1. USE OF LAUGHTER AND HUMOR IN MEDICINE Robert P. Chen, MD MBA Co-Director, CentraState Geriatric Fellowship Program CentraState Family Medicine Residency Program Department of Family Medicine Robert Wood Johnson Medical School at Rutgers

2. Abstract Current medical culture and research does not validate the therapeutic value of laughter and humor in medicine. However, there are many examples of the benefits of using laughter and humor, including improved patient-physician communication, stress reduction in medical professionals, and improved learning in medical education. Integrating humor in medicine can be challenging. It is important to learn the process of development and implementation of laughter and humor.

3. Medicinal effects of humor and laughter cross-culturally internationally religious/spiritual traditions.

4. Where is the evidence? doctor patient relationship wellness of the medical team

5. Why not use it? Current medical culture No formal teaching or training How to integrate it?

6. Development 1. Sense of humor 2. Presentation style 3. Rules to remember

7. Sense of humor Surround yourself with humor Laugh more often and tell jokes and funny stories Play with language Observe humor in everyday life Take yourself lightly and laugh at yourself

8. Presentation style Memorize the material Practice timing Involve the audience Speak clearly and vary your voice Use your body to supplement your words Use audiovisual aids Critique your presentation style Recover gracefully

9. Rules to remember Be yourself Use humor regularly Avoid offensive humor Be sensitive Be spontaneous Remember that humor is a tool to convey information Use relevant humor to emphasize the educational point

10. Implementation 1. Engage and build rapport 2. Ask for permission 3. Delivery 4. Feedback 5. Summarize

11. Engage and build rapport Share personal anecdotes Learn about each other’s background

12. Feedback Assess body language, voice tone, social cues Ask for feedback / reaction

13. General guidelines Use humor only with patients who are responsive to its use Use humor as a supplement, not a replacement for clinical treatment Caution to use humor in acutely critical situations Avoid humor that may offend

14. Before using humor Develop a rapport with the patient Perform a humor assessment –Determine patient’s typical response to humor –Ask the patient What or who makes you laugh? When and where do you laugh the most? Have your used play or humor in the past during stressful situations? Did the humor help? Is so, how? Ask the family what makes the patient laugh

15. Incorporating humor into care plans Discuss the advantages and appropriate use of laughter and humor with your patient and his family Reassure the patient and family that humor will not be used in place of analgesics Have humorous materials readily available Let the patient choose the humor strategies to be used Incorporate strategies that involve family and friends Encourage playfulness, with the patient’s permission, schedule “fun time” or “play breaks” Respond positively to the patient’s attempts at humor Regularly assess the effectiveness of humor: ask for the patient’s evaluation of strategies If humor is ineffective, modify or discontinue the humor strategy

16. Clinical scenarios Long-term care facilities Office Home visit

17. Conclusion Incorporating humor and laughter in medicine is a catalyst for change. It can serve as a wellness prescription. “Let us begin to consider that, along with eating your vegetables and getting enough sleep, laughter is a sound prescription as a wonder way to enhance health.”

18. References Bennett, H. Humor in medicine. Southern Medical Journal 2003:96(12):1257-1261. MacDonald, C. A Chuckle a day, keep the doctor away. Journal of Psychosocial Nursing 2004:42(3):19-25. Mora-Ripoll, R. The Therapeutic Value of Laughter in Medicine. Alternative Therapies 2010:16(6):56-64. Pasero, C. Is laughter the best medicine. American Journal of Nursing 1998:98 (12):12-15. Strean, W. Laughter prescription. Canadian Family Physician 2009:55:965- 967. Ulloth, J. Guidelines for developing and implementing humor in nursing classrooms. Journal of Nursing Education 2003:42(1):35-37.