Article from the Boston Globe’s On Call Magazine, July/August 2003

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

Patient education is serious business. Healthcare providers have to teach patients how to manage their symptoms and adhere to self-care instructions. And patients have to learn how to recognize serious side effects and what to do should they occur. This information is difficult enough to learn, but even harder when the teaching takes place under less-than-ideal circumstances — such as when providers are rushed and patients feel scared, sick, sad, or in pain. But the right balance of humor can be the spoonful of sugar that helps the medicine go down.

Humor is the perception of something funny, and laughter is the physical reaction to something funny, explains Carol Schlef, RNC, MSW. Schlef is a women’s health educator at SSM St. Mary’s Health Center in St. Louis, Missouri, who says a dose of “healthy humor” can be a good thing when helping patients learn what they need to know. When people laugh or anticipate something funny, she points out, they are usually more relaxed, less stressed, and able to think more clearly. At these times, the skills they use to learn — like problem-solving, creativity, memory, and attention span — are enhanced. Humor is also likely to make them feel better because laughter can increase respiration and oxygenation and bolster immune systems.

Schlef says humor can take many forms. Formal humor, for example, includes jokes or riddles while spontaneous humor includes word play and wisecracks. Sometimes humor can be planned, such as using a repertoire of light-hearted ways to teach a topic or technique. And sometimes humor just happens, such as when off-the-cuff comments get a laugh.

Used well, humor can help ease tension in frustrating or unplanned situations. Schlef recalls teaching a new mother how to take her baby’s temperature. This mother spoke little English and was obviously nervous, scared, and in pain from her recent C-section. While demonstrating how to shake a thermometer, Schlef accidentally hit it against the side of the crib. The new mother looked wide-eyed at the broken glass all over the floor but quickly broke into a smile when Schlef put on a clown nose she carries for occasions like this one, indicating that “I feel like a clown when I do something like this.” That lightened up an otherwise tense situation and created an environment in which she could teach, once again, how to safely shake down — but not break — a thermometer.

Humor and laughter are great tools to facilitate learning. Below, Schlef offers some pointers on how you can incorporate a dose of healthy humor in your own patient teaching.

Use humor to help build rapport. Schlef often teaches classes about pregnancy and birth to expectant mothers and their partners. Being a decade or two older than the soon-to-be parents, she builds rapport with her class by humorously noting that she and her students both share the challenge of ever-changing bodies. After she introduces herself and gives her professional credentials, Schlef may add, “Just a word of warning — menopause is like pregnancy, but it takes a lot longer than nine months to get over.”

Use humor to build a bridge to understanding. Humor not only builds relationships but also helps people be more receptive to learning. When Schlef used to teach pregnant teenagers about proper nutrition, she noticed that they seemed bored and disinterested. To heighten their interest, she created a special “food pyramid for teens” that identified the four major food groups as “refined sugar, fat, caffeine, and salt.” The teenagers laughed at how ridiculous the diet looked — and then were more receptive when Schlef introduced them to healthier ways of eating.

Rely on your “humor barometer.” Before using humor, try to gauge the other person’s receptivity. Schlef, for example, notices if patients have funny “get well” cards or amusing gifts displayed in their hospital rooms. She also pays attention to whether they react to light-hearted items she is wearing — such as silly earrings, funny buttons, bright shoelaces, or toys attached to her stethoscope. When patients smile or make approving comments, Schlef has a good indication that they are receptive to humor.

Don’t use the same humor approach with every patient. Choose humor based on each patient’s learning style, age, culture, and gender. Some people, for example, enjoy visual or physical humor while others prefer wordplay. Consider also when it is and isn’t appropriate to use humor. Well-timed, humor can lighten a sad or serious situation. Says Schlef, “Sometimes people cry until they can laugh — but they need to cry first.”

Also, you need to be ready to respond kindly to patients’ reactions, even when your efforts at humor fail. Sometimes humor “backfires” and is not appropriate or appreciated, Schlef says. She distinguishes between well-timed “healthy humor” that emits good feelings and “inappropriate humor” that can be perceived as offensive, belittling, or sarcastic. If your attempts at being funny fall flat, quickly apologize and let the other person know that you are not trying to be hurtful. In turn, when someone tells you a joke that you find offensive, don’t over react. You might say something like “that’s a creative way of looking at things” and then quickly change the subject.

Create opportunities for humor — even if you think you’re not funny. Lots of people, even those who appreciate a good laugh, avoid using humor because they think they’re not funny. Here are some ways to build humor into your daily practice:

• Start with jokes and riddles. In truth, it takes a lot of crafting and practice to be funny. Schlef recommends that you begin by telling riddles or jokes that others have created — such as ones you find in books or on the Internet. Practice saying them aloud in the mirror and then to your spouse, children, and coworkers. Notice what gets a laugh and what doesn’t. With practice, you’ll not only add to your humor collection but also gain confidence in your ability to use humor as a tool of patient teaching.
• Develop a humor repertoire. Even humor that seems spontaneous can be planned. Schlef, for example, has a repertoire of humorous quips and examples she uses in the infant-care classes she teaches. She finds that light-hearted teaching tools not only help the parents learn but also keep her enthused. “If you’re bored with what you’re teaching,” says Schlef, “everyone else will be too.”
• Keep a humor diary. Just like professional comedians, you should keep a notebook of funny things that happen each day, making sure to note down not just humorous incidents, but also how people react to them. By writing down just one funny event each day, you will soon build a healthy store of humorous anecdotes you can use.
• Use props. Schlef is a big fan of small and inexpensive toys and props. She may wear a lapel pin with a picture of a hand, turning the pin “thumbs up” or “thumbs down” to indicate her mood. She also keeps toys nearby, like stuffed crabs that coworkers can play with when they are having a less-than-ideal day. Even toys that make silly noises can lighten someone’s day and set the stage for learning and teaching.

How to Find Out More:

Carol Schlef, RNC, MSW, is a women’s health educator at SSM St. Mary’s Health Center in St. Louis, Missouri, and also the founder of a professional speaking business, Humor, Health, and Hugs. Her book, Mosby’s Maternal-Newborn Patient Teaching Guides, St. Louis: Mosby, Inc., 1999, shows how to use humor in patient education. You can reach her by e-mail at carol@humorhealthhugs.com

In print:

• Humor as an Instructional Defibrillator by Ronald A Berk, PhD, Stylus Publishing, 2002.
• Humor and the Health Professions by Vera Robinson, EdD, RN, Slack Inc., 1991.
• How to Develop Your Sense of Humor: An 8 Step Training Program for Learning to Use Humor to Cope With Stress by Paul McGhee, Kendall/Hunt Pub. Co., 1994.

On the Web:

• Association for Applied and Therapeutic Humor, www.aath.org
• World Laughter Tour, www.worldlaughtertour.com