The Medicine of Laughter

I was at a doctors’ meeting recently, at which the Tropfest 2012 finalist short film How Many More Doctors Does It Take To Change A Lightbulb was screened.

This somewhat edgier sequel to the 2006 film How Many Doctors Does It Take To Change A Lightbulb shows seven minutes of unprofessional GP conduct, spiced by per rectum jokes.

Looking around at my 30 or so colleagues, I was interested to observe that one of the most gentle, empathic and sensitive doctors I know was among those laughing the hardest. She later explained: “Laughing at misfortune is the only way I can keep caring. I’d fill up with misery otherwise … and be no good to anyone.”

A propensity for black humour has long been associated with medical students and doctors alike, and it is not hard to understand why.

Dealing with human vulnerability, illness, grief and pain on a daily basis can be stressful. Add in time pressure, bureaucratic frustrations and the expectation to remain caring, empathic and professional at all times, and something’s got to give.

We all know that having supportive family and friends, regular time off and interests outside medicine are important for our well-being and sustainability, but are these enough?

Do we also need additional ways of processing and then letting go of the absorbed grief we accumulate?

Some choose to debrief by yelling, ranting, moralising or whingeing. Others use humour in one of its many forms: dark, absurd, slapstick, satirical or otherwise. This may sometimes involve poking fun at our more intense colleagues who may, in turn, complain about those they believe treat serious issues insensitively and frivolously. Horses for courses.

It is true though, that using humour is inherently risky, particularly for doctors. Even if the intent is innocent, an attempt to lighten the mood at the wrong time or place can seriously backfire. What is funny to one person might be deeply offensive to another.

My advice: go ahead and laugh your cares away, spreading the sunshine of your humour if you will — but always treat patients with respect, tread carefully around those ever-so-serious colleagues and refrain from sharing any potentially inflammatory jokes via social media.

Personally, I like to think that I owe a good deal of my resilience to spending as much time as I can on the funny side of the fence. Writing a Last Word column each month has helped me to do just that.

I now find myself on the lookout for encounters that I can subsequently write about in a light-hearted fashion. The more I look, the more I find. Medicine may be a serious business but it is also seriously funny.

I have pages of ideas, most of which will never be submitted for publication. It doesn’t matter though. I’ve discovered that the simple act of recording such stories in a humorous style, even without sharing them with others, has been great for my mental health.

It is not insensitivity. It is not schadenfreude. It is a way of reducing the emotional burden of my job and allowing me to go to work smiling — ready to give the support and empathy my patients and colleagues deserve.

I enjoyed watching the Tropfest film. While I far prefer witty satire to predictable scatological humour, there is something about stories of inserted foreign objects that elicits a chuckle along with the cringe.


First published in Australian Doctor on the 15th June, 2012 On the Medicine of Laughter


The PAP tweet

mobile phoneNot so long ago, one of my young patients ‘tweeted’ that she was having a Pap smear.

During the actual procedure.

Yep, as I was scraping cells out of her endocervical canal, Miss C was busy tapping away on her iPhone. “@docs having pap smr atm, std chk 2, hope im clean … bfn” was posted to the internet for public consumption.

“I have, like, 100 followers,” she said proudly. I presume she meant on Twitter — she seemed unlikely to be the leader of a religious sect. I wondered how many of these had any interest whatsoever in her gynaecological checkup. Perhaps those with whom she had been sexually intimate would be interested, but I doubt they would have made up the entire hundred who’d received her tweet.

While I printed out her pathology form, Miss C updated her Facebook status to ensure everyone with whom she had ever had contact knew about her earth-shattering Pap smear news as well.

It got me thinking. When did getting a cervical smear go from being an embarrassing, secretive affair to one worth broadcasting? When was the mystery taken out of ‘women’s business’?

Quite a few of my under 25-year-old patients bring their friends and/or boyfriends into the consulting room with them when having smear tests. When I’ve politely suggested that Miss X might feel more comfortable if Mr Y waited outside, I’ve not uncommonly got a response along the lines of “It’s no biggie — it’s not as if he hasn’t seen it all before.”

I once had a very curious young man ask me to point out his lover’s anatomical landmarks. He particularly wanted to see her cervix, saying, “To see that would be totally awesome!”

The ‘secret women’s business’ divide is not cleanly split along generational lines. I had a 68-year-old patient request that her 15-year-old granddaughter be permitted to observe her Pap smear for educational purposes. “If she sees one being done, she won’t be as worried about it when it’s her turn to start,” my patient said matter-of-factly.

Later that same day, I had a 19-year-old look at me in horror when I gently explained that she would need to remove her underwear as well as her jeans. “Can’t you just, like, work around them?” she pleaded. “It’s, like, so embarrassing!”

My favourite Pap smear anecdote, however, involves a particularly self-conscious and nervous older lady and a mobile phone. After several attempts I had finally convinced this 52-year-old to have her first smear test in 20 years, and I was trying my best to make the experience as atraumatic as possible. To my horror, just as I was inserting the speculum, my mobile phone went off. The Beethoven ring tone seemed to go on forever but I tried to ignore it and continue seemingly undeterred.

At the end of the procedure the patient said: “Thank you so much for providing the lovely classical music — it was very thoughtful of you. It really helped me to relax. One thing puzzled me though — I couldn’t work out how you managed to start the music at the right time. Did you have a remote control or was there a switch on the speculum? Modern technology is amazing, isn’t it? A singing speculum — what will they think of next?”

Now, that’s the kind of Pap experience that would almost be worth a tweet if one was that way inclined.

Published in Australian Doctor on 22nd February, 2012 The PAP “tweet”–on-pap-smears