Letting the laughter in

By Michelle Gyenes, MD, MS, University of Toronto

A colleague and I walked into the examination room, where a new patient sat waiting. We introduced ourselves, each shaking the man’s hand in turn. He said, “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. My coworker, 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

One experience during my first year at medical school was very enlightening and uplifting. I participated 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. Throughout my experience 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, we visited a patient and his wife, who were joined by all of their children from across the region. The doctor joked with them about this encounter being more of a family reunion. Everyone laughed.

When shadowing another geriatrician at the memory clinic, I observed him preface his cognitive testing with an anecdote about a special pen 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 and lighthearted experience for the patient.

Promoting communication and trust

Research has shown that laughter can be a powerful tool in enhancing communication and building trust, particularly when working with older patients. Older adults often 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. During my summer experience, it became clear to me that using humor 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 clinician.

Laughter is the best medicine

The well-known adage, “Laughter is the best medicine,” dates back thousands of years. A quick literature search on Medline generated thousands of peer-reviewed articles exploring the effects of laughter on older adults, including studies on laughter therapy, laughter yoga, and the use 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, wasn’t 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.

Taking time to share a laugh

I learned so much from shadowing geriatricians that summer. They all, of course, had expertise in understanding the  complex conditions and comorbidities often associated with older age—and they also all incorporated laughter in their clinical practices. Patients and clinicians of all ages can  benefit from the extra bit of human connection found in sharing a laugh.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.