Humour: a tool to knock you off your pedestal

Alexander Torrie

For hundreds of years doctors have been placed on a pedestal, achieving a form of celebrity and authority over the lay person. Only doctors, went the logic, understood the confusing puzzle that is the human body. Only doctors could translate its strange signs and symptoms into a language that made sense. This attitude gave rise to paternalistic medicine, a system that implies that an individual’s healthcare is the sole responsibility of the physician. Paternalistic medicine gives the physician the power to make whatever decision they think is in the patient’s best interests, regardless of the actual capacity or desires of the patient.

In recent times there has been a push toward a ‘Patient-centred Care’ model of biomedicine. The internet has helped drive this change. More than ever before, people who are not educated in medical matters have the access and ability to translate their symptoms independently, allowing for a more equal playing field between doctor and patient.

Patient-centred care is, as the name implies, a form of care that attempts to include and involve the patient in their own healthcare decisions. It is the main model of health care taught at Otago Medical School. This model centres around the doctor-patient relationship, emphasising the doctor’s ability to connect with the patient and reinforcing the fact that your patient is also a human being with their own ideas of what being healthy means. But this begs the question: have doctors’ attitudes changed and evolved at the same pace as patients’ attitudes? And how do we measure this progress?

Humour is a tool that we can employ to provide insights into what social roles are at play in any given situation, allowing us to gain an understanding of an individual’s worldview and in some cases what they feel is wrong with certain systems.

This cartoon is an example of humour used to highlight specific shortcomings in the interactions patients are having with doctors. The ‘funniness’ of the image is based on ridiculousness and exaggeration – specifically on the high level of incongruity between the doctors response (concerned with the patient’s cholesterol levels, on the computer screen) and the serious physical wounds of the patient on his table. It reflects a common critique of modern medical practice, the fact that patients feel their interests sometimes diverge from doctor’s (scientific, technologically-mediated) concerns; that they feel largely ignored by their physicians in favour of what seems like less important information.

Humour is most clearly a tool for social critique when it is used by a vulnerable group to highlight the fundamental faults in a system designed and enforced by those in power. So, from a patient’s perspective, the cartoon subverts the traditional power dynamic of the clinic. It satirises the trope that doctors are infallible, and reinforces the importance of a patient-centred approach to clinical practice. It articulates a feeling shared by many individuals, which we can argue is created by a fundamental difference between doctor’s and patient’s views of the doctor’s role.

Cartoons like this one illustrate this gulf. They challenge practitioners to catch up with the times, relinquish ideas about distance and control in their interactions with patients, and build the relationship required for patient-centred care.

Ironically, just as humour has been a tool to point out this problem, others have argued that humour can also be a useful tool towards solving it. Making a joke about something doesn’t necessarily mean you are making light of it. Nor does it mean laughing at someone. Indeed ideally it means just the opposite. Humour can be a powerful way to show compassion.

Yet for a doctor, using humour as a means to improve patient rapport comes with risks. For a start it invites experiences of social failure and embarrassment (including for the doctor, if the humour doesn’t work!). But that doesn’t mean doctors shouldn’t try. For a patient with a chronic illness that is currently untreatable, sometimes a good, warm, human chuckle is the best thing a doctor can give.  At the very least, it shows the doctor’s willingness to relinquish their control, their power, and perhaps their pedestal for a moment …  to turn around, look the patient in the eye and engage, human to human.

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Alexander Torrie is a third year student at the Otago School of Medicine, Dunedin, New Zealand. This piece was written as part of the ‘Humour, Culture, & Media’ Humanities Selective (in the Early Learning in Medicine programme), and supervised/edited by Dr. Susan Wardell, Dept. Anthropology & Archaeology).

References

• Murgic L, Hébert PC, Sovic S, Pavlekovic G. Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country. BMC Med Ethics [Internet]. 2015 Sep 29 [cited 2018 May 23];16(1):65. Available here.
• Epstein RM, Street RL, Jr. The values and value of patient-centered care. Ann Fam Med [Internet]. 2011 [cited 2018 May 23];9(2):100–3. Available here.
• Neuwelt P, Matheson D. New Zealand’s Journey towards People-Centred Care. Int J Pers Cent Med [Internet]. 2012 Mar 31 [cited 2018 May 23];2(1):73–9. Available here.
• Meyer AND, Payne VL, Meeks DW, Rao R, Singh H. Physicians’ Diagnostic Accuracy, Confidence, and Resource Requests. JAMA Intern Med [Internet]. 2013 Nov 25 [cited 2018 May 23];173(21):1952. Available here.
• Mccreaddie M, Med P, Cert P, Ba P, Payne S, Pe C. Humour in health-care interactions: a risk worth taking. [cited 2018 May 23]; Available here.

See also, on Corpus, Laughing over an open body by Nicole Walters.