The four humors weren't that funny

Laughter, they say, is the best medicine. But can laughter cure Methicillin-Resistant Staphylococcus Aureus? Let me put that another way …

Once, when I was a young boy, there lived an alarming bit of eczema on my face. I itched, I whined, and my annoyed mother was forced to drag me to the doctor's office. Upon inspecting my grill, the pediatrician looked at my mother gravely, shook his head, and deadpanned: “I think we'll have to amputate.”

Petrified, I turned to my mother. Strangely, she was smiling. I was confused for a moment, but then I understood. This man, my doctor, had just made a joke under what was surely the gravest of circumstances. He had wielded his irony and slain two unhappy people. In their places were a smirking mom and a beaming, reverent (although still quite blemished) boy.

Can you see that this real-life example points to an important issue? If you are thinking, “Yes! Eczema can be cured by amputation,” you may have missed the point entirely. Also, you are hopefully not a dermatologist. What you should have gleaned is that humor in medicine has an important role, one that is often overlooked.

Toward the beginning of my clinical training, I was nervous around my patients. I ended up being very serious, both out of anxiety and respect. However, being serious all the time is not inherent to my character, and I think by trying to act a certain way I ended up appearing even more awkward than I really am. While medical school at Yale stresses the importance of the doctor-patient relationship, I never appreciated how humor can be used to one's advantage. It can distract a patient who is self-absorbed and depressed, help a patient to be on your side, and may turn a stressful situation into one of friendly rapport.

As my clinical training progressed, I developed a different way to think about respect. I feel that doctors should regard patients as though they are normal people. This is sometimes hard for a beginning medical student. I think that the majority of my patients do better when they do not feel they are being treated as extremely fragile. On the other hand, one cannot be perceived as cavalier or immature. Humor walks a razor's edge: it is vital to feel out the situation to determine whether or not, in the words of Woody Allen, “This is not the right crowd for this joke.” In short, don't tell a knee-slapper to a guy with patellar tendinitis.

I also have the particular concern that I tend to write often—in forums where plenty of people can read what I write—and I don't want to be disrespectful. For example, when I rotated through surgery, we amputated an unfortunate gentleman's toe which had become gangrenous. Would the patient whose toe I amputated appreciate it if he knew I was telling the above amputation-related humorous anecdote? Is it OK, but only if he never finds out? Should I hang up my word processor forever? Because of such ethical dilemmas, future columns of mine dealing with possibly taboo subjects will appear under the pseudonym “Galen,” or possibly “Assistant Dean for Admissions Thomas Lentz.”

Humor in medicine can also have value that goes beyond the obvious. In a word: cost-effectiveness. HMO executives and even the hospital president will be eating out of your latex-gloved hands when your cheery patients leave the hospital in record time. Numerous studies have shown shorter hospital stays for patients treated by funny doctors than for those who have brooding doctors who wear black, quote Søren Kierkegaard and pipe Wagner into their hospital ward.

You're thinking, fine, this will work if I'm a genuinely funny person, but what about my colleagues who are dull as a three-week-old scalpel? HMOs will still approve. If you're not that funny but still attempt humorous intervention, you may drive your patients from the hospital, saving society countless dollars. If all else fails, feel free to try a variation of the following (nearly foolproof) gag:

After a medical conference where attendees were plied with material from pharmaceutical firms, I ended up with a sample capsule from a drug company. It looks just like a normal blue and white capsule, except that it's about 8 inches long and 3 inches in diameter. Occasionally I'll put it in my breast pocket, enter a patient's room, say “Good morning, Mrs. Jones, it's time for your medicine,” and then produce this enormous pill.

Usually this is met by a laugh, although I'm sure to scout out my audience before I try such a trick. I never do it on anyone who's recently had abdominal sutures.

I wouldn't want to split any sides.