Article Figures & Data
Tables
- Table 1.
Studies Evaluating Frequency, Features, and Outcomes of Humor during Medical Encounters
Author, Year, Country Methods Definition of Humor Setting Sample Prevalence of Humor Other Humor Findings Clinical Outcomes Associated with Humor McCarthy, 2013, US Evaluation of audio recording Roter Interaction Analysis System (laughter/joke, as a positive talk, building relationship) Emergency department 26 patients who visited the emergency department for ankle sprain, back pain, head injury, or laceration Provider focused 21.6% of their talk on building a relationship (including social talk, jokes/laughter, approval, or empathic statements) Median of 4 (1.75 to 7) utterances of laugher/jokes as part of the physician pattern analysis and 4.5 (1.75 to 13.25) in the patient pattern analysis* No direct evaluation of outcomes Pawlikowska, 2012, UK Evaluation of video recordings Roter Interaction Analysis System (laughter/joke, as a positive talk, building relationship) Primary care clinic 88 patients who were seen during routine appointments with 3 clinicians, as part of a study evaluating patient enablement The variable of laughing/joking was found to be associated with patient enablement Haskard Zolnierek, 2009, US Evaluation of audio recordings This study developed and validated a Physician-Patient Humor Rating Scale Primary care clinic 246 physician-patient interactions, including 123 physicians 46 items were evaluated in the scale Humor subscales correlated with effective communication, patient involvement, physician, patient collaboration, and mutual trust. Patient negative humor was negatively correlated with overall physician satisfaction. High-income patients received and displayed more positive and less negative humor, were more dominant and displayed greater physician-patient trust than low-income patients. Weber, 2007, Switzerland Audio recordings Roter Interaction Analysis System (laughter) Hospital wards 71 ward round interactions in internal medicine including clinicians, nurses, and patients Laugher accounted for 3% of the total utterances studied. Doctors had 1.33 (2.06) utterances per encounter and patients 1.14 (1.96)† No direct evaluation of outcomes Adamle, 2005, US Encounter transcriptions Not clear, defined by authors Hospice 132 nurse visits, including 89 hospice patients, 17 nurses, and 44 primary care givers Humor was present in 85% of the visits Patients initiated humor 70% of the time, nurses 18%, and the caregiver 12%. There were on average 3 humorous remarks per visit. No direct evaluation of outcomes Sala, 2002, US and Canada Audio recordings A meaningful word or phrase that contained mirthful or comic content accompanied by laughter (laughter was not a strict criteria) Primary care clinic 92 visits stratified according to high and low patient satisfaction Humor was present 6.43 times per visit; on average one humor utterance every 3 minutes. High satisfaction visits contained more humor compared to low-satisfaction visits (5.59 vs 4.28) Physicians used humor 2.75 times per visit and patients 3.67 times per visit. Roter, 1999, US Audio recordings Roter Interaction Analysis System (laughter/joke, as a positive talk, building relationship) Obstetrics 82 patients evaluated by 16 physicians The frequency of jokes/laughter was higher in visits held by female obstetricians compared to male, regardless of the patient sex No direct evaluation of outcomes Levinson, 1997, US Audio recordings Roter Interaction Analysis System (laughter/joke, as a positive talk, building relationship) Primary care and orthopedic clinics 124 physicians (primary care and surgeons) communication skills based on 10 visits and correlated with malpractice claims Primary care physicians labeled as having no malpractice claims laughed and used humor more than those with claims. (Odds ratio, 0.43; 95% CI, 0.18 to 0.99). Greene, 1994, US Audio recordings Multidimensional interaction analysis scoring system (frequency of shared laughter between the physician and the patient) Primary care clinic 81 first visits of patients older than 60 years seen by 18 physicians Shared laughter between the physician and the patient was associated with patient satisfaction. - Table 2.
Distribution of the Use of Humor According to Setting, Decision Aid Use, and Gender of the Patient and Senior Clinician
Humor Present (n = 66) Humor Absent (n = 46) P Value Distribution by setting .98 Primary care 36/61, 59% 25/61, 41% Specialty clinic 30/51, 59% 21/51, 41% Distribution by use of decision aid .605 Decision aid, yes 31/50, 62% 19/50, 38% Decision aid, no 35/62, 56% 27/62, 44% Distribution by gender of the patient .29 Male patient 31/48 (65%) 17/48 (35%) Female patient 35/64 (55%) 29/64 (45%) Distribution by sex of senior clinician .84 Male clinician 40/67 (61%) 27/67 (40%) Female clinician 26/45 (58%) 19/45 (42%) Distribution by gender congruence .02 Gender congruent 43/63 (68%) 20/63 (32%) Gender incongruous 23/49 (47%) 26/49 (53%) n/131, % Humor use by portion of encounter Counseling 81, 62% Data gathering 22, 17% Introduction/opening 15, 11% Physical exam 13, 10% Humor use by subject Medical condition, treatment, testing 40, 31% Patient 29, 22% Third party (not present) 18, 14% Physician 16, 12% Other 16, 12% General life 9, 7% Third party (present) 3, 2% Humor use by purpose Relate to general life 44, 34% Other 32, 25% Introduce difficult topics 20, 15% Patient adherence 20, 14% Ice breaker 15, 11% By Subject Medical condition/treatment/testing Patient: I went [to the pharmacy] one day, my medication was like $250, and I just about fainted. Doctor: And your liver should be normal. Do you want me to do a liver biopsy just to see? Patient: So, the first time that I was diagnosed with Graves' disease I lost about 20 pounds and I was eating whatever I wanted. It was like the best weight loss diet ever! Doctor: You could eat whatever you want and still lose weight, ha-ha Patient Doctor: It's well tolerated because, you know, you're just a young kid. Patient: Haha oh yah Doctor: Well … sort of. Haha, you know you look great. You do! Patient: Haha. Far from a young kid. Hahaha It is all who you are talking to as to whether you are a young kid or not. Doctor: That is good to hear. Some people are of the mentality that they know everything there is to know and do not want to meet with a dietitian. Patient: Oh, no! I got kids; I have been told repeatedly that I do not know anything! Third party (not present) Patient: You know I have to chase my husband off to the doctor every now and then for [skin checks]. Patient: … My kids are so spoiled, they are so dependent on me. My son asked me the other day, ‘Mom where is the fork so that I can eat my dinner!’ Ha ha Doctor: I ask my wife that! Physician Doctor: Blood pressure is 139/75 [elevated] Patient: Oh that must be because of you! Haha because when I used to come in … Doctor: Oh ha-ha! I am not very intimidating! General life Doctor: So, you are taking the medication for the cholesterol and at last fall, you had asked about stopping it due to muscle pains. Patient: Yeah, during the winter there were a few nights that I was having leg cramps, but I thought it was related to surviving the Minnesota winter! By portion Introduction Patient: It's [the video recording] so funny because of YouTube Doctor: Haha. Right. Everything is on YouTube. Ha-ha Patient: Kids will tape it and they cannot figure out why they get in trouble if they put it on and somebody sees it. [Both laughing] Doctor: And that Facebook is worse because feel like ‘Ohhh’ you know and they can comment. Data gathering Doctor: Do you test [blood sugars] ever? Patient: Only when I come in here! Ha-ha Both laugh Physical exam Doctor: Well I will have you sit right there and I will listen to you, ok? Patient: You can make me have that [stethoscope] and I'll talk into it. Both laugh Doctor: [holding the tuning fork] Are you into music. Watch this! [hits tuning fork so that it starts buzzing] Counseling Doctor: This is not like selling encyclopedias. This offer [medication adjustments] stays open after today! Dead end vs continued exchange Dead end Patient: I should get my [institution name] medical book out, but it's too darn heavy for me to get out because my ribs are broken. Haha Continued exchange Doctor: It's well tolerated because, you know, you're just a young kid. Patient: Haha oh yah Doctor: Well … sort of. Haha, you know you look great. You do! Patient: Haha. Far from a young kid. Hahaha It is all who you are talking to as to whether you are a young kid or not.
