What’s Important: When Humor Goes Wrong

Humor is not dead. Over the years, countless studies have demonstrated the diverse benefits of humor. It is good for us, our teams, and our patients. As physicians and leaders, it behooves us to learn how to safely and appropriately incorporate wit and humor into our professional lives. At the same time, we must also know how to recover when humor goes wrong. The Value of Humor In both the workplace and clinical setting, humor creates a positive and collegial environment. Effective leaders know that humor conveys confidence and fosters group cohesion. It also relaxes listeners, allowing for a more receptive ear when leaders convey messages to their teams and constituency. For health-care teams, humor reduces both stress and burnout1–4. Physiologically, humor has been shown to significantly reduce serum cortisol, one of the key hormones involved in the stress response5. It has also been shown to have potential endothelial and cardiovascular benefits6–8. Clinically, humor may also enhance patient care and the patient experience. Norman Cousins famously wrote about the latter, describing the benefits of laughter as he struggled with ankylosing spondylitis9. In the physician-patient relationship, humor cultivates comfortable communication and can help to maintain a patient-centered encounter when executed with empathy and compassion. Without question, humor is valuable, both as an emotional release and as a tool to enhance group dynamics. However, as with any tool, it must be used carefully and skillfully. Some basic principles can help here10. First, know your audience. Are there sensitivities, vulnerabilities, or emotional wounds? Second, humor should not be used too soon, both in relationships and in a career. Relationships take time to develop, as does one’s professional reputation. Third, avoid politics, especially in today’s charged, partisan climate. And finally, avoid humor that disparages others. Instead, feel free to make fun of yourself. This is a safe way to introduce humor. These principles help us to employ humor successfully. That said, nobody bats a thousand, and we all make mistakes. If you use humor in your professional life, you will at some point fail. Recognizing this and knowing how to recover is critical. How Humor Can Go Wrong In general, there are 2 primary ways that humor can go wrong. Most commonly, a witty remark or joke simply falls flat. The ensuing silence is awkward and may disrupt the flow of a discussion or presentation. When this happens, situational awareness is key. Was your comment simply not funny? If so, move on quickly and recalibrate. Awkward silences are not helpful, and a short remark such as “that fell flat” or “tough crowd” may help with recovery. Self-deprecation is safe and can relieve tension. The alternative, and more worrisome, scenario occurs when your remark was ill-timed in the setting of a circumstance you were unaware of, such as a lost job or a poor clinical outcome. If so, acknowledge and address the situation with empathy and tact. One of the senior authors recently had to navigate this exact scenario. He had entered a break room where a few members of the clinic staff were enjoying afternoon coffee. The day had gone well, and he shared a corny “dad” joke about a taxi driver who was fired for going the extra mile. Everyone laughed except for one person, who remained solemn. As the group was returning to work, he sat down privately with her and asked if anything was wrong, or if she was offended in any way. As it turned out, she was struggling with a difficult interpersonal relationship and opened up about this. She appreciated the chance to talk with a faculty member about the situation. By the end of the conversation, she was in a better mood. The discussion was wrapped up with his heartfelt “please let me know if there is anything I can do to help.” The second, more serious “mode of failure” for humor is when an attempt at an amusing comment hurts someone. The last thing anyone wants to do is offend a colleague or patient. Unfortunately, it can and does happen. What then? If a comment or one-liner is offensive or hurtful, apologize as soon as possible. It is important to note that an ideal apology is more profound than a simple sentence or two, and instead is a meaningful process. Another factor to always consider is the power dynamic in the physician-patient relationship. This also holds true with the physician as team leader. It is known that patients tend to feel vulnerable in the clinical environment and may not feel comfortable expressing their true thoughts, opinions, or concerns. With humor, the perceived imbalance of power can potentially result in a patient laughing or expressing amusement, even if they did not genuinely find you to be funny. The patient may even feel that your comment was offensive or hurtful but may not feel comfortable conveying such feelings. This type of harm is more difficult to discern and requires careful attention to a patient’s body language or reticence. Be on the lookout for changes in posture, tone of voice, and facial expressions. Being observant of these signs is critical to understanding your patient and their feelings, and when an apology is warranted. Apologizing In the scientific literature, apologies have been studied extensively. They have been categorized as strategic or authentic11. A strategic apology, sometimes called an “instrumental” apology, is designed to avoid punishment and protect a person or corporation. Authentic apologies, on the other hand, genuinely seek to understand the affected person’s feelings and acknowledge them sincerely by taking responsibility. In both the workplace and clinical setting, authentic apologies are better received. A good apology should have at least 1 of several characteristics. These are sometimes referred to as the “R’s” of an apology12 and include remorse, responsibility, recognition, and redress. While each element plays a vital role in fostering forgiveness, remorse and responsibility may be the most important13. Remorse is a deep feeling of regret that is portrayed beyond words, through body language, tone of voice, and subsequent actions. Responsibility is the explicit acknowledgment of your fault. It goes beyond a non-apology or “ifpology,” in which an apology starts with “I am sorry if …” Accountability is crucial in making the one to whom you are apologizing feel validated. Conclusion In conclusion, our advice is not to abandon humor. It is good for us. If your joke falls flat, carry on with confidence and perhaps with some self-deprecation thrown in. If you offend someone, take responsibility and apologize right away. Do so with remorse, sincerity, and empathy. With the right approach and awareness of your audience, humor can be a powerful force for building bonds, relieving stress, and fostering a positive environment.