Learn How to Safely Use Humor to Improve Your Practice

Why was 6 afraid of 7? 7 ate 9! Get it?

We all like to laugh. Whether breaking up a long meeting or brightening a lunchtime discussion, a well-timed joke or witty comment makes us feel good. It temporarily suspends our mundane thoughts or worries and may even be followed by a moment of increased clarity. In the office setting, a patient encounter enhanced by a shared laugh brings warmth and authenticity to the patient-doctor relationship.

For centuries, philosophers and social scientists have tried to understand what makes us laugh. Various theories have been proposed. The ominous superiority theory posits that we laugh at the misfortune of others, whereas the more encompassing incongruence-resolution theory contends that we laugh when we resolve mental incongruence. “Why was 6 afraid of 7?” Our minds initially struggle with the incompatibility of innate numbers having human traits. When the punch line explains that “7 ate 9,” we smile because the incongruence is resolved, in this case with irony and wordplay. If the punch line is botched (e.g., “because 4 6 5”), the incongruence persists without resolution, so we do not laugh.

Humor and comedy also have been classified as low or high. Low humor, which includes more boisterous joking and buffoonery, is considered inappropriate in professional and clinical settings. However, high humor is witty and intellectual. It is clean, generally safer, and more appropriate to use around colleagues and patients.

But is humor good for us?

The answer is yes. At the physio­logic level, humor has been linked to responses such as reduced cortisol and catecholamine levels, greater endorphin levels, and even increased natural killer cell activity. This may be why Norman Cousins, the physician-writer who struggled with ankylosing spondylitis, remarked, “Ten minutes of laughter gave me two hours of pain-free sleep.” Psychologically, humor has been associated with decreased anxiety, depression, and stress in patients with breast cancer.

Group dynamics also may be positively impacted by humor, as long as it’s appropriate and used responsibly. In the workplace, humor has been associated with increased group cohesion and enhanced work performance. It also has been linked with decreased burnout and stress.

Unfortunately, many professionals are hesitant to incorporate wit and humor into their professional lives. Who can blame them? Many comments and jokes that may have been tolerated previously or considered acceptable are now correctly considered inappropriate. Like any powerful tool, humor has the potential for harm. A seemingly benign comment or witty remark that most would not find offensive may be deeply painful to a vulnerable colleague or subordinate. Playing it safe is always prudent. Totally avoiding humor, especially in today’s fast-paced and technical world, however, comes with a cost: We miss out on a chance to smile, laugh, and grow closer to patients and colleagues alike.

The question then arises of how to safely incorporate humor into our professional practices. Over the years, I’ve developed increasing respect for mentors and colleagues such as Thomas Thornhill, MD; Lew C. Schon, MD; Joseph D. Zuckerman, MD; and James W. Brodsky, MD. They have made countless audiences smile and laugh, while simultaneously explaining complex procedures or leading policy discussions. Their talks are never dry and are often downright funny. Nevertheless, these individuals are recognized orthopaedic leaders and, as far as I can tell, have never had to pay a visit to Human Resources.

So how is it that many leaders routinely and safely make us smile and laugh? Whether they know it or not, they are following some basic principles and guidelines. As with a refined baseball pitch or tennis swing, form and timing are important. Just as there are several important components to a professional pitcher’s biomechanics, there are important concepts that underlie the safe and effective use of humor.

Here are a few:

  • Know your audience. ​Thornhill once remarked, “It’s only funny if everyone laughs.” While some may chuckle at a whimsical comment, others may not. Those who do not may be offended or hurt. As such, there is a greater chance with larger groups that someone will be offended.
  • Make fun of yourself first. This is a safe icebreaker. Ironically, it also exudes confidence and security. I recently gave a talk to a group of primary care physicians. The room collectively exhaled and brightened when I explained the difference between a rhinoceros and an orthopaedic surgeon. One has thick skin, a small brain, and charges a lot. The other is a rhinoceros. It was a safe joke, at my expense, and a bit more colorful than two orthopaedists being called the definition of a double-blind study as they read an electrocardiogram.
  • Be competent. Clinically and academically, you have to be good at what you do. If not, you are just a wise guy. At the end of my fellowship, Dr. Schon told me not to joke at the podium until I had been in practice for five years. This is great advice for any young investigator or academician. It takes time to establish your reputation, and it should be based on competence, not humor.
  • Be careful with politics. Politics are increasingly personal and highly charged. Johnny Carson eschewed political jokes and was famously silent when it came to his own political beliefs. This is even more prudent today, given the polarized nature of our current political climate.
  • Be subtle and use facial cues. Humor that is subtle is usually sophisticated and reflects intelligence. It avoids being considered silly and generates respect. This goes hand-in-hand with the use of satire and irony, which are generally safe when it comes to humor. Facial clues also are valuable and can convert a dry line into a witty one. If a patient asks when you can do his surgery and you tell him that it depends how long your trial lasts, it is funny only if you wink.
  • Be careful with practical jokes. Because their goal is to cause humiliation, embarrassment, or confusion, practical jokes can be hurtful. They should either be avoided altogether or used with great caution. That said, a practical joke is sometimes a sign of affection. After all, we tease the ones we love. Probably the only way to safely play a practical joke is to create a fleeting moment of confusion for an individual you know well—someone who can smile at himself or herself and will see the joke as a love tap. Humiliation must be avoided, so make sure that no one else knows or that those who know are friends. Consider practical jokes as material for the advanced course, and be careful.

In conclusion, it is okay to incorporate wit and humor into your professional life. Sharing smiles and growing closer as individuals are good things. Some revved-up killer cell activity probably would not hurt, either. As with any surgical instrument or intervention, however, we must learn to use humor responsibly and safely.

Christopher Chiodo, MD, is the chief of the Foot and Ankle Division and fellowship director at the Brigham and Women’s Hospital in Boston. He has served on the AAOS Board of Councilors and as a deputy editor for the Journal of the AAOS.

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