Table 1.

Studies Evaluating Frequency, Features, and Outcomes of Humor during Medical Encounters

Author, Year, CountryMethodsDefinition of HumorSettingSamplePrevalence of HumorOther Humor FindingsClinical Outcomes Associated with Humor
McCarthy, 2013, USEvaluation of audio recordingRoter Interaction Analysis System (laughter/joke, as a positive talk, building relationship)Emergency department26 patients who visited the emergency department for ankle sprain, back pain, head injury, or lacerationProvider 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, UKEvaluation of video recordingsRoter Interaction Analysis System (laughter/joke, as a positive talk, building relationship)Primary care clinic88 patients who were seen during routine appointments with 3 clinicians, as part of a study evaluating patient enablementThe variable of laughing/joking was found to be associated with patient enablement
Haskard Zolnierek, 2009, USEvaluation of audio recordingsThis study developed and validated a Physician-Patient Humor Rating ScalePrimary care clinic246 physician-patient interactions, including 123 physicians46 items were evaluated in the scaleHumor 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, SwitzerlandAudio recordingsRoter Interaction Analysis System (laughter)Hospital wards71 ward round interactions in internal medicine including clinicians, nurses, and patientsLaugher 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, USEncounter transcriptionsNot clear, defined by authorsHospice132 nurse visits, including 89 hospice patients, 17 nurses, and 44 primary care giversHumor was present in 85% of the visitsPatients 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 CanadaAudio recordingsA meaningful word or phrase that contained mirthful or comic content accompanied by laughter (laughter was not a strict criteria)Primary care clinic92 visits stratified according to high and low patient satisfactionHumor 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, USAudio recordingsRoter Interaction Analysis System (laughter/joke, as a positive talk, building relationship)Obstetrics82 patients evaluated by 16 physiciansThe frequency of jokes/laughter was higher in visits held by female obstetricians compared to male, regardless of the patient sexNo direct evaluation of outcomes
Levinson, 1997, USAudio recordingsRoter Interaction Analysis System (laughter/joke, as a positive talk, building relationship)Primary care and orthopedic clinics124 physicians (primary care and surgeons) communication skills based on 10 visits and correlated with malpractice claimsPrimary 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, USAudio recordingsMultidimensional interaction analysis scoring system (frequency of shared laughter between the physician and the patient)Primary care clinic81 first visits of patients older than 60 years seen by 18 physiciansShared laughter between the physician and the patient was associated with patient satisfaction.
  • * Median and interquartile range.

  • Mean and standard deviation.

  • CI, confidence interval; UK, United Kingdom; US, United States.