When patients and doctors can laugh together they have succeeded in creating a mature, equitable relationship.
I am a psychiatrist, cancer survivor, and self-professed funny little $h!t. Humor is vital to both. I am providing below a link to a WiseGuys performance by Dov Siporin describing pranking his family and medical professionals through the early stages of the colon cancer that he knew would take his life. I would also recommend that anyone interested read "Cancer made me a Shallower Person, " by Miriam Engleberg. Both are hilarious and hearbreaking. Cancer is really serious, scary, and heartbreaking, but some of the experiences are really absurd, and you really have to laugh. For instance, I thought I would look cut with curly red hair, but then I tried on that wig, I looked like Vicke Laurence's "Momma," which I had not known I could even do, and was not exactly my goal...here's Dov:
my first dissertation was on comedy form & applied use you know. & it was not easy to get a supervisor. at all. then dennet/hurley came out w essentially my work (inside jokes.) stole my idea.
awful, tho gr8 beard, dennett. (& he had written about topic in something called "the 70s"?) _JC
case study cold open needs work.
otherwise, gr8 piece as always. =) _JC
As a patient, I'm wondering how you, as a doctor, like to be addressed?
As Dr. Cifu or as Adam?
As a primary care internist, I love laughing with my patients. Here is one of my highlights:
Me: Dude, you suck at diabetes. Your a1c is 12.
Pt (in a THICK country accent): Well, Doc, I'll tell you what happened. That little whore Little Debbie moved in, and she's cheaper than ever.
I relocated recently and had to find myself a new PCP. My mantra with patients has always been A day without laughter is a day wasted”.
After a recent test for myself revealed a serious health condition I interofficed my physician to say “ In considering further diagnostics please limit testing to those I can pass”.
I wanted to reinforce that humor is therapeutic and he need not be uncomfortable as we share the journey together.
I left my PC in part because he is humorless. I think that trait is part of his treating me like an inferior, rather than an equal partner in my care.
Well Dr. Cifu - you have inspired me to write about my favorite experiences with my docs over the years. My favorite line that I used with my patients I accidentally used in a talk that my wife was attending - we worked for the same healthcare system. Most of my chronic non-cancer pain patients hadn’t laughed in years, and one of the most important subspecialties is humor. Anyway, I used to tell the ones who felt that nobody could understand them that all they had to do was talk to a married person. Married people understand chronic non-cancer pain just fine. It always opened the patients up to new laughter which opened their minds to learning how to live with pain rather than having pain owning them. Needless to say when my wife heard that, I had to sleep on the couch for a couple of days, despite my own chronic noncancer pain. 🤣
Dr. Cifu- So nice to hear the human side of medicine. I’m a man, and a practicing RN since 1985, (so I’m getting up there). I clearly remember a lot more of those type interactions for at least the first 2 decades. And I worked in NYC in areas from one of the first designated “AIDS units”in the 80s-90s, oncology, and a Pheresis Unit hoping to help patients from infants to the elderly by collecting stem cells prior to high dose chemo. While the odds of great outcomes was slim; interactions that allowed patient and caregiver to be more familiar; even off the cuff allowed for smiles, laughs, and tears. It was all good - I know it was good for me. I chuckled while listening to this week’s reflection- so Thanks you. Perfect at this time of Thanksgiving.
Well done Adam! 👏 I recall reading a meta-analysis of communication processes in healthcare showing that lawsuits are caused more by the nature of the patient-provider RELATIONSHIP than by objective medical outcomes. The human qualities of warmth, respect, empathy etc researched by Carl Rogers that facilitate good psychotherapy outcomes also contribute to good medical care. Patients need to bring those qualities to the medical encounter too!
Another story about my favorite Vermont MD. I mentioned in my previous comment that he was a dispenser. In other words he had his own little pharmacy in his office. That was not that unusual in those days in rural areas. So one day while I was visiting him he showed me his selection of placebos. He was a big believer in them. They were in bottles of different sizes and colors both capsules and tablets and even some liquids. He told me he had one patient who drove for many miles to see him to get the wonderful green pills that he prescribed for his arthritis. The key was they usually worked and he never charged for them.
Wonderful stories! My uncle had severe dementia and was in assisted living. He remarked to an aide: "I'm in another world." She replied. "Not yet!" He did not know whether he had had lunch or not, but he remembered this joke and repeated it to us. Amazing.
Love this one, Dr. Cifu! Laughter is love's currency with our patients.
Smashed my distal phalanx a few years ago. Did a real number on it, broken in 4 places. When Dr came in to work on it he said "oh, I see you hurt your rush hour driving finger". We joked and laughed at ways we had hurt ourselves while doing things that some would consider not so smart. My wife, not liking blood and the proceedures, had left the room. Afterward she couldnt understand why we were laughing while the fingernail was being removed, stitches put in and being in a little bit of pain. I have found that guys are more prone to engage in this type humor than women.
Thanks for writing about an important but neglected topic, all while bringing forth smiles! :) As a school psychologist, humor was my most valuable tool for establishing rapport with kids, which is essential for a helping relationship, and even for getting the best results on an IQ test. Luckily I'm a big kid myself so I was usually able to get them to laugh. If I couldn't, that was not a good sign. The hardest part of my job was to refrain from laughter when kids were being unintentionally funny. I wish I had kept a diary, because Art Linkletter was right, and kids DO say the darndest things! Sometimes they are also very creative when they don't know the right answer. When I asked one elementary aged boy for the definition of "transparent," he confidently stated, "That's when you have to go back and forth between parents!"
Woke up with a cold and feel pretty rotten and I have to say, this actually put me in a much better mood. Thank you! Laughter is indeed an important tool for healing our minds, which are in charge of our bodies.