Laughter as Medicine (and Other Dangerous Prescriptions)

“Laughter is the very best medicine.”Remember that when your appendix bursts next week.— "Weird Al" Yankovic

Humour in medicine isn’t something they teach.

It’s a bit like having a foot fetish or believing in God — awkward to admit in polite company, potentially career-ending if misused, but oddly common and quietly essential to the human condition.

If you know me, or you've seen me on stage, you’ll know I flirt with stand-up. “Career” is generous. It’s more like store-brand Diet Coke — gets the job done, tastes slightly off, but nobody’s dying.

Yet. At least not in a literal sense.

It’s a tolerated escape hatch. My wife lets me have it because it keeps me from being (more) insufferable in the house.

But humour’s not something I switch off. It follows me. Into clinics. Onto wards. Into palliative chats with men who’ve been dying for weeks but nobody’s said it out loud.

Humour as Catharsis

Humour works alone. Humour works together. You can laugh with someone, or quietly to yourself in a room full of existential dread. That makes it rare — most coping mechanisms are selfish. This one’s affiliative.

In consultations, that shared laughter becomes a moment — not “doctor” and “patient,” just two humans in a pressure cooker.

But get it wrong? It dies in the room. It hurts the room.

A palliative visit. A man who’s stopped eating, stopped walking, stopped waiting. I asked if I could be blunt. He nodded. I said,

“Has anyone told you you’re dying?”

He looked at me and said, “Thank fuck for that.”

I laughed. His partner cried.

I apologised briefly. Not for the laugh. For the release. That gallows chuckle was his, not mine — I just followed him through the door.

When It Works

Humour lands best when the air’s too heavy to breathe.

• After the sixth referral rejection.

• When the parent’s doing a better impression of a doctor than I am.

• When you’re both staring at the weight chart like it personally betrayed you.

That’s when humour resets the room.

"I can’t drug your Ex-husband though. Don't get me wrong - I’d love to, but arsenic's not on formulary."

"Yeah, your blood pressure’s terrible — but so’s the current NHS strategy, and we’re still trying."

Used with care, humour cuts the tension and spares the dignity. Used badly, it's just a flex. Or a wound.

When It Doesn’t

You don’t always get to know. You can read a room wrong. You can read yourself wrong.

Some patients joke with you because they’re comfortable. Others do it because they’re terrified.

Some say something “cheeky” that’s actually racist, or sexist, or just vile. And you smile through it — because blowing up a therapeutic relationship over one remark doesn’t seem like good medicine. But god, it’s bad humanity.

There’s hypocrisy in that. If I cracked a joke with a patient that made them uncomfortable? That’s an incident report. But if they do it to me? I’m expected to rise above it, nod along, be the bigger man.

Which I can be — but let’s not pretend we haven’t noticed the imbalance.

Humour as Performance

We all perform in the consult room. Don’t lie.

I’ve got a doctor voice. It’s clipped, calm, an octave higher than necessary. My wife hates it.

But it’s not just a voice. It’s a mask.

Not in the sinister, “deceitful” sense — but in the autistic, ADHD, trauma-survivor, long-term-mentally-unwell sense. It’s a way of separating worlds.

Compartmentalising. Protecting. Masking works.

Until it doesn’t.

I’ve masked my whole life — mentally, socially, professionally. And in general practice, that comes in handy. You can switch tone, pace, mood to match the room. You can jump from bereavement to baby rash to burnout in eight-minute cycles — and no one sees the thread unravel underneath.

But the risk? If you ever break the mask — or get caught switching — people feel it. And they don’t always like what they see.

I remember a patient. Chaotic life, chaotic consultations. Loved a bit of banter. Jokes flying, tone casual. Until one day, he said something a little too familiar.

I flinched. Tone shift. Mask back on.

“Aww, why you sounding so serious? I was just joking.”

And that was it. I couldn't put it back in the box. From then on it was all joking, a transactional analysis nightmare trying to get back where he felt comfortable. In control perhaps.

“Aww, you used to be so sound, man. What happened?”

What happened is I got seen. Instead of recognising the shift as professional boundary-setting, he saw it as betrayal. From then on, the trust frayed, the personas clashed, and neither side was getting the “real” you.

That’s the thing with humour as a tool: it relies on authenticity — or at least the illusion of it. And once the audience (read patient) doubts the person behind the mask, the performance stops being therapeutic. It just becomes weird.

As most comics will attest - when the audience smells fear, you're toast.

If You Can’t Feel It, Steal It

Not everyone has instinct for humour. That’s fine. What you don’t have in instinct, you can borrow in observation.

Watch the seniors. Listen for the metaphors. Note when the joke gets slipped in and how the room changes. You don’t need to copy the material — just the timing.

And be honest: we don’t do enough of this. We don't model well. We supervise procedures. We don’t supervise subtlety. And that’s a loss.

Sarcasm and the Culture of Cynicism

Clinicians — especially those in long-haul fields like general practice — are fluent in sarcasm. It’s armour. Not all of it’s clever. Not all of it’s kind. But it sticks.

Students pick it up fast. By final year, most of them have a well-honed gallows humour toolkit. That’s not a sign they’re broken. It’s a sign they’re watching and adapting.

But if we don’t talk about it — if we don’t name it — it calcifies into cynicism.

Yes, It Can Be Taught

I ran a workshop once called So You Think You’re Funny?

It wasn’t about jokes. It was about style. Affiliative? Self-deprecating? Defensive? Passive-aggressive?

We covered timing, pausing, knowing your audience, telling stories instead of jokes, and not punching down. We talked about “funny files.” We talked about being human on purpose.

When I asked people to label their humour, almost everyone wrote:

“sarcastic.”

Some added dark, dry, inappropriate, relatable. A few said they weren’t funny at all — then told me a story so specific and brilliant it could only have come from someone with pitch-perfect comic timing.

Final Word

Humour in medicine is a dose-dependent drug.

Too little and you’re cold. Too much and you’re dangerous.

But get it right? It’s a shortcut to empathy, clarity, and sometimes even healing. Not because it’s funny. But because it’s real.

We don’t use it to perform.

We use it to connect.

We use it to level.

We use it to see and be seen.

And that’s worth learning.

Stay funny

—DW