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Enforced humour annoys patients

BMJ 2003; 326 doi: (Published 26 June 2003) Cite this as: BMJ 2003;326:1418
  1. Roger Dobson
  1. Abergavenny

    Researchers investigating the working of a special “humour ward” in a hospital caution that a regime of a joke a day for each patient, cartoons on the doors, and jokes on the walls may not be to every patient's liking.

    They say that some patients, especially those in pain, are not amused by enforced humour.

    “Often humour attempts are not welcome by patients, especially when they are in pain, in low spirits, or are feeling depressed,” said the team (Health Communication 2003:15;319-30).

    In the study the researchers, who found that real humour was more likely to be found in spontaneous interactions than in the contrived humour introduced by experts, looked at the effects of the humour regimen in a 20 bed rehabilitation unit, the Medical Institute for Recovery Through Humor (MIRTH), in an Oklahoma City hospital.

    The purpose of the now closed unit was to promote rehabilitation through the use of humour. “MIRTH conveyed an overt humour identity through its decorations, wall hangings, and personnel attire. Walking into the unit, one saw cartoons, pictures of animals, humorous sayings, jokes and puns, posters of popular mid-20th century comedy characters like Lucille Ball and the Marx Brothers, and stuffed animals,” said the authors.

    And there was more. The door to each patient's room was decorated with a picture of a cartoon character or a block of quotations. Each of the sections of wall between the doors had a theme, such as having a border of yellow “smiley” faces and being filled with cartoons, jokes, and quotations. Another section portrayed Kermit the Frog and Miss Piggy. Staff in the unit planned and delivered, where appropriate, a joke of the day for each patient.

    “The findings suggest that humour in the activity sessions was mainly a by-product of more predominant effects, such as patients' positive attitude and happiness,” said the authors.

    “Our observations of the activity sessions and the patient-provider interactions suggest that humour was more often embedded in the emergent communication rather than in the imposed messages designed to elicit laughter or amusement.”

    They concluded, “Given that humour in health contexts can be as detrimental to patients as it is efficacious, we offer a final caveat. Though our observations of a MIRTH unit suggest that staff and patient use of humour were beneficial for these particular rehab patients, we do not advocate that providers impose humour on all their patient interactions. Individual differences dictate that humour, as with all communication behaviours, must be employed sensitively and rhetorically.”

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