When Is Humor Helpful?

When Is Humor Helpful?

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An analysis of inpatients’ and outpatients’ comments that employed artificial intelligence and natural language processing found that humor can be an effective communications device. It can help convey that the caregiver empathizes, is compassionate, is trying to be helpful, is attentive, and is pleasant. However, if humor is used in a flippant or sarcastic fashion, it can accentuate the patient’s negative perceptions about the caregiver; it adds insult to injury.

Why does humor in the workplace sometimes have magical effects and at other times is disastrous? The answer is not as simple as “some jokes are better than others,” or “some people are funny while others are not.” The reality is that injecting light-hearted remarks into professional interactions always entails risk. Guidance on when that risk is worth taking and might in fact lead to great rewards can be derived from analyses using artificial intelligence (AI) and natural language processing on data from one of the most emotionally charged professional settings: health care.

Our interest in humor in health care emerged unexpectedly during explorations of a large dataset of patient comments aimed at understanding what patients value most in their care. Artificial intelligence and natural language processing were used to extract positive and negative insights from comments in 988,161 survey responses received from patients about their experiences across the United States during 2020. Of these, 17% were inpatient and 83% outpatient experiences, respectively, and it is possible that some of the responses were from the same patients.

From these comments, our analytical technology extracted 1,270,000 insights and categorized both positive and negative insights into themes and subthemes. This technology makes it possible to identify issues that are important to patients but may not be captured by standard survey questions, such as, “How often did your doctor explain things in a way you could understand?” That question provides insight into whether clinicians conveyed information but not how they made patients feel as they did.

In fact, there are no survey questions to our knowledge in which patients are asked if they found their doctors or nurses humorous. But in our analyses of patients’ narrative comments, humor came up repeatedly when they described positive experiences with their clinicians (see the exhibit at the bottom of this article). Patients commented on how their clinicians interacted with them, and regardless of what survey questions they were asked, they seemed to see the clinician’s ability to use humor in difficult moments as reinforcing acts of caring.

Our analyses indicate that humor is not the main course when it comes to caring but is more akin to a valued condiment. The actual main course that is appreciated by patients is courtesy, respect, and related subthemes. Patients don’t remark on the technical skill of clinicians very often, but their comments suggest deep appreciation of empathy, kindness, helpfulness, and patience. And when patients note that care with these attributes was accompanied by humor, the humor seems more than welcome (see the exhibit for examples).

Using humor in this way does require intense attention to the moment and authenticity in conveying caring. This means that clinicians should focus first and foremost upon reliably being empathic and kind and trying to be helpful — i.e., by showing the behaviors characterized in the first column of the exhibit. If patients feel confident that these behaviors characterize their care, they are likely to welcome clinicians’ gentle explorations of building connection through humor.

On the other hand, when patients perceive the absence of courtesy and respect, the use of humor by caregivers adds insult to injury (see the exhibit for examples). In short, humor is not a stand-alone asset or liability. It serves to amplify the positive or the negative signals that patients pick up from their doctors and nurses.

Examples of How Humor Can Convey Caring

Humor can help convey:Verbatim comments
Empathy and compassion“[A] the nurse who took care of was amazing…very caring and all of my questions…and had sense of humor and [I] liked that.”
Kindness“Every nurse treated me like a close friend, responding to me extremely fast, and even stayed to converse with me making me laugh every day.”
Helpfulness“I had an excellent anesthesiologist who came and explained the procedure, made me laugh, and put me at ease.”
Attentiveness“[Dr. X] was as always meticulous and competent with his treatments, while being thorough with easy-to-understand explanations of my condition, options, his recommendations, future options, etc., all delivered kindly and with a good sense of both humor and compassion!”
Patience“[Dr. Y] always provides full explanations well beyond the norm, i.e., anatomical lessons on probable causes of injury (in an interesting and even humorous manner) and answers all patient questions thoroughly without any sense of being rushed or time-pressured.”
Being pleasant“This provider had a very good bedside manner. He made me laugh many times when I was initially nervous about the appointment.”
Providing emotional comfort“This provider had a very good bedside manner. He made me laugh many times when I was initially nervous about the appointment.”
Source: Press Ganey analysis of surveys of patients’ inpatient and outpatient experiences experience surveys and online reviews © HBR.org

Examples of How Humor Can Backfire

Humor can convey a lack of:Verbatim comments
Empathy and compassion“[T]he doctor was the only one to show no respect and even joke at a question I was concerned about.
Kindness“[W]hen I arrived at triage, my water had been broken for about six hours. I was told that my doctor would likely start me on pitocin. I let the nurse know that I did not want Pitocin, and she made a sarcastic comment along the lines of “we’ll see.”
Helpfulness“My mother drove 1.5 hours to [town] only for [Dr. Q] to question why she was in the rehab hospital for so long, who were her doctors and “what do you want from me?” My mother wanted to get up and leave. He even made a comment, “Well I see your CAT scan. Looks like you still have a brain. I see you still have a crack on the skull. Maybe that’s why you still have headaches.” My mother returned home without any clarity to the cause of her headaches let alone relief.
Attentiveness“The discharge doctor did NOT listen to me or ask me any questions. He tried to be funny, but he was not. A hospital discharge should be taken seriously.
Patience“In the recovery the nurses were making fun of patient out loud.
Being pleasant“I am Hispanic. [I] felt as if I was stereotyped. When I asked about carpal tunnel problems that I am having, doctor told me to try laying off of the burritos. Doctor was very arrogant.
Emotional comfort“[A] group of nurses were telling jokes and funny stories with continuous loud laughing. They continue with this [behavior] for over 1-2 hours.
Source: Press Ganey analysis of surveys of patients’ inpatient and outpatient experiences experience surveys and online reviews © HBR.org

Although our data come from health care, we think that this basic approach is likely to be generalizable to other settings. Humor offered for no purpose other than providing a distraction is often irritating. Humor in the absence of obvious courtesy and respect can be taken as callous disregard. But when humor is a subsidiary component of meaningful interactions between clinicians and patients, it can break down the line that separates them. When clinicians and patients laugh together, patients feel seen, heard, and not alone in their suffering.

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