Laughter… the best… tool … :-)

In recent decades, as insurers have taken over the delivery of medicine, we doctors are trained to be ever quick and to the point during the brief interaction we have with our patients.  Our time is short, our patients’ needs long and finding the middle ground takes skill and practice.

One common experience, even ritual it can seem as it happens so often, is the “hand on the door remark,” the “by the way…” the patient interjects as you leave believing you have successfully concluded the visit, meeting the patient’s needs of the day.

It is usually the reason they are really there, not the headache or infection or funny pain.  It’s the divorce, the failing job or wayward child, now expressed as chest pain or suicidal thoughts…

We are trained to help get these important issues to the forefront of the visit, but it is so hard to elicit.  Most people do not want to admit they have lost control over their lives.  Most people don’t realize how their out-of-control lives affect their physical health.  Most don’t want to believe their coping skills are so poor that they are actually hindering their own recovery—the drinker or smoker (or toker) who won’t stop, yet won’t consider medical help (and that doesn’t always mean pills…)

The medical visit is a powerful experience, filled with desire, needs, fears, hopes.  Patients often fear reaching out, and the act of the doctor reaching in to help can be experienced with gratitude or fear, or both.  There is the inherent inequality of the relationship, with the patient as needy supplicant and the doctor as benevolent deliverer, who holds the keys to treatment or denial of the same.

Of course it doesn’t seem that heavy most of the time.  And I view it as one of my imperatives to keep it from feeling heavy all the time.  Of course I always want to respond appropriately to the distressed patient and gauge my demeanor to meet their need.  But nearly always I try to make them laugh.

Why do that?  As noted, the doctor visit is a brief, sometimes intense encounter often with much to do in a very few minutes.  So I hope to break through that initial, well, terror, the patient feels at some level, so we can dispense with any ritual delaying of the reason they are truly there and get to the matter at hand.   And it is also because I genuinely like my patients and want them to feel comfortable.

I try hard to gauge them as I enter, remarking to myself on their dress and body language.  A compliment about them, or a remark remembering their prior visit and their family or prior need demonstrates that care.  I do the same for my family.  These common courtesies are so little demonstrated in our current busy on-line lives, that taking a moment to do that helps us both feel more comfortable.  

I often come in singing, “Good morning!” and it usually breaks the ice.  (If not, I have that feedback for the next visit.) And more than one patient has remarked they come in just to hear me sing that to them.  More than once I have sung and the patient immediately breaks down weeping about their troubles, saying, “I didn’t intend to cry!” but the gentle laughter and kindness was able to reach in to them viscerally and allow their feelings out.

It’s not laughter that I’m seeking, but offering courtesy, respect and honor toward the patient who is coming to me with their troubles, so that I may shed what light I may have on their needs and help them.  For me making light of the visit itself (“I love these days in windowless rooms, saves me from all that sunshine!”)—not of them or their reasons for being there—takes away the tension associated with the form and allows us to dig into the matter at hand.

Laughter—genuine, I-like-you-let’s talk—good cheer provides an intimacy and a space where the therapeutic relationship can thrive.

So a lawyer and a doctor and a chicken walk into a bar….


Dr Hoffman

Dr. Rebecca Hoffman is a Family Practitioner and works at Kaiser Permanente in Salmon Creek, which is in Vancouver, Washington. Interests include using diet and healthy living to stay healthy and attending to mental health and its physical manifestations. Personal interests include hiking, jogging, music (she plays the harp), dance, theater, storytelling and writing. She lives with her husband and two daughters.

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