You know the proper way to pass a scalpel, right? Handle with care, make sure the surgeon’s ready, and do not mix it up with the suction tip—or you are in for a bloody mess. Turns out, passing a joke in a clinical setting works the same way. Humor, like a scalpel, is sharp, useful, and needs to be handled with precision. Humor? In medicine?! Has this not already been done by Robin Williams in Patch Adams? Is my next column going to be about how we can learn physics from watching Flubber? No. In all seriousness now, folks, humor is important in medicine. There is ample evidence that it can improve patient satisfaction,1 increase compliance with treatment recommendations,1 and reduce malpractice claims.2 It even reduces patient anxiety and has comparable analgesic effects to some pharmaceuticals!3 It is powerful stuff and has plenty of implications for veterinary medicine. Well, sure, you can easily recognize the value of humor in tense situations, but that does not mean it is as easy as tossing a rubber chicken into the exam room before you roll in. Paradoxically, if you take this seriously, you need to go deep into cognitive neuroscience to understand it. That’s good, because you are a science nerd, right? I believe humor is one of the most underused, effective, physiologically and socially beneficial clinical communication tools on the planet. It is fast, powerful, and the only adverse effect is milk coming out of the nostrils. However, doing it well does require some finesse. The point here is you are trying to make someone else laugh, not just amuse yourself, and that simple goal, while incredibly helpful in a team-based communication setting, can also be maddeningly elusive. According to the latest psychological research,4 to wield the weapon–er … tool well, you need an understanding of just two things about a person: how seriously they are taking something, and whether it aligns with their goals (i.e. “motive-consistency”). Two things about people Of course, the human brain is the most complex computing machine that has ever existed in the universe. However, on the other hand, simplify it down to two variables and you will be extracting guffaws from clients in no time. To recklessly oversimplify human thought, think of humor as only being possible on these two axes. The tricky part is an accurate reading of the person’s position at any given time—every object, situation, conversation, thought, person, or animal is going to get rated on the seriousness axis and the motive-consistency axis, and it’s going to mostly happen at a subconscious level, and be constantly changing. However, if you can figure these two things out for any given person, you have a high probability of making them laugh: Seriousness. Just how it sounds. Literally just how consequential something is to someone. Motive consistency. Does this person/object/feeling/situation “align” with the person’s own goals, values, desires or urges. Here’s the magic formula for humor: for any given thing, push the needle away from serious while staying motive-consistent. Another way to put it is to make a “playful turn” (i.e. non-serious), but make sure it scratches the person’s itch (i.e. it’s something they actually want). Bring it to the exam room An example: A client comes in with an older dog, Bella, concerned about some cloudiness in the dog’s eyes. They are taking the situation seriously, however, in your exam, you identify the cause as lenticular sclerosis (i.e. “no big deal”). There is potential for laughter here, but first, you need to explain that Bella’s vision and comfort—her quality of life—are in no way under threat. That reassures the client it is not a serious problem and opens up the possibility for laughter. Here is one I use: “This doesn’t really affect her significantly, and dogs don’t rely on vision nearly as much as we do. I just wouldn’t let her drive home at night.” I’m not saying I’m Chris Rock or anything, but that joke probably works 80 percent of the time. Because I have created safety around this just-until-now serious issue (the change in appearance of the dog’s eyes), I can use a playful turn to lighten the mood. It stays motive-consistent because the client knows Bella is not being harmed, and I’m a (reasonably) competent veterinary professional. While nobody comes to their veterinarian for laughs, we all know our clients are not perfectly calibrated on which issues to take seriously. Sometimes, the mental weight of a situation (its importance, solemnity, consequence, etc.) can be crippling for people, and we have both the knowledge and responsibility to guide people through the challenges. It is our job to know and signal to our clients what we should be worrying about and what we should not. If that skin “tumor” turns out to be just a nipple, there is an opportunity there for levity. In other words, we can use our secret veterinary knowledge about what is versus what is not serious to bring our clients away from misperceived threats. Do you get it? It is great to have nipples instead of tumors, but your clients will not laugh unless you can prove to them you are on their side. Calling them an idiot for wasting your time is going to violate trust, a crucial component of making someone genuinely laugh. They need to feel like you are on their side, part of the new model of relationship-centered care that is just plain better for everybody (including the pets!). Veterinary clients usually want good customer service, fair (to unrealistically cheap) prices, painless treatments and procedures, and exuberant praise for their quality as a pet-owner (or at least assuagement of their guilt for mucking things up so badly). Amongst all sorts of other things: reassurance, compassion, information, security, competence, ease and comfort, etc.5 The point is, many motives can be going on at once, and each new thing is going to be rated as either consistent or inconsistent with any number of these motives. It seems like a lot, but remember two things about this: 1) this is all happening subconsciously in the greatest computing machine that has ever existed, and 2) it is probably not any more complicated than the Krebs cycle, which you memorized at some point in your existence, so you can do this. A surgical tool Used well, humor removes anxiety faster than a 45-minute lecture on biochemistry. It does not replace empathy—it delivers it. With speed and efficiency. That is why I think of humor as a scalpel. Not a hemostat. Not a retractor. A scalpel. Like any surgical tool, it should be sterilized with self-awareness, sharpened by observation, and handled with care. But like any tool, it can wound if mishandled. If your joke violates any of your client’s motives, it will not be funny—it will feel cruel. That is why jokes about suffering, grief, or telling someone they actually own a Chihuahua and not a purebred Japanese Chin only land when seriousness is dialed way down, and the client feels secure with your intentions. This is where humor becomes clinical communication, not just entertainment (Read: “In Practice”). In practice If you want to humor your clients, here are a few tips: Read the room. Are they tense? Distracted? Vulnerable? This data informs you about their possible motives. For the current topic of conversation, gauge their seriousness. How consequential does it feel to them? And what psychological values are at play? What are their motives? Empathy, responsibility, identity? Start low stakes. Self-deprecating, observational, or absurd humor tends to be safer. A bad “meow” based pun is a perfectly commendable first effort to test the waters. Watch the response. Laughter, smiles, and body language—these are your feedback mechanisms. Awkward stares are a good indicator to switch strategies away from humor (at least for now). If it works, great. If not, do not panic. Humor is not about being a comedian. It is about signaling safety, connection, and shared understanding, and like anything else in medicine, it takes practice. Sure–it is a lot to think about during a conversation about Roscoe’s fourth anal gland abscess, but you know what, you are already thinking about a million other things during that conversation, so why not make it fun? You memorized the freaking Krebs cycle–you can do this. Final thought At the end of the day, pet owners do not just want solutions. They want to be seen. Humor—when done right—does both. It says, “I see the situation clearly, I know what’s a real threat and what’s not, and we’re gonna handle it together.” Our clients are anxious about money, their pet’s pain, and what the surgery means for their lifestyle, their kid’s attachment, or their marriage. They may not say that out loud, but it is humming in the background of every word they speak. We can use humor to strip away some of their less helpful anxieties (assuming we have established trust and competence and all that). So, try viewing conversations with clients as opportunities for laughter. Identify the serious and gently guide them away from false alarms while staying in line with their motives. Be thoughtful and spontaneous, and let the playful turns take care of the rest. A successful joke says, “I’m with you.” I love working with those clients the most: the ones who come in scared, leave feeling seen, and, somewhere in between, laugh with me. Like a scalpel, the right joke—handled with skill—can cut away fear and expose the trust beneath. Greg Bishop, DVM, is a small animal veterinarian and a part-time veterinary technology instructor in Portland, Ore. Dr. Bishop also creates the monthly cartoon series, “The Lighter Side.” The author’s opinions do not necessarily reflect those of Veterinary Practice News. References Wrench JS, Booth‐Butterfield M. Increasing patient satisfaction and compliance: an examination of physician humor orientation, compliance‐gaining strategies, and perceived credibility. Communication Quarterly. 2003 Sep 1;51(4):482-503. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. Jama. 1997 Feb 19;277(7):553-9. Van der Wal CN, Kok RN. Laughter-inducing therapies: Systematic review and meta-analysis. Social science & medicine. 2019 Jul 1;232:473-88. Hatzithomas L. Play-mirth theory: a cognitive appraisal theory of humor. Frontiers in Psychology. 2024 Dec 6;15:1473742. Hughes K, Rhind SM, Mossop L, Cobb K, Morley E, Kerrin M, Morton C, Cake M. ‘Care about my animal, know your stuff and take me seriously’: United Kingdom and Australian clients’ views on the capabilities most important in their veterinarians. Veterinary Record. 2018 Nov;183(17):534-.
