There is a place for humor in medical crisis situations

LETTER — Posted June 14, 2004

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Regarding "Exam room comedy best used with caution," (Article, May 24/31): Despite the "rules" given for bedside humor that reject humor in crisis situations, physicians who routinely deal with medical crises know that humor often can help patients, their families and caregivers more calmly handle trying circumstances.

As an emergency physician in a busy university hospital/trauma center, I often have found that patients who are aware of their situation often derive comfort from gentle humor from their own caregiver -- or among caregivers.

"Your wife told me that you really came here for the food!" I might tell someone around whom we are busily scurrying to treat his acute MI. His smile -- or oftentimes a pretty good stab at his own humorous retort -- alters his attitude, as well as that of everyone else in the room.

Humor that acknowledges the situation and includes the patient and family in the joke (rather than making jokes at a patient and family's expense) greatly calms the situation. It emphasizes the team effort -- thus including the patient and family to be a part of the treatment effort -- and often seems to even improve the patient's condition.

Humor often can be vital for staff and trainees. When, for example, senior staff members enter a situation in which residents are in trouble managing a critical patient, self-deprecating or stress-deflating humor helps re-establish resident confidence and often puts a resuscitation or critical procedure back on track.

"I think your only problem here is that there is a full moon" is rather weak humor, but being so innocuous and nonjudgmental, it often achieves the desired goals of restoring resident assurance and smoothing kinks in the resuscitation process.

When medical crises occur, they stress physicians who don't deal with them on a daily basis. To these physicians, they certainly don't appear to be the site for jokes.

For emergency physicians, intensivists and trauma surgeons who routinely deal with these catastrophic events, however, humor is part of our armamentarium and a measure of our savoir faire.

Kenneth V. Iserson, MD, Tucson, Ariz.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/06/14/edlt0614.htm.

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