Part V

Concerns and Cautions About Using Humor in Health Care Settings

1. Will patients (or colleagues) consider it unprofessional?A brief explanation of the health benefits resulting from humor and laughter helps counter this.  You can maintain your professionalism and still adopt a lighter style of interaction with patients and staff.

2. Will I be seen as incompetent? Establish your competence first (especially among other staff), and then let your sense of humor emerge. Patients will generally welcome a lighter style of interaction.  (Also, see explanation in #1.)

3. Will patients misinterpret humor as indifference about their condition? Shared humor does not replace concern, care, & respect. It is added to it.

4. Doesn't improving our sense of humor just increase our workload? Learning to lighten up will not take time away from your job.  Quite the opposite, you will soon find that humor lightens your workload, because it enables you to sustain a frame of mind conducive to doing your work more efficiently. You will also begin to enjoy your work more as humor gives you a more frequent diet of positive interchanges with patients and staff.

5. Be sensitive to whether the patient is responding positively or negatively to humor. Don't force humor or laughter upon the patient if s/he is not receptive. Think of humor as a medication.  Some medications can be used with most patients, but others cannot. Two patients with the same symptoms don't always get the same medication. Some patients have allergic reactions. Be sensitive to the patient's humor allergies.

6. Remember that patients often don't feel like laughing. They may be nauseous, in pain, or just not in the mood.

7. Remember that patients may not respond to humor until they have come to accept the fact of their disease. Do not try to use humor to overcome their depression or anger. The time may come, however, when humor can help them turn the corner of acceptance.

8. Avoid joking with other staff in the presence of patients who are about to undergo a test, treatment, or surgery. The exception to this rule is when you have already established a good joking relationship with the patient.  Although you may need a laugh, the patient doesn't understand that. It if happens, explain your laughter to the patient.  If the patient initiates the humor, of course, you can go along with it.

9. Patients may think you won't consider them sick if they laugh & joke with you. They may fear that you'll give them less attention than others who are "really" sick. Assure them that this is not true, and that you enjoy tending to patients who are in a good mood.

10. What should I do if I really don't think the patient's humor is funny? Don't fake laughter, but smile and acknowledge it as a joke.

11. What should I do if the patient's humor is offensive, or goes too far in some way? Be honest and tell them you really don't enjoy that kind of humor. Be flexible, open, and supportive of their humor generally; but there are limits to joking, as with any other behavior.

12. Remember, many patients have no history of using humor under stress. It may be unrealistic to expect them to react favorably to humor in a hospital setting.

13. People generally use the same coping mechanisms in the hospital that they've used in other stressful situations. This may include getting angry, depressed, withdrawn, anxious, assertive, or demanding.  Each of these coping styles are compatible with humor on your part once you know the patient well.  But always be sensitive to how the patient is responding to your playful style.

14. Remember that patients may have religious convictions, which stress reverence for the  seriously ill, as well as the dead. This may be incompatible with any form of lighter interaction.

Conditions Where Humor is Inappropriate

1. During any acute crisis.  (But it can help adjust to the crisis afterwards.)

2. When the patient needs to cry.

3. When the patient needs quiet time.

4. When a patient in an adjacent bed is very sick or dying.

5. When the patient is trying to come to grips with any emotional crisis.

6. When the patient is trying to communicate something important to you.

Nothing is more frustrating than having someone appear to not take seriously  something you're trying to communicate, and that is very important to you.  This  can destroy your rapport.

7. If you have any doubts about the appropriateness of humor in a situation, try another approach (e.g., compassion, concern, and touch).

8. Avoid:

 a)  Ethnic jokes, sarcasm, and mockery.

 b)  Humor at the expense of any other person. Laugh with, not at.

 c)  Joking about any patient or their condition.