Healing Power of Laughter

Working primarily with children, I have a fun time at work. Of course, when I worked in family practice - ages, cradle to grave - I still had fun. If you can make a child (or the parents) laugh, you can ease pain and a considerable amount of anxiety.

Before I walk into the examination room, I review the chart. Among other important tasks, I have to first determine if I have seen this patient before. We see so many patients that it is easy to forget the details of a prior visit. If I sutured up a head laceration on a little boy at a prior visit that is seeing me today for a cough, I am certainly going to mention that cut. What was a routine, uneventful visit for me was a very important day in this child's life. The child and the parents love that I "remembered".

I usually write superfluous things in sidebar of the chart note, such as getting a new puppy or going to Disneyland.

At the next visit, I will ask about the puppy (even by name if I wrote it down), or what was their favorite ride at Disneyland. This sets the stage for a very productive visit, and I am credited for having a fantastic memory (which I do not). Routinely, depending on the age of my patient, I greet the child first. I then ask the child to introduce the other people in the room. (The female adult person in the room may not be the parent.)

One day, I asked a little five year old to introduce the woman sitting in the chair that I assumed to be the mother.

"That's my Mom", he said.

"What is her other name?"

A blank stare and silence followed. "Don't you know my name?", the mother asked.  "What does Daddy call me?"

"Babe?", he responded.

I am speaking at the upcoming California Academy of Physician Assistants annual conference this month in Palm Springs. In addition to a session on pediatric otalgia (ear pain), I am also participating in a "Two slides; Two Minutes" session in which the presenters have only two minutes (and two slides) to make clinical point, or to give a clinical pearl. Mine will be "Bird hunting".

Whenever I look in a reluctant child's ear, I tell them I am looking for little birds. Once I have their attention, I will gently look inside their ears with an otoscope while making little chirping noises. Not only does this hold their attention long enough for me to have a thorough examination, it tells me they can hear.

If I have to clean out some obstructive earwax, I tell them it is a bird's nest! Or, bird poop...

Finding age-appropriate humor is very important. For the little people, I often look at the chart with a puzzled look and say, "So you are seeing me today for stinky feet?"

That either will get a giggle or they will agree that their feet stink. Some will even lift up their feet, smell them, to see if it is true. Or, in some cases, put them to my nose for the test. A three or five year old is easy to amuse, but a spiked-hair, heavily-pierced, Gothic teenager is a different species all together. A particularly hostile teenager boy was answering my questions with a loud, obnoxious "NO" to everything I asked.

"Do you smoke?" "NO!"

"Do you drink alcohol?"  "NO!"

"Do you take any drugs?" "NO!"

"Do you have sex?" "NO, I mean...YEAH!"

"Are you alone when you have sex?" I made him laugh. That broke the ice and we had a very productive visit after that. I stopped asking teenagers if they were "sexually-active" when a adolescent girl once responded, "What do you mean? Do I, like, move around a lot?"

As well as dole out stickers and sugar-free lollypops, I do a few magic tricks. If a child is on their best behavior, I will do a little trick for them at the end of the visit. One involves a lit thumb (this is a flesh-colored, latex thumb with an LED light that I slip over my own thumb). I will hold it to their ears and it will magically light up. I can then move it to my own ear and transfer the light. I can then pull it out of my other ear.

I also have a magic bag (with a hidden pocket) that can transform a Barbie sticker to a Spiderman sticker (or vice versa depending on the sex) instantly. It also works for changing favors of those lollypops. I can also make a variety of balloon animals, Ninja swords, and hats.

My wife gave me a balloon-twisting class for my birthday years ago, and it comes in very handy from time to time. Although I have this lingering fear that someone is going to choke on one of my deflated balloons and sue me, my balloon mentor, Bosco the Clown, assures me that it is not very likely. He estimates that he has made a million balloon animals in his long and exciting career and has not killed a child yet. I even invented my own adult-version of an anatomically-correct "wiener dog". that I will make for an appropriate adult. I will let your imagination figure this one out.

Several years ago, my PA wife and I were on a medical mission in Jamaica. I brought a huge bag of long balloons to make each one of the kids a balloon animal or a big balloon hat.  After a full day of seeing patients in a hot, humid building with chickens walking around, there were several older woman waiting around to talk to me. Wondering what cultural faux pas I had committed, I found out that they wanted me to make them balloon hats to wear at the political rally that night.  I can tell that I was very proud to see several of my Carmen Miranda balloon hats prominently displayed during the event.

I had the privilege of meeting the clown/doctor Patch Adams several years ago. He was once chastised by one of his patients for not being serious enough. Patch said that she can have a choice: He can be a stern, serious, get-down-to-business doctor, or a "silly doctor".

In the end, the patient prefered the silly doctor...the one that made her laugh.

"The arrival of a good clown exercises more beneficial influence upon the health of a town than twenty asses laden with drugs."

- Dr. Thomas Sydenham, 17th Century Physician

Related Topics: Include Dads in Kids' Doctor Visits, Choosing A Doctor

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