’s use in medical education—both as a method of teaching medicine, and teaching trainees how to use it in their own practice.
“We need to approach it in a more positive light, defining how we can use humour effectively in medicine and how to impart this to our trainees,” he says. He points to medical improv, a burgeoning field that the Medicine, Ethics, and Humanities program has explored during student electives, as one example of how to train both humour and communication skills more broadly.
In general, Dr. Bakewell says, research suggests people perform better cognitively after laughing, even more so than after exercise. “Clearly, a deep neural process is at play when we are exposed to something humorous—but again, the phenomenon has not really been well examined in medical education.”
Maintaining levity after a year of pandemic
Humour may also play a role in offsetting the mental health effects anticipated from the COVID-19 pandemic, with its proven reduction of depression and anxiety.
“This year has been so difficult to maintain our humanity, our sanity, our resilience,” he muses. “As an essential part of a complete human experience, everyone could and should incorporate humour in their lives, albeit in a balanced, appropriate way given the circumstances.”
There is also room for research into how to integrate humour into physician wellness. “It may have utility in being included more formally in a wellness program,” Dr. Bakewell says, explaining that patients confess they want providers who have that full human experience, and who can joke and laugh appropriately.
We mustn’t feel guilty engaging in daily laughter, whether in our practices, between colleagues or in our personal time, assures Dr. Bakewell.
“It’s important that we all come through this pandemic with our mental health intact,” he says.
Scrubs reruns, anyone?
