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. |