I’m thinking that I don’t, but I love this movie quote. Let’s talk about the ups and downs of using humor in practice.

My longtime dentist had played football at Princeton University. At my last exam, he told the story of how he made a tackle and rolled out of bounds with half of the other team heaped on top of him. He painfully got up, dusted off, and an opposing player blasted him with a hit that was four steps out of bounds and 10 seconds after the whistle. The Doc was writhing on the ground a lot longer this time. By the end of the story, I was laughing really hard and did not notice that he had jammed a needle full of lidocaine up near my pituitary gland. Talk about “alternative medicine!”

This guy is a rock star, both as a successful dentist and as a human being. I’ve tried to adapt his mildly self-deprecating humor and situational comments into my own practice.  There is never a harsh edge, mocking commentary, or loss of focus on the exam. The adaptive part acknowledges that I could never reach my dentist’s level of expertise in this area. Go too edgy, or to excess, and you’ll lose your “audience.” That is, retain your kindness and professionalism in any light-heartedness that you may indulge.

Humor is such a great tool, but it has to be applied so carefully. I envy those of you who do it naturally and intuitively. The “why” is that it can put patients at ease. So often we forget that patients are anxious about symptoms, diagnoses, and yes, financial considerations. A deep breath and a smile can go a long way to ease these situations.

Now, the dangers. If you are going to incorporate humor, you had better have a “read” on the personality of the patient and the situation. I try to be more formal upon entering the room, with greeting and discussion first. (This pretty much eliminates the possibility that I will see patients dressed as Darth Vader on Halloween. I’d hate to tell someone that he has retinitis pigmentosa through all of that heavy breathing.) Roll in with a big joke, and unless you are VERY familiar with the patient, you’ve started off on the wrong foot.

Another problem is that your approach may distract from exam quality and prescribing.  Probably once a month I write a patient’s eyeglass Rx twice, instead of single recordings of eyeglass and contact lens Rx. Why? We’ve had a bit too much fun in the exam. It’s easy to knock yourself out of your rhythm, especially if you’ve been practicing for as long as I have. By-rote procedures suddenly aren’t by-rote if you build in too many distractions.  Mrs. Smith’s GPC doesn’t present the challenge that it once did, and if we aren’t careful, the mind can wander.

One thing to avoid is the long, drawn-out story. Rattle off some five paragraph tome about three animals going into a bar, and your punch line might go over like a lead balloon.  Where do you go from there? The professional comedian goes on to the next joke. You can only go sheepishly forward and do your slit lamp exam. Stay brief, and stay on point.

Confidence in this area is everything. What if you’re not so sure of yourself? As we said in Air Force days, “If it don’t fit, don’t force it.” While the bad joke is worse than none, you’ve still got to put your personality into it. A big smile, especially at introduction and exit, will get you most of the way there. Not a hand-shaker? Try it, or fist bump instead. You can always wash your hands later. The big smile generates the same good feelings as the well-placed laugh, although on a lower level. I’m a big believer in primacy-recency effects, as the first and last impressions tend to be the lasting ones.

My bottom line is that I don’t want anyone to leave my office saying, “He was funny.” I want them to remember that I put them at ease in a difficult situation, and cared enough to do so while I made things right.