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"You have turned my life around"
 

I am 87 years old, with a problem of the prostate gland. Before I met Dr. Baum, I went to the bathroom every 30-60 minutes. After Dr. Baum's treatment on my prostate, I go only 5 times per day and only 1 time at night! You turned my life around. I am so very grateful!

-Sidney Daigle


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-Gerald Wallace

 


"A merry heart doeth good like a medicine." Proverbs 17:22

I don't think I have to persuade any of the reader's of this column that medicine is a high-stress occupation. We are not dealing with inanimate objects but with life-and-death situations every day. In addition, many of us are trying to run a small business in which we have little experience or expertise. With new regulations and "the era of change" on the horizon, most of us are living in an area of uncertainty and out of our comfort zone.

Is it any wonder that we are suffering from burnout and are anxious and upset? The danger is that we can pass this anxiety to our staff and ultimately to our patients. There is no better way to relieve the tension and pressure of our work than to inject a small dose of humor. Humor is not only socially acceptable but is actually welcomed. Your staff and your patients will enjoy being in an atmosphere of fun and rather than one of gloom.

Recently we have recognized and documented that humor has a therapeutic value and has a positive impact on patients' health and recovery from illness. Now I would like to extend the importance of humor to include it as part of the style of our practices. For this article I have interviewed Dr. Steve Allen, Jr., the Assistant Dean for Student Affairs at the State University of New York Health Science Center, Syracuse, New York. Dr. Allen has long understood that humor can be a valuable asset to the healthcare provider and that tasteful humor can improve the rapport between physician and patient.

Dr. Allen noticed that this relationship exists in his own practice as a primary care physician but he also has personal evidence that this connection between humor and health has existed for more than 1000 years. Each year Dr. Allen provides medical care to the Zuni Indians in New Mexico. In the Zuni culture there are three groups of healers: the medicine men and women, the bone pressers or their equivalent of the orthopedist, and finally the clowns. These are Indians that use face and body paint, wear funny costumes, and have a social license to do funny and silly activities in public. Those Indians that are ill can call for a clown to visit the home to perform funny acts and tell funny stories more often than not, the treatment works. Thus it is clear that the Indians have understood for centuries that humor has a very important role in the healing process.

Another lesson that Dr. Allen learned from the Zuni Indians is that a young man or woman could enter the profession of medicine man by three means: 1) apprenticeship to an existing medicine man, 2) killing a bear, and 3) previous experience with a severe injury or illness. To Dr. Allen this demonstrated that in the Indian culture, it is recognized that patients can teach us a great deal about our profession as healers. The Indians have formalized the right to become a healer if you have had an illness. Of course, having a severe illness is not a prerequisite to becoming a modern physician, but there's no question that those of us who have experienced a "dose of our own medicine" such as William Hurt in "The Doctor" become more sensitive to the needs, wants, and concerns of our patients after recovering from the illness or injury.

Dr. Allen believes that the patient as well as the physician is a contributor to the success of the healing process. Each has to contribute 50% to the healing equation. Humor is a method of saying to the patient, "I know more about the science of medicine, but you know more about you than I do. Help me understand you and I will help you understand the science behind your problem." Both the physician and the patient have special knowledge which is necessary they work together for the patient's benefit.

Neither the knowledge of medical science nor the patient's knowledge alone is more valuable to the healing equation than the combination of the two. As physicians we have to remember that, unfortunately, most patients consider themselves beneath or inferior to the physician in qualifications and therefore don't contribute to this equation.

Dr. Allen believes that humor is helpful in generating trust with the patient. Humor is helpful in demonstrating to the patient that the doctor is also human and has not a higher order of being.

Humor is a terrific anecdote for resolving conflict and anxiety. Dr. Allen recalls being on an airplane that was delayed at the gate for 45 minutes. The pilot spoke to the passengers over the loud speaker: "Ladies and gentlemen, will you please take your seats so I can see out of the rear view mirror and back this plane out!" This was all that was needed to relax the passengers, release the tension and improve the mood of the passengers and the flight crew.

Another advantage of humor is that it stimulates creativity. Dr. Avner Zvi, of Tel Aviv, Israel, demonstrated that individuals who watched humorous videos were able to provide more creative solutions to problems than a matched control group that did not have access to the humorous material. Recently, PET scan data has revealed that the part of the brain responsible for humor is the same area of the brain responsible for creativity.

Dr. Allen recalls a situation where a husband was very upset with his wife, who had diabetes, because she wasn't taking good care of herself. Dr. Allen suggested that they have a role reversal and that he be responsible for her diabetes. The husband was given the responsibility to manage the diabetes from sunup to sundown. This included her diet and the insulin dose. After just two days the husband called Dr. Allen and asked that he be relieved of the responsibility of managing his wife's diabetes. Through a clever subterfuge and the use of creativity on the part of the physician, the husband gained a greater understanding of his wife's chronic illness. It is through ingenuity and humor that we can create the "turn on the light" or the "wow" experience that can ultimately benefit our patients.

Norman Cousins, a former editor of the Saturday Review, clearly identified the positive benefits of humor. He had a debilitating and life-threatening condition, ankylosing spondylitis, and was in constant pain and discomfort. Mr. Cousins used humor as a form of pain relief. He documented that he received 3 hours of pain relief after watching comedy videos like "The Three Stooges" and "Abbott and Costello" while receiving only 1/2 hour of pain relief after taking analgesic medication. Later his documented responses were verified, that is, that humor does release endogenous endorphins which provide more potent pain relief than equivalent amounts of morphine. Dr. Allen suggests that these anecdotal recoveries and cures also be studied. Perhaps we can learn from the exceptions as well as those that undergo scientific, double-blind scrutiny.

In order for humor to have a beneficial response it must be tasteful and tactful. Dr. Allen describes a situation where a patient, immediately after a mastectomy, tells her doctor, "My husband won't look at me and won't touch me." The doctor responded, "You tell him that you are as beautiful as the Playboy center fold and you have the staples to prove it!" Obviously this situation is not the place for levity and humor. Tasteless humor at the expense of the patient not only can result in loss of rapport but the patient will never risk an emotional comment again. Inappropriate humor can debilitate, humiliate and cut deeper than a scalpel.

What are some methods of incorporating humor in our practices? Humor has to start from the top down. If the doctor is dour and downtrodden, then it is unlikely that humor will be an important ingredient in the office. However, if the doctor has an aura of being lighthearted and does not take him/herself too seriously, then it is likely that the staff will soon find ways to infuse humor in the work place. For example, have a Gary Larson cartoon calendar on your desk and paste up appropriate cartoons for every one to see; start out your staff meetings by asking everyone to tell a joke or funny story; use humorous FAX's to send to colleagues and insurance companies (maybe when they are laughing, you'll get paid sooner); encourage your staff to find humorous stories and cartoons in the newspaper and post them on a humor bulletin board in the office; dress up for Halloween and April Fool's Day; create a humor room in your office where patients can play with toys, games, and watch comedy videos; place a sign on the ceiling over the exam table that says "Smile You're On Candid Camera" (I promise you that everyone will relax as soon as they see the sign and your exam can be performed easier); or when all else fails call your office and ask for yourself! All of these ideas of incorporating humor into your practice will have the effect of letting the patients know that "humor is tolerated here." Your patients and staff don't need a written prescription to laugh and have a little fun even with something as delicate and serious as a visit to the doctor.

It is of interest that the word silly is derived from the Germanic word selig which means blessed, healthy, innocent, carefree. Now that the Clintons are throwing the healthcare cards into the air, let us hope that when those cards hit the floor all the healthcare providers will feel blessed and that our patients will be healthier, then all of us will be a little happier. Nothing short of magic can bring back the "good ol' days," but by adding a little humor to our practices, we can still have fun and enjoyment from our wonderful profession. There is both wisdom and therapy in laughter.