Letting the Laughter In

The resident and I walked into the examination room, where our new patient sat waiting. We introduced ourselves, each shaking the man’s hand in turn.

He responded, “You both look so young. I’m surprised you’re not scared of me,” clearly referring to his skin, covered in visible growths as a result of a genetic condition called neurofibromatosis. The resident, without skipping a beat, replied “I’m a doctor – people are usually scared of me!”

The patient responded with a good laugh. Immediately at ease, the visit began.

The presence of laughter

I recently completed my first year of medical school, and was participating in a summer scholarship program for students interested in geriatrics at Sinai Health System in Toronto. This program gave me the opportunity to observe geriatricians and residents in a variety of care settings. One constant through almost all of my experiences in this program was the presence of laughter.

Giving a positive patient experience

One afternoon, during a home visit with my summer mentor and supervisor, Dr. Samir Sinha, the patient and his wife we visited were joined by all of their children from across the region, with whom he joked about this encounter being more of a family reunion.

When shadowing another geriatrician, Dr. Barry Goldlist at the Memory Clinic, I observed him preface his cognitive testing with an anecdote about a special pen that a friend had made for him. He gave the patient the pen to use during the cognitive testing, and then at the end, joked amicably about needing the pen back, turning the visit into a more positive experience for the patient.

Promoting communication and trust

Research has demonstrated that laughter can be a powerful tool in promoting communication and trust, particularly when working with older patients. Older adults can experience ageism in a variety of contexts in their day-to-day lives, both overtly and covertly. Over time, negative age-related stereotypes can become ingrained in an individual’s self-concept. Medical appointments in particular can therefore be accompanied by a unique degree of apprehension, with concerns about one’s memory, thoughts about the future, and decades of both medical history and life experience influencing the visit. Though I am early in my training, it is clear to me that using humour appropriately can help to ease the tensions often associated with a medical visit, promoting effective communication and trust and ultimately benefiting both the patient and the practitioner.

Laughter is the best medicine

Unsurprisingly, I’m not the first to come to this conclusion. The well-known adage, “Laughter is the best medicine,” is thought by some to date back thousands of years. A quick literature search on Medline generated thousands of peer-reviewed articles outlining research that explores the effects of laughter on the beneficial health outcomes for older adults from laughter therapies, laughter yoga, and the introduction of clowns in nursing homes.

While the efficacy of laughter as an intervention raises interesting empirical questions, research has shown that it can be difficult to ascertain robust results. However, across all of these studies, it was clear that laughter, when used appropriately, is not associated with risks or harms. Indeed, it can promote both psychological and physiological well-being. Applying these concepts to clinical practice, laughter can strengthen existing relationships and assist in the formation of new relationships.

Making time to share a laugh

I have learned so much from my experiences observing the work of geriatricians this past summer, who all have expertise in understanding the  complex conditions and comorbidities often associated with older age, and who all seem to follow the unwritten rule of incorporating the routine use of laughter in their clinical practices. While it is important to prioritize communicating empathy towards a patient’s life stressors and experiences, there is room for humour in the geriatric consultation. Furthermore, what has become clear to me is that patients and providers of any age can likely benefit from the extra bit of human connection found in sharing a laugh.