The new patient was a young, athletic-looking male who towered over me. As I shook his hand, I judged he was at least 6'6" tall. Walking back to the consultation room with him, just to be friendly and warm things up, I said, "I promise not to ask you if you ever played basketball in school!" My thought was he had probably been asked that mundane question ad nauseum over the course of his young life.
My attempt at a friendly quip apparently failed to be humorous. It would have been better if I had made no mention of his height.
Reasons for Office Humor
Jovial banter is common in doctors' offices, since the reason patients are there is usually due to sickness, pain, disability, etc. Not every visit is a preventive annual check-up. New patients may be nervous and use humor to take the "edge off" the doctor-patient face time. They may make feeble jokes or use unfunny one-liners, and we laugh a little to be polite. Then maybe we, the doctors, use a tired, trite line that usually gets a smile, and they pretend to be amused. This is fairly normal.
Some doctors or health providers are gifted with a good sense of humor, timing and application, and are able to use it successfully with most patients. But it is a dangerous and difficult thing to master. Mistakes can be made.
When Humor Can Cause Problems
One faux pas is trying to lighten things up too much when the patient has a dead-serious health issue. If a patient tells you they have had to "up their meds" and take more opiate pain medication, it is no time to tell jokes about constipation. Compassion and understanding would obviously work better. Yet I admit I have found myself in this situation more than once, tongue-tied and murmuring something intended to be comforting, but falling flat.
A second mistake, which may seem obvious, but definitely happens: Don't start trading "naughty" jokes with a patient. When a patient starts things off with their favorite naughty joke, don't offer one back. Things can escalate to the point that when it's your turn to tell a joke, it wins the "off-color" contest and becomes known in the community as "The dirty joke Doc Hanks told me."
Third, don't try to keep making a silk purse out of a sow's ear. If people only politely hee-haw at your weak "one-liners," they are probably not very funny. If your favorite joke only elicits a belly-laugh from one in 10 patients, stop using it!
Taking Office Humor Seriously
An entire treatise can be (and has been) written on the subject of sarcasm. A fair definition of sarcastic humor could be "a dry and witty form ... almost like taking a 'dig' at someone without technically doing so." Another definition could be, "Meanness disguised as humor." To paraphrase Clifford Lazarus, PhD, in Psychology Today (June 26, 2012), sarcasm should be used like a potent spice in cooking. An occasional sprinkle of dry wit can spark a conversation, but too much can ruin the conversation and taste very bitter to the recipient.
I can't help but give an example of what I consider a rather benign sarcastic joke. A 12-year-old girl, feeling "full" of herself, asks her mother, "Mom, what's it like to have the greatest daughter in the world?" To which the mother retorts, "I don't know dear, better ask your grandmother." Slightly spiced and not bitter.
It has been said that "tragedy plus time equals comedy," although the origin of the phrase is obscure. It means that with the passing of time, some unfortunate event might actually become humorous. When there is more distance, more time passing since the event occurred, perspective can change. For example, riding in the front passenger seat of your friend's car and watching her little son vomit all over the back seat is not funny for anyone at the time, but will probably be funny to you in a short time (especially since it wasn't your car).
Chiropractors discuss bad news and tragedy with patients all the time. The impairments caused by serious injuries, financial losses and the challenges of chronic pain or crippling arthritis are good examples.
Personally, in learning to navigate the exchange of emotional dialogue with patients, injecting seeds or larger servings of humor has been a tricky challenge. Considering our responsibilities, isn't it important we doctors take humor seriously?
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