Stan Wasbin, MD, discovers the value of humor to relieve his stress and that of his patients.
My clinic day began like all the others. There was headache, fatigue, diarrhea, weakness, dysuria, halitosis, vertigo, constipation, rectal bleeding, back spasms, and sweaty palms; and, that was just me. As I plodded through the morning, my stress-related symptoms intensified. Inevitably, my jaw tightened, and beads of sweat erupted on my forehead. But, before I could enjoy my lunch break, I had to contend with one more pain in the neck.
Mrs. P explained in excruciating detail that her husband, the patient, had been experiencing neck pain for months. Thinking that breaking eye contact with her might shorten the narrative, I stared down at my watch. I listened impatiently. I thought sagely. I examined gingerly. I chewed parsley. I diagnosed confidently:
"This is cervical strain," I informed them.
"But," replied the wife, "I thought only women had those?" The comment scored a direct hit on my funny bone. When I laughed, a gush of relaxation washed over me and my jaw suddenly relaxed.
During the lunch break, I reflected at length upon this abrupt positive change in my mood and overall state of well-being, all triggered by simple laughter. It became clear to me that the one thing my clinic day had been lacking for so long was humor. But, looking at it from the patient's point of view, I wondered, was the doctor's office really an appropriate setting for jokes and laughter?
I returned to the clinic a bit drowsy from reflection and overeating. My first patient of the afternoon, Ms. Q, complained that her ears were hurting.
"Has your hearing been affected?" I asked.
"No," she replied, "But, my stomach hurts."
I loped along with her to address this new complaint. "Are you vomiting?"
"Not yet," she replied.
"When will you start?" I countered, testing the waters of medical humor.
"I don't know; I'm not a big vomiter," she explained.
"Do you know any big vomiters?" I asked, warming to the comical approach, even though such wisecracking in this context still remained well outside of my comfort zone.
An expression of perplexity gave way to a tentative smile, whose owner then added that she had been experiencing "really bad" diarrhea.
"Have you ever had really 'good' diarrhea?" I expelled. Ms. Q laughed -thank goodness - and a voice resounded in my head: "Laughter really is the best medicine! Dispense it!"
Soon I encountered Mr. R, whose blood pressure was proving refractory to the best pharmaceutical options. "Let's see, what medication are taking right now?" I asked.
"It's the little round blue pill," he informed.
"Ah ha!" I proclaimed, "We often find that blue pills don't work. That's why I try to prescribe only white or red ones."
"Won't the white pill make me throw up?" he asked.
"Yes, but only if your insurance covers vomiting," I replied, evoking hearty laughter. I then re-checked his blood pressure, observing that the systolic reading had dropped twenty points from just moments ago. Could his laughter have resulted in a lower blood pressure?
Then came Mr. G. During his previous visit, he had revealed to me that although he could speak French, he nevertheless was unable to understand what he was saying. "And, now," he resumed, "I have a frog stuck in my throat." I was trying to determine whether or not he was joking, when, without missing a rib-it, he added, "And, I can't stop coughing."
"Have you ever suffered from any kind of lung disease?" I queried.
"A few years ago I had walking pneumonia," he replied.
"Have you ever had any other walking diseases?" I asked, half fearing he might leap out of the chair at this provocation. Instead, he chuckled. So, I ventured further, informing him that even though medicine inherently is uncertain, I still could provide 100 percent assurance that the cough would either get better, get worse, or stay the same.
"What about my arm pain?" he asked.
"That's going to stop hurting as soon as it feels better," I promised. In between guffaws, he resumed speaking French. Although my knowledge of that language is poor, I think I detected an obscenity or deux. When Mr. G left, he smiled at me and asked "You feeling OK, doc?"
In fact I was feeling better than OK: For once, I found myself calm and happy during clinic. Moreover, I was being a more careful listener if for no other reason than to sniff out more humor. Next came Mrs. Z, in the throes of another painful bout of herpes zoster. Growing more comfortable with my humorous side, I cautioned against making any rash decisions, and suggested that she join a Shingles Club. Although she laughed tepidly at these remarks, I did note that she grabbed a complaint form on her way out. Clearly I had to be more discreet with my kidding around.
Undaunted, I felt that finally I was hitting my stride. With a smile on my face, and an unaccustomed lightness in my step, I entered the room harboring my last patient of the day. "How are you doing, Mr. C?"
"Well, not so good, I guess, or else I wouldn't be here," he replied, unjustifiably confident in the assumption that he was the first to utter this retort, which I already had heard a thousand times.
"Well, I'm here, and I'm doing great." I replied. And, was I ever! This new calmness and cheerfulness suited me so well that I decided to make humor a permanent fixture of my practice. I previously had recognized that my humorous side is a large part of who I am, and its expression made me a better and happier person. Now I stood convinced that being funny - without being vulgar, inappropriate or disrespectful - made me a better doctor. The calmness and cheerfulness I derived from being silly was contagious, rendering my patients more relaxed, revealing, and forthcoming. This enhanced connection and understanding allowed me to be more helpful to them.
However, one nagging question lingered in my mind. Would I be able to restrain my humor in the presence of those patients not receptive to the jocular approach? Or, like the wind, would I hit everything in my path? I do not yet know the answer, but, I have a funny feeling.
Stan Wasbin, MD, practices urgent care medicine at the Sleepy Hollow Clinic in Laguna Beach, Calif., and also maintain a housecalls practice out of his home in San Clemente. He maintains a firm conviction that laughter is the best medicine.
This essay was contributed as part of the October 2010 Physician Writer Search topic "My Best/Worst Day as a Physician."